Immediately after the operation you will probably feel drowsy and have some abdominal pain or discomfort and you may experience some nausea and/or vomiting. You may require an injection for the pain or nausea.

When you are awake enough to comprehend and remember what is said, your gynaecologist should come and discuss the results of your laparoscopy with you. The severity, location and likely impact of your endometriosis should be explained, as well as the nature of any surgical treatment that was done. Sometimes, the gynaecologist will leave you a diagram showing the location of your endometrial implants and cysts.

For the first 24 to 48 hours after your laparoscopy you will probably experience some generalised abdominal discomfort and bloating due to the manipulation of the internal organs and vagina during the operation. You may also experience mild to severe pain in the shoulder region due to leftover carbon dioxide gas accumulating under the diaphragm and irritating it, causing pain to be felt in the shoulder region (this is known as referred pain). The tube that was placed in your throat may give you a sore throat for the first day or so. Usually, painkilling tablets such as Panadeine or Panadol will be sufficient to relieve the pain. You may also have some bleeding from the vagina, especially if a D&C was performed, and your stitches may bleed a little.

Even though a laparoscopy is said to be only a minor operation many women feel pretty terrible afterwards. Some women say that they feel like they have had ten rounds in the boxing ring or have been run over by a truck! So in most cases you will need a day of bed rest after your operation and you will be able to return to work in two to five days. However, it will usually take five to seven days or more before you get back to your normal level of activity. It is advisable to avoid heavy lifting for a week or so and to avoid strenuous exercise, such as running, jogging, swimming or brisk walking, for one to two weeks.

Sexual intercourse should be avoided until any vaginal bleeding has ceased, as should the use of tampons, vaginal sprays and suppositories.

If you develop a fever, a vaginal discharge with an unpleasant odour, heavy bleeding, swelling of the lower leg or severe abdominal cramps you should notify your doctor immediately.

Risks and complications of a laparoscopy

In general, the risks associated with a laparoscopy are minimal and the rate of complications is low. Since a laparoscopy involves the use of a general anaesthetic it has the usual risks associated with undergoing a general anaesthetic, including an allergic reaction and chest infection, especially if you are a smoker. The more common, but still unusual, possible complications are wound infection, accidental injury to an internal organ such as the bowel or bladder, and internal bleeding during or after the operation.

*41\83\2*

There’s a general belief that if you have back problems, then your bed should be as hard as possible, even to the extent of sleeping on a hard board rather than a mattress. That belief is a dangerous fallacy because a bed that’s too hard can be just as bad for your back as one that’s too soft.

Says The National Back Pain Association (NBPA): “We do not recommend rock-hard mattresses for bad backs. The term ‘orthopaedic’ has misled people into buying ultra hard beds in the hope of finding relief. Far from easing a back problem, an impossibly hard bed could simply make the condition more uncomfortable than ever. On the other hand, a bed which is too soft can inhibit ease of movement and makes the spine sag, stretching and straining the ligaments that support it.”

The NBPA suggests a simple test to assess whether your bed provides the correct support. This is what you do:

Lie down on the bed (preferably wearing only very thin clothing or none at all) and slide one of your hands, palm down, between the small of your back and the mattress.

Now ask yourself how easy it was to insert your hand between your back and the mattress. If you had to struggle to push your hand through, then the bed is probably too soft. If your hand slipped in so easily that there was quite a gap between it and the two surfaces, then the bed is probably too hard. However, if your hand slid through fairly easily but without there being a large gap, then the support provided is just about right. Simple though this test is, it is nevertheless a remarkably good guide as it takes into account the two major variables that determine whether the support is correct: the firmness of the mattress and the weight of the sleeper. Naturally, if you share your bed, then this test should be carried out by both of you at the same time.

There are two inexpensive ways to ‘cure’ a bed that’s too soft to provide adequate support:

The simplest and least intrusive solution is to place a board between the mattress and the top of the bed’s base. While almost anything that’s solid and big enough can be used as a bed-board, it’s really best to have one made from plywood or blockboard that’s cut to the right size. Alternatively, you can buy bed-boards – including some that fold away – from specialist suppliers (see the Appendix).

m Another possibility is to place your mattress directly on the floor. Of course, one drawback to this approach is that it will mean that your bed will be very low indeed and you may experience considerable difficulty getting in and out of it. Making it won’t be good for your back, either!

Do keep in mind that the methods above will only make a difference if your bed has a sprung base – if you have one with a solid base, that will already be as hard as it can be, and all that’s left in that case is to change the mattress for a firmer one.

A bed that’s too hard is more difficult to improve and it may be best to think about replacing it. In the meantime, you may find that placing a foam or fibre-filled overlay on the mattress can help.

*46\124\2*

Some of the symptoms of depression may be the result of a different condition. Low energy level and fatigue may be symptoms of medical conditions, such as low thyroid functioning, which can be diagnosed easily by means of a simple blood test. But there are other conditions as well that can masquerade as depression.

A neighbour of mine, a highly successful scientist and a charming person in his mid-fifties, seemed to undergo a change of personality over the course of about a year. During this time he walked around feeling fatigued and down in the dumps for many months. His sleep was restless and he would frequently wake up during the night. These symptoms might easily have been mistaken for depression. A visit to his doctor and, subsequently, to a sleep laboratory, revealed that he had a condition known as sleep apnoea. He stopped breathing for short intervals numerous times during the course of the night, which would wake him up. As a result of his breathing difficulties, his brain was not receiving sufficient oxygen. Small wonder that he was exhausted during the day, felt miserable and had difficulty concentrating. The problem was entirely corrected by a continuous positive air pressure (CPAP) machine, which ensures that he receives sufficient oxygen throughout the night. He became once more his cheerful self and I would see him tirelessly mowing his lawn and attending to his garden. We would once again chat and share jokes and his mood was completely restored with the help of one critical substance upon which all of our lives depend, namely oxygen.

This same person later developed weakness and tiredness and again lost his usual ability to concentrate and function normally. Another visit to the doctor and some simple blood tests revealed that his blood chemistry was abnormal. This turned out to be due to a rare tumour of the adrenal gland. Removal of the tumour corrected the problem and restored him once again to his previous high level of functioning.

In summary, many of the symptoms of depression are not unique to this condition, but may also be the result of medical conditions, some of which such as low thyroid levels or sleep apnoea are relatively common, while others such as tumours of the adrenal are rather rare. A visit to a competent doctor can often help sort out whether there may be a medical condition masquerading as depression. Even if you choose not to go to a doctor in the first instance but decide instead to try and treat your own depression, it is still worth bearing these other medical conditions in mind in case the symptoms do not resolve within a reasonable amount of time.

*62\75\2*

There are all sorts of problems about epilepsy. Epilepsy is the name given to recurrent ’seizures’ (also known as ‘fits’, or ‘attacks’), of which the fairly well-known grand mal convulsions are only one type. A whole variety of brain disorders can cause epilepsy, which should perhaps be considered no more than a stereotyped reaction of the brain to a variety of stresses. It is not generally known that, in spite of the most modern methods of investigation, an underlying cause can only be identified with certainty in about one third of people with epilepsy. The good news that has emerged from research studies over the last twenty years is that the long-term outlook for the cessation of seizures is very much better than was previously considered to be the case, as earlier research referred only to people with epilepsy whose seizures were the most difficult to control.

People with epilepsy have many worries. Children with epilepsy may be upset or worried about telling their friends and what will happen to them in the future. Women with epilepsy are understandably concerned about the possible effects of anti-epileptic medication when pregnant. Not everyone understands the impact of epilepsy upon the eligibility to hold a driving licence. Many employers understand little about epilepsy, and people with epilepsy may not have the same possibilities of employment, or of career advancement.

Epilepsy can begin at any age in life, but is particularly likely to begin in early childhood. One of us is a paediatric neurologist with a particular interest in epilepsy, and the other works with adults with epilepsy.

*1\188\2*

During the past 20 years, American apple-growers and farmers have more than doubled their use of insecticides containing organophosphates, carbamates, propoxur or pyre-thins, and, at the same time, have suffered increasingly from aplastic anemia and leukemia.

Although there is no proof of cause-and-effect, according to aLancet (2:300) report, the evidence strongly suggests that many of these potentially fatal bone marrow disorders result from exposure to insecticide mist or fog. Malathion, DDVP, Raid, Holiday Fogger, and Baygon were among the household insecticides to which the aplastic anemia and leukemia victims were exposed. Children, it seems, are much more susceptible than adults, and insecticide inhalation is more dangerous for them than is contact with the skin. Most victims were exposed to mist or fog for only a few hours and did not begin to feel unwell until several days or weeks later.

*191\143\2*

Symptom

A bulge in one of the typical locations:

• just above or below the crease of the groin

• just above or below the navel

• at the navel

Home care

If you suspect a hernia, take the child to the doctor.

Precautions

-    A strangulated hernia is a medical emergency that must be immediately corrected surgically (within hours). Signs that a hernia has become strangulated are: swelling; severe pain; nausea; vomiting; severe weakness or collapse. If these symptoms appear, take your child to the hospital immediately. Never attempt home care for a strangulated hernia.

-    Trusses or belts used to reduce a hernia are useless and may be harmful or dangerous.

-    Doctors do not consider it beneficial to strap an umbilical hernia.

A hernia (or rupture) is a protrusion of tissue through the wall of the body cavity. It might be compared to the protrusion of an inner tube through a hole in an automobile tire. Several types of hernias may occur in children.

The most common hernia in a child is an indirect inguinal hernia, which is present at birth but may be or may not be recognized immediately. In fact, this type of hernia is not usually noticed until some later age. The hernia begins as a bulge just above the midpoint of the crease of the groin. It then enlarges toward the middle of the body until it reaches and enters the scrotum (the pouch containing the testes) of a boy or the labia majora (outer folds of the external genitals) of a girl. The bulge is actually a pouch-like sac underneath the skin made of peritoneum (the membrane that lines the abdominal cavity). The sac usually contains either a portion of the veil-like apron that overlies the intestines or a loop of the small intestine. Less often, it contains a loop of the large bowel, part of the urinary bladder, or an ovary.

A rarer hernia in children is a femoral hernia, which appears below the crease of the groin, near where the pulse of the main artery to the leg can be felt. Occasionally, a ventral hernia appears in the midline of the abdomen, above or below the navel. In infants, an umbilical hernia often appears at the umbilicus (the navel). This is not a true hernia, however, because it contains no sac. An umbilical hernia usually disappears on its own before the child reaches five years of age.

*108/84/5*

Alcohol

Both you and your partner need to eliminate alcohol. If your infertility is caused by problems such as polycystic ovaries, fibroids or endometriosis, alcohol can compromise the efficient functioning of your liver and make it less able to get rid of excess circulating hormones. Alcohol will also stop you absorbing essential nutrients like zinc which are crucial for fertility.

Genetically Modified Foods

We know that the fertility of animals feeding on genetically modified foods can be reduced, so it is only common sense for you to eliminate these foods, as best you can, from your diet. We do not yet know the long-term health risks of GM foods but anything that may compromise good health needs to be avoided when you are aiming to increase your chances of conceiving.

Genes are a set of coded instructions, made from DNA, which control physical and behavioural characteristics such as hair colour. Genetic modification means that genes from other species can be introduced into a particular plant, usually to make it more resistant to pests, viruses, weed killers or other hazards. For instance, it is now possible to buy a tomato which contains a fish gene to boost its frost resistance. The gene is from a flounder because they survive well in cold water. This same flounder gene has also been introduced into salmon which could be on the market in two years time. In the cold dark days of winter a salmon stops eating and growing but adding a flounder gene keeps them eating all year round, speeding up their growth rate by 400 per cent. This kind of ‘tampering with nature’ explains why GM foods have been called ‘Frankenstein foods’.

There are worries that GM foods will make various diseases resistant to the antibiotics which have saved millions of us from death in the last few decades.

This is because, when genes are transferred in the lab, marker genes are transferred along with the DNA. This enables scientists to identify which cells have become modified. Usually a gene for antibiotic resistance is used as a marker. The British Medical Association (BMA) fears that resistance to antibiotics might transfer to animals or humans and leave patients vulnerable to diseases such as meningitis. For example, genetically modified maize contains a marker gene which passes on resistance to ampicillin, an important antibiotic used to treat bronchitis, ear infections and urinary tract infections in humans. Some urinary tract infections can impair fertility so we need the medical ammunition to deal with these infections.

The BMA has issued a report, called The Impact of Genetic Modification on Agriculture, Food and Health, and has called for studies to see whether these foods could damage our immune system or cause birth defects.

It is also possible that the DNA from our food could be transferred to the natural bacteria in the human gut, creating lethal substances and a whole generation of new diseases which won’t be killed off by antibiotics.

*31/73/5*

It’s a myth that tornadoes “suck up” cows, small dogs, and houses into their funnel. So don’t worry about becoming an accessory to the storm if a twister’s heading your way. What you should worry about is getting struck by Bessie, Toto, or even a Toyota, because with winds in excess of 250 miles per hour, a tornado can lift and toss large objects hundreds of feet from its path. It can also leave a path of destruction 1 mile wide and 50 miles long, so it’s best to take cover when a tornado blows into town. Here’s how you can keep from twisting in the wind.

Stay tuned. “Doppler weather forecasters can locate a tornado before it touches down,” says Johnson. Since tornadoes occur as the result of a nasty thunderstorm, you should check out the radio or television news if there’s a bad boomer in your area. You also can buy a weather radio with a warning alarm that will turn on automatically and warn you when a tornado watch or warning has been issued. They are available at electronics stores.

Go when it’s green. If you’re out and about, be warned when the sky turns green, there’s large hail, you see a wall of clouds, or you hear a loud roar like a freight train. These are signs that a tornado may be on the way – unless, of course, you live next to the railroad tracks.

Get down. “Get to the basement if you can,” says Johnson. “If you can’t, go to a center hallway, a bathroom, or a closet on the lowest floor. You want to find a strong, low location.”

Get out of the car. If you’re in your car or a mobile home during a tornado, get out and find shelter. If you can’t get into the basement of a nearby building, lie flat in a ditch or low-lying area.

*119/36/5*

How does the extract work in practice and not just under laboratory conditions? If we consider this treatment in relation to human beings suffering from rheumatoid or osteo-arthritis, then, in general, the first signs of a beneficial reaction will be noticed after about three weeks from the time of commencing the treatment. Before we go any further this statement needs some qualification because each case can be different and this assertion refers to the general situation.

Some people respond to this treatment in the first week, whilst others may take as long as fifteen weeks before noting any change in their condition. Another important factor is that the change in condition is not usually dramatic or sudden but is in the form of a slow and progressive improvement. Usually the first change noticed is a decrease in pain and, as the days pass by, this is followed by an improvement in mobility and increased freedom of movement. There is probably also a degree of psychological therapy induced at this stage. So begins a cycle of treatment involving internal medication, through taking the extract, coupled with physical therapy, by using the muscles and joints. Of course, care has to be taken not to overdo things but in general progress is steady and good.

It is only fair to point out that some people may temporarily get worse before getting better. The number of such cases, however, compared with those experiencing direct benefit, is small. The general symptoms described by people who have experienced such a deterioration preceding improvement have been as follows.

At periods ranging from one to four or five weeks after taking the mussel extract capsules, an increase in pain and sometimes also in stiffness occurs. In some cases the pain is very sharp and intense and is accompanied by considerable heat and tenderness in the affected area. Also, in some cases, this effect spreads to other areas of the body. Some people describe these symptoms as being like an attack on all potential sites where arthritis might have set in but has not yet become evident. In any event, this situation can lead to the affected person consuming some form of pain killing preparation (such as aspirin) for the temporary relief of the symptoms.

Usually after such a ‘flare-up’, which tends to last for a few days only, people enjoy a steady and pain-free improvement. The main difficulty which arises in cases like this is to know whether in fact the flare-up is created by the substance and precedes improvement, or whether in fact it is a flare-up due to a change in treatment. Usually, of course, the changes in treatment that would cause this to happen do not take place because most people take the mussel extract capsules in conjunction with their existing treatment until beneficial results become evident. Fortunately, the flare-up condition does not happen frequently and it is usually an indication that the extract is working and that good results will follow.

Neither the age of a person nor the duration of suffering diminishes the help this treatment offers. A person of eighty may respond just as quickly as a baby. Again, a person who has had arthritis for many years may notice improvement just as quickly as someone who has just developed the condition and the overall results may be just as satisfactory. This is not to say that this extract is capable of eliminating deformities or of rendering degenerated bone surfaces wholesome and new again. We are discussing improvement in general terms, and whilst it is perfectly true that some people have seen nodules disappear and deformed fingers become straight, flexible and active again, there are stages of deformity associated with arthritis which only surgery could rectify, and sometimes which are even beyond the help of surgery.

Mussel extract, of course does not work for everyone, but having said that, the success rate is good. Of people undergoing trials on this substance, some of whom were chronic cases who had not responded to any other treatment, more than 60 per cent benefitted. This percentage has also been confirmed by private reports from numerous subjects with varying degrees of affliction. The evidence to date suggests that relief from symptoms of osteo-arthritis can occur in thirty to fifty per cent of cases. The significance of these figures is enhanced by two factors which are of great importance when considering the beneficial aspects of any product – length of time that the results last and the absence of side-effects.

*14/48/5*

Repeated cycles of dieting may actually increase the body’s metabolic efficiency and make it even harder to lose weight. Such cycles may also change the way fat is deposited, with more fat being laid down in the stomach region.

There are certain factors that can modify the set point weight to some degree. Exercise has been shown to lower set point. In other words, regular exercise doesn’t just burn calories; it actually seems to shift the regulation of body weight to a lower level. Similarly, certain drugs can lower set point. Anyone who has stopped smoking cigarettes and subsequently gained weight can attest to the effects of nicotine in keeping set point weight down. What’s more, evidence suggests that long-term response to a high-fat diet can raise set point. Thus, lowering the percentage of fat in your diet may help you lower set point.

The set point model has much to tell us, not just about obesity, but about the eating disorders as well. For the anorexic, self-starvation and severe weight loss cause the metabolism to slow to a crawl. The greater the loss, the more the body fights to return to its preprogrammed level. This explains why a person with this illness feels she must maintain such vigilance against hunger. Her body is fighting for its very life, and will muster all of the available resources to defend its existence.

Although they may have lost as much weight as an anorexic, bulimic women may be at a statistically “normal” weight or above. But the set point model suggests that “normal” can’t be defined by referring to some chart, such as the Metropolitan Life tables of height and weight. Normal weight can be defined only for a particular individual.

In fact, I would throw out the word normal altogether and substitute natural instead. To illustrate: Woman A may be five feet four with a small frame and a set point range of 114 to 120 pounds. Some insurance-company chart somewhere probably says this particular woman is “average.” But woman Â-same height, same frame-may have a set point range of 130 to 136 pounds. She’s above the statistical average, but she is at a good and healthy weight for her. Each of these women has a set point range that reflects her natural weight.

But now Woman  reads an article that says her weight is “above average.” She feels compelled to diet and loses twenty pounds. She now weighs about the same as Woman A, around 116 pounds. No one would consider her emaciated, yet she has lost 15 percent of her body weight-the same percentage required for a diagnosis of anorexia! Although statistically “normal,” her body may be in a state of semistarvation. Because she needs more food than she is eating, she is at risk of developing uncontrollable binge urges, thus trigg ering the vicious cycle of bulimia.

To break the cycle, people may need help. They need a teacher who will show them the way to regain a healthy balance between the mind and the body.

*48/35/5*