Med Blog

The sleeping pattern begins to change in the first 6 months. This is a time of considerable irregularity, as babies’ neurological systems mature at different rates, but in early infancy sleeping patterns tend to coincide with feeding times — that is, babies wake to feed.

By 6 weeks of age, babies are awake for longer periods during the day, as they begin to take an increasing interest in their environment and interact with their care-givers. By 6 months their sleep is less linked to feeding patterns. Rather than sleeping for most of the time, they are awake for longer periods and seem to have several naps during the day. Some infants, to the great delight of their parents, are already sleeping through the night.

Between 6 months and 1 year of age, sleep patterns change considerably. The typical baby will sleep 10-12 hours at night and have two naps during the day. A greater number of babies sleep right through the night. Some may wake several times but will often go back to sleep with a minimum of fuss. This is also the time when they begin to establish more regular and predictable patterns of sleep and feeding and playing. There is still variation, depending on temperament and other factors. This is also the time when patterns are easily disrupted by illness. Many sleep problems have their genesis during this period, with parents unwittingly interfering with their babies’ sleep cycles, for example waking him for a feed. It is important that your baby be allowed to develop his own sleep patterns with minimal parental interference.

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Nausea is feeling sick in the stomach and we all know what vomiting is!

As with all symptoms, the first thing to do if you develop nausea is to find out the reason for it. Here are some of the many possibilities. Nausea can be directly due to your cancer itself — such as when it is in the stomach area or liver, blocking the bowel or kidneys or in the brain (this last usually causes headache as well). Nausea can be due to cancer treatment — radiation, chemotherapy or too little corticosteroid hormone in the system. Cancer can also cause nausea indirectly, for example, through release of too much calcium in the blood. Anxiety can itself cause nausea and can also aggravate nausea of any cause. Of course, don’t forget that your nausea could be nothing to do with your cancer. For example, it could be caused by something you have eaten, a virus, gastritis, a stomach ulcer, or even a hangover!

It is important to consider every possible explanation. For example, just because you are having chemotherapy, you should not jump to the conclusion that any nausea you have is due to it. Chemotherapy-caused nausea usually follows a similar pattern for each course of treatment. If your pattern changes drastically, another reason should be looked for.

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Is easily broken. This is a common injury following a fall, for instance from a horse. It is recognised by a swelling and a deformity over the collarbone. Often a grating may be felt or a grating sound may be heard when the arm is moved.

Falls on the extended hands of young adults often fracture a bone in the wrist, known as the scaphoid. This will produce tenderness and pain near the base of the thumb. Although the wrist may still be used, this fracture is often missed and is regarded as “just a sprained wrist.”

It is a serious condition and requires at least 12 weeks in plaster. If neglected and not immobilised for at least two or three weeks, the bones may not heal quickly and could require five or six months in plaster, or even an operation at the end of that time.

Elderly people, particularly women, when they fall on the wrist, may break the lower part of the radius, the main forearm bone. This is obvious by the formation of a particular type of swelling at the lower part of the forearm, just before the wrist. It looks like and is in fact called the “dinner-fork deformity.” As the two broken ends may be driven one into the other (impacted), there is often still considerable mobility left in the wrist, and it doesn’t just hang limp. Put the arm in a sling and seek medical aid.

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The drugs need to be taken for as long as a year and the stones may re-form when they are stopped.

The main use, then, of CDC, is in those with cholesterol stones for whom surgery is a considerable risk or who have stones in inaccessible areas such as deep inside the liver.

While the concept of dissolving gallstones is an intriguing idea and seems more attractive to sufferers than operation, it is a possibility for only a few and operation remains the most effective treatment.

Most sufferers lose all their symptoms following removal of the gall bladder and can function satisfactorily. The bile is produced at a constant rate and drips down into the duodenum rather than being concentrated and entering in spurts.

Unfortunately, a few people will not lose their intolerance to fatty food and we are not sure why.

My advice is that, if your gallstones are causing trouble, you will be better if you and your gallbladder are parted.

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Not all lumps in the breast are due to cancer.

A frequent finding, particularly in young women, is that the lump is due to a fibroadenoma.

These are benign, that is, non-cancerous tumors which consist of both fibrous and glandular tissue. They are smooth, hard and freely moveable in the surrounding breast tissue and rarely become larger than a pea.

The doctor may be confident of the diagnosis, yet breast cancer is so common, so feared, and its treatment has such poor results if the diagnosis is made late, that most surgeons agree all breast lumps should be examined.

Small cysts may form in the breast and these can both be diagnosed and treated by inserting a needle into the cyst and withdrawing fluid for examination.

Even before removing what appears to be a benign lump, the surgeon will talk to his patient to find out her wishes should he discover that the tumor is malignant.

The normal procedure is to operate, remove the lump and subject it to frozen section.

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Symptoms are what you feel— things such as pain, nausea, lack of energy and breathlessness. In this chapter we will talk about how to tackle symptoms that worry you for any reason.

Of course, now that you have cancer, I know that every symptom you get will worry you to start with. You probably feel a stab of panic whenever you notice any minor discomfort in your body because this could signal that your cancer is active. This reaction is natural and normal.

I suggest that whenever you get any new symptoms, you stop and ask yourself these questions:

Is this symptom one that I would have worried about before I had the cancer?

Would I have contacted my practitioner about it?

Is there a commonsense explanation for it?

(For example, unusual activity that could have caused muscle pains, something you ate that could have caused nausea or indigestion, tension that could have caused a headache.) The answers to these question will help you to decide what action you should take. For example, if you would, have waited a few days to see how it went before you had cancer, that’s probably still what you should do.

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It was widely (and wrongly) believed for many years that sugar and starchy foods like potato, rice and pasta were the cause of obesity. Twenty years ago, every diet for weight loss advocated restriction of these carbohydrate-rich foods. One of the reasons for this carbohydrate restriction stemmed from the ‘instant results’ of low carbohydrate diets. If your diet is very low in carbohydrate, you will lose weight. The problem is that what you primarily lose is fluid, and not

fat What’s more a low carbohydrate diet depletes the glycogen stores in the muscles making exercise difficult and tiring.

Sugar has been blamed as a cause of people becoming overweight largely because it is often found in high fat foods, where it serves to make the fat more palatable and tempting. Cakes, biscuits, chocolate and ice-cream contain a mixture of sugar and fat. However, the primary sources of fat in our diet are not sweet. Fatty meat, cheese, French fries, crisps, butter and margarine contain no sugar.

Current thinking is that there is little evidence to condemn sugar or starchy foods as the cause of people becoming overweight. Overweight people show a preference for fat-containing foods rather than a preference for foods high in sugar. In a survey performed at the University of Michigan where obese men and women listed their favourite foods, men listed mainly meats (protein-fat sources) and women listed mainly cakes, biscuits, doughnuts (combinations of carbohydrate-fat sources). Other studies have found that obese people habitually consume a higher fat diet than people who have a healthy weight. So, it appears that a higher intake of fatty food is strongly related to the development of obesity—not carbohydrate-rich foods.

Whether you are going to gain weight from eating a particular food really depends on how much that food adds to your total kilojoule intake in relation to how much you burn up. To lose weight you need to eat fewer kilojoules and burn more kilojoules. If your total kilojoule balance does not change—there will be no change in your weight People who consume a high fat diet automatically eat a high kilojoule diet because there are more kilojoules per gram in fatty foods. This is why eating low-fat foods makes weight loss much easier.

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1. Maintenance requirements in a fat loss program may be more demanding and may differ significantly from actions leading to initial fat loss.

2. Energy restricting diets alone should not be used for fat loss over an extended period as these lead to physiological adaptations which can counteract the fat loss.

3. Energy restriction below 1200kcal per day should not be used over an extended period except in special cases of supervised dietary restriction for severe obesity.

4. Except where contra-indicated, physical activity should play a significant role in long term maintenance of fat loss.

5. Resistance training may be indicated in the maintenance stage of a fat loss program to ensure a counterbalance to the adaptations that occur to slimming.

6. Clients who have been on very low energy diets for extended periods may need to be gradually re-fed until daily energy intake is around 1200-1500kcal per day.

7. Clients should be made aware that long term continuous fat losses will only occur with increased changes in energy balance and/or alterations to the type of food intake and energy output.

8. The proportion of LBM to fat loss following a diet is likely to be much higher in people with a lower initial body fat level, hence people who are only mildly overfat and who use dietary restriction alone to treat this, are actually likely to finish with an higher proportion of body fat than at the start of a slimming initiative.

9. Physical activity should form a more significant part of the initial fat loss and fat loss maintenance regimes of those with a relatively low fat to total body mass ratio.

10. Behaviour modification principles utilised for fat loss should be continued in the maintenance stage.

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The process of conversion of fatty acids in the blood stream to triglycerides in the fat cell and back again to fatty acids in the bloodstream is a constant one. The biochemical term for the rebuilding of FFAs into TG in the fat cell is esterification. There is an active cycle of free, or unesterifted, fatty acid uptake into the fat cell which is then re-esterified within the fat cell. Hence there is an ongoing process of lipogenesis, lipolysis and release of FFAs.

Fats which are released into the bloodstream during lipolysis are liberated from their glycerol base and transported to the muscle via the blood to be used as fuel. However, more fat is usually released than is used up. At rest, it has been shown that about 70 per cent of fats released into the bloodstream are re-esterified back into the fat cell, but this decreases to about 25 per cent after the first 30 minutes of a low intensity exercise session. When the exercise is completed, some fats continue to be burned in the recovery process, but about 90 per cent of those released which have not been used up are then re-esterified, and stored back in the fat cell until another day. In exercise then, about one-half of the increase in fat oxidation contributing to the extra fuel supply comes from a reduction of the percentage of re-esterification (fats re-entering the fat cell), rather than an increase in fats being released from the fat cell.

The process of re-esterification may be important for the fat loss process as some studies have shown that the degree of re-esterification, in contrast to the extra fat used up, may be influenced by the post- and pre-exercise meal of the exerciser. Injecting glucose into a fasted subject for example, has been shown to increase the re-esterification of fats back into the fat cell more quickly than it inhibits lipolysis, possibly due to the increase in insulin following a glucose load which then has an inhibitory effect on lipolysis.

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Have you ever wondered how your tummy system works? When you poke something into your mouth it vanishes. We all know that. But vanish where, and what happens to it?

As you probably know, the bowel, or intestinal, system really begins at the mouth. From the mouth is a continuous canal to the far end, to an opening we call the anus. It is actually a single tube which we arbitrarily divide into segments and call by different names.

The oral cavity is guarded by gums and teeth in front, and the tongue sits in the lower part. A baby is born with gums but no teeth in sight. That’s fortunate for the breast-feeding mum. Have you ever thought how terrible it would be breast-feeding a baby with the full component of twenty sharp milk teeth? Ouch! No, several months pass before the baby is endowed with a first set of teeth.

The oral cavity leads directly into the pharynx, passing the two red tonsils on each side, and the pharynx gives way to the oesophagus, or food pipe. This leads to the stomach via a small valve.

Digestion starts when food mixes with saliva in the mouth. But in the stomach it receives a major boost—the wall is lined with many glands which pump potent acid and some other digestive chemicals, called enzymes, into the mass of food. It tends to become a mixed-up mass, largely fluid in nature.

The stomach is merely a dilated part of the bowel. It houses the food until the valve at the far end allows it to pass into the next part, called the duodenum.

At regular intervals, the stomach valve (called the pyloric valve) opens and the fluid starts its long trek down the bowel. Firstly it traverses the duodenum, which then leads into the small bowel (firstly named the jejunum, and later the ileum) Here various extra enzymes are added, and much of the nutritional elements of the food is absorbed by the bowel wall for use in the body.

At the far end of the small bowel (named ’small’ not because of its length, for it is very long, but because it is narrow in diameter), it dilates into an area called the caecum. This is where the small bowel connects to the large bowel (‘large’ because it is very wide in diameter, although it is quite short in length, in contrast).

Here the appendix occurs as a small worm-like organ (about the thickness of a pencil). It has an opening where it joins the caecum. It is several centimetres long and has a blind, closed far end; if its opening, or mouth, becomes blocked then trouble looms, for germs can easily establish a foothold and set up an acute infection which we refer to as acute appendicitis.

In the large bowel, fluid (mostly water) is reabsorbed by the walls, making the contents much firmer. From the large bowel, the canal continues as the rectum. There, in the rectum, the residue of the bowel contents is stored until a suitable time when it can be passed. When this occurs, it gently passes down a much narrower tube, called the anal canal.

At the end of this is a valve, called the anal sphincter. When this releases, the final, unwanted debris is expelled from the digestive system via an aperture called the anus. Afterwards, the valve re-closes, and stays closed until another bowel movement is made.

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