There are various factors which increase your particular chances of developing breast cancer, whether you take HRT or not:

• If a very close relative, such as your mother or sister, developed breast cancer, although recent evidence suggests this may be less of a risk than was once thought.

• If you have ‘benign’ breast disease (your doctor would tell you if you have); this is not always a higher risk factor in itself, but as lumpy breasts make the detection of cancer more difficult, some doctors prefer their patients not to take HRT.

• If you finished your periods later than average, that is you had a late menopause (after about the age of 55).

• If you are very overweight.

None of these means that you will get breast cancer, just that your chances of getting it are higher than for women who don’t fit into any of these categories.

From the last two in the list, you will see that there appears to be a link between oestrogen and breast cancer. In other words, women who have been producing oestrogen for longer than average have a higher than average risk of developing breast cancer. So, if these women take HRT for many years more, this risk will increase further, and this is something they should be aware of, so that they can make an informed decision. Even so, it is only a risk, not a certainty.

Conversely, you are at a lower than average risk of developing breast cancer if you had an early menopause (whether surgical or natural); the ‘downside’ for this group of women is that, because they produced oestrogen for a shorter than average time, they are at an increased risk of developing osteoporosis. It seems we really can’t win!

Some breast cancer tumours depend on oestrogen to grow, and some don’t. If your breast cancer developed before the menopause (that is, while you were still producing oestrogen), then HRT is a definite NO for you; but if it developed long afterwards, then in some cases HRT may be acceptable. This is a situation where you and your doctor will have to balance the risks against the benefits. It is obviously difficult to work out these risks and benefits. Most research identifies the risks to the population at large, whereas you want to know how it might affect you as an individual, regardless of how it might affect anybody else. Your doctor or specialist should be able to help you.

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Your well-being is strongly influenced by what you eat and drink. Healthy eating should not be bland or restrictive, but enjoyable and satisfying, important features of healthy eating include low levels of fat and sugar, and plenty of water, fresh fruit and vegetables. To reduce the fat content of your meals you should:

• remove visible fat from meat and poultry

• grill, steam, microwave or boil foods rather than frying them

• use minimal oil and margarine in cooking, sauces and spreads (one to two tablespoons a day)

• eat more fish (but don’t fry it!)

• choose low-fat dairy products

• limit your intake of ‘hidden’ fat foods such as processed meats and pastries.

Lugging around too much weight is one consequence of poor nutrition and inadequate physical activity. Another is the health risks that accumulate with the weight. Obesity increases your likelihood of developing heart disease, adult-onset diabetes and life-threatening blood clots in many parts of the body including the brain. It also makes surgery more dangerous by increasing the time it takes and the risk of complications.

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Well, what is the best way to cope with stress? Let us discuss this under the following second five categories:

The 80 per cent law. This law is useful for perfectionists. Perfectionists expect their lives to be 101 per cent, and if anything is not what they expect it to be they feel it is the end of the world. Since the world is a real world and is always short of 101 per cent, they are forever disappointed, dissatisfied, and distressed. Let us go back to our school-days. If you scored 80 per cent in an examination, you felt content and happy. Our lives cannot be 100 per cent all the time. Our problem is that, when stressed, we magnify that 20 per cent that is not doing well and let it become exaggerated to ruin whatever we have achieved already. In times of disappointment

and stress, be optimistic and look at the 80 per cent This is similar to a psychological test for identifying optimists and pessimists. A glass is filled with milk to half way. The optimist will say the glass is half full; the pessimist will say it is half empty.

What do we do with our biological reactions? There are two ways to deal with this locked up energy which has nowhere to go, as modem stress does not normally require physical action. One way is to let it out by some action, like punching the car, although my patient told me it did not make him feel any better; in fact it made things worse. When a person gets upset, it is quite common for him to throw things at the alleged enemy, usually the husband or wife. I always admire the Greeks for their wild parties, in which people throw and crack plates by the dozen. This is probably a more controlled and socially acceptable kind of release. The other ways of letting off steam is through exercise—walking for hours, playing golf or tennis, swimming, riding a bike, etc. All these are good ways of coping with the excess energy built up through the normal biological reaction to stress. Or there are relaxation exercises, whereby this energy is absorbed back into the system and put to a more constructive use. Differrent forms of relaxation exercise exist in different cultures: yoga, transcendental meditation, Tai Chi, and self-hypnosis are examples.

Coconut, apple, or tomato? Whether or not a situation stresses us depends on how we perceive it. A certain situation may be stress for one person, but a source of pleasure for another. Jumping out of a plane is a real stress to most of us, but there are a lot of people who enjoy it as a sport. The level of anxiety produced by a stressful situation is dependent on the person who is experiencing the stress. Beauty is in the eyes of the beholder, and it is the same with stress and pleasure.

Tao and Chinese philosophy. Chinese philosophy very enlightening. Tao’ is the Chinese philosophy of The Way’. In this philosophy, our lives follow a mysterious way and may not be under our full control. We may experience disappointment at one point in time, but further along the way this disappointment may turn out to be a blessing. To illustrate this, read this short story of a farmer and his son.

Once upon a time, there was a farmer who had a teenage son. He was a good man who believed in the philosophy of Tao. One day his son went hunting. He found and captured a fast white horse which was running wild in the countryside. He brought the horse back to the village. The villagers were very excited. They all came and congratulated the father. However, the father was not excessively excited, but smiled and said: This is the way, this is the way’. The son rode the horse every day and enjoyed himself. A few months later, there was an accident. He fell off the horse and broke both legs. He was unable to walk, and had to sit in a chair all day. The villagers were all shaken and came to express their sorrow. They were surprised to find that the father was not excessively sad. The father said: This is the way, this is the way’. A few months later war broke out in the country. AH the young men in the village were conscripted into the army. The villagers were proud of these young men as they were fighting for their country. Battle drums were beating loud, and these young men were expected to destroy the enemy and bring back honour and glory. The son who had broken his legs was still on crutches and was not able to join the army. The father said: This is the way, this is the way’. A few weeks later it was learned that they had lost the battle. The young men of the village were killed in an ambush, and there were no survivors. The only young man left in the village was the son with the broken legs. The father said: This is the way, this is the way’.

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We can learn to control pain in very much the same way as tension and anxiety, and this includes pain from organic as well as psychological causes. But before describing the self-management of painful conditions I shall discuss with you some particular aspects of pain. This will make it easier to understand exactly what we are doing when we start to work on the actual

pain-relieving procedures.

Excessive Pain-Of course, under some circumstances a warning may be too strong. As a psychiatrist I see examples of this almost every day. The child who is warned too much about the dangers of life may grow up to be a coward, and the warning has done as much harm as good. The little girl warned too strongly about boys may live out her life as a spinster, and what was intended well has done her harm. So it is with pain. Our body is not always able to regulate the strength of the warning according to the exact needs of the case. The pain may be too severe or last too long. Conversely, pain sometimes is not severe enough. This is so in the early stages of some forms of cancer. In these cases the disease may spread to other organs of the body before the pain is sufficiently severe to bring the patient to seek help.

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Q. After the food has spent its appointed time in the duodenum, what is the next step?

A. The food then passes to the small intestine. This is a long continuous tube that coils round and round, and fills the area which is commonly known as ‘the tummy’ or ‘gut’ in colloquial talk. It roughly fills the space between the lower part of the rib cage and the pelvic bones. It starts at the end of the duodenum and finally runs into the large bowel at a dilated area called the caecum.

I might add that ‘small’ refers to its width, not length. It is quite narrow, much like a hose. It has soft walls, and is very moveable. In fact, it slips and slides over itself in a remarkable manner. On the outside it is shiny and glistening, and slimy to the touch. This is important so that there will be no obstruction to the passage of food along its length.

Q. What happens in this part of the system?

A. Here is where digestion of the food takes place, and for this reason it is a vital part of the body. The first part or two fifths of the small bowel is called the jejunum — coming from the Latin word jejunus which means empty (ever felt empty when hungry!); the second part, roughly three fifths, is called the ileum, which comes from another Latin word ilia which means intestines.

By the time food reaches the small gut, it has been acted on by the acids and chemicals of the stomach and duodenum, so that it is now a strange thickish fluid. It has been broken down into its basic natural components. The inner lining of the small bowel consists of a huge number of undulating folds, and on these are located tens of millions of microscopic finger-like projections called villi. These also contain a copious blood supply.

Q. What do the villi do?

A. The villi contact the food, and actively absorb it into the blood system. Various parts of the bowel concentrate on different food components, for example starches are absorbed more readily in one section, fats and proteins in another, vitamins in another area. As the food is automatically carried along by natural waves of contraction called peristalsis, gradually the food components are sucked up by the ingenious villi.

Q. What happens to the food after it goes into the blood stream?

A. From here it is conveyed into larger vessels called the portal system. This travels to the liver, where much of the material is stored. Sugars are converted to glycogen and kept for later use, whilst a certain amount travels to the tissues for immediate use.

Ever notice how you suddenly seem to have more energy after a good meal? Some vitamins are used at once, whilst some are stored for later use.

Q. Where does the small intestine end, and what happens then?

A. The small gut ends in the lower right side of the abdominal cavity at the ileo-caecal junction, where there is a small valve.

Q. Isn’t that where the appendix is located?

A. True, as nearly anyone who has suffered appendicitis, and probably had an operation knows. Have a look at where the surgeon’s scar is. This is called McBurney’s point. The caecum is an enlarged part of the bowel, and projecting from this is a small, narrow organ a bit like a pencil, usually 5-10 cm in length, called the vermiform appendix — vermiform because it looks a bit like a worm! It is strange the way doctors name things and the reasons. Normally the appendix is hollow enabling food to enter and leave it freely. Occasionally the mouth becomes jammed, probably with little stones or worms, germs inside suddenly reproduce en masse and a serious condition called acute appendicitis may develop.

Q. Is this really a serious disease in today’s modern world?

A. Yes it is. Fortunately, most people are aware of the possibility and will quickly report pain around the navel, or in the R.I.F. (the right iliac fossa as the doctors say) and have the correct treatment. But some foolishly neglect it, or do not realise the importance of the symptoms. Even in this enlightened day and age, about sixty Australians die annually from appendicitis! It is an incredibly large figure, but shows little sign of lessening each year.

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An extremely common condition that’s estimated to affect millions of people every day, sciatica can be broadly defined as a pain or other unpleasant or disturbing sensation that is generally felt in one or more of the following areas of the body: the lower back, the buttocks, the outer sides of the thigh and calf, the feet, and toes.

Two key points about sciatica:

1) The name ‘sciatica’ describes a symptom, not a specific disease nor even necessarily the exact underlying cause that leads to the pain; and

2) The areas where the pain is felt are not an indication of where the cause of it originates – sciatica almost invariably stems from troublein the back, whether or not any pain is experienced there as well.

Sciatica, in fact, is just one of the many symptoms that can mark different kinds of back problems, or more specifically problems affecting the spine.

Although spinal problems and sciatica are directly linked as cause and effect, this relationship is often less than obvious when a sufferer first experiences sciatica, especially when the pain or discomfort is relatively mild and perhaps only present for a very short time. Identifying the cause of the pain is made even more confusing at times because:

Sciatic pain – wherever it occurs and whatever form it takes – is not necessarily accompanied by back pain of any kind; and

Back pain – even that resulting from the very kind of spinal problems that normally give rise to sciatica – is not necessarily accompanied by sciatica.

To add extra confusion, sciatic pain potentially manifests itself not only in many different places but also in a wide variety of ways and degrees of intensity. At one extreme, sciatica may be no more than an occasional light tingle that’s sensed rather than felt in some part of the buttocks, legs, or feet; at the other extreme, it is a searing, wrenching, agonising pain that affects most of the leg and can become truly disabling. It is in the nature of sciatica that it frequently comes and goes for no obviously discernible reason, at times disappearing of its own accord for days, weeks or even months, then to perhaps eventually return with a vengeance.

While the relationship between some kinds of sciatic pain and spinal problems is often less than obvious at first, equally obscure can be the reason why sciatica may be experienced by a sufferer at certain times but not at others. However, apart from any underlying spinal condition that may be responsible for bringing on sciatica, there are many additional causes that could be described as ‘secondary’ in that they have been identified as likely to trigger sciatica, no matter how good your spine may have been in the first place. Common examples of these contributing factors include:

Poor posture – how you stand and sit affects how well your spine, no matter its condition, will be able to cope with the demands you place upon it.

An incident that suddenly, perhaps only very briefly, placed a much greater than usual strain upon the spine – this could be because of being involved in an accident, falling down or slipping, or just merely lifting something heavy or bending down awkwardly.

The cumulative effect of strain upon the spine – such as resulting from frequently driving long distances or spending hours hunched over a desk. Cumulative strain can contribute to sciatica in two separate but connected ways: first, it can cause one of the specific spinal conditions whose symptoms include sciatica; secondly, once such a condition exists, it can make it worse, so that sciatica if not present previously, now manifests itself.

Whether you’re overweight – it’s obvious that the heavier you are, the more weight your spine has to support. It also follows that the poorer the condition of your spine, the greater is likely to be any harmful effect that being overweight will impose upon it.

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The Chinese “boat people” of Hong Kong, according to Lancet, traditionally feed their babies only from the right breast and, among their menopausal women who develop breast cancer, tumors are several times more common on the left side than the right. Other populations sometimes show a slight difference in breast tumor sidedness but never a great preponderance like this. Chinese boat people are unique.

The bad outcome of only using one breast is not surprising. A constantly engorged breast never empties and its secretions (including ingested and inhaled pollutants) remain forever trapped in the ducts of that breast, irritating them and in some cases, ultimately transforming them into tumor tissue. Bottle feeding does not carry the same risk as using only one breast because both breasts dry up quickly when neither one is used.

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Signs and symptoms

Any marked delay in a child’s achieving speech or an impairment of speech raises the suspicion of a speech or hearing problem.

Home care

If your baby is to learn to speak adequately, he or she must be spoken to and listened to. Incorrect speech should be corrected, but a child should not be scolded, deliberately ignored, or forced to practice speaking. Stuttering in children aged two to five years old can be disregarded unless it is still a problem several months after its onset. It should not provoke anger or anxiety, suggestions that the child speak more slowly or more clearly, or laughter and taunts from brothers and sisters. Stuttering warrants professional attention if it is severe, constant, or prolonged.

Precautions

• If your child’s speech does not develop more or less in accordance with the timetable above, consult your doctor.

• Do not refuse to understand your child or try to force him or her to speak more clearly.

• Do not call the child’s attention to stuttering.

• Read, sing, and speak to your child whenever possible.

• Notice if your child speaks only in a monotone or with a marked nasal quality, or if the vocabulary and ability to pronounce words are diminishing instead of improving.

Medical treatment

Your doctor will perform a complete physical examination, checking the child’s throat, palate, and tongue, and testing the child’s hearing. If your child is under the age of five you may be referred to a speech pathologist for evaluation and treatment if: stuttering is severe, constant, or unduly prolonged; the child seems to be severely frustrated in his or her efforts to speak clearly; or you need assistance in handling your child’s development of speech. If your child substitutes sounds or stutters after the age of five or six, your doctor may suggest he or she be seen by a speech specialist.

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Orris Root

Orris is a powder obtained from the root of the iris flower; it was used previously in many kinds of cosmetics because it has a pleasant odor, its color is like that of the human flesh to which it clings firmly, and it holds its scent for a long period of time.

Cosmetics which contain no orris root are advertised as non-allergenic; however, no cosmetic can promise to be totally allergy-free. Commercial sources for orris-free cosmetics include: Elizabeth Arden, Botay, Mary Dunhill, Armand’s Sympathy, Max Factor’s Pancake, Ar-Ex Cosmetics, Almay, Marcille, Mansfields.

The mother of a child who is sensitive to orris should throw away her old powder puff and should not allow a barber to use any kind of cosmetic powder on the child’s head or face after a hair-cutting.

Cottonseed

After cotton is harvested, the fibers are separated from the seeds. The fibers may still contain some seeds, which can cause an extremely dangerous form of allergy. The following should be avoided:

Linters: The short cotton fibers clinging to the seeds and used as stuffing in high-grade mattresses, cushions, upholstery fillings, coarse cotton yarns, and to make miniature golf courses.

Hulls: Used in feeding beef and cattle (milk obtained from cows fed these hulls is a highly dangerous source of cottonseed allergy).

Cake: Used in feeding cattle, as fertilizer, or as flour to make doughnuts.

Oil: Used in making oleomargarine and mayonnaise (in general, this oil is a very weak allergen).

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What is a Miscarriage?

The medical term for miscarriage is ‘spontaneous abortion’ and it occurs before week 24 of pregnancy. After 24 weeks, the delivery of a baby which has died is called a stillbirth. Many women do not like the term ‘spontaneous abortion’ as it reminds them of ‘induced abortion’ which is the deliberate ending of a pregnancy.

The miscarriage may be complete or incomplete. If it is complete, then the miscarriage has finished and all ‘the products of conception’ have come away. These include the foetus, placenta and amniotic sac. In an incomplete miscarriage some of these ‘products’ are left behind and bleeding can continue. In this situation there is always a possible risk of infection if the products are left for any length of time and the woman will be advised to have an ERCP (evacuation of the retained products of conception).

Many women will not notice anything amiss until they have a scan and are then told that the foetus seems to have stopped developing and has died – this is called a ‘missed abortion’. They are usually offered a D and Ñ (dilation and curettage) which is a scraping of the womb lining.

In some cases, the fertilised egg (ovum) will not have developed or developed poorly. On a scan, there will be a pregnancy sac but no embryo because the foetus stopped growing very early in pregnancy. The medical term for this is ‘blighted ovum’.

What Causes a Miscarriage?

This is still largely an unanswered question. There are medical reasons why some women miscarry and tests can show if these are the reasons. Other women will miscarry and yet all the test results are normal. It is easier for a woman to deal with a miscarriage if there is a reason for it happening, and for something to be done about it so that it doesn’t happen again.

Some experts believe that a miscarriage is the most sensitive of all indicators that a woman or her partner has been exposed to an environmental hazard. Others would disagree.

There is certainly a greater risk of miscarriage before week 12 of pregnancy. This is because, until the twelfth week, the embryo is floating unattached in the womb. At the twelfth week, the embryo becomes attached to the placenta instead and the pregnancy is much more firmly established. If a problem occurs after this point, the reasons are usually quite different from those of a miscarriage before the twelfth week.

We know that about one in four pregnancies end in early miscarriages, but should we accept this high rate as ‘normal’? Arthritis is very common in our society as we get older; in other cultures it is not. Does this make it ‘normal’? Or are there ways of preventing arthritis by looking at our lifestyle?

In the same way, we need to look at all the possible causes of miscarriage (lifestyle factors as well as medical problems) in order to prevent it recurring.

The risk of miscarriage increases as we get older. Before the age of 40 the risk of miscarriage is about 15 per cent and it can rise to around 40 per cent in women over the age of 40, mostly because of genetic abnormalities.

Fibroids

A further complication that comes with age is fibroids. These are non-cancerous growths that grow in or on the wall of the womb and are more common as we get older. They are thought to be oestrogen-dependent, as they can shrink at the menopause. Fibroids are given different names depending on where they grow. Fibroids that protrude into the womb (sub-mucosal fibroids) can give the greatest risk of a miscarriage because they may make it difficult for the implanted embryo to develop properly.

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