Though chemotherapy had pushed her into menopause in her late 30s, Virginia had never taken estrogen, dismissing it as “unnatural. ” She’s been generally healthy in the twenty years since, taking antioxidants and calcium and magnesium supplements (though not getting much in her diet), walking to and from work every day, eating well, and never smoking. Still, as she approached 60,1 recommended she have her bone density checked, since early menopause, chemotherapy, and no HRT were all risk factors. Although she had no symptoms and hadn’t lost any height, a bone scan showed her spinal bone density was almost 25 percent lower than ideal (though just about what was expected for her age), and her hip was almost 35 percent lower than it would have been at its peak (and close to 20 percent lower than what you would expect at her age). Her NTX level was also relatively high, meaning she needed to take immediate action to avoid a fracture.

Other lab tests pointed out that even with the supplements Virginia took, she wasn’t getting enough for her bones, so she increased her dose and backed it up with a range of other nutrients similar to the plan described in Chapter 10. The only change she made in her diet, which was already basically good, was to add more servings of calcium-rich food, which she had been lacking. Her feelings about prescription HRT hadn’t changed any, but natural progesterone cream appealed to her, so she started on it right away. She took up some more structured exercise in addition to her daily commute/walk. She decided on strength training focusing on her upper body since it is the lower body that gets more of the impact (and so bone density benefit) of walking.

Virginia’s been on the progesterone for a year now, reports no side effects, and says she feels good overall. Her NTX has dropped and in another year a new bone scan should show if her progress has been sufficient to stick with the course, but I’m confident she’s stopped losing bone mass and that her body is building some back up.

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Once you start talking about “refining” menus and cutting back the amount of food you serve, make sure you are providing the nutrients the body needs. Eliminate junk whenever possible. Serve a meal that is low in fats, sugars, and salt and that, instead, is high in fiber, protein, fruit, and vegetables—not additives or condiments. While many people are advocates of eating something from each of the four food groups, you may end up with too fatty a diet that way and with insufficient fiber. I suggest you think of the balanced meal as composed of three elements: One Fruits & Vegetables selection, plus one Animal Foods & Nuts selection, plus one Pasta & Staples selection equals a very nice meal.

I’ve made my calories go as far as they can by using this method. It is essential that you not buy too many shoes with your calories, or too many little black dresses—the well-rounded diet, like the well-rounded wardrobe, needs a little of everything.

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The Resolution Phase, when the response cycle moves backward through the Plateau and Excitement Phases to the passive unstimulated state. After climbing the sexual peak, the female returns to the plains. The pulse and blood pressure return to normal. The muscle tension and the vasocongestion also disappear.

The two basic changes which all the organs undergo to return to normal are: release of muscular tension in the body, and return of the blood to the heart from the congested blood vessels. The heart rate, blood pressure and respiration return to normal within minutes. If a woman has had a sex flush of her skin during the Plateau Phase, it will rapidly disappear; she may also have a thin layer of perspiration on her body.

The congested areolas around the nipples return to normal as the venous constriction is relieved. This rapid relief of areolar congestion makes the nipples look more erect. The tell-tale secondary erection of

the nipples is another sure, externally visible sign that orgasm has taken place.

Within five to ten seconds after orgasm, the clitoris returns to its normal position as during the pre-excitement phase. In cases where manual stimulation of the clitoris is resorted to produce an orgasm, its return to the normal overhanging position is another indication that an orgasm has taken place. The contracted outer-third of the vagina relaxes and the orgasmic platform is lost.

Where the female partner has not gone beyond the Plateau Phase, the resolution takes much longer. If an inadequate male partner leaves her high and dry at the Plateau Phase, chronic congestion of her pelvic parts occurs, resulting in backaches, a constant feeling of congestion  in the  pelvic area and, in some cases, local irritation causing vaginal discharge. Intercourse makes her more tense, irritable and frustrated.

The female is ever ready to scale the sexual summit once again if restimulated, unlike the male who cannot respond immediately. Hence the necessity of an ever-potent male to fulfil the evergreen female. However, in this Stress Century, the civilised man is a tired man and does not have the energy to carry repeated sexual burdens.

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Fat

Fats are needed in the diet as a source of the fat-soluble vitamins A, D, E and K. Fat also helps insulate our bodies and protect the unborn child and the vital organs of the body against sudden temperature changes. Fat also supplies us with the essential fatty acids that the body requires for normal metabolism. Good sources of dietary fats are fish, avocado, seeds and nuts. Meats and dairy products also are high in animal fat and cholesterol which can cause other problems.

As fat furnishes the body with twice as much energy as protein or carbohydrates, you need to eat less fat in the diet, especially if pregnant. A high fat diet will also add extra unhealthy weight to you and the unborn child. The daily intake of fat should be 25 per cent of the day’s total kilojoules.

Water

This is one of the most important parts of the diet for without it the body cannot eliminate toxins that are formed by the mother and developing baby. Water helps keep the kidneys flushed and healthy.

Water can also be a source of toxic waste from our environment. I suggest that a water purifier be purchased and used to filter these toxins from the tap water before drinking. The Filter Fresh jug-type is among the best. The water is kept in the refrigerator and tastes great. Drink 6 to 8 glasses every day.

*7/199/5*

There are four superstars in the antioxidant nutritional world—three vitamins and a mineral. Individually they are all megastars in their own right. Together, in combination, it’s like the Woodstock of cellular concerts—it’s as if the four Beatles got together in Strawberry Fields in Central Park—can you imagine? Well, that’s what it’s like when vitamin C vitamin E, beta-carotene and calcium get together deep inside your very life programme. It’s a happening!

What do these superstars do? They do lots of good things. They patrol our cells looking for free radicals. And when they find a free radical they give it an electron, making it stable and harmless. Antioxidants can do this because they are specially designed to be able to give away their own electrons without becoming unstable or turning into free radicals themselves.

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Pitiriasis

This is the name given to an inflammation of the skin that is characterized by branny scales.   There are many different forms of it, all receiving special names, but it is clearly a symptom that needs very little direct treatment. As the general health of the community improves with better nutrition and other improved ways of living, these diseases, which   fill   the   text-books   with   very   interesting   details, will probably disappear altogether.    We say this because almost a volume could be filled with the different changes which take place in the skin when it is passing through a simple crisis.   To name and describe the particular phases of it is of interest to those who desire to make a special study of such conditions but of minor significance to the individual who suffers from it.

Psoriasis

This is a chronic inflammatory disease of the skin marked by the formation of scaly red patches. It begins with tiny scale-like lesions which join together, and in bad cases may disfigure almost the whole body. Like so many other skin complaints, it may vary with each individual and change from time to time in the individual himself. It appears to run in families, and the hereditary factor should be taken into account because it enables one to endeavor to make as complete a change in surroundings as possible. This is a difficult condition to overcome, and this fact has tended to develop a pessimistic outlook, both in the patient and in the attendant, which stands in the way of recovery. All the factors making for physical, mental and emotional balance will have to be carefully adjusted to obtain the desired results.

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Functions:   Essential for the health of the whole body; not made by the body and must be taken in the diet

Sources:   Vegetable oils, fish oils, evening primrose oil

Causes of   Processing of ingested oil (such as heating), poor Deficiency:   diet, deficiency of nutrients necessary for absorption (B6, zinc, vitamin C, vitamin B3), drugs, alcohol, ageing

Deficiency Signs   Fatigue, irritability, general ill health, joint pain, and Symptoms:   skin problems, hair loss, premature ageing

* Evening Primrose Oil: the seeds of this plant (used by the American Indians for healing) produces a pure oil rich in EFAs. It is being used more and more for a variety of problems and is now available on prescription for eczema. Some of its benefits are:

• Lowers cholesterol

• Keeps blood vessels healthy

• Helps insulin to work

• Prevents inflammation and controls arthritis

• Relieves PMT

• Lowers blood pressure

• Helps in loss of excess weight

• Used in the treatment of multiple sclerosis, alcoholism, allergies, hyperactivity, anxiety and depression, skin problems

• Retards ageing

• Thought to prevent cancer.

Here is an extract from Dr Caroline Shreeve’s book The Premenstrual Syndrome (Thorsons) about how evening primrose oil helps PMT and other conditions. Note that deficiency of essential fatty acids is not rare:

The prolactin level itself is normal; and so, often, are the measured levels of oestrogen and progesterone. But because the body is lacking in EFAs [my emphasis] it is hypersensitive to the normal level of prolactin which is present. Instead of having too much prolactin, the affected women have too few EFAs, but with respect to the premenstrual symptoms this amounts to the same thing. B6 increases the efficiency with which the body tissues make use of the EFAs. So, a person taking a supplement of pyridoxine is able to utilize the supply of EFAs that is available to her, to the best advantage.

Efavite is a product made to take with evening primrose oil; it contains all the necessary nutrients to convert the raw material of the oil into a very valuable healing substance. (For more information read Evening Primrose Oil by Judy Graham (Thorsons)

Some people are not really prepared to change habits, yet they expect results. If you don’t follow the rides (good nutrition, exercise, etc.); if you drink alcohol excessively; if you smoke; and if you refuse to control tension, then you can forget it, you will not recover. But there are other traps you can fall into, some of which follow.

*146\326\8*

All gynecological cancer requires some form of surgical intervention. This is because a sample of tissue is always necessary to make an accurate diagnosis. Your doctor will review this sample with all members of the cancer care team tore recommending a treatment plan to you. The extent and impact of any further surgery will vary depending on the type of cancer. For instance, with cancer of the placenta, the surgery is usually suction curettage (‘D and C) to remove the placenta or ‘mole’. This is relatively non-invasive and does not leave any abdominal scarring. However, most of the cancers, especially ovarian and endometrial usually require extensive surgery involving complete removal of the womb (a hysterectomy) and ovaries that have an impact on fertility and menopause. Other types of gynecological cancer, such as vulva or vagina cancer require removal of the external and/or internal organs that provide sexual pleasure and this has an impact on sexuality and intimacy.

For many women the surgical scar is a constant reminder of the cancer experience and can take some adjustment in accepting it as a life saving measure. Some women who cannot resume ‘normal’ intimate activities because of the scar, or who experience mild anxiety or depression as a result of it may benefit from counseling.

Most operations for gynecological cancer will take at least an hour to perform and not only do you have to deal with the possible diagnosis of cancer, and the need to have a major operation, but you will be very worried about the cancer having spread further than you and your doctor think. You also will have to trust the surgeon to do a good job. It is important that if there is a possibility of cancer being present that your surgeon is an accredited gynecological cancer specialist. This is especially important in ovarian cancer. You can find this out by simply asking him/her or by going to the website of your local cancer society. After discussing all aspects of your surgery it is important that you give consent to do what is necessary to reduce or eradicate the cancer. Preservation of ovarian function is possible in a lot of circumstances so make sure you and your surgeon have discussed this important area in some detail.

I just felt very unattractive I suppose for a very long time with the scarring. It was the major issue. It’s just such a dramatic mark and a constant reminder of a major illness for me. It’s not like I had a caesarean or a baby or that sort of excuse. At first I never felt comfortable with it but once I got used to it I got over it.

It took a few years. I didn’t have a relationship for about four years.

` My partner was very accepting and I thought ‘what have I been worrying about all this time?’

Seline

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In the kidney, urine is formed from waste substances and water that are passed from millions of tiny blood vessels into the drainage tubes. With diabetes, the walls of these blood vessels sometimes thicken until the waste substances and water can no longer pass out of the blood vessels to start forming urine. The kidneys have an enormous reserve capacity and most of the blood vessels have to be damaged before there is any noticeable effect.

Proteinuria

The earliest sign of kidney damage is protein in the urine, called proteinuria. This can be discovered with urine tests and everyone with diabetes should have his or her urine checked for protein at regular intervals. Nowadays, many clinics are testing urine for microalbuminuria, tiny amounts of protein which may indicate the earliest stages of diabetic kidney damage in people with insulin-dependent diabetes. In those with non-insulin dependent diabetes microalbuminuria may indicate an increased risk of heart or other blood vessel problems. If it is found in several samples but without urinary tract infection other kidney tests can be carried out. Proteinuria does not necessarily mean you have other kidney function problems but it does indicate the need to check for them. If you have high blood pressure it must be very carefully controlled and frequent checks must be made for urinary tract infection.

Cystitis

The commonest cause of proteinuria among people with diabetes is urinary tract infection, such as cystitis or bladder infection, pyelonephritis or kidney infection. A midstream urine sample is easily taken and will be sent to the laboratory for analysis so that appropriate antibiotics can be given. Non-diabetic men rarely have urinary tract infection but diabetic men may do so and it is common in women. The symptoms are a burning sensation on passing urine which may have blood in it or smell bad, and a very frequent desire to pass urine, although there may be little there to pass. Urinary tract infection may upset your glucose balance and so your blood glucose levels should be checked frequently.

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The articular cartilage is a special type of connective tissue that lines the three bones that form the knee joint—the patella, the femur, and the tibia—and allows the joint to move in a fluid motion. Without this protective layer of articular cartilage, the bones forming the joint would rub together, which could cause a great deal of pain and discomfort, as occurs in arthritis. Also known as hyaline cartilage, articular cartilage consists of a white elastic material, similar to the gristle found inside the joint of a turkey leg, and is anywhere from 1/8  to ?  inch in thickness.

Articular cartilage consists primarily of water, collagen, and other molecules known as proteoglycans. Articular cartilage is extremely resilient and is designed so that it can withstand both shear (side) and compression force. This special cartilage can sustain the enormous force exerted through the knee when you are running on pavement (which could be up to seven times your body weight!) or when you are twisting or pivoting in a sideways motion.

Articular cartilage may be a biomechanical wonder, but it is not immune to injury from overuse or abuse. In fact, injuries to the articular cartilage are the most common knee injury. There is some evidence that continual stress on the articular cartilage may make it more prone to injury. In addition, over time, the articular cartilage can simply wear out. In fact, by middle age, nearly everyone will show some degree of damage to their articular cartilage, and if this damage becomes severe enough, it may develop into arthritis. In fact, all forms of arthritis—from the inflammatory variety such as rheumatoid arthritis to “wear-and-tear” osteoarthritis—involve destruction of the articular cartilage.

Problems involving the articular cartilage are one of the most frustrating in all of medicine. Unlike ligament or meniscal injuries, once the articular cartilage is damaged, there is little that can be done. Unfortunately, articular cartilage cannot be replaced or made synthetically. Although not from lack of trying, researchers have been stymied in their attempts to stimulate the body to make it on its own. There are some treatments, however, that I will discuss later in this chapter that may make patients more comfortable and some promising new ones that may actually help the body to better heal itself.

There are four basic types of injuries involving articular cartilage.

Chondral fracture. If you fall directly on your knee or bang your knee very hard, it could result in a fracture of the articular cartilage that does not involve bone. The knee may feel painful and swollen. In this case, the articular cartilage may not be permanently damaged, rather it may simply have become compressed—similar to the way plastic can bend under pressure—and will return to its normal shape immediately. However, there might still be microscopic parts of the articular cartilage that are permanently damaged. The pain is variable and often does not reflect the extent of the injury. Because articular cartilage has no nerve endings, the pain is secondary to abnormal stress placed on the bone that the articular cartilage covers—the subchondral bone. The normal forces of daily activity become abnormal because the shock absorber is damaged. The bone is subsequently stressed, and the patient might experience pain. Fortunately, the bone will eventually remodel itself to withstand the new stress, and the pain will subside, but it could take up to 6 months in some patients.

An MRI cannot “see” articular cartilage, but it will show a tremendous amount of hyperemia, or blood flow, to the injured area, which suggests a chondral fracture.

Chondromalacia. Chondromalacia refers to the softening of the articular cartilage. Articular cartilage is arbitrarily graded from 0 to 4, 0 being normal and 4 being the most damaged. A healthy, smooth surface—the kind that would be found in an uninjured surface—is graded 0. Grade 1 means that there is some blistering or disturbance on the surface; grade 2, the surface is scratched or fissured; grade 3, the Assuring is deeper, almost down to bone; grade 4, the surface is worn away to the bone and the bone is also worn out.

Arbitrarily, if there is destruction to the articular cartilage surface and its appearance to the naked eye is indistinguishable, the terminology is different depending on the patient’s age. In those patients under thirty, damage is termed chondromalacia grade 0 to 4, whereas over thirty years of age, it is called osteoarthritis.

We still have a lot to learn about articular cartilage, but it appears that once the surface is damaged, it is more vulnerable to repetitive wear and tear, destruction, and overuse phenomena. Professional hockey and basketball players invariably have abrasive wearing of the articular cartilage due to the magnitude of the forces and the repetitive nature of the activities involved in their careers. Amateur athletes similarly might suffer from overuse wear and tear, which is technically arthritis.

Traumatic chondromalacia. A significant blow to the knee, such as one that might occur in a football injury, could tear off either a small piece of articular cartilage or a large fragment containing a piece of bone directly under the subchondral surface. This is called an osteochondral fracture. Such a severe injury would cause much discomfort, and if the bone fragment is visible on X ray, it might require surgery.

Osteoarthritis. In older patients, pain and perhaps swelling of the knee in the absence of other injuries could suggest osteoarthritis, a condition that is caused by the gradual wearing down of the articular cartilage.

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