ENDOMETRIOSIS: PAIN AND EMOTIONAL TURMOIL

The human body was created with pain receptors. Without them we could not survive. Pain receptors tell us, for example, when to pull our hand from a dangerously hot object. Should we come into contact with something and it pierces our skin, pain receptors tell us we are bleeding and need first aid. Pain receptors also alert us when internal organs misfunction – heads ache, kidneys throb, throats burn, a uterus cramps. Everyone knows what most of such pain is like, but it can be difficult for a person who has never experienced a wrenching, disabling pain to comprehend another’s misery. A knowledge of biology, a degree from a medical school, or even compassion for another human being cannot always guarantee either understanding or correct treatment.

Why is pain such a mystery? An individual’s response to bodily pain is always unique because pain is supremely subjective. Two people may be able to agree with each other about what a headache feels like and that childbirth usually causes more physical distress than a routine internal examination. They may not, however, agree about exactly which sensations and what degree of intensity constitute acute pain or an odd and persistent ache.

Each of us has a different pain threshold, which is a combination of psychological and neurological factors. At one extreme, stoics and mind-control practitioners may choose to feel no pain—some can even staunch the flow of blood from a wound by use of willpower alone. At the other extreme, hypochondriacs fervently believe in their suffering, and encourage it or create new illness. Most people fall somewhere between these two extremes. Whatever the pain—acute, throbbing, stabbing, burning, dull, aching—they can describe it accurately enough in all us varying degrees and severity so that others can understand.

This ability to communicate a private sense of pain to another gives us a chance to obtain medical help in a manner that is most effective. But what happens when communication is thwarted by a physician who invalidates a patient’s report of pain, thereby invalidating the cause?

For women who have been told by doctors again and again that the pain they feel does not exist, emotional turmoil may become as much a symptom of endometriosis as the actual physical disability. As a palliative, unsympathetic doctors may prescribe Valium or other tranquilizers. Generally, when the pain persists, another doctor is consulted. Should he concur with the first, he may simply prescribe stronger tranquilizers, and a woman’s illness becomes doubly wearing. Her self-doubt begins to grow as her pain increases in severity. The questions such a victim asks herself, however, remain unanswered: «How can I be creating such horrible pain? Since doctors tell me that I am to blame, bow can I stop doing this to myself?’ Clearly, this situation is emotionally wrenching. Rather than follow their own inner voices, which know chat this pain means something, these women are made to feel defeated, somehow responsible—and guilty—until the disease becomes so advanced and so serious that even a minimally experienced physician is finally able to diagnose it.

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SKIN CARE: NAPKIN RASH

When dealing with a baby’s skin problems, certain facts must be born in mind. These are that the skin of a baby is thinner, softer, and has fewer hairs and sweat glands than an adults.

There is no single cause of rash on the skin in the area broadly covered by the baby’s napkin. Obviously, almost any skin disorder can manifest itself in this area. Furthermore, any of these disorders may be further aggravated by a physical environment of warmth, moisture, humidity and exposure to various infective organisms present in this area.

Contact dermatitis is one of the commonest causes of a rash in this area. This may be due to a chemical present in either the urine or faeces. Previously it was thought that ammonia formed from the breakdown of urea by various bacteria was the main cause. This, however, is probably only one of many possible chemicals involved. Occasionally detergents used in the laundering of the napkins are implicated. Even creams innocently applied by mothers either to prevent or treat a napkin rash, may be involved.

The eruption usually has the appearance of a burn. Initially it may simply be red, but then blisters and ulceration can occur. The classical distribution is on the convex surfaces in closest contact with the napkin, the creases being spared.

Seborrhoeic dermatitis is probably the second commonest cause of a rash in this area. It is an ill-understood, self-limiting condition which may also affect adults. There is usually no family history of the condition, and no nutritional or infective factor evident. Frequently there is associated ‘cradle cap’. This is a mixture of grease and scale that piles up on the crown of an infant’s head to form a coating resembling a cap. The exact cause is unknown, but may result from over-cautious bathing or fear of injuring the ‘soft spot’. Initially this condition consists of retained vernix, the greasy film which assists the passage of the babe through the birth canal. When this vernix persists as a dry crust on the scalp, it is termed cradle cap.

Seborrhoeic dermatitis usually commences in the napkin area between the ages of three months and one year. The symptoms are usually fedness with scaling. The creases and folds are involved, unlike with contact dermatitis. Frequently other creases, such as the armpits and under the chin subsequently become involved. In severe cases other areas of the trunk can also be affected. The baby is usually quite well, and does not scratch the rash. »

Infantile eczema usually occurs in infants of parents with the atopic tendency to either eczema, hay fever, hives or asthma. The rash usually appears between the ages of two to three months. It is often first manifest on the cheeks and forehead, but not necessarily. The rash is invariably red, lumpy and involves the creases. It is always itchy, unlike the other rashes.

Psoriasis may occur solely in the napkin area of infants. The features are similar to psoriasis in other areas. It is thought to be induced by external factors such as monilia, in a genetically predisposed infant. It develops very rapidly, and rarely confines itself solely to the napkin area. Usually it clears quickly with appropriate treatment. Relapses are exceptional, and the long-term prognosis is fair. It is estimated that only between 10-20 per cent of these infants will develop psoriasis in later life.

Thrush, sometimes known as monilia, is a frequent cause of and contributing factor to napkin rash. This is a yeast infection caused by the fungus Candida albicans. It can occur at any age. The appearances of a bright red rash, not necessarily symmetrical, with small pustules is very suggestive of thrush. Frequently the area about the tip of the penis is very red, and small, bright red satellite spots appear elsewhere. The area may weep, particularly in the creases. The source of infection may be bowel, particularly after a course of antibiotics. Alternatively, the infection may originate from mothers with vaginal thrush.

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FATS, HEALTH AND FAT LOSS

It should be obvious from the discussion above that fats in food are not necessarily bad. In fact, a severe restriction of polyunsaturated fats may compromise the intake of essential fatty acids and vitamin E. As the human body requires a minimum daily fat intake, it is neither wise nor practical to advocate a ‘no-fat’ diet.

The health implications of particular fats and oils are influenced by the proportion of different fats they contain. For example, olive oil is described as a monounsaturated fat but olive oil also contains polyunsaturated and some saturated fatty acids. Its predominant fatty acid is the monounsaturated oleic acid, so it is called monounsaturated. Margarines are often thought to be made up of polyunsaturated fats—in fact, about 20 per cent of the fat in these products is saturated fat. They also have some monounsaturated fatty acids and up to 15 per cent of the undesirable trans fatty acids. Their total polyunsaturated fat content makes up about half the fat they contain.

The percentage of different fatty acids is really only important if the total amount of fat in the food is significant. The fat content of both margarine and butter for example is about 80 per cent. This means that for every 100g they have 80g of total fat. One teaspoon—about the equivalent of a thin spread on a slice of bread—would contain about 4g of fat. About 30-40 per cent of the margarine will be cholesterol-raising fats (saturated plus trans) or about 1.5g per teaspoon. Butter, on the other hand, rates a high 60 per cent saturated and 5 per cent trans fatty acids in every 100g, or about 2.5g per teaspoon. The total fat content and the total energy in both products however are equal. By contrast, a food such as an egg has about 6g of fat, of which 2g is saturated (all of this in the yolk—egg white has no fat) which is midway between a thin spread of margarine and a thin spread of butter. The occasional consumption of small quantities of any of these foods (a teaspoon of spread or a whole egg) is likely to have little effect on the intake of both saturated and total fat. This fact contrasts with common consumer beliefs regarding the perceived fat contents of margarine, butter and eggs.

One other postulated health implication is the susceptibility of fats to ‘oxidise’ (a chemical alteration to the fat molecule caused by reactions with oxygen ‘free radicals’). Polyunsaturated fatty acids (PUFAs) are the most susceptible to oxidation, especially the long chain highly unsaturated Omega-3 fish oils (which is why fish ‘goes off faster than meat which contains mainly saturated fat). Balanced against this is the intake of antioxidants, especially vitamins C, E and beta carotene. Oxidised fats and other compounds in the body have been linked to many detrimental processes, including atherosclerosis, cancer formation, cataracts and ageing. Research is still intense in this area and many answers about oxidation and health effects are not yet available.

Monounsaturated fats (i.e. olive oil, canola oil, avocados) are generally seen as the best type of fat for health purposes. They tend to reduce blood cholesterol at least as well as the polyunsaturated, but don’t oxidise as readily and have no known links with other health problems. In the case of olive oil, a major source of monounsaturated fat, we also have a long history of people safely consuming substantial amounts of it without apparent detrimental effects. Its major virtue may be not only that it contains a good mix of fatty acids, but that it also contains a wide variety of antioxidants. However, olive oil still contains the same energy, gram for gram, as other types of fats. And while there is some recent research now querying the fat storing potential of all fats, the prudent advice for those interested in lowering or maintaining body fat is still to decrease all fats in the diet.

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COPING WITH ENDOMETRIOSIS: VITAMIN AND MINERAL THERAPY

Many women with endometriosis have heard of the benefits of treating the disease with vitamins and minerals and certainly members of the Endometriosis Association (Victoria) have talked about success with vitamin B6 and evening primrose oil in eliminating pain and treating lethargy and depression.

Most vitamins and minerals discussed in this section below can be bought off the shelf at your local health food shop.

Vitamin B

Vitamins can help in alleviating pain; in particular, vitamin B6 has been reported as being beneficial in the treatment of premenstrual syndrome and associated problems.

Although it is not certain why vitamin B6 helps, many PMS sufferers vow it has been instrumental in alleviating their symptoms of depression, lethargy, mood swings, irritability and pain.

Vitamin C

The merits of vitamin C have long been acknowledged. Alternative therapists say it helps not only with heavy bleeding (because it strengthens the blood vessel walls and helps the body to absorb iron) but also helps promote healing.

Vitamin E

Another healing vitamin, it is often recommended for the prevention of thick scar tissue and to promote healthy skin; this would explain why it helps alleviate pain as it acts on adhesions and scar tissue left by endometriosis implants.

Zinc

Many practitioners believe zinc helps with PMS symptoms and also improves fertility.

Evening primrose oil

Many PMS sufferers cannot do without their evening primrose oil (EPO) as they say it helps alleviate symptoms and keeps the condition under control.

Endometriosis sufferers on hormonal drug therapy also report that it has helped them cope with the side effects often associated with these drug treatments.

Evening primrose oil is expensive (currently about $20 for a month’s supply) so you have to weigh up the benefits with the cost. EPO is a good source of gammalinolenic acid (GLA) — one of the essential fatty acids which produce prostaglandin.

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IS ENDOMETRIOSIS BECOMING MORE COMMON

There is much debate as to whether or not endometriosis is becoming more common.

Some gynaecologists believe that there has been an increase in the actual number of women who have endometriosis. These gynaecologists believe that the condition has become more common because women are having fewer children and having them later in life — two factors which they believe predispose women to developing endometriosis.

Other gynaecologists believe that there has only been an increase in the number of women being diagnosed. The rate at which endometriosis has been diagnosed has certainly increased over the last 30 years, particularly since the introduction of laparoscopy in the early 1970s. This does not mean that the condition is more common than it was 30 or 40 years ago. It is more likely to mean that the condition is being diagnosed more frequently because the introduction of laparoscopy has made it much easier to diagnose and because there is a greater awareness and recognition of the condition by the medical profession.

The increased rate of diagnosis could also be a reflection of the fact that nowadays women are less likely to accept that some of the symptoms of endometriosis such as period pain and heavy bleeding are a normal part of a woman’s life. Consequently they are more persistent in seeking a diagnosis — and treatment — for their symptoms.

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