The function of the hypothalamus is critical for body weight regulation. Research with rats has shown that damage to the hypothalamus can have serious consequences. Damage to the ventromedial hypothalamus (VMH) is associated with hyperphagia (over-eating), decreased thermogenesis and spontaneous aotrvity, and elevated insulin levels. Obesity is almost an inevitable result! On the other hand, destruction of the lateral hypothalamus, only microns away, is associated with decreased food intake and a reduction in body fat.

These changes are partly influenced by the actions of chemical messengers, called neurotransmitters. Different types of neurotransmitters function to stimulate specific areas of the brain responsible for certain mental states. There are a number of neurotransmitters that can either promote or discourage feeding. For example, seratonin, derived from the amino acid tryptophan, can reduce food intake and this is now the basis of several appetite-suppressing drugs. Ingestion of carbohydrate results in the release of seratonin which inhibits the norther intake of food. Conversely, another neurotransmitter in the brain, neuropeptide Y, stimulates food consumption. There are a number of other chemical messengers that either stimulate or inhibit food intake—the strength of specific signals after a preferred food has been eaten may affect that food’s desirability for further consumption.

Isolation of a ‘satiety’ gene, by geneticists working at Rockefeller University in 1994, suggests that genetics may play an important part in hunger. Research carried out over several years has suggested there may be a mechanism coded for by a gene or genes, which ‘switches off hunger signals in the hypothalamus. Scientists have searched for, found, and now synthesised a protein hormone which they have called ‘teptin’ Qeptos is Greek for ‘thin’ which may result in major advances for drug therapy for obesity—if it lives up to its early promises.

In addition to dealing with neurotransmitter signals and proteins, the hypothalamus integrates a wide variety of messages, from the first smell of food to its metabolic fate as stored energy, by a series of neurotransmitters, hormones and signals from circulating nutrients.

Physiological signals—Stomach and intestinal distension are mechanisms for terminating feeding by negative feedback via the nervous system. The release of hormones such as cholecystokimn and the stirnulation of special receptors in the gut also provide signals to reduce feeding.

Nutrient -Circulating glucose, amino adds and may also signify that food has entered the body’s system and reduce the desire to eat. Low blood sugar levels promote hunger and it is possible that lesser degrees of changes in blood sugar may also influence appetite mechanisms.

Hormonal signals—A variety of hormonal changes occur in response to ingested and absorbed nutrients and some of these may influence appetite mechanisms. Insulin is one of the main hormones involved in nutrient metabolism but its role in appetite mechanisms has not been clearly identified.

Metabolic signals—The conversion of nutrients into storage tissues may influence appetite mechanisms. For example, the amount of carbohydrate and glycogen stores or fat in adipose tissue may feed back signals to the hypothalamus, giving it important information about the status of the body’s energy reserves.

From this wealth of feedback the brain must sort out relevant signals and make decisions about food intake. When hunger is high, an individual’s ability to inhibit inappropriate food choices is reduced. Many food companies, especially snack food manufacturers, exploit this by advertising their products on television around meal-times.

*110\186\4*

Endometriosis is a disease that can affect any girl or woman who is menstruating.

In order to understand endometriosis you need to know how your menstrual cycle works. The tissue that lines the inside of the uterus is known as the endometrium. Each month the hormones in your body stimulate the endometrium to grow and thicken and then break down and bleed. This bleeding is your period.

In endometriosis small patches of endometrium grow outside the uterus in other areas, such as on the ovaries or on the surface of the other organs inside the pelvis. These patches of endometrium respond to the hormones in your body in the same way as the lining of the uterus. Therefore, the misplaced endometrium thickens each month and then breaks down and bleeds. Unfortunately, there is no way for this blood to leave the body so it irritates the surrounding area causing pain and the other symptoms of endometriosis.

The most common symptoms of endometriosis are period pain, backache, heavy bleeding, pain when using your bowels, pain with sexual intercourse and difficulty in becoming pregnant.

There are two main types of treatment for endometriosis: drugs and surgery.

Drug treatment is most commonly used for teenagers. Most of the drugs work by stopping your periods and drying up the patches of endometriosis. Surgery involves burning or cutting out the patches of endometriosis.

*100\83\2*

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*