Health related information and news from around the world.

What are they?

A heart attack occurs when the muscle of the heart cannot get sufficient oxygen-containing blood for it to function. Angina pectoris (a tight chest pain that comes on exertion am goes) is often the earliest sign that something is wrong. In this condition there is insufficient blood getting to the heart muscles, especially on exertion, and the person complains of tightness in the chest as the heart muscle goes into cramp.

A heart attack is like a very severe bout of angina. Sometimes the loss of blood supply is sufficiently severe to kill off a part of the heart’s muscle, and less commonly the damage from a shortage of blood is so severe that it causes almost instant death.

The heart finds itself in this lethal condition as a result of a lifetime’s abuse which causes a progressive narrowing of the arteries (atherosclerosis) that supply the heart with oxygen. Blood clots may obstruct the arteries further.

Heart disease is now the prime killer in the western world; although in the US death rates have fallen by a quarter over the last fifteen years. Given that much of this improvement is caused by lifestyle changes it makes sense to look at heart attacks as substantially preventable. Historic evidence and evidence from populations who migrate from one country to another also strongly suggest that mankind doesn’t have to suffer from coronary artery disease and heart attacks.

There are compelling reasons for rejecting a fatalistic view that heart attacks cannot be prevented. We still have a lot to learn about heart disease, but it does seem clear that it is affected by lifestyle. We have seen that the coronary-artery death rates in the US and Australia have fallen dramatically over the last fifteen years. This improvement pre-dates the widespread use of coronary care units and coronary bypass surgery and even the widespread use of drugs for combating high blood pressure. The fall in heart disease has, however, coincided with a considerable reduction in both cigarette consumption and consumption of saturated fats. However, things are not quite as simple as this suggests, because heart-attack rates are still high in Sweden despite their wealth of medical technology and falling cigarette and fat consumption, and rates in American women are falling despite their rise in cigarette consumption.

What causes them?

No one knows exactly what ultimately causes heart attacks but several fairly clear-cut ‘risk factors’ have been established after vast and complicated studies worldwide.

• Smoking. Several studies have shown the link between smoking and heart disease. A study of particular interest looked at British doctors who stopped smoking between 34 and 55 years of age. It found that their coronary death rate fell by half over five years compared with doctors who continued to smoke. Stopping after 55 appeared to make much less difference. The degree of risk with smoking is related to the number of cigarettes smoked. Filter cigarettes are probably not protective. Cigarettes act along with the contraceptive pill to increase the risk of heart disease in young women twenty fold.

• High blood pressure. Many studies have found that reducing raised blood pressure, provided the treatment is begun in middle age, reduces mortality from strokes, heart failure and kidney failure. There is some evidence that anti-hypertensive drugs reduce mortality from heart attacks.

• High blood fats. The fats in the blood are many and take different forms. They all come originally from the digestion of dietary fat. The fractions of fats that seem to be of greatest significance in heart disease are the lipoproteins. High density lipoproteins (HDLs) appear to protect against heart disease, whereas low density lipoproteins (LDLs) seem to be harmful in this respect. The balance of these two types of lipoproteins can be altered by what we eat.

• Exercise. Studies show that those who take regular, vigorous exercise tend to have fewer heart attacks, though the evidence is not so clear-cut as is that on smoking, high blood pressure and dietary fats.

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Group therapy is tailor-made to address some of the problems eating disorders cause—loneliness, isolation, hopelessness. As someone found, just seeing other patients in the room shows a patient she is not alone and bolsters her confidence that therapy will be worthwhile. Patients gain hope by meeting others who have gotten better. Hearing other patient express feelings gives her the strength to speak out for herself. If two heads are better than one, imagine having half a dozen heads all working on the same problem!

After group sessions, patients lose the attitude that “nobody understands me,” because they’ve just encountered a lot of people who do understand. Another benefit is a rise in self-esteem. Patients begin to feel useful to other people. Their experience is respected, their advice is welcome. They sense they are helping one another, and thus begin to feel more effective and worthwhile as human beings.

In group therapy, a patient sees that others who are ñ about her health and who challenge her self-destructive behavior aren’t enemies. What a discovery! Ideally, she comes to realize that friends, loved ones, and other patients can be her allies in the struggle to get better.

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Jane Brennan’s family lost an entire person. Not literally, of course. But between the three of them—56- year-old Jane, her 57-year-old husband, Bob, and their 29-year-old daughter, Jennifer—they’ve taken off more than 150 pounds. They’ve done it by turning weight loss into a family affair, according to Jane.

It all started when Jane finally gave in to her daughter’s constant nagging to do something, anything, to slim down. Jane had put on about 60 pounds over the course of 17 years, going from a size 10 to a 16. And Jennifer seemed to be following in her mother’s footsteps, going from a size 8 to a size 16.

Together, mother and daughter went to Weight Watchers. As they started losing weight, Jane’s husband decided to get in on the act. Over the years, Bob’s own waistline had expanded from 38 inches to 42.

The threesome, from Broomall, Pennsylvania, were determined to take off and keep off the extra pounds. Every day, they compared notes about what they had eaten and how much. They exchanged ideas for keeping their eating habits on track—for example, munching on carrot sticks to fill up. As often as possible, they ate meals together. “No one was moaning and groaning, especially about what we had for dinner,” Jane says. “All of us had the same goal. We talked the same language.”

For Jane, who had tried to lose weight in the past, having the support of her family made all the difference. “I think there’s a definite advantage to losing weight with other people, especially those who share your eating times and rituals,” she says. “That way, you can encourage each other. You might have a bit of friendly competition, too.”

WINNING ACTION

Get your family involved. Ask everyone in your household to join you in your weight-loss efforts. When the entire family participates, meal planning becomes much easier. Plus, family members can support, encourage, and inspire one another.

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- I am nearly sixty and am thinking of starting on HRT. Will I need smaller or larger hormone doses than I would have needed ten years ago when I went through menopause?

It’s likely that your hormone requirements and tolerance will both be somewhat lower than they were ten years ago. This is not the case for women who have been having HRT continuously since menopause: their needs and tolerance will not change much in ten years.

Having said that, your dose will depend on why you are thinking of starting HRT. If it’s for symptom control, you will need lower doses than if the main reason is to prevent or control osteoporosis or heart and blood vessel disease.

- Will HRT make me look younger, by removing facial wrinkles for example?

HRT will not remove wrinkles, but over a period of some months it may improve the texture and thickness of skin by increasing the collagen in it so that the skin looks fuller. An estimated 15 to 30 per cent of collagen is lost from the skin in the first five years after menopause. The best way to prevent wrinkles forming is to avoid excessive sun exposure, wear a hat, and use sunblocks and moisturisers.

- If I forgot to take my oestrogen tablets for a week, would I notice any difference?

Any symptoms you had before starting on HRT would probably return within a matter of days.

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When Libby Hathorn and Glenn Bates interviewed more than 130 Australian men and women aged up to fifty-five for their book Half-Time, they commented on the diversity of views that women participants held on sex. Regardless of whether they had reached menopause or not, some women found sex disappointing, and less enjoyable as they got older: it wasn’t fulfilling; it had become mechanical, lacked excitement and adventure; or their partner was insensitive to their needs and feelings. The opportunity to reduce or discontinue sexual activities under the socially acceptable excuse of ‘sexless middle age’ was for some a great relief. However, most felt that with age came greater self-confidence, less anxiety, a deep satisfaction in their sexual relations, and a greater enjoyment of cuddling and shared sexual intimacies than they had ever thought possible.

Women who had reached menopause also had varied views on sex. Some had lost interest in it and were not concerned at seeing it lose some of its significance in their lives, while others were taking more initiative in sexual relations. Though women said they needed to have more direct stimulation to get aroused during sex, and orgasms were less frequent for some, they still felt a strong sexual drive and found the total sexual experience very pleasurable.

Feedback from women about their experiences of sex at and after menopause confirms this range of views. Some, such as Betty, who fell in love with a younger man while in her fifties, view sex as a crucial part of the relationship. ‘I feel good about myself and about my partner, and wonderful sex seems to flow from that. Since I’m no beauty, I’ve always tried to make sure I’m interesting company: this means spending time regularly on activities that extend my interests and challenge me. My partner and I are very conscious of looking our best for each other, and so eating healthy foods and taking regular exercise have become part of our life together.’

Others we spoke to had found new opportunities for romance, triggered by a change of partner, a variation or development in the relationship with their existing partner, a greater acceptance of themselves, or simply a freedom from anxieties about contraception and pregnancy. Other couples had compensated for joyless sex by developing satisfying non-sexual activities, or else sex had been relegated to the background because one or other partner felt overwhelmed by problems associated with dependent children, dependent parents or inlaws, or financial burdens.

June’s life is full of pressures from which sex provides no release. She has effectively vetoed sex with her husband, declaring her unwillingness to put any more energy into it. In doing so, she admits that she is also making a statement about her dissatisfaction with her husband for letting himself ‘go to seed’.

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Little is understood about why these mood swings occur, seemingly without conscious intent or reflection. One theory proposes a direct role for the fluxing ovarian hormones, the brain being one of the organs influenced by oestrogen. Others link menopausal mood swings with the relationship stresses that often occur during this life stage; the expectations, attitudes and personality of the woman; and influences like culture, social class and employment. Then again, maybe there is a biological explanation for mood swings.

Germaine Greer suggests that menopause may put ‘women back in touch with their anger after thirty-five years of censorship by oestrogen’. She adds that the middle-aged female employer (one could add executive, wife or mother), dealing with people who ignore what she says on the basis that she is menopausal, is quite likely to have to think of a number of strategies to get their attention. ‘A good deal of the anxiety of the middle-aged woman is caused by her awareness that she is turning into some kind of a harridan, a scold, a fishwife, but if you can’t get attention any other way, what are you to do?’

Other unproven hypotheses for mood changes have shifted the focus to environmental factors. These include allergies to foods and petrochemical products, and the accumulation in bones during adolescence and early adulthood of lead, which is then released into tissues and blood with the onset of menopausal bone loss.

Studies of the effects of hormone therapy on personality suggest that use of oestrogen may moderate mood swings and cause women to become more agreeable. A recent Oxford University study found that oestrogen in the form of implants reduced shifts in mood, possibly because of changes in neurotransmitter function in the brain.

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Modern medicine tends to equate the menopause with a formidable array of symptoms, and longer-term deterioration of body tissues that it blames on oestrogen deficiency. The implication is that menopausal women need hormone therapy to minimise or avoid symptoms and to maintain good health into old age. This view of menopause is increasingly under attack as oversimplified. Critics say that the absence of serious menopausal problems in many women who undoubtedly experience an overall drop in oestrogen (and other sex hormone) levels has not been adequately explained.

Some critics of the medical view also argue that the increased incidence of many diseases attributed to menopause may largely reflect ageing processes that would occur even if there were no such life stage as menopause. Others say that the focus on hormonal factors leads to the neglect of other possible biological contributors to symptom development and later health problems. These include lack of exercise, smoking, and poor nutrition involving inadequate vitamin and mineral intake. There is also criticism of the tendency to neglect psychological and social influences on mood states like irritability, depression and anxiety, which may be glossed over as ‘menopause-related’ without further investigation. The emergence of these symptoms at menopause may have less to do with hormones than with the reappraisal of personal relationships, or changes in self-confidence or self-esteem.

Although the medical view is widely criticised, women themselves are often the first to vouch for the effectiveness of oestrogen in relieving distressing symptoms like flushes and sweats. There is also good evidence that oestrogen has a beneficial effect on bone structure and blood vessel function, in some women at least. The challenge facing thoughtful doctors and those who run menopause clinics is to try to work out, in conjunction with their patients, the pluses and minuses of hormone use. And it is imperative that women learn all they can, so that they are equipped to make informed decisions in favour of HRT or against it.

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The idea that food intolerance might cause Crohn’s disease is highly controversial. Almost all the work on this subject has been carried out by Dr John Hunter of Addenbrooke’s Hospital in Cambridge. He finds that over 80 per cent of patients recover on an elimination diet, and then react to specific foods when these are reintroduced. By cutting out the incriminated foods, these patients can remain well. Some of them later relapse – as is common in Crohn’s disease – but after two years, 80 per cent of those still on their diet remain well. This compares favourably with the standard treatment, using corticosteroids. Of patients treated with these drugs, only 40 per cent are still well after two years of treatment.

Because patients with Crohn’s disease are often very ill, carrying out an elimination diet is not all that easy, and other doctors have been reluctant to try this new approach. The technique that Dr Hunter uses is to feed his patients on an elemental diet during the first part of the elimination diet, or to feed them in some other way – using an intravenous drip which puts nutrients straight into the bloodstream, for example. Other doctors, who are sceptical about food intolerance, suggest that the Crohn’s disease symptoms clear up simply because the patient’s gut is being given a rest from digesting real food, or because the patient’s nutritional status is improved. But if this were the case, one would not expect the patients to remain well afterwards, on a normal diet that just excluded certain food items.

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Strong impressions, agitation, fear and panic usually disturb the sleep pattern. The reflexes of the subconscious mind prevent quiet relaxation during sleep. After all, not every part of the body is asleep, many functions such as the circulation and, with it, the activity of the heart and the lungs, never stop to rest. If they stopped working our life would stop too. Digestion and everything linked with our metabolism continues working during the hours of sleep. Part of the brain rests, consciousness in particular being switched off, but other parts continue their function at a reduced rate.

We should not eat much in the evening and should avoid heavy or indigestible food completely; neither should our last meal of the day be taken late if we wish to prevent the subconscious mind, with its reactions and reflexes, giving us excitable and restless dreams that rob us of valuable energy for no good reason at all. It is of equal importance to try and forget the day’s happenings, perhaps by listening to some soothing music before going to bed.

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Every anatomical detail of the human body serves a specific purpose. For example, why is the nasal space divided into three corridors through which air must pass before it can enter the nasopharyngal canal and the bronchial tubes? In flowing past the blood-vessel-lined interior of the nose the air is warmed and prepared for the lungs. In addition, the anterior nostrils are considerably smaller than the posterior nares and this causes a partial vacuum in the nasal interior, which sucks the warm air from accessory nasal cavities and mixes it with cold air coming in with each breath. With designed! Even the smallest detail has a purpose.

This finely tuned detail of anatomical construction becomes more obvious to us when we consider the ear. If the smallest detail in its structure is changed, the acoustic requirements, the reception of sound waves and the transmission to the auditory nerves, will be disturbed and our hearing impaired. Any deformation produces damage and problems. Of course, the same thing applies to our nose.

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