The Arsenal Files 1/The Arsenal Files (Arsenal Computer).ISO/health/blackbag.025

Text File | 1993-06-04 | 21KB | 432 lines

                          Weekly Health Bulletin
             Courtesy of Black Bag Medical Information Services
             America's Online Health Information Connection(tm)
                               302-994-3772

       This document is provided for educational purposes only. The
information provided is NOT to be considered as diagnostic or
individual advice. No specific medical quidance or treatment can be
recommended without consultation with a physician. You  should consult
your personal physician prior to utilizing any medical information
discussed in this document. Those contributing to this informational
bulletin, disclaim all responsibility for any actions taken by persons
in reliance upon information stated in this program. Should you choose to
disregard this warning, you assume the risk and responsibility for your
actions.

Gynecologic Problems

Important Facts About Endometriosis

Endometriosis is a disease that can occur in any menstruating woman.  It
affects a woman's reproductive system and may be responsible for severe pelvic
pain, especially during menstruation.  Endometriosis is often suspected to be a
cause of infertility.  But many women who have the condition have no symptoms
at all.  Most women with endometriosis may be treated very effectively by means
that are best adapted to their specific problems.  The information in this
pamphlet describes endometriosis and explains causes and treatments.


Female Reproductive Organs

Because endometriosis is a disorder of a woman's reproductive system, it is
important to understand how this system works.  For a woman of childbearing
age, the uterus has two functions:

o It contains and nourishes a baby from the beginning of pregnancy until birth.
o It aids in the delivery of the baby.

Two ovaries produce the eggs, or ova, as well as the female hormones that cause
the tissue lining the uterus--the endometrium--to prepare for the fertilized
egg.  If the egg that is released monthly during a woman's regular cycle (the
menstrual cycle) is not fertilized, the endometrium is shed by bleeding
(menstruation).


The Menstrual Cycle

The menstrual cycle affects the lining of uterus, the endometrium, in this way:
     On the average, a menstrual cycle lasts about 28 days, but it can vary
greatly in length in different women.  After the end of menstruation, on about
day 5 of the cycle, the female hormones produced by the ovaries signal the
endometrial tissue to grow and thicken.  Blood vessels grow and nutrients are
made to prepare for the possibility of pregnancy.
     By day 14, the endometrial lining is about 10 times thicker than it was
one week earlier.  At this time ovulation occurs--an egg is released from the
ovary into the tube.  If a sperm unites with the egg in the tube, the
fertilized egg will move to the uterus and become attached to endometrium.
     If the egg is not fertilized, it continues down the tube to the uterus and
will eventually be absorbed.  Hormone levels decrease and endometrial tissue
breaks apart and is discharged out of the body on about day 28.  This emptying
signals the end of a cycle, and the process begins again.


What is Endometriosis?

  Endometriosis is a condition in which tissue that looks and acts like
endometrial tissue is found in places other than the lining of the uterus.  It
occurs at menstruation when normal endometrial tissue backs up with menstrual
blood through the fallopian tubes and then implants and grows in other places
such as

Ovaries
Tubes
Outer surface of the uterus
Bowel
Other pelvic structures

Endometriosis may also develop on body tissues located anywhere in the abdomen;
these tissues respond to the cycle of changes brought on by the female hormones
just as the endometrium normally responds in the uterus.  Thus, at the end of
every cycle, when the hormones cause the uterus to shed its endometrial lining,
endometrial tissue growing outside the uterus will break apart and bleed.
     Unlike menstrual fluid from the uterus, which is discharged freely out of
the body during menstruation, blood from the abnormal tissue has no place to
go. Body tissues respond to this menstrual-type bleeding by

1. Surrounding it with inflammation (tissue that becomes red, swollen, and
painful around the area)

2. Trying to absorb it back into the circulatory (blood) system

The monthly inflammation subsides when the bleeding ends (at the same time
normal menstrual bleeding ends), and scar tissue is produced around the area.
This pattern occurs in the same cycles the menstrual cycle:  month after month,
patches of endometriosis are triggered by the female hormones to menstruate
blood; the blood is absorbed by the surrounding, inflamed area; and scar tissue
forms.  Endometriosis may also cause adhesions, abnormal tissue growth that
binds organs together.
     Sometimes a patch of endometriosis is surrounded by enough scar tissue to
cut off its blood supply; such tissue can no longer respond completely to the
hormones.  This is called a burned-out plaque of endometriosis.  Other patches
may rupture, or burst, during menstruation and spread their contents to other
pelvic areas, causing new spots of endometriosis to develop.  Thus, the
condition may become gradually worse with time, although symptoms may come and
go.


Who Can Have Endometriosis?

Endometriosis can occur only after the menstrual flow begins:  the disease has
never been found in a young woman who has not yet begun to menstruate.  After
menopause, endometriosis is no longer active unless, for some reason, a woman's
hormones become active again or she is given hormones for some other medical
need.  Endometriosis is most common among women in their 30s and 40s.
     Little is known about why some women develop endometriosis and others do
no.  However, there is some evidence that the condition may be inherited.


Preventive Factors

Because endometriosis is affected by hormone production, certain factors
influence the progress of the disease:

o Since the hormones made by the placenta during pregnancy prevent ovulation,
the progress of endometriosis is slowed or stopped during pregnancy.

o Oral contraceptives (birth control pills) are thought to protect against or
halt the process of endometriosis in the same way that placental hormones do
during pregnancy.


Effects

Women who have endometriosis tend to be less fertile (or able to become
pregnant) than other women.  Some women may find out that they have
endometriosis after consulting a gynecologist for treatment of infertility.
Once it is found, infertility caused by endometriosis can frequently be treated
with good results.
     A number of problems may be due to endometriosis, although they may also
have other causes.  If you have any of these symptoms, you should see your
gynecologist:

1. Increasing discomfort and pain during your menstrual period, called
dysmenorrhea.

2. A sharp pain deep in the pelvis during intercourse.  This may be a result of
endometriosis that has lodged in the body space between the uterus and the
rectum.

     Cancer is found very rarely with endometriosis, occurring in less than 1%
of women who have the condition.  When it does occur, it is usually found in
older, more advanced patches of endometriosis.  However, the long-term outlook
in these very rare situations is reasonably good.


Special Tests

Ordinarily, the doctor will look at your complete medical and menstrual
background and perform a pelvic exam--an examination of the pelvic structures
during which the doctor looks for signs of anything abnormal.  The doctor may
examine you between menstrual periods and then again during your menstrual
periods in order to compare the change in certain findings from the pelvic exam
at different times in the cycle.
     An accurate diagnosis can be obtained only by a procedure called
laparoscopy.  This is done under a local or general anesthetic, with a slender
light-transmitting telescope that is inserted through a tiny cut made in the
lower abdomen.  This enables the doctor to view the pelvic organs and actually
see if endometriosis is present.


Treatment

Different types of treatment may be needed for endometriosis:

Hormonal Therapy.  During recent years, different types of hormone treatment
have been developed.  In such treatment, doses of hormones or drugs are given
to temporarily change the patterns of the normal female hormones and thus slow
the growth of endometriosis.  One type of hormonal treatment mimics the
hormones of pregnancy.  Another causes your body to react in a way similar to
menopause.  Since hormonal therapy shuts off ovulation, women being treated for
endometriosis will not get pregnant during such therapy, although some may
become pregnant shortly after the therapy is stopped.

Conservative Surgery.  Surgery may be performed, during which spots of
endometriosis are cut away from their abnormal locations.  If you are concerned
about infertility, you should be reassured that good ovarian tissue and normal
tubal tissue are left intact as much as possible to aid the chances of
achieving pregnancy after the operation.  Such surgical treatment of infertile
patients who have endometriosis is often, but not always, successful.

Major Surgery.  In cases of severe endometriosis it may be necessary to remove
part of all of the reproductive organs to relieve symptoms and to stop the
production of the female hormones that trigger further growth of endometriosis.
     With surgical treatment of endometriosis, it is important that you
understand the considerations of the gynecologist performing the surgery.
Decisions concerning what type of surgical procedure is best for the individual
woman can only be made during the surgery itself, when the gynecologist can
actually see and evaluate the extent of the endometriosis.  The doctor will
always act in your best interest--keeping your wishes clearly in mind while
making these decisions--but sometimes findings may be very different from what
is expected.  If surgery is needed, be sure that you talk with your doctor
before the operation and that you understand fully what is involved.


Finally . . .

Endometriosis affects women differently in each case.  This pamphlet gives
general information about endometriosis.  Your doctor can best answer specific
questions or concerns you may have.


Glossary

Dysmenorrhea:  Discomfort and pain during the menstrual period.

Endometrium:  The mucous membrane that lines the uterus.

Hormones:  Substances produced by the body to control the functions of various
organs.

Lactation:   The period after the birth of a baby during which the mother
produces breast milk.

Menstruation:  The discharge of blood and tissue from the uterus that occurs
when an egg is not fertilized.

Ovulation:  The release of an egg from one of the ovaries.

                TIPS ON HANDLING LIFE'S LITTLE PAINS

Following are a few tips that may help you to overcome the aches,
pains and minor injuries which pop up every now and then.

NOTE:  If you have serious pain, please consult your physician.  This
may be an indication of an underlying problem which should be checked
out.
_______________________________________________________________________

Sore Muscles:
    For the pain that hits 24 to 48 hours after you've overdone a
    workout, take one day of rest, then do a shorter, lighter workout
    than usual.  Repeat the one-day-off, one-day-easy sequence until
    pain is gone.  Moderate exercise can alleviate aches from
    overused muscles faster than incactivity.  But if the pain gets
    worse when you continue to exercise, stop and see your doctor.

Leg Cramps:
    Stand up to stretch the muscle, then walk around for a few
    minutes.  Apply a warm, wet cloth to relax the muscle.  To avert
    recurring nighttime leg cramps, place a firm pillow against the
    soles of your feet to keep them from extending into the
    pointed-toe position, which may bring on a cramp.

Paper Cuts:
   First be sure the cut is scrupulously clean.  Then get a bottle of
   clear nail polish and daub it on the cut to protect it from
   irritants like air and soap.

Cold Sores:
    Spread a soothing gel called Zilactin over the sore (it's
    available without a prescription).  It should stop the pain for
    up to eight hours and will even stick to the wet mucous membranes
    inside your mouth.  In tests, cold sores covered with Zilactin
    withstood even their worst enemy, a citrus drink.

Cankers:
    Hold a wet tea bag to the canker sore.  Choose a black tea like
    English Breakfast, which contains tannin, and astringent with
    surprising pain-relieving power.  You can also dab a canker sore
    with a styptic pencil, which contains alum; the alum can ease the
    pain and keep the infection from worsening.  After each meal and
    at bedtime, take a swig of hydrogen peroxide, swish it around for
    several minutes then spit, but don't rinse with water.

Mild burns:
    If you nuked your pizza in the microwave and scorched your
    palmate, over-the-counter cough lozenges containing benzocaine
    may cut the pain.  Submerge superficial skin burns in cold water
    until they no longer hurt when you take them out of the water.
    Don't use direct ice or cold running water--both are painful.

    Dr. Robert Buchanan, a professor of surgery at the University of
    Oklahoma Health Sciences Center, says cooling a burn immediately
    and protecting it from infection are the most important
    treatments.  Besides water, he says, "shaving cream works great,
    because it absorbs heat as it ixpands, effectively halting the
    burning process.

Earache:
    To ease nighttime earache pain caused by clogged tubes, try
    sitting upright for a few minutes.  That may be enough to start
    your Eustachian tubes draining and  relieve the pain-producing
    pressure.

    Then, slightly prop up your head and shoulders with pillows while
    you sleep to facilitate drainage.  You also may want to get up
    and take a drink of water.  Sipping and swallowing triggers the
    muscular action that helps your Eustachian tubes open and drain.
    Open tubes mean less pain.

    Chewing gum or sucking on a hard candy also may help.  Going
    through the yawning motions may be even better.

Sinus Headache:
    Don't exceed the recommended dose of an over-the-counter
    decongestant or you may make yourself even more inflamed.  And
    forget antihistamines.  They dry up your nose and thicken the
    mucus.  You want the opposite.

    You can treat a sinus headache by inhaling moist heat from a
    warm, wet towel or the steam from a basin of water.  Analgesics
    like aspirin also help.  And ask your doctor for drugs that treat
    inflammation and infection and drain clogged sinuses.

Toothache:
    The best way to ease the pain while waiting for the dentist
    depends on whether the tooth nerve is alive.

    Hot, moist towels applied to your jaw over the pain site may help
    if the tooth is dead.  If heat aggravates the pain, the tooth is
    alive and infected and the nerve is inflamed.  Cold packs on the
    jaw for 15 to 20 minutes, four to five times a day, may help.

Sore Gums:
    Mix a teaspoon of salt in a glass of water that is as warm as you
    can stand it.  Swish it around in your mouth, trying to get some
    between your teeth.  Then spit it out and repeat until youve used
    up the glass of water.  Do this once each hour.

    If your gums still hurt after several days, see a dentist for
    treatment.

Sprains:
    If the pain is severe or you lose strength or movement in the
    joint, see a doctor.  Otherwise, for sprains that affect the
    ankle, wrist or knee: keep the area slightly elevated and apply
    ice for 15 to 20 minutes, four to five times a day.

    To make a customized ice pack, fill a plastic bag with ccrushed
    ice, mold it to the injured joint and place in the freezer to
    harden in that shape.

    For longer-lasting ice treatment, keep a layer of cloth between
    you and the ice.

Strains:
    For strained (stretched or torn) muscles or ligaments, use ice
    compresses for the first five to seven days.  Then, switch to hot
    packs for relief.

    Wrap a hot, wet towel around the strain, cover with plastic wrap
    and finish with a dry towel to hold in the heat.  apply these hot
    packs four or five times a day for 20 minutes at a time.

    Caution:  Don't rub any type of ointment on your skin before
    applying a hot pack.  Heat makes skin absorb so much of the cream
    that it can cause deep blistering.

Tennis Elbow:
    If you start to feel pain during a game, switch to a form that
    calls for less forearm rotation.

    If pain continues, rest your arm and hold ice against your elbow
    for 15- to 20-minute intervals, four to five times a day, being
    careful to apply the ice over a protective layer of cloth.

    Take an anti-inflammatory painkiller like aspirin every four
    hours for two days.  If the pain persists, see your doctor.


Part III

   The Food and Drug Administration has concluded that no over-the-counter
smoking deterrent product on the market today has been shown to be effective
in helping people quit or reduce smoking.  New shipments of these
nonprescription products will be prohibited after Dec. 1.
   Products that will be affected include pills, tablets, lozenges and
chewing gum-type products sold under various names such as Cigarrest,
Bantron, Tabmint, Nikoban and others.  They may continue to be sold until
supplies are exhausted.
   "Smoking is one of the nation's leading public health risks, and we favor
any safe and effective method for helping people kick the habit," said FDA
Commissioner David A. Kessler, M.D.  "However, to reduce smoking-related
illnesses and deaths, smoking deterrents have to work."
     Several manufacturers of the nonprescription products have discussed
with FDA the possibility of conducting clinical trials on lobeline sulfate
and silver acetate -- two ingredients in products now on the market.  Past
studies with these and other ingredients have not proven their effectiveness
in helping people stop or reduce their smoking, FDA reported.

   Several prescription products are approved as smoking cessation aids.
Marion Merrell Dow Inc., which manufactures Nicorette, a prescription
chewing gum drug for this purpose, has expressed interest in gaining FDA
approval for switching the product to nonprescription status, which would
allow its use without the supervision of a physician.  Before allowing a
switch, the agency would need to consider carefully Nicorette's own
potential for addiction, since it contains nicotine.
   FDA, which is a U.S. Public Health Service agency within HHS, believes
that allowing ineffective products to stay on the market discourages
research to find effective ones. The agency has informed companies that it
is anxious to work with them to develop new products in this area.
     The announcement was published as a final rule in the Federal Register
June 1.
                              ####


          This news file is compiled weekly from the archives of the
                      BLACK BAG MEDICAL INFORMATION SERVICES
                                  302-994-3772
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