HIV INFECTION AND ITS EFFECTS ON THE EMOTIONS: FATIGUE AND ACCOMMODATION-ACCOMMODATING TO FATIGUE

June 20, 2011

Fatigue is an integral part of this infection. Whether its cause is psychological or physical, fatigue cannot be ignored. First, talk to your doctor: some medications can counter fatigue. The best way to deal with fatigue may be to accept it and go on from there. Decide what you want to do most, be sure it is possible, plan it out, and pace yourself. When Dean wants to go to a concert on Thursday, he begins resting on Tuesday and takes off Friday and Saturday. Lisa’s husband stayed in the community theater but tried out only for small roles. Steven gets up late, goes to work late, and goes home early. Dean kept his job but cut back his hours and tried to have meetings in his office rather than in offices across town.     Try to plan things that can, if necessary, be changed or postponed. Dean’s long-time partner helps him in this: “We deal from day to day. We don’t look ahead because the illness is so powerful and changes at any time. Plans for one day can easily be impossible, so we just do what we had planned a few days later.” June’s son had planned a trip to Europe in great detail: reservations for travel and for hotels, sites to visit, places to eat, tickets for everything. When he realized he was too easily fatigued to go, he planned another trip, in the same detail, to a part of the United States he had always wanted to see.     Know what times of the days you have most energy, and plan accordingly. If possible, cook and eat at those times when you have energy: food is the body’s best source of energy. Otherwise, use those times of the day for things you want to get done, things that will give you a sense of accomplishment. Alan schedules appointments for late morning or over lunch. Lisa’s husband asked the community theater to change rehearsal times to early evenings, when he had more energy; the theater was happy to accommodate him.     In general, try to find ways to accomplish what you want with less energy. Lisa’s husband’s fatigue also affected their social life: “Socially, we didn’t go out as much. But then we redefined ‘socially.’ Instead of going out drinking and dancing, we entertained at home. Our social life didn’t disappear.” People who find driving tiring can often take public transportation. Or they consolidate several trips into one, or ask their friends to drive them. When they want to buy clothes or household supplies or presents, they order from catalogs. Catalogs from large department stores have enormous selections of everything from shampoo to shirts to lamps to sheets. To buy groceries, they find a store that delivers, or ask their friends. They get their medications from pharmacies that deliver.     If cooking is tiring, buy foods that are prepared or that can be micro-waved. Try cooking a large amount of food and freezing what you don’t eat. Spaghetti sauce, chili, pot roasts, stews, and soups all taste good made in large amounts and reheated, and they freeze well. If eating is tiring, use nutritional supplements that come as powders and are mixed with milk. Or make a nutritional supplement out of milk, ice cream, and fruit mixed in a food processor. Alan used to do all the cooking, and he still does most of it, but when he is tired, Alan says, “My partner offers to do parts of the meals. He makes great desserts.” Helen does the dishes immediately after eating; she finds that less tiring than letting them stack up and doing several meals’ worth at once. She keeps a chair in the kitchen for when she needs to rest. Dean keeps a chair in the shower, and sometimes he showers sitting down.     Cleaning services may not be prohibitively expensive; friends might help with cleaning too. To minimize what must be cleaned, try consolidating your living into one area or one floor. Make a bedroom on the first floor, or turn the bedroom into a living area. Consolidating your living also saves steps. Put a dorm-sized refrigerator next to your bed for juice or fruit. Keep the phone near your bed.     Wear clothes that are easy to wear and to care for: jeans, knitted shirts and pants, sweatsuits, clothes with elastic waists and no buttons, clothes that can be washed and dried easily and do not need ironing. Alan used to do the laundry alone; now he and his partner do it together. “I don’t get as tired,” Alan says, “and it’s more fun that way.”     If several friends or relatives have offered help, do not be shy about accepting it. After all, you need the help, and if circumstances were reversed, you would want them to accept your help. Try making lists of things you would like help with. Perhaps one friend would not mind regularly watering plants, another might feed your cat, another might help with the laundry.     Fatigue often makes paying bills particularly onerous. Friends can help with regular bills; they can write the checks for the mortgage, rent, utilities, taxes. Some banks will deduct payments for monthly bills directly from your banking account.     Do what you can; don’t give up before you need to. June worries that people give in too soon to their fatigue, and then they miss doing what they are capable of doing. When June is not at home caring for her son, she visits other people with AIDS. “Some are tired and giving up,” she said. “I say to them, ‘Don’t tell me you can’t go out next Wednesday. This is only Sunday. How do you know how you’ll feel on Wednesday? If you think tired, you’ll be tired.’” Steven says, “I keep pushing myself. I do wake up tired and don’t like that. I make myself get up. I get out of that bed.” Alan agrees: “The main thing is that I not feel like an invalid. I still cook, even though my partner helps out a lot now. But I still cook.”     If you know you’ve done your best, then relax and rest. Try not to let fatigue affect your good opinion of yourself. You’ve done what you could.
*73\191\2*

IBS AND CANDIDA ALBICANS: CANDIDA – WHAT CAN HAPPEN AT THE DOCTOR’S?

June 12, 2011

Scenario a)Patient: Doctor, my bowel is worse. I’m so bloated and not sleeping; it’s getting me down. There was a bit in a magazine about a fungus in the bowel called Candida; could it be that?Doctor: You worry too much, Mrs Lamb – and don’t believe all you read in magazines. No, Candida is only a problem in the vagina and in babies’ mouths. Have you had any more thoughts about a part-time job?Scenario b)Patient: My bowel is getting worse. I had afternoon tea with a friend and I blew up like a b»alloon. It is always the same if I eat bread or anything sugary. I try to keep off these things but I get such a craving for them. It’s like needing a drug. You can see how much weightI have put on. There was a doctor on the radio saying that sugar craving can be sign of thrush in the bowel; could that be my trouble?Doctor: Well it’s possible. We could try you on an anti-fungal drug for a couple of weeks to see if it helps.Scenario c)Patient: Doctor I’m really depressed with this bowel trouble. My diet is becoming very restricted, I am always tired and I have lost a stone in weight. Do you think it could have anything to do with this? (She produces an article on Candida).Doctor: I’m certainly seeing a big increase in fungal infections, so it’s a possibility. Let’s see, yes, you had antibiotics for that septic toe and you have had three prescriptions for pessaries for thrush this year. It could well be a fungal problem. Patient: Will I need more tests?Doctor: There isn’t a reliable test for overgrowth of bowel Candida. Patient: Can you send me to a specialist?Doctor: I’m afraid not; there are very few doctors in the Health Service who deal with problems like this. You could see a clinical nutritionist privately, but it could be costly. The alternative is for me to start you on a course of a drug called Nystatin. It has been around a long time and is quite safe but, to be honest, a lot of people do not tolerate it well. It can kill off the yeast cells too quickly and the poisons from them can make you feel pretty rotten.Patient: I will gladly put up with being off-colour for a couple of weeks if it will clear this bowel.Doctor: No, you would have to be on it for several months. I think the best plan would be to see if I can get the pharmacist to order one of the newer anti-fungal substances. They are from plants and seem to work well. You will have to keep to a diet and look after yourself a bit more; you try to do too much.*71\326\8*

CANCER IN FEMALE REPRODUCTIVE ORGANS: UTERUS CANCER

June 1, 2011

The main function of the body of the uterus is to provide a suitable environment for a growing embryo and fetus. Under the influence of a huge increase in the amount of oestrogen and progesterone the uterus grows from an organ of approximately 7-8 cm long in the non-pregnant stage, to an organ that reaches from the floor of the pelvis to the diaphragm when carrying a fetus. It surely is one of the miracles of nature that this hugely increased size goes back to normal within a week or two following delivery of the baby!
Cancer of the Uterine LiningCancer of the body of the uterus can develop in the lining of the uterus (‘endometrium’) or in the muscle (‘myometrium’.) Endometrial cancer is the most common gynecological cancer in women worldwide. There seems to be two types of cancers that can affect the uterine lining. The first – being the more common and found in up to 70% of cases – is due to an excess of oestrogen or to oestrogen which is not balanced by progesterone which takes place when ovulation does not occur. The second type, which is oestrogen independent, is much more aggressive and spreads more commonly to lymph glands and elsewhere.Type I Endometrial Cancer (a cancer that affects the lining of the uterus) occurs particularly in women who are overweight. Over 80% of endometrial cancers occur in women who have entered the menopause.When the ovaries eventually give up growing follicles and producing eggs at menopause, the amount of oestrogen and progesterone falls to between one-tenth and one-twentieth of that seen in younger women. Furthermore, the oestrogen in the menopause is ‘oestrone’ which is much less powerful than the oestrogen produced by the pre-menopausal ovary. The source of this oestrone in women following menopause is mainly from body fat. The body fat converts prehormones, particularly male hormones, into oestrone. Therefore the more fat a woman has, and then the more conversion of these hormones to oestrone takes place. So that, if a woman is double her ideal body weight, she produces more than double the amount of oestrogen. Since there is little or no progesterone around to counteract this oestrogen, then the oestrogen acts on the lining of the uterus to cause it to grow, to become thicker (‘hyperplasia’) and to eventually develop a cancer. These cancers are usually similar when seen under the microscope to the normal lining of the uterus and only in about 10% of cases do they invade deeply into the muscle.The other causes of this excess oestrogen situation include tumours of the ovary; taking oestrogen for hormone replacement without the addition of progesterone, and diabetes mellitus – in which more of the precursors are converted to oestrogen. The use of Tamoxifen, although an anti-oestrogen commonly used in breast cancer, also has paradoxically oestrogen-like effects on the uterine lining and doubles the risk of uterine cancer developing.The second type of uterine cancer, when seen under the microscope looks quite different to the normal uterine lining. These cancers, which may be confusing to understand, but which doctors may refer to as ‘poorly differentiated cancers’, ‘papillary serous cancers’, ‘adenosquamous cancers’, and ‘clear cell cancers’ can spread very rapidly, and often invade deeply into the muscle or spread outside the uterus. These Type 2 cancers are stimulated by abnormalities in the genes that control the growth of the uterine lining, but what causes these gene changes is currently unknown.*1/144/5*

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