Неврозы – Neuroses

The usual symptoms of candidal vaginitis are itching in the anogenital area, a vaginal discharge which may be white and cheesy or mucopurulent, and odour. Signs include a vaginal discharge, excoriation of the skin and violaceous oedema of the vulva. The presence of yeasts may be noted in cervical smears.

The history and clinical examination will frequently indicate the diagnosis.  The organism can be detected by microscopic examination of vaginal smears or by culture on Sabouraud’s medium. If the patient’s history suggests exposure to STD, examination for concurrent infections should be considered.

The possibility of a predisposing condition should be considered and patients should be tested for glycosuria.

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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

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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You may have pins and needles and some pain or discomfort in your chest for a few days. Any numbness or tingling’ sensation under your arm may last several weeks or months. If you have had a mastectomy or auxiliary lymph glands removed, your shoulder will probably also be stiff. The exercises explained above will help you to regain the movement in your arm, and apart from doing these regularly, you should try to use your arm normally as much as possible. However, heavy housework and lifting should be avoided for about 6 weeks, and you should use your other arm to carry shopping etc.

Depression

You are likely to feel tired for at least a few days, and may find you become easily depressed. Many women experience a sense of elation immediately after their operation which then gives way to lethargy and exhaustion as the anxiety they have been feeling starts to be relieved. Mood swings are common, ranging from elation to depression and anger. This is a normal reaction which should settle down in time.

If you have problems sleeping, waking in the night and worrying so that you are exhausted during the day, your GP should be able to prescribe a light sedative which you can take for a few nights. Even three good nights’ sleep can help you to cope again, and stop the cycle of tiredness and anxiety.

If your appetite is poor, it will improve in time, and you should eat what you want when you want until it does so.

Although you should take things easy and rest when you need to for the first few days you are at home, it is important to try to get out and about as much as possible and to return to your normal life as soon as you feel able to do so.

Some women worry that they will be less attractive to their partners, or will be unable to find a partner, after a breast operation, but in the majority of cases these fears are unfounded.

Telling children about cancer

Young children can only understand very simple*’explanations about why their mothers have to go into hospital. By the age of 10, most children can grasp quite complicated details, and it is better to be honest rather than let their imaginations dream up something much worse than the reality. However, it is probably better to give them a little information at a time and gradually build up the whole picture, taking your cue from your children about how much they want to know. All children need reassurance, and a chance to express their own fears and to talk about things if they want to. Older children may find their anxieties difficult to cope with and to express or understand. They should be encouraged to talk about their fears, but not pushed into doing so before they are ready.

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