Ишемическая болезнь сердца-Ischemic heart disease

The discussion of the side-effects of treatments in this section should not be seen as alarmist propaganda. It is important that this point be appreciated because, unfortunately, such techniques are used in some types of sales drives. The purpose of describing these effects in the following discussion is that they have a very important role in medicine. Discussion of; any therapy without including the side-effects involved is completely invalid. There is another reason. This is that one of the parameters which must be used in comparing the value of any therapy with any other is that of the side-effects. p r instance, if two treatments are equal in their effectiveness for treating a particular condition but one of them exhibited undesirable side effects, then the one which did not would obviously be a better treatment, even though it was, overall, no more effective.

As this book will be connected primarily with rheumatoid and osteoarthritis it will be appropriate to reserve the discussion mainly to these two conditions.

Salicylate therapy

Starting with rheumatoid arthritis, it is probably true to say that the most universally preferred therapy by practicing clinicians is salycilate therapy. Put into simpler terms this usually means aspirin, although other forms of the compound are used. An example of another form is sodium salicylate.

Aspirin is the name given to a compound known chemically as acetyl salicylic acid which is now produced by synthetic means. It did, however, originate in the bark of trees, and before methods for synthesizing it were devised, extracts from the bark of the willow tree were, used in the treatment of rheumatic diseases.

Using acetyl salicylic acid as an example of salicylate therapy, it will be convenient to refer to it in the name of aspirin. There are some variations in effect of the various salicylates but this discussion will be of too general a nature to consider these.

Generally speaking, aspirin shows three beneficial effects: it is an anti-inflammatory, anti-pyretic and an analgaesic agent. It is almost certainly the drug in widest use in the treatment of rheumatoid arthritis and has been used in this way since the beginning of this century. With its anti-inflammatory and analgaesic action it eases pain in two ways. One is by direct pain-relieving action on the central nervous system; the other is by reducing inflammation and thus relieving the pain created at the inflammatory site. It is possible that the anti-pyretic (heat or temperature lowering property) may only be applicable in fever conditions. The effects of salicylate therapy tend to be felt quickly, bringing rapid relief. The duration of relief, however, may not be more than a few hours, thus necessitating repeat doses at frequent intervals.

Side-effects of salicylates

Taking a brief look now at the negative side of this particular therapy (the side-effects) it will be found that regular consumption of salicylates, even in small doses, may induce gastric problems. The most common and the most serious problem is gastric hemorrhage and ulceration. A lot of research has been carried out on this topic and it is believed that factors other than the straight consumption of salicylate can influence the degree of severity of this type of damage) For instance it would be fairly obvious to most people that the taking of aspirin on an empty stomach would be more likely to cause gastric upset and damage than if taken ink conjunction with a meal. However, the degree to which stress, such as tiredness, emotion, or perhaps exposure to adverse climatic conditions, may have an adverse effect is not known. The fact that stress conditions, in conjunction with aspirin, can lead to a marked increase in the severity of gastric damage compared with aspirin alone has been demonstrated in laboratory tests on animals.

If large doses of salicylates are being consumed, then in addition to bleeding and ulceration, effects such as nausea, dizziness, kidney problems and partial deafness can occur.

It must be remembered that people differ considerably in their reactions and responses to pain and to drugs, etc. Thus, there is no hard and fast rule as to the effect that a particular person might anticipate from a given amount of drug. As will already have been realized, apart from many external factors, it also depends very much on the individual and the situation involved.

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A repeat laparoscopy, also sometimes known as a second-look laparoscopy, is performed some time after a diagnostic laparoscopy in order to monitor the progression of your endometriosis. It is most commonly performed for one of the following reasons:

• following a course of hormonal treatment

• continued infertility following surgery

• recurrence of symptoms

• persistence of symptoms following an apparently normal laparoscopy.

Following hormonal treatment

A repeat laparoscopy at the end of a course of hormonal treatment enables your gynecologist to see exactly how effectively the treatment has eradicated your endometriosis. The location and size of your implants and cysts can be charted and compared to the chart that was made during the laparoscopy performed before your hormonal treatment began.

If the repeat laparoscopy showed that the treatment had eradicated your endometriosis then nothing further needs to be done for the time being. If it showed that the treatment had only been partially effective then it might be worthwhile considering a continuation of the same treatment. If it showed that the treatment had been ineffective you will need to consider some other form of treatment.

Infertility

If you have had surgery in order to improve your chances of conceiving, a repeat laparoscopy may be recommended if you have not conceived within six to twelve months of the surgery. In this situation the laparoscopy will be performed to determine whether or not any adhesions have developed that may be reducing your chances of pregnancy.

Recurrence

A repeat laparoscopy is advisable if you have a recurrence of your symptoms following a period of remission, particularly if you are contemplating any treatment. You really need to know that the symptoms are due to endometriosis and not some other condition. In addition, it is advisable not to undertake any hormonal treatment unless you know that you definitely have endometriosis.

Normal laparoscopy

A repeat laparoscopy may be advisable if you have had persistence or worsening of symptoms that may be due to endometriosis, despite the fact that you have previously had an apparently normal diagnostic laparoscopy. It is now recognized that, in the past, a proportion of women with endometriosis were incorrectly diagnosed as not having endometriosis because their gynecologists did not recognize their atypical implants or because they had microscopic endometriosis.

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One of the most fascinating avenues of biochemical research over the past few years led to the discovery that the body manufactures its own natural painkillers. These substances became known as endorphins, from endo (meaning «arising from within») and morphine. Evidence suggests that endorphins play a direct role in regulating appetite and affect other functions such as pain relief, memory-even blood pressure.

Like a lock that accepts only a certain key, cells of the central nervous system have receptors that accept and respond only to particular endorphins. For example, it appears that one receptor involved in stimulating appetite (called the «kappa» receptor) is designed to work only with the substance known as dynorphin. Dynorphin molecules fit into the kappa receptors. Nerve impulses then travel to the hypothalamus, which interprets and relays them as hunger cues. Appetite is thus stimulated, particularly for sweet-tasting foods.

Scientists soon found that rats given morphine (which increases endorphin activity) and allowed to choose from among the macronutrients tended to increase their fat intake while ignoring the carbohydrates. The investigators then administered drugs known to block the opiate receptors. Doing so, they found, tended to suppress eating. They found the same effect in humans. They then theorized that use of opiate blockers (also known as opiate antagonists) suppresses appetite by producing feelings of fullness or satiety.

But what triggers the release of endorphins in the first place? Further experiments found that food deprivation or stress can play a role. In other words, if you are under stress-pressure at work or school, for example-your body secretes endorphins to control the damage. Some of those endorphins ease any physical pain you might be feeling, while others work to stimulate your appetite, especially for sweet foods. You may respond to these signals from your hypothalamus by gobbling down a slice of pie, for example.

But why should eating sugar help relieve stress? Why doesn’t lettuce (to pick a food at random) have the same effect?

As it turns out, the very act of eating sugar stimulates the opiate-releasing process even further. Not only does sugar make the body release more endorphins, it also enhances the ability of the receptor to bind with the substance-like oiling a lock to make a key work better. Thus, eating sweet foods does indeed relieve stress, producing feelings of relaxation and contentment by enhancing the amount of natural painkillers floating around inside the body.

You might have spotted the flaw in this otherwise tidy little system. Here’s the problem: When a person is under stress, the body releases endorphins that stimulate the appetite for sweet foods. The person then eats a candy bar. The sugar in turn stimulates further secretion of endorphins, triggering greater appetite and leading to more consumption of sweets. Where does the cycle end?

As you might have suspected, it may not end. Theory has it that some people with bulimia might be caught up in the vicious cycle represented by the opiate-receptor feedback loop.

A bulimic will typically skip meals in the belief that doing so will keep her weight under control. But skipping meals only defers appetite; it doesn’t eliminate it. Eventually the urge to eat becomes overpowering, leading to a binge. Food deprivation itself can trigger the release of endorphins, which in turn stimulate appetite. Thus a bulimic who deprives herself of meals causes her body to produce a powerful natural appetite stimulant.

Many a patient reports that her binges occur in times of stress. Research has shown that stress also cranks up the endorphin system. Finally, when a binge leads to consumption of high-sugar items-ice cream, cookies, candy-even more opiates are released, stimulating appetite even further, and the vicious cycle kicks into high gear. For many, the only thing that disrupts this process is a drastic measure: self-induced vomiting.

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Having discovered the secret of calorie-burning chores, Kay Black has never had a trimmer figure—or a cleaner, more organized house.

When Kay, age 55, recalls how she started losing weight, she laughs, «It was an accident.» Not that she didn’t wantto lose weight. Sure, she was carrying an unwanted 60 pounds on her frame; and of course she was tired of being mistaken for her daughter’s grandmother. But she simply couldn’t find the motivation to exercise.

Then Kay decided to organize her family’s books—all 5,400 of them—by cataloging them on her new computer. «I teach college geography, so I do a lot of reading,» she explains. «Besides, my family just loves books.» Each night, she’d carry several armloads upstairs, type up the data, and tote the books back downstairs. She’d stretch for 15 to 20 minutes to prevent next-day stiffness, then take a hot bath. By the time the project was complete, she had lost 5 pounds!

Kay decided that this was too easy not to continue. «Nothing breeds success like success,» she says. She stripped and repainted her daughter’s room and rearranged the attic. She shoveled snow in the winter and turned her garden into a «gym» in the summer. She took up walking, too, usually getting a 40- to 50-minute workout 5 days a week.

These days, Kay is a svelte 112 pounds, down from her heaviest of 172 pounds. Her family’s book collection is as organized as ever. And her house is so tidy that she’s even prepared for unexpected guests.

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