BEFORE OPERATION ON BREAST CANCER: PREPARATION FOR ANESTHESIA
You will be told not to have anything to eat or drink for at least 6 hours before your operation (‘nil by mouth’). The reason for this is that any food or drink left in your stomach when you are anaesthetized could cause you to be sick and to choke on your vomit.
While you are still on the ward, you will be given your ‘pre-med/, if you are to have one, and any medicines you normally take. You will then be taken to the operating theatre, probably on a hospital trolley. You may go first into the anesthetic room or straight into the operating theatre to be given your anesthetic.
The anesthetist, or an assistant, will ask you several questions to confirm your identity and make sure that you are the right person in the right place. Your identity bands will also be checked. Many people have many types of operations each day in a hospital, and these checks, which may be repeated, are essential to make sure no mistakes are made.
The anesthetist will then fit various monitoring devices to watch over you while you are asleep. A probe may be attached to your finger to measure the amount of oxygen in your blood; some sticky pads may be put on your chest so that your heart beat can be recorded on an electrocardiograph; and a cuff may be put around your arm to measure your blood pressure. All these monitoring devices enable the anesthetist to make sure that the anesthetic remains effective and that you remain well during surgery.
A plastic cannula will be put into a vein in the back of your hand, and any drugs will be introduced into your body through this.
Once the anesthetist is happy with the readings from the monitors, your anesthesia can start.
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ASKING ABOUT ENDOMETRIOSIS
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.
What type of woman gets endometriosis?
Traditionally, gynaecologists have described the typical woman with endometriosis as being white, middle class, career-oriented, intelligent, a perfectionist, over-anxious, ambitious, obsessive, and underweight, in her 30s or 40s with a stressful career and who has deliberately delayed childbearing to pursue an education or career. Such a description is a myth, derived from the impressions and judgments of a few of the leading gynaecologists of the 1930s and 40s. Nevertheless, the myth has been handed down as fact to other gynaecologists. Not one of the descriptions has been scientifically proven and many have been refuted. With improved diagnosis-since the introduction of the laparoscopy – endometriosis has been found in the entire spectrum of women. However, some doctors still believe the traditional description or parts of it-and the preconceived idea still persists in many of the current medical textbooks and journals and popular literature.
Inaccurately, endometriosis is still frequently referred to as ‘the career woman’s disease’.
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PREVENTIVE MEDECINE: COPING WITH STRESS
A large number of people harbour negative feelings such as hate, distrust and resentment, sometimes holding on to grievances for years. These feelings work away inside them to make them ill even though the source of the problem is often someone else. Whilst serious grudges and really intransigent problems may need professional insights and expertise, many such negative emotions can be overcome by individuals themselves once they realize that they are doing themselves more harm than anyone else. The starting point is to realize that the past is done and gone and that nothing can undo what we have done. The aim should be to come to terms with what has happened and then try to make amends for it in some way. Often simply having the strength to say ‘sorry’ after many years can lift a burden off your shoulders. Sometimes such feelings are best put down in writing rather than discussed face to face, or it may be better to open the door in writing and then meet to talk it out. Very few people can throw a heart-felt apology back in someone’s face and if time has healed the emotional wounds even a little then things can go very well from there. It was a wise man who said, ‘He who cannot forgive breaks the bridge over which he himself must pass’
The secret of all attitudes, beliefs and behaviour is to know yourself and to have insights into these facets of yourself. This can be very difficult but there are excellent books that can help. Perhaps one of the best is ‘I’m OK-You’re OK’ by Dr Thomas Harris. A few sessions with an insight-trained counselor of some kind can also be invaluable in opening doors for you which then alter the whole way you think in the future. It pays to listen to what good friends say too. There are few people who will be really honest with you in life and, ironically, your partner may not be the best person.
So many emotions, types of behaviour and beliefs are destructive and harmful to us that it is a shame that so little is said about all this in health education of all kinds. It should really be a major strand of preventive medicine-the benefits would be enormous. The burden on doctors would fall dramatically if they were trained to deal with their patients in this way-giving insights into their personalities as an explanation for their ill health. Alas, few doctors are capable of doing this and those that are have too little time to exploit their skills. Hopefully there will soon be a shift away from dealing with the obvious complaints to dealing with the underlying personality problems that produced them in the first place.
If you doubt the importance of the personality in illness and health, think of all the major diseases that we are heir to. Smoking, for example, has an enormous psychological component to it and most smokers won’t or can’t give up until they understand the underlying psychological mechanisms that make them do it. The problem with overeating is much the same. Both are oral pleasures for people who are arrested at the oral stage of their psychosexual development. Most VD is caused by promiscuous behaviour which could be prevented if the individuals concerned had insights into themselves and their actions. The majority of car crashes are in no way ‘accidental’ and neither are the thousands of unwanted pregnancies that occur each year. And so I could go on. And I haven’t even mentioned the obvious emotionally-based problems within marriages, families and working groups-all of which produce disease. The greatest tool of preventive medicine, then, is self-knowledge, and until our medical-care system comes to grips with this people will continue to injure and kill themselves quite unnecessarily.
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FEED YOUR BODY RIGHT: SHE SLIMMED DOWN BY SITTING DOWN
When it comes to eating, Kathy Wilson was a stand-up kind of person. She would stand at the cupboard and snack. She would stand at the refrigerator and snack. “I can honestly say that I never sat down and ate a meal,” says the 48-year-old DeWitt, Michigan, resident.
By the time she reached her mid-forties, Kathy weighed 262 pounds. Her blood pressure was way above normal. And she no longer wanted to go out with her husband, because she was embarrassed by her size.
All of these factors drove Kathy to confront her weight problem. She knew that she had to slim down, but how?
After looking into several weight-loss programs, Kathy decided to enroll in Jenny Craig. In the program, clients eat prepackaged meals until they’re halfway to their goal weights. Then they switch to preparing their own food, using menus provided by Jenny Craig.
“Typically, when you think of a diet, you think of what you can’t eat,” Kathy says. “But I learned that I can eat what I want, as long as I control my portions.”
She also learned to stop sabotaging her weight-loss program by eating in front of the fridge. “When I started adding up the calories, I realized that I was taking in a lot more than I should have been, mostly because of my stand-up meals and snacks,” Kathy ‘ “* says. “Sitting down«t the kitchen or dining room table each time I ate forced me to be more aware of the food that I was putting in my mouth.”
Within a year of starting the Jenny Craig program, Kathy had lost 100 pounds. She has maintained her goal weight of 162 pounds since April 1994.
Now that she’s slimmer, Kathy is more active than she used to be. She loves to run, ice-skate, and play softball. She was so impressed with how the Jenny Craig program changed her life that she became the director of a Jenny Craig center in Lansing, Michigan. “I want to help others achieve their weight-loss goals, as I have,” she says.
WINNING ACTION
Leave stand-up to the comedians. Research shows that nearly all of us, whether we’re heavy or slim, underestimate by 20 to 50 percent how much we eat. Like Kathy, we forget about the snacking in front of the refrigerator, the taste-testing during meal preparation, the nibbling during meetings at work. And those calories can add up fast. To keep tabs on absentminded eating, get in the habit of sitting at the table for every meal and snack. This simple action will help remind you that what you’re putting in your mouth counts toward your daily calorie intake. You may realize that you’re not as hungry as you thought!
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