Antidepressants Blog

The outside world is a hostile place, as a baby soon discovers. Germs abound and are ever ready to pounce upon anybody who is susceptible. Babies are extremely prone, and so are infants and children of school age.

Fortunately babies receive a fairly high level of immunity (in built protection) from their mothers, and for their first several months are fairly resistant to these onslaughts. Breast-fed babies continually receive protective factors from the mother, which add to this normal protection and keep it going.

But sooner or later this comes to an end, and the baby then has to face these hostile enemies, who are ready and waiting for a new victim.

In recent years, researchers have developed an astounding array of protective methods for keeping baby free from many of the more serious potential invaders. These are readily available to all babies in this country in the form of immunization. This gives each baby a flying start in life; it ensures a high level of immunity, right throughout life, from some of the terrible life-threatening germs that are still around.

Many infectious diseases are spread simply from person to person. Often this happens by droplet infection. A person with the disease may cough or sneeze, in so doing imparting an enormous number of germs into the surrounding air. Anyone who comes into this radius may pick these germs up and, if personal resistance is low, subsequently contract that illness. In those of a young age group, when their normal body resistance is not high (after mum’s immunity is no longer available), then there is a high level of susceptibility to these germs.

Many are caused by viruses—extremely minute germs. Others are caused by germs called bacteria—these are ones that are larger. We often have suitable treatment in the form of antibiotics that will effectively counter bacteria. But the viruses still have doctors baffled, and at present very few antibiotics are available that will destroy them.

As a general rule, children are more susceptible to the infectious diseases than adults. In older persons, there has been built up a fairly high level of immunity, often from a previous attack of the disease or from constant contacting of small doses of the germs over a long period of time.

In most cases, a reasonable-sized infection yields a fairly high level of resistance to subsequent bouts. It does not give total protection for every infection; but if subsequent attacks do occur, they are usually far less severe.

Many of the childhood infectious diseases are fairly mild. Many may be treated at home with fairly simple measures available to most parents. Others need the doctor’s attention.

As a general rule, never fail to call the doctor if your child appears to be ill, is not obviously responding to your home medications, or if the condition is worsening.

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There are short term and long term risks associated with pollutants in the air. The short term risks of breathing polluted air include headache, eye irritations, inflamation of the respiratory tract and asthma related disorders. In the long term, air pollution can contribute to the development of cancer, emphysema, birth defects and behavioural problems in children.

Lead, once a major domestic pollutant as an ingredient in house paint, is now pumped into the air in vehicle exhaust or found in soil contaminated by industry. In children, high lead levels are thought to be responsible for a lowering of the intelligence quotient, loss of concentration and hyperactivity. Workers in certain industries run a high risk of lead poisoning. These include zinc miners, petroleum plant workers, car mechanics, sheet metal workers and those dealing with explosives. Lead poisoning results in nervous disorders and stomach and brain related illnesses. To avoid its effects, workers should wear appropriate protective clothing. Parents can have their children’s blood lead levels tested and may consider moving to an area of lower contamination if levels are high. Avoid walking, cycling or jogging in heavy traffic or wear a face mask.

Insecticides, fertilisers, bleaches and blooms of toxic algae affect many of our waterways and can seriously affect our health. Even within our reservoirs, the fluoride and chlorine added to the water to kill bacteria are themselves under a health cloud. Try to drink the purest water available to you and invest in a good water filter. Otherwise, always drink from the cold tap as hot water has sat still in a tank and in pipes and will contain more metals.

Chemicals are not the only pollutants of the atmosphere. Concern is mounting over the dangers of electromagnetic waves to human health, particularly to those living in the vicinity of high voltage power cables. The links between television and computer screen emissions and conditions such as cancer, nervous disorders and cataracts are being investigated. Sit at least 2.5 metres from a television screen and if possible, fit a shield to the screen of your computer.

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Greater enjoyment of sex and improved sexual functioning are among the most commonly reported contrasts between the effects of St John’s Wort and those of the selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Lustral and Seroxat. Although the literature on the SSRIs reports very low levels of sexual side-effects (for example, less than 1 per cent for Prozac and 2.5 per cent for Lustral), any clinician who uses these medications will tell you that these figures are grossly underestimated. One survey of patients on SSRIs reported the frequency of such side-effects to be approximately 34 per cent, and it would not surprise me to find an even higher percentage depending on how carefully the patients are questioned. Considering the importance of sex in the lives of many (if not most) people, it is worth considering the difference in the sex lives of people who have switched from an SSRI to St John’s Wort.

In some people the sexual side-effects of the SSRIs can be extremely marked. For example, they may cause impotence in men or complete inability to achieve orgasm in women. Depressed people generally have a diminished interest in sex to start with, and any anti-depressant may improve the level of interest and overall drive to connect with others sexually as well as socially by reversing7 the symptoms of depression. Initially people are so grateful to be free of their depression that any sexual side-effects they might experience might seem like a small price to pay for feeling better. After a while, though, the side-effects become less and less acceptable as they begin to take a toll on a person’s relationships and impair one’s quality of life.

Sexual side-effects of the SSRIs can involve decreases in sexual interest or arousal or subtle changes in the experience of sex. A colleague of mine, for example, who was previously on Lustral and is now taking St John’s Wort, described how on Lustral he had been able to function sexually but the orgasms just did not feel as good. ‘On Lustral’ he recalls, ‘I was still interested in sex and my erections were fine, but it took me longer to reach orgasm and, when I did, the arc of the orgasm was slower and more protracted and did not reach its previously satisfying level of intensity. I am glad to say that on St John’s Wort my orgasms are back to normal again.’

It would not surprise me, however, if in the course of time evidence emerges for alterations in sexual functioning on St John’s Wort as well, though perhaps only in a very small percentage of those who use the herb. This might be more likely to occur if people push the dosage of the herb above 900 mg per day, as I predict many will in their attempts to explore the full range of the herb’s efficacy. I have already encountered two people who claim some alteration in libido and sexual pleasure on St John’s Wort, albeit to a lesser degree than on the SSRIs. Given our best understanding, that St John’s Wort probably works at least in part by increasing the availability of serotonin, the biological mechanism believed to be responsible for the sexual side-effects of the SSRIs, some sexual side-effects might be expected to be reported as the herbal anti-depressant is more widely used.

It is important to remember that a slight decrease in sexual enjoyment may be an acceptable trade-off in exchange for being free of the painful symptoms of depression. One man whose depression had been successfully treated with Prozac for the previous two years switched to St John’s Wort after seeing a television programme about it. Two weeks after the switch he wrote to me that ‘the ol’ sex drive has come back with a vengeance … my wife is thrilled.’ Several months later, however, I checked up on how he was doing and learned that his depression had returned and that he had developed panic attacks, which resulted in his returning to conventional anti-depressants. It must be acknowledged that no medication, herbal or otherwise, is right for everyone. Nevertheless, St John’s Wort may actually turn out also to be of some value in panic disorder, as the following accounts suggest.

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This theory was confirmed in the case of Ted Parsons, whom I first saw in 1948. Parsons had been a successful executive, on the way up, associated with a large company in Chicago. After a rapid rise he had become, over a period of years, an alcoholic. He was suspended from his job and actually became a “skid row” type of drunkard.

With his family’s help, he had managed to pull out of this nosedive and had become a founding member of the Alcoholics Anonymous group in his area. But after ten years “on the wagon,” he had begun to backslide. Another interval of alcoholism ensued, followed by a period of abstinence. This time, however, he recovered his sobriety but not his health. When he was not drinking, he suffered from extreme fatigue and almost constant headaches.

In preparing to perform food-ingestion tests with corn and wheat (which from an allergy point of view is virtually identical to barley and malt), he avoided these foods for four days. His fatigue was greatly accentuated for two days as a withdrawal reaction, following which he felt much better. During the test with wheat porridge, he developed progressive nasal obstruction and fatigue, as well as tautness of the nape of his neck and delayed dizziness. Reactions persisted for several days.

Some nasal symptoms and fatigue were still present prior to Parsons’ corn test four days later. The trial ingestion of corn porridge and com sugar was also followed by a progressive increase in fatigue and some staggering upon leaving the office. Fearing that he might head for the nearest bar on the way home, I placed him in a taxi, paid the driver to take him home directly, and called his wife to tell her what I had done. His fatigue increased during the night.

Parsons called me the next morning and commented, “It is funny to have a hangover twenty-one months after having stopped drinking. There is no difference between the fatigue this morning and a bad alcoholic hangover.” He went on to describe how he had to crawl to the bathroom because he was too weak and dizzy to walk, but that his lassitude, dizziness, and uneasiness could be relieved just like that (as if by a snap of the fingers) with a drink.

When he asked, “What is wrong with me?” I explained that he was having a true hangover—not from bourbon, but from corn, its principal ingredient. He had apparently been allergic to wheat (barley malt) and corn, as well as certain other foods, for years without realizing it. His addiction to bourbon had been an attempt to get a high level of cereal grains into his system as rapidly as possible and to maintain that level of stimulation. His more recent headache and fatigue could be explained by the perpetuation of his corn and wheat (barley malt) addictions, but at a much lower, unsatisfactory level, by the use of more slowly absorbed wheat- and corn-containing foods.

By the avoidance of wheat, com, and a few other incriminated foods, Parsons’ headache and fatigue not only subsided, but what is more, his craving for alcohol disappeared.

This craving is, of course, the bane of many ex-alcoholics’ existence. One can, with extraordinary willpower, stop drinking, but it is far harder to conquer the desire to drink. Parsons’ case suggested a possible reason for this. The consumption of other grain-containing foods would perpetuate the underlying problem—food addiction/allergy. Thus, in a sense, the alcoholic is never completely free of his “alcoholism” as long as he is consuming the foods which constitute his addictant.

Parsons, for instance, carried around with him a pocket full of candies containing corn sugar, which he sucked whenever he had the urge to drink. This was, in fact, the standard operating procedure of his Alcoholics Anonymous unit. Through practice, these individuals had found that they could relieve their craving for grain-containing alcoholic beverages by sucking on another rapidly absorbed form of grain. They had, in effect, transferred food addiction in its highest form—alcoholism—to food addiction in a less severe (and from the addict’s point of view, less satisfactory) form, corn sugar addiction. When Parsons realized that he was actually perpetuating his problem by eating this candy, he stopped immediately and avoided all contact with wheat, corn, and related foods which had been implicated.

It was through Parsons that I became acquainted with the members of Alcoholics Anonymous in the Chicago area. In the late 1940s, I carried out a study of forty-four members of this organization. I attended meetings, but instead of participating in discussions (which was forbidden to outsiders, under the organization’s rules), I stayed in the kitchen and interviewed members. Their histories, at least, suggested a strong correlation between alcoholism and susceptibility to the various food components of alcoholic beverages.

What are these food components? It soon became apparent that the study of alcoholism from the point of view of clinical ecology was hampered by the lack of information on the manufacture of liquor. Through much detective work, it was possible to track down the components of various drinks, though some of this information was guarded as trade secrets. Government regulation in this respect was lax, and alcohol was not regulated by the Food and Drug Administration but by the less food-conscious Treasury Department.

Gradually it was possible to put together a comprehensive theory of alcoholism as the apex of food allergy (the term “food addiction” did not come into use until 1952). According to this view, alcoholism is the acme of the food-allergy problem because alcohol is rapidly absorbed all along the gastrointestinal tract, from the mouth to the stomach to the intestines. Food, on the other hand, is mainly absorbed in the intestines, and more slowly at that.

There were four facts about alcohol which did not seem to fit into the theory. Their existence threw doubt on the entire concept. Wanting to obtain pure samples of corn mash whiskey, and other pure items for testing, I called a meeting with the research and technical directors of a major Illinois distillery. 1 presented my theory to them and pointed out the four existing discrepancies:

Why did corn-sensitive patients react to Scotch whiskey? Scotch comes from the British Isles but no corn (maize) grows there.

Why did grape-sensitive patients react to Puerto Rican and Cuban rum but not to Jamaican rum?

Why did corn-sensitive patients also react to apple brandy? The public relations officer of the producer of the brand in question had assured me that no corn went into the manufacture of their product.

Why did corn-sensitive patients react adversely to a popular American brandy but not to French brandy?

The research and technical directors of this distillery had been polite but somewhat skeptical, when I first presented this possible interpretation of alcoholism. But as I explained apparent exceptions to the theory, they became increasingly interested. They not only knew some of the answers but began to fill in some of the holes in the theory themselves.

First, all-malt Scotch whiskey is made of dried, roasted barley or malt, which, from the allergy standpoint, is closely related to wheat, if not virtually identical with it. But blended Scotch whiskey manufactured for export to the United States is blended with cereal-grain whiskey made from corn which is shipped from the United States or Argentina. Thus, persons sensitive to corn could be expected to react to it.

Second, Jamaican rum, like other rums, is made from cane. However, the laws of Jamaica demand that rum manufactured there be bottled on the island, whereas Cuban and Puerto Rican rums are shipped from their home ports to the United States in big hogshead barrels. Most of these were then blended with up to two-and-one-half percent grape brandy before bottling. Hence, grape-sensitive patients could be expected to react to the Cuban and Puerto Rican rums.

The distillery experts were not sure why the patients sensitive to corn reacted to apple brandy, however, and the whole theory was put in doubt when the manufacturer told me that the product did not contain corn. But after testing a few more patients highly sensitive to corn and confirming my earlier impression, I wrote the president of the company manufacturing this brand of apple brandy and suggested that the person answering my earlier inquiry had misled me. In the meantime, I had learned about trade practices in the liquor industry and asked specifically what the source of the caramel was which was used to maintain uniformity of color in the brandy. No one knew, off-hand. But upon corresponding with the manufacturer of this product, they learned that it was made from half corn sugar (dextrose) and half cane sugar.

Fourth, the possible corn content of the popular brand of grape brandy which precipitated reactions in corn-sensitive patients could not be confirmed through correspondence with the manufacturer of the product. But upon visiting their California plant in the early 1950s, I learned that corn sugar was used in its production.

This interpretation of alcoholism has not been widely accepted, either by those responsible for the policies of Alcoholics Anonymous or by those who teach courses on alcoholism. One apparent reason is that many alcoholics were quick to grasp an implication of this theory: namely, that some reformed alcoholics could drink compatible alcoholic beverages as long as they avoided both drinks and foods prepared from those substances to which they were allergic. In other words, a corn-sensitive patient who was a confirmed bourbon alcoholic could drink some wines and rums, provided these alcoholic beverages were free of cereal grains and he was not susceptible to grape, cane, or yeast. The effects of alcohol per se on the body did not seem to be an appreciable cause of alcoholism.

It should be emphasized, however, that the prospect of social drinking of compatible alcoholic beverages is not for all alcoholics. Although such a program may be possible for an alcoholic having a very limited food allergy problem, it cannot be considered if one is yeast-sensitive, because yeast is present in all alcoholic beverages. Also, the person who already has a wide base of food allergy usually also has a tendency to develop new food allergies readily, even though he indulges in a compatible alcoholic beverage in moderate amounts and only once, or at the most, twice, weekly. Not only the foods used in manufacturing an alcoholic beverage but also the foods eaten while drinking must be taken into account, due to the extremely rapid absorption of food-alcohol mixtures. In order to minimize the chance of sensitivity spreading to other items of the diet, all compatible foods—including those entering food-alcohol mixtures—should be used according to the principles of the Rotary Diversified Diet.

The only way to know whether one is actually sensitive to corn, wheat (rye, barley, malt), or other grains, yeast, grape, potato, or other ingredients of alcoholic beverages is to undergo extensive food testing. And only in the presence of a food allergy problem of limited extent (a distinct minority of cases) should social drinking of compatible alcoholic beverages by reformed alcoholics be considered.

In the great bulk of addicted drinkers of alcoholic beverages, abstinence from drinking, according to the Alcoholics Anonymous approach, is still the most highly successful rehabilitation program. However, there are obstacles in the application of this program, because this concept of alcoholism is not widely known.

My interpretation of alcoholism was first published in various medical journals starting in 1950.1,2 This view has also been confirmed by several clinical ecologists, including Richard Mackarness of England and Marshall Mandell of this country.3,4 My list of the food sources entering the manufacturing of alcoholic beverages has been published recently.

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Denise Miller was the manager of a large retail store. She worked in the business office of that store, in the rear of the building, adjacent to the parking lot. When she sat near an open window and worked, she inevitably became depressed. The source of her problem was located in the cars and busses which spewed their exhausts in the direction of her office all day long. Since she could not change her place of employment, she was able to get a good deal of relief simply by keeping the windows shut and sitting some distance away from them.

One winter she took her vacation in Florida. Staying with relatives, she was given a big room, with the bed away from the walls of the room. She had no problem. But during the last two days of her stay, other relatives came to visit, and so she was moved into a smaller room with the bed wedged in one corner. The walls of this room, as well as the rest of the house, had been painted not long before, and Miss Miller began to react.

She hallucinated, seeing purple frogs hopping around her room. A lion sat on the foot of her bed and scared her out of her wits. In desperation, she decided to go home. On the Twentieth Century Limited to New York, she later said, she shared her bed with a gorilla. She was very upset, since every time she tried to get to sleep, the gorilla’s arms enfolded her!

Tests revealed that these strange symptoms were brought on by exposure to fresh paint, which was part of her overall susceptibility to many chemicals. By avoiding such exposure, she was able to maintain relatively good health.

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Signs and symptoms

Dyslexia varies in severity. Some of the problems dyslexics may have include: confusion about whether they are right-handed or left-handed; difficulty learning to tell time or remembering the order of days, months, or seasons; hyperactivity; problems with language; difficulty telling left from right and up from down; coordination and balance problems; problems with memory; and seeing letters and numbers reversed.

Dyslexia is diagnosed by a series of tests of visual perception, memory, and space and time perception, and by medical and psychological evaluations. A child who has the symptoms of dyslexia may have a disorder or disease of the central nervous system, problems with hearing or vision, or emotional problems, rather than a learning disability. The possibility of a physical or psychological cause for the problem must be ruled out before a diagnosis can be made.

Home care

A child with dyslexia needs special support and help from the family. However, the child does not need to be over-protected. The child should be challenged as well as encouraged. Finding a balance is not an easy job. The child’s teachers and doctor may be able to help parents work with a dyslexic child. The situation can be hard on the whole family, so a parent needs to be sensitive to how the problem may affect the dyslexic child’s brothers or sisters. They may need extra attention or professional help.

Precautions

• If your child seems to be intelligent but has unexpected problems with reading, the child may have dyslexia. The sooner the problem is identified, the easier it will be for the child, so get professional help as soon as possible.

• Rather than consider the child a failure, encourage him or her to develop new skills.

Medical treatment

There is no cure for dyslexia. If the child has physical or emotional problems as well as dyslexia, these will probably be treated first. Then a treatment plan will be made to work on the reading problem. The plan may be developed by a team of educational professionals, in consultation with the child and the child’s parents, doctor, and teachers. The plan will include special education and training for the child based on his or her particular problems and strengths.

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That’s not to say that everything about your sex life is going to stay the same as you get older. It never stayed the same your first 50 years, so why should your last 50 be change-free? The problem is that younger men, looking ahead, see change leading only to some kind of feeble approximation of the real thing.

Not so. “Your physical responsiveness is altered to a degree, but not radically,” says Dr. Brauer.

So if you want to have sex for the rest of your life, don’t focus on your physical changes. Focus on the things you can do to make sure that you keep having sex for the rest of your life.

Do it or eschew it. The secret to healthy sex in your sixties or seventies and beyond is to have healthy sex in your fifties and forties and before. “It’s very difficult for a man who pretty much stopped having sex in his fifties to start it up again when he’s 75,” Dr. Brauer says.

That’s because sex is plumbing. The more the blood flows to the penis, the more it wants to. “If you stop having sexual relationships, the disuse leads to atrophy of the blood vessels in the penis and impairment of blood flow to the penis,” Dr. Vinik says. Translation: Your equipment shuts down, taking your sex life along with it.

Go solo. Those times in your life when you might be partnerless are no reason to let the plumbing back up. “I recommend that men maintain a certain frequency of erection and orgasm,” Dr. Brauer says. “At least two orgasms a week have been found to be associated with improved physical health and longevity. And that can be achieved with solo sex if that’s what it takes.”

You won’t be the only guy using masturbation to keep his equipment in working order.

“Two-thirds of married men are doing some kind of regular self-stimulation,” Dr. Brauer says. “That can and probably should continue throughout life.”

Ask for a helping hand. At 20, your erection may happen from just thinking about her disrobing. At 35, it may happen by watching her disrobe. At 60, it happens if she fondles your genitals, robed or not. “Direct stimulation is very important for a man in his middle or later years,” Dr. Brauer says. “And not only direct stimulation but continuous stimulation.”

That shouldn’t be a problem since you don’t often hear men grumbling, “What a drag. I have to put up with a lot of stroking and licking from her before the real action.” But Dr. Brauer suggests that you find tactful ways to instruct her on this since she may misinterpret the new requirement as an insult to her sex appeal.

Stay high and dry. Fact: You’ll deliver less ejaculate as you get older. And sometimes you won’t ejaculate at all, a change that’s considerately accompanied by less urge to do so. “Enjoy the process without feeling that you necessarily have to ejaculate to finish it off,” Dr. Brauer says. Having orgasms without ejaculating may allow you to have this sort of climax more frequently than if you did ejaculate, he adds.

Check your hormones. Your hormone levels don’t generally drop enough with age to cramp your sexual style. But sometimes they do, and you may feel the need to talk to your doctor about getting testosterone supplements, often in the form of a skin patch you apply to your body.

“If your testosterone levels are lower than average for your age, you may benefit from supplementation,” Dr. Brauer says. “In fact, some doctors believe that if your testosterone levels are lower than average and you are in your mid-thirties, supplements may be desirable. It may also be worthwhile to make sure that other hormones are also at a reasonable level. Other hormones to check are thyroid and adrenal since these, too, can have an influence on sexual interest and response.”

Call a mechanic. If technical difficulties beyond your control do keep you from getting erections in your later years, take advantage of some tools available for men with erection problems. The ideas of using a vacuum pump to draw blood into the penis, or injecting an erection-producing substance directly into the penis before sex, might have seemed weird a few decades ago but are now increasingly common among diabetics and others. A new device known as Muse inserts a rice grain-size soft pellet of the erection-enhancing substance called alprostadil one inch up the urethra. “It is helpful for some men with unstable natural erections,” says Dr. Brauer.

“For a certain number of men with erection insecurity, a mechanical device is wonderful,” Dr. Brauer says.

And in case you’re wondering, the shots are relatively simple. “During genital examinations, we give the patient a little pinch,” says Dr. Vinik. “When he asks what that was all about, we tell him that’s all he’ll feel when he gives himself the shot. It’s a piece of cake.”

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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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A definite diagnosis of endometriosis is one made when a gynecologist has actually observed endometrial implants or cysts in your pelvic cavity during a laparoscopy (a minor surgical operation using a laparoscope) or, occasionally, a laparotomy (major abdominal surgery).

In general, a laparoscopy is the preferred method of diagnosing endometriosis because it is a simpler and shorter operation and the use of the laparoscope enables better detection of small implants as it magnifies them to several times their actual size.

Classical endometrial implants and cysts can usually be easily recognized and diagnosed by a gynecologist during a laparoscopy. However, atypical implants and microscopic endometriosis can be missed if the gynecologist relies only on a visual impression. An increasing number of gynecologists are using biopsies to diagnose endometriosis in doubtful cases. This involves removing a sample of tissue, known as a biopsy, from any area that the gynecologist thinks may be the site of an endometrial implant for examination and diagnosis under a microscope.

A definite diagnosis is extremely important as it enables an accurate assessment of the severity and extent of the disease to be made and provides a guide as to the likely effect of the condition on your fertility. This is essential information if you are to think about and make informed decisions regarding the management of your endometriosis.

The Commonwealth Department of Community Services and Health, which administers the Pharmaceutical Benefits Scheme, will not subsidize the cost of some of the drugs used in the treatment of endometriosis unless a definite diagnosis has been made.

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Studies in East Africa in the 1930s found that diabetes was rare. Nowadays there are diabetic clinics in all town hospitals.

Diabetes is undoubtedly an ancient disease and Galen, who lived in the second century and was the greatest medical authority in the Roman Empire, certainly described it. What most people do not realize is that he only saw two cases! The condition was further described in the seventeenth century in Europe, but it was rare until the eighteenth century, when it became a common disease among the English aristocracy. Obesity and diabetes emerged together as societies became affluent and ate more fat, oil, sugar, meat, wine and beer, together with refined cereals. In 1971 one researcher reviewing diabetes in the tropics wrote that, ‘The incidence of diabetes is likely to increase with urbanization or as the complexity of civilization takes hold of any racial group.’

Diabetes is not one simple condition, but a family of conditions. There are, however, two common types. The first (now called Type I diabetes) most commonly first occurs in children but can affect people of any age. Such people need insulin by injection – usually for life. This is a very rare condition among the children of many tropical communities and is also rare in Japanese children. Type II diabetes is the adult-onset type that usually, but not always, occurs in the obese (usually women). In both types genetic and environmental factors are important.

The cause of diabetes is as yet unknown but it has recently been suggested that a high intake of foods rich in high-fibre starch is protective and might even be a good treatment for diabetes. Trials have now shown that slimming on a high-fibre diet can ‘cure’ many cases of adult-onset diabetes completely. Other studies have shown that eating a high-fibre diet can reduce the need for insulin in Type 1 diabetes, and in certain trials patients have been able to stop taking insulin completely when eating the correct diet rich in unrefined starches. Obviously this all has to be done under the watchful eye of a doctor who is expert in diabetes-it is not a do-it-yourself treatment for diabetics.

*59/72/5*