Health and medical information

You will probably be visited by an anesthetist on the ward before your operation.

An anesthetist is a hospital doctor who has been trained in the special skills of giving drugs which cause loss of sensation or consciousness, or both (anesthetics), and those which block feelings of pain (analgesics). Anesthesia is a vital part of any operation, and a great deal of time and trouble will be taken to make sure that you receive the anesthetic which best suits you.

The pre-anesthetic visit

The main reason for the anesthetist’s visit before your operation is to decide what type of anesthesia would be safest for you. This visit also gives you the opportunity to discuss any problems or worries you may have concerning your anesthesia.

The anesthetist will ask you several questions about any anesthetics you have had before, any drugs you are taking, and about your general health. It is important that you answer these questions as fully as possible. You should also mention to the anesthetist if you have any false or crowned teeth.

If you have had any problems in the past such as an allergy to a particular anesthetic, it will be helpful if you know the name of the drug concerned or the hospital where the operation was carried out. The appropriate records can then be checked to make sure another type of anesthetic is used for your breast operation. You should also tell the anesthetist if you know of any other member of your family who has reacted against a particular drug, as you may have the same problem.

The anesthetist may also want to examine you and to look at the results of any tests you have had. There are different types of anesthetic which can be used for breast operations, and some health problems will preclude the use of certain ones.

General anesthetic

Virtually all breast operations require a general anesthetic; the only exception may be for a biopsy, which can be performed in the out-patients’ department using a local anesthetic. A general anesthetic will put you to sleep, and abolish any feelings in your body. It can be given in two different ways.

1    Intravenous anesthetics can be injected into a vein via a plastic tube which is inserted into your hand or arm, and will put you to sleep within a few seconds.

2     Inhalational anesthetics are gases which you breathe in through a face mask and which act within 1 to 2 minutes. As the use of a face mask can cause some people to panic, it is not normally applied until you are asleep.

During the operation, the anesthetist will make sure you stay asleep by giving you more drugs as necessary.

Risks of general anesthesia

People with certain medical conditions, such as heart or lung disease, may not be given general anesthetics as they are potentially at greater risk.

Some people are afraid of being put to sleep by a general anesthetic because they fear the possibility of never waking up or of suffering brain damage. General anesthetics are very much safer today than they were even 20 years ago, because of the many advances in techniques and drugs. Therefore, their risks are small, although they do have to be borne in mind. If you are worried about this, you should discuss with your anesthetist the possibility of an alternative.

Local anesthetic

When the general anesthetic has taken effect and you are asleep, the anesthetist or surgeon may inject some local anesthetic into the area of the wound. This is the same type of anesthetic that a dentist uses to numb the teeth before a filling. The injection will provide you with pain relief after the operation, for about 4 to 6 hours.

Other medication

In some hospitals, a pre-medication drug (‘pre-med.’) is given routinely to patients to reduce their anxiety before an operation. A ‘pre-med.’ is given by mouth, as tablets or syrup, or by injection several hours before the operation, and will probably make you feel sleepy and relaxed.

You may be asked whether you would like to have a ‘pre-med.’, or you may have to ask for one yourself if you feel anxious and have not been offered one. You can, of course, also say that you do not want one if they are given routinely in your hospital. The anesthetist will be able to discuss this with you.

You may also be given any drugs that you normally take, such as diuretics (‘water tablets’) or drugs to reduce high blood pressure.

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Is endometriosis cancerous?

Endometriosis is definitely not a form of cancer, nor is it a pre-cancerous condition.

Endometriosis is sometimes referred to as a benign cancer because it behaves like cancer in some ways. Like cancer, it is able to grow and expand, to implant itself in a distant part of the body after having been transported there by the bloodstream or the lymph vessels and to invade or penetrate organs and tissues in the body.

But unlike cancer, endometriosis does not destroy the organ or tissue on which it implants itself.

Any tissue in the body can develop into cancer. Therefore, theoretically, any endometrial implants and endometriomas have the potential to become cancerous. But it is extremely rare for endometriosis to become cancerous.

Is adenomyosis the same as endometriosis?

Adenomyosis is sometimes confused with endometriosis because some gynaecologists still refer to adenomyosis by its old names of ‘internal endometriosis’ or ‘endometriosis interna’. These terms should no longer be used as endometriosis and adenomyosis are two quite different conditions.

Adenomyosis is a condition in which the endometrium lining the uterus penetrates and grows into the adjacent muscle layer of the uterus. How the endometrium invades the muscle wall is not clear.

Adenomyosis is most commonly found in women in their 40s and 50s who have had children.

The main symptoms of adenomyosis are heavy bleeding and painful periods. It is thought that about 25% of women with adenomyosis have no symptoms at all.

The severity of the bleeding is related to the extent of the condition and in some women the bleeding is so excessive that the woman is actually haemorrhaging.

The severity of the pain appears to be related to how far the endometrium has penetrated into the muscle wall and some women may experience severe and incapacitating pain during menstruation.

A doctor may suspect that a woman has adenomyosis from her symptoms and an examination will usually indicate a moderately enlarged uterus. A definite diagnosis is difficult and is often only made when the uterus has been examined following a hysterectomy.

The drugs used for the treatment of endometriosis are not effective in the treatment of adenomyosis and for many women the only treatment for adenomyosis is hysterectomy.

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The way we think and the attitudes and beliefs we subscribe to have a great influence on our health and the way we look at prevention.

In a stressful world which is full of change most of us have to cope with the problems of growing up, going to school, leaving school, forming relationships, having children, making a home, holding down a job, bereavement, problems with children, illness, and much more besides. Many of these problems are in no way ‘our fault’, yet they can have a profound effect on our health, often reducing our ability to withstand infections and even making us susceptible to killer diseases such as cancer. Several studies have confirmed that stress impairs the functioning of the immune system. The typical responses of individuals to bad luck and stress vary enormously. A few people seem to thrive by overcoming obstacles, but it is probably true to say that more ‘illness’ and ‘disease’ is caused by stressful events in people’s lives than is caused by ‘real’ disease. But as well as these ‘external’ sources of stress and emotional upheaval there are many more ‘internal’-or self-generated-causes and some people are much more likely to be troubled with these than are others.

Some people hold beliefs that are almost bound to make them suffer more than necessary in the hurly-burly of everyday life, and others have personality types that make them exceptionally vulnerable. Both of these can be modified-at least to some extent-and increasingly people are realizing that their personalities have an enormous influence on their health and illness patterns.

Uncertainty is a potent cause of stress in many people’s lives but rational, clear thinking can overcome or reduce many of the stresses associated with uncertainty. For example, if you think you are about to be made redundant you can explore all the possible alternatives ahead of time, perhaps even starting to look into retraining. This positive action will make you feel a lot better and you will be less uncertain about your future because you will at least have explored, and

Uncertainty over a physical symptom is a major source of stress to many people who, often quite wrongly, imagine they have a serious disease. The answer here is to seek a professional opinion, and get the necessary tests done, so that your suspicion is either confirmed or proved wrong, and you can deal with the resultant situation appropriately. We all seem to have difficulty coping with problems which don’t have definite boundaries, yet can do so much better once the problem is defined clearly. Fear of the unknown is a disease-producer, yet so much information is available today that there is no need to fret unnecessarily over all kinds of imagined horrors.

Another source of stress is the inability many people have to make decisions at all. This in itself tears them apart because the very act of choosing one direction in life by definition rules out certain others and such people cannot bear to have any doors closed-they want all their options open all the time and so decide on nothing. In such circumstances it helps to write down the problem in logical steps and then to work out on paper all the possible answers you can see. This is best done with the help of a partner or a friend, but for some people in certain circumstances a professional counselor may be the answer. Often an outsider can see a way through an apparently insuperable problem, partly because he or she is outside the problem that looms so large in the troubled person’s life, and partly because he or she can bring experience from dealing with other similar problems to bear on this particular one. Often an outsider sees a totally new way out of the dilemma that is entirely invisible to the individual involved because of his or her upbringing, education and way of thinking, emotional state, or whatever.

One of the things that makes many people ‘ill’ is coming to terms with the fact that in modern life many problems simply don’t have an answer. Things are so complicated today that the simple answers of our grandparents often can’t be made to apply. Coping with the unchangeable is a sign of emotional maturity and again professional help may be necessary.

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For Sharon Poppendeck, having her second child at age 39 was a welcome joy. But the postpregnancy pounds that lingered a year later were just plain unwelcome.

Sharon had read that metabolism starts to slow at around age 40. But the Indianapolis resident couldn’t understand why the extra 10 pounds that had accumulated around her belly and thighs just wouldn’t go away, no matter how hard she tried to shed it.

Puzzled, she began scrutinizing her eating habits like a scientist searching for a new discovery. Healthy foods? Yes. Snacks? No. She didn’t even eat when she took the kids for their favorite fast-food meals. Or did she?

Sharon didn’t usually order, but she did eat—everything the kids didn’t. “I’d just pick it up and finish it so I didn’t have to throw it out,” she says. “I didn’t even notice that I was doing it.”

Now, when she takes the kids out for fast food, she eats her typical healthy meal beforehand so that she’s not tempted to finish their leftovers. And forget the guilt about throwing away food. Into the garbage it goes!

Sharon also made another discovery and adopted a no-eating policy in her car. “I would always carry little snacks with me in case the kids got hungry,” she says. “The problem was that every time I gave them a handful of crackers, I ate a handful, too!” She still carries snacks for her children, but she herself doesn’t eat them.

Sure enough, the weight came off. And Sharon, now age 42, says that it has remained off, thanks to her bit of detective work.

WINNING ACTION

Leave the leftovers. Unlike what you may have learned growing up, you are not a human garbage disposal. So don’t feel compelled to eat your kids’ or grandkids’ leftovers. If you can’t bear to throw out uneaten food, wrap it up and put it in the refrigerator for later. In restaurants, request a doggie bag—unless you’re going to be too tempted to eat the leftovers yourself. In that case, let the waiter take it away.

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