Archives

For the day Среда, Апрель 22nd, 2009.

BREAST SURGERY: STAYING IN HOSPITAL AFTER OPERATION

An operation to remove a lump from the breast will probably last about 20 to 30 minutes; mastectomies may take up to an hour. Therefore you are likely to be away from the ward for no more than 3 to 4 hours. You may feel drowsy and slightly sick as the effects of the general anesthetic wear off. If your mouth is dry, you can take sips of water, but drinking too much immediately after your operation can make any nausea worse. As your digestive system will not be affected by the operation, you will be able to eat as soon as you want to.

Following a mastectomy, you may be returned to the ward with a drip inserted into your arm. This contains a saline solution to replace the fluids that have been lost from your body during the operation, and will be removed after about 24 hours or when you are able to drink freely.

Drainage tubes

One or more small tubes will extend out of the side of the dressing covering your wound, each draining into a plastic bag or bottle, which will probably be placed beside you in the bed. Although the drainage system is cumbersome, you will be able to get up and move around the ward while it is still attached, but do remember to make sure the collecting bag(s) is supported before you do so. It may be taped to the.-side of your body or pinned to your nightdress. The weight of an unsupported bag will pull on the wound, causing discomfort.

During the first day following your operation, fresh blood and fluid will drain into the collecting bag. On the second day, the amount of fluid will probably have reduced substantially, and may be mostly clear, with a small amount of blood. Following a wide lump excision, the single drainage tube may be removed after about 24 hours. Each of the two tubes required after a mastectomy will be taken out when the drainage into them has reduced, which may be anything from 1 to 7 days after your operation.

The wound

Your wound will probably be covered by a clear dressing with an overlying pressure dressing to reduce bruising. The pressure dressing consists of a wad of gauze covered with Elastoplast strapping which is quite tightly applied after wide lump excisions and mastectomies. This will probably be removed after about 24 hours, once a doctor has visited you on the ward to check your wound.

If you do not want to be able to see the wound through the remaining clear adhesive dressing, do ask a nurse to cover it with gauze. You may find the sight of the blood-encrusted wound, the stitches and possibly some bruising upsetting. However, it will improve each day, and it should have healed and begun to look a lot better after a couple of weeks.

The wound may have been stitched with an absorbable material that will dissolve of its own accord in time, and only its ends may be visible. Alternatively, the stitches may be of a nonabsorbable material, possibly with a small white bead attached at each end. Stitches of this type will have to be removed 7 to 14 days after your operation. Many wounds are now stitched with a single continuous stitch, and appear as a single straight line.

The pull of the stitches may cause a feeling of tightness which will improve after a few days.

*41/39/5*

PHYSICAL EXAMINATION FOR ENDOMETRIOSIS

A physical examination usually involves:

• testing a specimen of your urine

• taking your blood pressure

• examining your breasts

• examining your abdomen

• a pelvic examination (sometimes also known as an internal or a vaginal examination).

The purpose of the pelvic examination is to try to determine whether there are any indications that you may have some endometrial implants or cysts present. Sometimes, the pelvic examination will suggest the presence of endometriosis but often nothing abnormal will be found, especially in the early stages of the disease.

Knowing what is involved in a pelvic examination will help to relieve any anxiety that you may have and help you to relax and therefore make the examination more comfortable for you and easier for the doctor. Ask your doctor to explain the procedure to you before she or he begins.

It is best if you empty your bladder just before the examination as a mil bladder will make it difficult for the doctor to perform the examination satisfactorily.

During the pelvic examination you will usually be asked to lay on your back with your legs spread apart, knees bent and feet together.

While the doctor is examining you it will help if you tell him or her when you can feel any pain or discomfort. A pelvic examination may cause a little discomfort but it should not be painful. If the examination does cause pain ask your doctor to stop for a moment to allow the pain to subside while you relax again. After the examination has been completed ask the doctor to describe what he or she felt.

The doctor will begin by examining the external genitalia, which includes the vulva, clitoris and labia, for any signs of inflammation, irritation or infection.

The doctor will then insert an instrument, known as a speculum that holds the sides of the vagina apart to examine the vagina and the cervix. The doctor may also take a Pap smear or a sample of any unusual discharge using a cotton swab or a wooden spatula. Once a thorough examination has been made the doctor will remove the speculum and perform a bimanual pelvic examination.

In the bimanual examination the doctor inserts two gloved fingers into your vagina and places the fingers of the other hand on your lower abdomen in order to feel the outline, shape, size and location of the pelvic organs between his or her hands. The doctor will also feel for any nodules, lumps, growths, enlargements or areas of tenderness.

During the examination the doctor may be able to feel nodules of endometriosis in the Pouch of Douglas, on the utero-sacral ligaments or in the recto-vaginal septum. It may also be possible to feel if the ovaries are enlarged, which may indicate cysts on the ovaries. The doctor will also be able to feel if the uterus is lying in the normal position or if it is stuck in a retroverted position.

Occasionally, the doctor may feel that it is necessary to perform a recto-vaginal examination if you are complaining of symptoms involving the bowel. This examination is similar to a bimanual pelvic examination but the index finger is inserted into the vagina and the middle finger into the rectum. The fingers of the doctor’s other hand are placed over the lower abdomen to help outline the organs and feel for any enlargements or growths.

If a pelvic examination does not indicate anything abnormal and if it was not performed near the time of your period it may be worthwhile having another examination just before, or during, your period when the endometriosis is most active thus making the implants more tender, larger and easier to feel.

*19/41/5*

PREVENTIVE MEDECINE: DISEASE AND THE WESTERN LIFESTYLE

To many, if not most, of us living in the West, the notion that some of the diseases we all take for granted as the major killers are preventable is indeed hard to accept. Strokes, heart disease and cancers between them kill most westerners yet they are relatively uncommon in the non-westernized world. Why should this be, and is it possible that by altering the way we live we could reduce or even abolish these conditions?

At first, the suggestion that it is our western lifestyle that causes many of our major diseases seems quite ridiculous, but the pioneering work of a group of doctors who spent decades in non-westernized parts of the world must make us think again. They noticed that certain non-infective diseases were very much less common in traditional societies than they were in the West. They wondered at first what to call these diseases. ‘Diseases of civilization’ (meaning modern, western civilization) is not quite right because evidence suggests that some of them were around but uncommon in the ancient civilizations of Egypt, Greece, Rome, India and China. Given that the conditions they found to be so common were now mainly seen in communities that had adopted our western, technological way of life, they decided to call them ‘western diseases’.

The first two criticisms that are immediately thrown at such a suggestion are, first, that people in the Third World tend not to live to be old enough to get ‘our’ diseases, and second that their medical systems are so poor that they simply do not diagnose the conditions even when they are present. Neither of these criticisms stands up when examined in depth, and studies which show that migrant populations (originally without western diseases) adopt the diseases of their westernized brothers in their new country, prove without doubt that it is not simply that whole populations in the non-industrialized world are somehow immune to westernized diseases. It is also impressive (if depressing) to watch peoples with traditional lifestyles take on our disease pattern as they adopt our way of life.

So what could possibly be causing these western diseases? Obviously motor-car accidents can only occur where there are motor cars, and pollution from industrial effluent or cigarette smoke is only found where these two abound, but these are not the diseases I mean when I refer to western diseases. The conditions in question are such disorders as: high blood pressure, obesity, diabetes, heart disease, appendicitis, piles, varicose veins, gall-stones, kidney stones and cancer.

Of course, any of many changes in western lifestyle in recent years could account for the frequency of all these conditions today and their virtual absence until the last century in the West and in most of the world today, but because many of them seem to affect the digestive system it makes sense to start looking for clues in the food we eat. Modern technology has radically altered the production and preparation of food and it now seems that food changes are at the heart of many of these ‘new’ western diseases.

*56/72/5*

FEEED YOUR BODY RIGHT: SHE NEVER LEAVES HOME WITHOUT HER BUTTER SPRAY

How can you lose 100 pounds on a 1,200-calorie-a-day diet and still enjoy going out to restaurants?

Carry butter spray and fat-free salad dressing in your purse.

That’s what Alayne Gunto of Moundsville, West Virginia, did when she became determined to whittle her 242-pound figure.

Alayne comes from a family with a history of weight problems. While she tried on and off to slim down, she was never really successful. Then her mother, father, and grandmother all had heart surgery within months of each other. That was the wake-up call Alayne needed. She decided to lose weight because, as she says, «I didn’t want to put my husband and children through that experience.»

Alayne put herself on a strict 1,200-calorie-a-day eating plan. She paid attention to what and how much she ate, something she had never done before. She kept close tabs on her portion sizes by reading food labels and using measuring cups. She started eating breakfast every day but quit her habit of munching on high-fat

snacks. To bolster her resolve, she joined TOPS (Take Off Pounds Sensibly), where she participated in regular weigh-ins.

All of these strategies helped Alayne hold course on her self-styled weight-loss program. But there is one trick in particular that she says has kept her from blowing her calorie and fat budget. «I like to eat out, but I want to know exactly what’s going into my mouth,» she explains. «I don’t want to leave it up to the restaurant to tell me I’m eating low-fat. I don’t necessarily believe their advertising. So I order my salads and baked potatoes plain. I just open my purse and dress them myself.»

Alayne’s strategy worked. Within 15 months of starting her weight-loss program, which included daily walks, she reached her goal weight of 145 pounds. She has maintained this weight for 2 years.

These days, just looking in the mirror is incentive enough for Alayne, a 34-year-old homemaker, to keep her eating and exercise habits on track. And although she admits to occasionally going over her fat and calorie budget, she never goes to a restaurant without her condiments.

WINNING ACTION

Stick with your own low-fat or no-fat condiments. Salad dressing and butter pack a lot of calories for the little room that they take up. Take a tip from Alayne and pack your own when going to restaurants. These travel particularly well: Marzetti’s fat-free salad dressing, available in packets at the supermarket salad counter, and I Can’t Believe It’s Not Butter spray.

*49\89\8*