What is it?

Cystitis is an inflammation of the lining of the bladder. More than half of all western women suffer from it at some time in their lives, and some do so repeatedly. Although cystitis is unpleasant it is not dangerous and can be prevented much of the time if you know what to do.

What causes it?

• Bacteria which normally live in and around the bowel opening can find their way up the urinary-passage and into the bladder. This happens very easily in women because the passage is very short. The germs multiply inside the bladder, irritate it and make the woman want to pass water frequently, often with a burning sensation.

• Friction along the urinary passage during sexual intercourse. A woman who is insufficiently aroused produces only a very small quantity of natural secretions in her vagina. Her partner’s penis then causes too much friction and ‘milks’ germs up her urinary passage and into her bladder. Also, some women’s bladders are directly bruised by their partner’s penis in certain intercourse positions.

• Allergies are an uncommon cause. Some women are allergic to vaginal deodorants, perfumed talc and so on.

• Irritable bladder. A few women have exceptionally sensitive bladders.

• Anxiety or depression. Some women who are depressed or who are having relationship or sexual problems develop cystitis. This often removes them from the sexual arena altogether-which may be what they unconsciously desire.

• Coffee, tea and alcohol can cause cystitis in some women.

Prevention

• Eat a healthy, balanced diet low in refined foods and high in fruit and vegetables and cereal fibre. This, in itself, will help prevent infections.

• Drink plenty of fluids-about 3-4 pints a day. This flushes out germs and keeps your urine dilute.

• Don’t wait until you are bursting to pass water. Get into the habit of going before you leave on a journey or go somewhere where you will not have access to a lavatory. Avoid hanging on until you can’t wait any longer.

• Ensure that you empty your bladder fully. Don’t rush off the lavatory-give yourself time.

• If you think your cystitis is related to sexual intercourse here are some things to do.

1. You and your partner should wash your genital areas beforehand.

2. Your partner should spend more time in foreplay to arouse you better.

3. Pass water before and after sex.

4. Use KY jelly or a similar bland lubricant if you don’t produce enough natural secretion yourself. These are available from chemists.

5. Avoid intercourse positions that seem to cause bruising of your bladder.

• Get into the habit of wiping your bottom from front to back, to avoid dragging germs from your bowel opening to your vaginal area.

• Wash your vaginal and anal area every morning and evening, even if you don’t plan to have sex. Get into the habit.

• Never use vaginal deodorants, perfumed soap or talcum in the vaginal area.

• Avoid coffee, tea or alcohol if they seem to make you worse or drink them very dilute.

• Avoid wearing tights-change to stockings. Never wear jeans or tight, airless trousers. Wear cotton, rather than man-made, panties.

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Publication of scientific information

This criticism is of a minor nature really, but it is worthy of consideration. It is about something which occurs in many walks of life and in particular in professional circles.

When scientific research work is done that results in) information which is valuable in a particular field, it is usually written up in a specific way and submitted to a journal 01 magazine for publication. This is one of the recognized ways of spreading scientific information. Quite often papers of this type are presented by their author at appropriate conferences^ throughout the world.

But, when papers are submitted, there is a tendency for two things to happen. One is that the prestige, rank or name of the author within a particular field is often very influential in having the paper accepted by a journal. Thus, the situation can arise where a person of high standing in the scientific world will have a paper accepted for publication that may be of very little value or significance. This can happen: everyone is subject to human weakness and error. On the other hand, a brilliant paper by an unknown person working in the same field may not be published because the person working the same field may not be published because the person is unknown; because the distinguished author of the other paper might be embarrassed by the content of the unknown author’s paper; or simply because only one paper on this topic can be accepted for some reason, and in this case, obviously the distinguished author gets in. Furthermore, the rank or rating of the particular journal in which an article appears can be regarded as an indication of the quality of the article. The same situation can arise here whereby a ‘distinguished author might have work accepted for a top-rated journal whilst someone of no standing, but who has done excellent work, might not even be considered. The result can be that the good work is published in another journal of lower standing.

It is not being suggested that these happenings are regularly occurring, simply that the principle exists and occasions arise where it can happen. The obvious answer is for thorough evaluation of all work submitted on a particular topic without regard for the ’standing’ of the author. Obviously the accuracy or reliability of work reported would have to be verified but, and this is important, this factor should not be influenced by the source of the report.

The attitude of the doctor

Before getting on to the direct criticism of some of the techniques used in assessing the value of treatments, we might consider another everyday matter.

There are occasions when people suffering from chronic conditions are told by their doctor that there is no cure for their condition; that they must expect such things at their age; and that they will have to learn to live with it. Some doctors also believe, and tell their patients so, that the best way to deal with the situation they find themselves in is to accept it and not fight it. Admittedly, in partial support for the last suggestion, there is some evidence to suggest that conservative management of the disease may result in a better long-term result than would be achieved by intensive drug therapy. However, the conservative therapy requires correct doctor and patient attitudes. It does not necessarily have to include a negative approach to the problem. It is this attitude as part of the therapy, not the type of therapy that is under criticism here.

A quotation from a doctor reads: ‘In discussions of the, treatment of rheumatoid arthritis it is seldom sufficiently stressed that rheumatoid arthritis is an incurable disease. There is no agent which will significantly alter the course of this disease over a number of years.’

What a statement to make, and why make it?

First of all, the statement is not accurate. If it had to be said in this way then it should have read: ‘There is no agent known at present which will significantly alter the course… Secondly, the disease is only incurable until something is found to cure it. Thus, it seems completely unnecessary to be so pessimistic and thus so depressing. Even if the statement were accurate it is unnecessary. It cannot do anyone any good at all to have this sort of statement made to him or her, and it may well do harm by creating a stress factor if said to à patient.

It is respectfully suggested that a truthful, but positive and encouraging attitude by the doctor will be beneficial in helping the patient with any type of therapy. This factor has been demonstrated ’subjectively by the reports of people who have been on mussel extract treatment. There have been those who have been on this treatment on the recommendation î their own doctor. Someone else may have noted the benefit they have derived and decided to ask their doctor if they should also try it. The responses have ranged from open-minded agreement to blinkered antagonism.

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Although lymphoedema cannot be cured once it has developed, the arm-raising exercises can help to reduce the swelling and to prevent it getting worse. It may be controlled by a combination of regular, gentle exercise, massage (which you will have to be taught), general skin care and, when appropriate, by the wearing of an elastic compression sleeve. Although you can carry out most of the measures to control lymphoedema yourself, you must ask your doctor’s advice before starting any form of treatment.

*      Skin care. Germs can enter the body through dry, cracked skin, and you should therefore use a simple moisturizer after every bath. If your skin has become very rough, your doctor will be able to prescribe a special cream to treat it.

You should always protect the hand and arm on your affected side from injury and possible infection, for example by wearing gloves while you are gardening or using strong cleansing agents, and a thimble when sewing. If your hand or arm is cut or grazed, however small the injury, make sure it is thoroughly cleaned, treated with antiseptic, and covered with a clean dressing. If persistent inflammation or swelling follows an injury of this sort, ask your doctor’s advice as soon as possible.

Blood pressure measurement, blood tests and injections should be done on the other arm whenever possible.

*     Movement and exercise. Gravity tends to cause the lymph to pool, and its effect can be counteracted by raising the arm whenever possible. This can be done by resting your affected arm on a cushion – on the arm of a chair when sitting, and beside you when you are in bed – so that it is above the level of your heart.

Although too much exercise will cause the swelling to increase, gentle regular movement of the arm helps the lymphatic fluid to drain away. The exercises described above should be done gently at least once a day, while wearing a compression sleeve if you have one.

*     Massage. Massage of the affected arm and armpit, as well as of the lymph glands in the neck (and of the chest if fluid has started to accumulate here), will help lymphatic drainage away from the arm. A nurse or physiotherapist should be able to advise you about this, as specific lymph drainage massage must be done to ensure that it is effective. Massage clears the way ahead of the swelling so that fluid can drain from the swollen area. It should be gentle but firm, just enough to move the skin.

*     Compression sleeves. In some cases of lymphoedema, an elastic compression sleeve may be worn which prevents fluid building up in the arm and provides support to the muscles. These sleeves can be obtained from a hospital appliance officer, to whom you must be referred by your consultant or breast care nurse.

Compression sleeves should be put on in the morning when the swelling is least, and can be removed at night. Moist skin makes them more difficult to apply, and it is therefore best not to have a bath immediately before fitting your sleeve. Once the sleeve is on, it should be smooth and creaseless. It should never be rolled back as it will act as a tourniquet. The elastic gradually loses its strength and the sleeve will need to be replaced every 3 to 4 months.

It is important that you wear your elastic sleeve in hot weather, even though it may be uncomfortable, as this is a time when your arm is likely to swell.

*     Compression pumps. The use of a compression pump is not always suitable in every case; your doctor will be able to advise you about this. The pump is attached by a small tube to an inflatable cuff, and is powered from the mains electricity. Air is pumped in to inflate the cuff and is then gradually sucked out to deflate it again. The effect is a gentle squeezing of the arm which assists the drainage of lymph away from it. Compression pumps are normally used at regular intervals throughout the day to help reduce swelling.

Your pump should not be used if you have an infection in your arm, swelling in your chest, or if it causes pain.

If you are attending a lymphoedema clinic, your progress will be regularly monitored and you will be given advice about all the measures you can take to help control the condition.

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Making the decision about which treatment you will have is often difficult. You should allow yourself time to explore the options to make the decision that is right for you. Do not allow yourself to be pushed by others into making a decision.

In order to make the best decision you need to consider your lifestyle, goals, values and feelings, as well as the severity of your disease and its symptoms, and the purpose of the treatment. You also need to weigh up all the potential advantages and disadvantages of each of the treatments against the possible relief that it will bring.

Get as much information as you can. Make an appointment with your gynecologist to ask any questions that you may have.

Do not hesitate to get a second opinion if you have any concerns or doubts.

It helps if you discuss the issues with your partner, a friend or another woman with endometriosis.

No treatment offers a magical or permanent cure for endometriosis.

It is not possible to give reliable figures for the success rates of the different types of treatment because few large-scale studies have been carried out. Gynecologists believe that, overall, success is related to the severity of your condition: the milder your disease the more likely that your treatment will be successful. Nevertheless, there is a wide variation in the way women respond to treatment and it is not possible to predict how you will respond.

Women react differently to each treatment and you may find that you need to try two or three treatments before you find one that works for you.

Regardless of the type of treatment used, some women will have a recurrence of their symptoms. It seems that approximately 20% of women will have a recurrence within 12 months and as many as 50% will have a recurrence within five years.

Anne’s story

Diagnosed with endometriosis at the age of 2 7, 1 was told that the best treatment was to take the male synthetic hormone, Danazol. I had to take 600 milligrams a day for nine months. I was a little apprehensive about taking Danazol but realized that not all women suffered the side effects that I had read about. I decided that if the Danazol was going to get rid of the terrible period pain I was suffering every month then I was prepared to take the tablets.

Every day whilst on the medication I looked for side effects from the drug. I jumped on the scales every morning to see if I had gained weight. I peered in the mirror to see if I was growing a beard and I inspected my skin to make sure I wasn’t developing acne.

I was surprised that I actually felt good during the time I took Danazol. For the first time that I could remember my whole life didn’t revolve around my menstrual cycle. No periods and no pain for nine months was sheer bliss. I did develop a few side effects, but the relief I obtained from the pain far outweighed the side effects.

I gained about six kilograms in weight. This gain appeared to be more a body building, muscular weight increase which didn’t bother me. I experienced some nausea and occasional vomiting but it wasn’t a major problem.

The only other side effect I experienced which, unfortunately, has been irreversible was a deepening of my singing voice. My upper range decreased four tones. Luckily, I am not a professional singer but I still get frustrated occasionally at the change. At the end of the Danazol treatment, a laparoscopy revealed no evidence of endometriosis and I subsequently had two children. Seven years later I had another laparoscopy and was again diagnosed as having endometriosis.

This time I took the trial drug Buserelin, one of the GnRH agonists. It was in the form of a nasal spray. I took the drug for six months and during that time had no side effects. I had been told by my doctor that I might experience hot flushes, dry vagina, depression or headaches. Luckily, I didn’t experience any of them. Another laparoscopy at die end of the Buserelin treatment revealed that apart from one endometrial cyst, the endometriosis had disappeared.

Six weeks after this laparoscopy I was back in hospital having the cyst and left ovary removed. Although I was a registered nurse and familiar with hospital environments, I was still nervous at the prospect of major surgery.

I need not have worried – everything went according to the plan my doctor and I had discussed. I had a continuous morphine infusion for the first 24 hours after the operation – it was great, I experienced very little pain. I was up walking around the day after surgery and drinking and eating the day after that.

I was discharged from hospital five days after the operation and was back at part-time work and playing sport six weeks after the surgery.

Three years later I feel great. I still get some ovulation and period pain every month, but nothing like the severe, debilitating pain I experienced before I had treatment.

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The aim of any therapy is to help the patient return to a normal life. The anorexic needs to learn there are ways besides starvation to cope with the problems of growing up.

The first step is to return the patient to a healthier physical condition. The patient is not likely to benefit from psychotherapy if her starvation is too severe.

Let’s digress for a minute to look at the difficulties that starvation itself (that is, starvation not necessarily caused by anorexia) can cause. In a famous study by Ancell Keys at the University of Minnesota, thirty-six carefully screened normal males voluntarily decreased their food intake over six months. They each lost an average of 25 percent of their original body weight. The experimenters monitored their progress carefully.

The symptoms produced by starvation were the same we now know as the classic symptoms of anorexia. The men became preoccupied with food-reading cookbooks, collecting recipes, dreaming about food. They reported more depression and noticed that their ability to concentrate was impaired. They developed bizarre eating habits, such as mixing unusual types of foods together, creating superstitions surrounding certain foods, or stretching out their meals for extended periods of time. They noticed increased irritability, difficulty sleeping, a loss of interest in sex, and social withdrawal. After the experiment ended, a few of the men actually went on to become chefs.

The Keys study reveals why restoring weight is such a priority for treatment of anorexia. Extremely low weight, no matter what the cause, results in such severe disturbances in thinking and feeling that any form of therapy is unlikely to be successful until there is some degree of return to a healthier weight. Additionally, in some ways anorexia represents a phobia about mature body weight. As with other phobias, the fear won’t go away until the patient confronts the things she fears most.

Once weight increases to a healthier level, we can start to address other aspects of the illness. We now begin to resolve the underlying psychological issues that contribute to the disorder. The task involves showing the patient how to accept herself and like herself. We help her build a new identity that isn’t based solely on her ability to starve. In so doing, we loosen her grip on childhood and help her make the passage into adolescence and adulthood.

Through family therapy and social-skills training, we work to improve the patient’s relationships. Anorexic girls are so focused on themselves and on their condition that they lose the knack of dealing with other people. They are scared of reaching out for fear they’ll be rejected. As her peers grow and mature, the anorexic is left behind and now has a lot of catching up to do. Treatment focused on social-skills training can help.

*56/35/5*

For years, Sonia Turner went to bed wanting to lose weight and woke up wanting to lose weight.

“Desire wasn’t the problem. What I lacked was the belief that I really could lose weight,” recalls Sonia, a 43-year-old real estate agent from Timmins, Ontario. “I decided that before I could change my body, I had to change my way of thinking.”

In January 1997, when she weighed 285 pounds, Sonia started a scrapbook called My Dream Book. In it, she pasted images of people exercising, news stories of folks overcoming adversity, and, most significant, a photograph from her husband’s company newsletter showing a trim-looking, smiling couple at a Christmas party.

Sonia and her husband hadn’t gone to that party. “I wanted to stay home because I was embarrassed,” she says. “I cut out that picture and said, ‘Next year, we’re going.’

For several weeks, Sonia listened to motivational tapes and poured over the classic book The Power of Positive Thinking. Finally, she felt ready to address eating and exercise.

Sonia wanted a plan for life, not just a diet. She evaluated her eating habits and started making more sensible food choices. She took up walking, and as the pounds came off, she graduated to jogging. She also signed up for TOPS (Take Off Pounds Sensibly), which provides group support to its members.

By the time the holidays rolled around, Sonia had lost 135 pounds. She and her husband went to the company Christmas party and danced the night away.

Now, her sights are set even higher: She wants to run a marathon. “To be able to run is an unbelievable experience,” she says. “I just fell in love with it.”

Her dream book remains central to her motivation. Only this time, it’s packed full of pictures of runners crossing the finish line.

WINNING ACTION

Learn how to believe in yourself. Not ajl of us grow up with a positive sense of self or the belief that we can get what we really want. Sometimes, we have to learn those important lessons from others. Some of my favorite sources of motivation are Anthony Robbins’s Awaken the Giant Within, Oprah Winfrey’s Make the Connection, and Jon Kabat-Zinn’s Full Catastrophe Living. And like Sonia, we should go ahead and dream. After all, dreams do come true.

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