Antidepressants Blog

Where are cancer cells most likely to escape being killed by chemotherapy drugs? Firstly, they may escape wherever there are big deposits. One of the biggest deposits is often, but not always, the primary cancer. There may be a choice between surgery and radiation to tackle these large deposits. Secondly, there are parts of the body where there seems to be some sort of barrier to the penetration of chemotherapy drugs. Radiotherapy can be used to treat these areas. They are the central nervous system (brain and spinal cord), the testis and the ovary. For example, in acute lymphoblastic leukaemia of children, the chance of leukaemia cells getting into the central nervous system, testis or ovary is so high that preventive treatment of these areas by radiation is recommended. This addition to the usual chemotherapy treatment has been shown to improve the cure rate.
Bone marrow transplantation is a special instance where radiation is combined with other treatments to produce some cures. The preparation includes radiation of the whole body. Although bone marrow transplantation has been tried for many types of cancer, the only ones it can cure are certain types of leukaemia. The entire treatment package is very arduous, dangerous and lengthy and the chance of cure is usually not high. Try very hard to get all the facts before agreeing to this type of treatment.
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Cancer

Obviously, the more different types of treatment you have, the more your treatment is likely to ‘cost’. The situation with combination treatments is so complex that you could be very tempted just to tell your doctor to go ahead with whatever is most likely to cure you. The problem is that doctors have a tendency to overtreat, as we have seen. They are likely to want to add to your treatment anything that could be active against your cancer. They will probably make little or no attempt to weigh the likely additional cost against the likely additional benefit. In any case, you can do that much better than they can. It is therefore very important that you ask exactly what difference each part of your treatment is likely to make. What could happen if you only had one type of treatment? Does the addition of radiation improve the cure rate or only the local recurrence rate? How difficult is it to treat a recurrence? Would you still have a chance of cure if the disease recurred or is the ‘first bite at the cherry’ really your only chance? You will have to try to weigh up the possible costs against the possible benefits to come up with the decision that is best for you.
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Cancer

Insulin, while performing lifesaving functions like leveling out blood sugar levels, does so by increasing the risk of heart and other diseases and by contributing to obesity. The normal concentration of blood sugar is from 80 to 120 milligrams of glucose for each 100 milliliters of blood.6

We understand that insulin is somehow associated with diabetes and that insulin’s job is to bring down excessively high levels of blood sugar. Type II diabetics have either lost the ability to secrete enough insulin to keep blood sugar levels in check or have developed a condition called insulin resistance, which essentially "locks" insulin out of target cells and keeps it circulating at high levels, a major risk factor in the development of cardiovascular and artery diseases. Insulin regulatory mechanisms break down from weak genetics, obesity, or from the overuse of blood sugar homeostatic mechanisms (eating too much sugar!). Stress also plays a role in increased insulin resistance.

‘When I get annoyed about something I go after the largest carbonated drink I can find!"

MIKE

The role insulin plays in the body, however, is much more diverse and powerful than bringing blood sugar levels under control. As one textbook terms it, "The major function of insulin is to promote storage of ingested nutrients." As a storage hormone, it has an impact on virtually every tissue in the body. Insulin’s primary targets are the liver, muscles, and adipose (fat) tissue. Insulin first pulls sugars out of the bloodstream and deposits them in the liver as glycogen, then in the muscle as glycogen, and finally converts it into triglycerides for storage in fat tissue. Insulin hormone "builds" fat.

Insulin increases the synthesis of several types of fat/protein and fat/sugar complexes, such as triglycerides, cholesterol, and very low density lipoproteins (VLDL), which aid in the building of muscle tissue and deliver glucose to those muscle cells for energy. LPL (lipoprotein lipase) is an enzyme that actually pulls triglycerides into fat cells for storage; insulin increases both the production and the action of LPL and inhibits those same fat cells from converting back into blood glucose.

Just keep two facts in mind as we continue this discussion: Insulin promotes fat storage, and excess carbohydrates stimulate insulin.

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Weight loss

At times it is impossible to walk away from the child in the midst of a tantrum: for example, at other people’s houses or when shopping. It is still important that the behaviour not be reinforced. Suggested strategies for dealing with tantrums are outlined in a separate section on management of behaviour problems.

Sometimes the child can become quite frightened during a tantrum, probably because he feels out of control, and appears genuinely distressed. On these occasions you should simply hold the child for a few minutes, until he is back in control. Even during this period it is important not to reinforce the behaviour by being too warm and affectionate to the child. Furthermore, there should never be a reward for the child at the end of the temper tantrum. For example, a child may have a tantrum after his parents have insisted that he tidy up the toys, or perform another task. Once the tantrum is over and the child has regained composure, you should gently guide him back to the original task. If this is not done, then the child will very quickly learn that the way to avoid doing things is to have a temper tantrum.

If parents can manage a child’s temper tantrums correctly, then they will be able to manage successfully most of the other difficult behaviours that are an integral part of childhood. If they unwittingly allow the child to use repeated temper tantrums to get his own way, there is a good chance that the child will continue to use temper tantrums, or variations of them, as a way of relating to parents, other adults and peers. It will be likely to interfere with social learning, relationships and learning to deal with frustration.

When to see your doctor

You may want to speak to your doctor or another health professional to ‘coach’ you about behaviour management techniques. It is very often helpful to have somebody to support and encourage you during what is often a taxing time. Occasionally the family doctor will refer you and the child to a paediatrician or psychologist for more specialised advice.

Prevention

It is unlikely that temper tantrums can be totally prevented — they are a normal part of growing up. However, parents can certainly do much to make sure that they are not prolonged or made worse and that there are no associated behaviour problems, by handling the tantrums appropriately in the way suggested above. A commonsense, low key approach will usually work.

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THREATENING SAME-SEX CHILDHOOD FOE

Do you remember a bully, a “meany,” some child who just seemed to have it in for you? There seemed to be something about you that resulted in a monstrous reaction on the part of this one particular child. You might have sprinted with terror past his house, snuck down the alley on the way home from school, done anything to avoid direct confrontation with this one child.

One husband reported, “His name was Carl. This kid hated my looks, my name, my clothes, my walk, my parents, even my dog. I have never been so afraid in my life, not even in the war, as I was afraid of Carl.”

“She was the meanest girl. She gave the word ‘bitch’ a bad name. She put me down to everybody. I hated her. I wished she would die. I’ll bet she became a gossip columnist.” This wife frowned, reliving her anger as she described this love-map imprint.

The same-gender conflict and fear gets on our love map, a danger zone that is reflected in our choice of a partner and in our day-today working and loving. Think about conflicts with people at work, about conflicts with certain family members, and try to relate these relationships to your love map. You will see that these maps influence all living.

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At this stage of the process some people may go into psychotherapy. As was discussed in chapter four, psychotherapy can be extremely beneficial. Many of us who have an anxiety disorder have suppressed our primary emotions of anger, grief and so on. Psychotherapy helps us contact these feelings. Experiencing them is part of the healing process.

People have asked the question of what to do with their thoughts while working through issues in psychotherapy. There will be issues in therapy which need to be thought through and worked with, and they may cause anxiety and attacks. Again, it means walking a fine line. Be aware of why they have occurred and let them happen.

As our management skills increase we will begin to realise a subtle pattern emerging with our anxiety and attacks. When we are avoiding confronting particular personal issues, or in other words, not being honest with ourselves, we may find ourselves reacting with anxiety or an attack. We can use these subtle guides to get to know and understand ourselves on a deeper level.

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For many types of cancer, complete surgical removal of the primary tumour is the only treatment that is ever capable of producing a complete and permanent cure. Surgery cures more cancers than does any other form of treatment. Surgery is also recommended to cancer patients for other reasons: to make a diagnosis, to relieve or prevent symptoms and to reconstruct parts of the body. We will look at each of these in turn later in this chapter.

There is one basic problem with surgical treatment which does not apply with other types of treatment. Surgery is done while you are unconscious and therefore incapable of making any decisions.

If something unexpected is found during an operation on you, decisions about the best immediate course of action will be taken out of your hands. They will be made on your behalf by the surgeon. Most surgeons take it for granted that they should be making all the decisions, so they have no strong reasons for trying to prevent this situation from arising. There is only one way to make sure that you make the decisions about what operation will be done. You must make sure that you know, as completely and accurately as possible, before your operation what will be found when you are opened up, and what can be done to deal with this situation. The more careful and thorough your pre-operative assessment is, the greater the possibility of the exact opertion lat you agree to being performed.

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If the blockage occurs in a large artery, so much heart muscle may be deprived of blood that the heart cannot cope with its normal function and death may occur. This may be immediate or happen within a few hours, a day, or longer.

Sudden death is always a possibility following a heart attack and the risk is greatest in the first few hours, decreasing over the following 48.

The cause of death is usually due to the development of an abnormal heart rhythm.

Damage to the heart muscle may make electrical conduction through the heart unstable.

There are a number of abnormalities of rhythm but the one causing death is ventricular fibrillation.

The best way to prevent or treat this is for the person to be under the care of trained medical or paramedical personnel.

Coronary care units have been established in all public and most large private hospitals. The person with the suspected heart attack is admitted to this special ward and is monitored by having a continuous electrocardiograph displayed on screens.

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It must be stressed that the evidence is not all bad. Some of the studies involve such small numbers that no valid conclusions can be drawn.

An epileptic woman who stops taking drugs because she becomes pregnant is at risk of having convulsions. The convulsion with the associated lack of oxygen during the fit may, in itself, be dangerous to the foetus.

Besides, most women do not know they are pregnant until four or six weeks after conception.

The developing foetus has already been exposed to the drug and stopping it when pregnancy is confirmed may be too late, if in fact, the drug does have harmful effects.

All life is a risk and, at the moment, it appears there is a greater risk to the baby if the epileptic woman stops her medication during pregnancy than if she continues it.

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Firstly, it performs an essential protective role. Because of its resilience or ability to resume its previous shape after deformation, it can withstand considerable trauma without permanent damage. This mechanical barrier is mainly due to the arrangement and nature of the collagen and elastic fibres in the dermis. It also constitutes an effective barrier to the passage of substances into or out of the skin. This chemical barrier is provided by the layered cells of the epidermis, which impede the loss of water and body salts and prevent the penetration of external substances.

Secondly, the skin is a most effective and essential sensory organ. This is a result of it being richly supplied with nerve endings, which provide an effective sensory defence against potentially harmful stimuli. It also acts as a ‘relay station’ between external influences and internal organs, via a network of nerve fibres. Of equal importance, is its role as an organ of expression: for instance we may express anxiety by sweating, fear by pallor, anger by redness, pain as a grimace, or happiness with a smile.

Thirdly, the skin acts as a remarkable thermostat. This is mainly achieved by its blood vessels and sweat glands. The metabolic processes of the body continually produce heat, which must be dissipated to maintain a constant body temperature. Under normal environmental conditions this may be achieved by varying the diameter of the blood vessels in the skin, resulting in changes in the volume of the blood flow. This blood flow can be varied 100-fold from maximum constriction to maximum dilation of the vessels. Increased blood flow is accompanied by increased heat loss, whereas a reduced blood flow retains heat.

If, however, blood flow alterations are insufficient to regulate the body temperature, then the sweat glands are activated. This will occur with extreme external temperature increases, excessive exertion, or the fever accompanying an illness. The sweat bathes the skin and cooling results from its evaporation.

Fourthly, the skin plays an active part in the body’s defence against such micro-organisms as bacteria, fungi, and viruses. The surface of the skin is never sterile. It is host to a permanent resident colony of various bacteria which are relatively innocuous. Their presence, however, inhibits the growth of more dangerous organisms on the skin. Further protection is provided by the dryness of the skin’s surface. Most organisms are relatively intolerant to dry conditions, much preferring humid or moist environments. The continual shedding of the superficial epidermis also discourages bacterial invaders. Sebum, the oily secretion produced by the active sebaceous glands, contains fatty adds which have a strong anti-bacterial and anti-fungal action. A thin coating of this on the skin provides a further protection.

Finally, the skin is an important barrier against damaging ionizing radiation, such as ultra-violet light. For skin unprotected by hair or clothing, the only significant defence against the destructive effects of U.V.L. is melanin. Without melanin the epidermis would be a thin transparent membrane, allowing

U.V.L to damage the sensitive structure of the dermis. Melanin is a complicated large protein produced by special cells, melanocytes in the basal layer. From there it is distributed throughout the epidermis. The amount of melanin in the epidermis governs the colour of a person’s skin: the more melanin, the darker the skin colour. There is no difference though in the number of melanocytes in white and in black skin. The difference is simply one of activity, reflected in the amount of melanin or pigment these cells produce. Various factors may influence this, including sun exposure, pregnancy, various hormonal disorders, and drugs.

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