Antidepressants Blog

•     Keep the number of sex partners you have down to a minimum. You can never tell if someone has herpes-until it’s too late.

•     Avoid public lavatories if possible. Some recent work has shown that herpes virus can survive on lavatory seats for a number of hours and on cotton gauze for 72 hours.

•     If someone has sores of any kind, skin contact should be avoided. The sufferer from recurrent herpes should not have intercourse during an attack. Many people with recurrent attacks have a warning when one is about to occur. This varies from individual to individual but can be an itch, tingle or burning in the genital area. This type of sensation rules out sex until the sores have healed. These precautions also apply to kissing (not just on the genitals) someone with a cold sore on the lips.

•     Oral sex increases the risk of getting genital herpes because the mouth is such a reservoir for the virus. Some people overcome this by using a sheath on the man before fellating him. Unfortunately, although this confers some protection it is not totally safe because the pores in the latex of the sheath are larger than the herpes virus and some could pass through.

All of this may sound daunting but in fact the risks involved in sexual activity between individuals who have no sores are very small indeed. Unfortunately, lesions inside the woman’s vagina or on her cervix are not visible and it can be impossible to know if she is ’safe’.

•     Vaccines are being researched but so far the outlook is not very encouraging and experts think that a safe, effective vaccine is a long way off, and possibly may never be found.

•     Wash your hands thoroughly with soap and water after touching the sores.

•     Don’t share towels-it is just possible to pass the virus to someone else via a towel.

•     Never use saliva to wet your contact lenses.

•     Not everyone who has one attack of herpes goes on to have another-about half of all sufferers never get another attack. Keep a record of when you have your attacks (if you have them repeatedly). You may find that you get them under specific conditions. These can be avoided, at least to some extent, to prevent more attacks. Here are some conditions that some people find make their herpes worse or brings on an attack:

1. Tiredness or stress.

2. A particular time of the menstrual cycle.

3. Friction from intercourse or masturbation.

4. Sunlight and sun beds.

5. Tight clothing.

6. Nylon knickers.

The avoidance of any or all of these will help prevent herpes in at least some people.

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Preparation: Preparing patients for the group experience is absolutely crucial. Half an hour spent explaining what to expect and how the group operates can mean the difference between success and failure. I tell patients that group therapy will give them a chance to see others express all kinds of feelings-positive and negative-and will provide feedback and encouragement. Therapy helps fight the feeling of isolation, that the patient is battling alone.

Group therapy is a challenge. Patients may feel bewildered at times. Change takes time-longer, perhaps, than they may think. They may feel discouraged. The rewards, though, can be great. They will enjoy a rare opportunity to have their thoughts and feelings recognized and accepted by others. This in turn will lead to new feelings: trust, closeness, and the sense of emotional support.

Early sessions: Patients introduce themselves and describe their experiences. Soon they find things in common-friends, feelings, even symptoms. I encourage these links between people, but at the same time work to draw in other members who may feel different or left out. All patients should have a chance to speak during the session, and there should be time at the end to discuss their reactions to the group experience.

Usually a patient is surprised to hear that other people share her thoughts or feelings. She may be surprised to hear girls (who even she can see are emaciated) stating that they feel fat.

Hearing someone express self-hatred or disappointment can stir up similar feelings in another patient, making her painfully aware of emotions she didn’t know she had. That’s the downside of “getting in touch with your feelings”-you may not like what you find. Patients may want to run away from this experience – and thus the group- to avoid dealing with it. But recognizing and talking about these feelings reduces their impact. I encourage patients to keep attending even if they are not yet able to express their feelings to the group.

A therapist in an eating disorder group, unlike the leaders of other types of groups, will usually encourage contact between members outside of the session. At the first meeting, patients exchange phone numbers; we encourage them to call each other as an alternative way of coping with their urge to binge or starve.

Later meetings: At first, patients may tend to direct their thoughts and feelings to the group leader. Eventually, though, patients speak more freely to each other. When that happens, the impact can be enormous. As one patient told me, “I couldn’t believe it-I gave someone in the group some advice and she actually took it! I really felt worthwhile for a change!” For many patients, such an experience may be the first time that something she says is listened to and treated as being of value.

Though each group is different, common themes emerge. At first, talk of eating behavior may dominate the scene: “I’ve forgotten how to eat,” “I don’t know what to eat or how much,” “I’m afraid that if I start to eat again I won’t know when to stop.” As time passes, other themes appear: assertiveness, the fear of displeasing others, anger, isolation, emptiness, and hopelessness.

Eventually patients explore broader issues, such as family relationships or the role of women in society. The issues vary depending on the age and background of the patients. While younger patients generally deal with problems of sexual maturity and the frightening path to adulthood, older patients may be wrestling with unstable marriages, child-rearing problems, or career choices.

As group therapy progresses, so do other forms of treatment. For example, patients often use their individual sessions to discuss feelings that emerge during group.

Progress in group therapy means symptoms grow less severe. Patients report that they have gained weight, their physical strength has increased, and they feel less bothered by cold. Success reinforces their commitment to therapy and gives others hope and encouragement.

Termination: Bringing group therapy to an end can be tricky. Groups stop meeting for many reasons: They reach the cutoff point agreed to earlier; the therapist leaves; members drop out. Leaving the group can be a sad and difficult time for some patients.

For each patient, leaving the group is a mixed blessing. On the positive side, it means stepping into the future armed with self-awareness. On the downside, some patients leave before they’re really ready, or they leave to avoid digging any deeper into their disorder.

Terminating therapy is easier if the group has been open-that is, without a fixed time frame or membership roster. In an open group, patients leave only when they feel ready. Leaving is a decision they make for themselves, a step toward autonomy. An open structure might mean a member can return to the group if she finds she needs further support.

Problems: The biggest problem with group therapy is the high dropout rate. The same factors that cause patients to drop out of any therapy group also affect eating disorder patients. These factors, as identified by Dr. Irving Yalom, include denial, low motivation, feelings of inadequacy, social insecurity, and fear of other people.

There may be external factors as well. The patient may be afraid to ask permission to leave work to attend a session, or her school activities may conflict. Sometimes her reluctance relates to difficulties with assertiveness or excessive rigidity.

Competition is often a problem: Patients may vie with one another to see who can be thinnest in the group. Members need to confront such rivalry directly and work through the problem during group discussions. Also, in individual therapy the patient has the therapist all to herself. Not so in a group. Sometimes patients feel they must compete for the therapist’s time and attention. If they fail, they feel inadequate or worthless.

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Kym Hubert lost 85 pounds, but not until she finally threw out the scale that had become her obsession. Kym, of Chino Hills, California, had struggled with her weight for 20 years—a consequence of her preference for fatty foods (chocolate milkshakes were her favorite). In 1991, she joined a weight-loss program that required daily weigh-ins. After 4 months, she dropped out, discouraged. But she didn’t get rid of the scale.

Soon, Kym was weighing herself three times a day: in the morning after she got out of the shower (to see if she had lost weight overnight), before dinner (to see if she had lost weight during the day), and before bed (to see if she had gained weight during dinner). Unfortunately, her scale seldom showed good news. By June 1997, she weighed 245 pounds.

Desperate to help Kym overcome her obsession with her weight, her husband smashed her scale. At first, she felt exasperated and frustrated. “It was sort of like having your addiction taken away from you,” she says. “I became very depressed about my weight.” But eventually, she was able to refocus her energy on a new interest: walking.

“My husband, who’s a runner, belongs to a group that includes runners and walkers. He kept asking me to join the walkers in the group,” she recalls. “I finally decided that I could sit either around and stay depressed or try something that might bring my husband and me closer together.”

On her first outing with the walkers, Kym trekked 1 miles. She hurt afterward, but she agreed to meet the group the following Saturday. Pretty soon, she was also walking 3 nights a week, either with her husband or a girlfriend.

By April 1998, Kym felt fit enough to add running to her fitness program. In October of that year, she joined a gym and weighed herself for the first time in months. She had lost 80 pounds, thanks largely to walking and running. And, as a bonus, she says, “My relationship with my husband has improved 1,000 percent. We’re spending more time together, and I’m not feeling depressed anymore.”

Today, at age 41, Kym is more concerned about how she looks and feels than how much she weighs. She’ll never again use a scale to measure her success.

WINNING ACTION

Stay off your scale. When you’re trying to slim down, don’t rely on your scale to measure your success. Because muscle is heavier than fat, your weight may not change much as you become more fit. Instead, some experts recommend using your clothes as a guide. Do your shirts and ST pants feel looser? Do you have more room in the waist? If so, celebrate. That’s the sign that you’re making progress.

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- Will Medicare cover all my menopausal tests and treatments? Medicare covers all investigations except bone density scans, and this may change in the near future.

- Can premenopausal women increase their bone strength? The reason I ask is that my bone density is low, possibly due to a time many years ago when I was anorexic and didn’t have periods for over a year.

You are right in thinking that your low bone density probably relates to the time when you were anorexic, which is likely to have had an adverse effect on your peak bone mass. With the current state of knowledge about osteoporosis, the most helpful things to do at this stage are to make sure your diet is nutritious and well balanced, with plenty of calcium-containing foods (see chapter 6), to avoid smoking, to exer-

cise regularly, and to get regular sun exposure, which will help your body make vitamin D (essential for calcium absorption).

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Discussions on sex after menopause tend to focus on one aspect above all others — the physical changes to the vaginal lining, which becomes thinner, less acidic, and more easily damaged with age. A compelling argument against this focus, put forward by Germaine Greer in The Change, is that ‘it has been proved time and time again that women’s orgasms do not originate in the vagina and that other forms of love play are more effective in pleasuring women … if she is one of the many women who have been fucked when they wanted to be cuddled, given sex when what they really wanted was tenderness and affection, the prospect of more of the same until death do her part from it is hardly something to cheer about.’ Granted the truth of this, there may be times when vaginal sex or masturbation is sought by women, in which case it is not much fun feeling as dry as the Nullarbor and being about as responsive as a derailed train. Finding the oasis in the desert can be a struggle, though HRT can be very helpful.

Christine was incensed by some friendly advice to ‘use it or lose it’ when she related that sex with her husband was unsatisfactory. ‘How can I use it when it feels like scratching an

open wound?‘ she asked. Once she had faced the need for alternative sources of lubrication, and the vaginal lining became more elastic under the influence of oestrogen cream, a localised form of HRT prescribed by her doctor, Christine lost her fear that sex would hurt, and she started enjoying it again. ‘All I need for good health and a long life is vegetables, fish, laughter and sex, not necessarily in that order,’ she quipped.

Other physical aspects of menopause that can unsettle the desire for sexual intimacy involve changes in skin sensation. Barbara noticed a heightened sensitivity to touch soon after her menopause and literally could not bear the feeling of her nipples being stroked or her clitoris being stimulated, previously pleasurable sensations. ‘I explained this to my husband so he didn’t take it personally, and we agreed it would be a good idea if I discussed it with my doctor. She was very reassuring, explaining that the changing balance of hormones around menopause can have an effect on the sensitive nerve endings in the skin of some women, and that the altered sensation usually passes with time.’

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Recent UK research suggests that, although our health is generally better than that of women in centuries past, we seem to be more prone to osteoporosis than our female forebears. A team of researchers examining bones buried between 1729 and 1852 in the crypt of a London church found that the rate of bone deterioration was lower than in modern women of a similar age. They suggested that lack of exercise in modern lifestyles might be an important factor. The women buried in the crypt came from a section of the city dominated by the silk-weaving industry. Their work involved considerable movement in the upright position, activities now known to increase beneficial pressure on the skeleton and stimulation of bone formation.

To benefit bones, exercise has to be vigorous and prolonged, averaging three to five hours a week in total (adding together short bursts of activity) at 75 per cent of maximal aerobic capacity, that is, three-quarters of the peak workload that your heart and blood vessels can manage. And this workload has to be maintained. In one study, the benefit to bone density achieved during one year of an exercise program was lost entirely in the year after it finished.

Other inherited and lifestyle factors believed to contribute to osteoporosis include race (Asian and Caucasian women are at greater risk than Polynesian and Negroid women), a small body build, an excessive intake of alcohol or caffeine (from coffee, tea and soft drinks), insufficient dietary calcium, smoking, the intestinal malabsorption condition known as coeliac disease, a high salt intake, a diet rich in fat and protein, and the excessive use of antacids containing aluminium, or of cortisone-like drugs.

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You may be confused by the distinction made between the ‘natural’ and the ’synthetic’ hormones of HRT. When your doctor describes a particular HRT hormone as natural, this means that it is broken down according to a normal biological pathway of the body. For this to occur, it must have the same structure as a hormone produced by the woman, or a very similar one. Examples of natural oestrogens include Progy-nova, Ogen, Premarin, Estraderm, Oestradiol Implants and micronised Oestradiol (a component of Trisequens). There are, however, significant differences between the architecture of these various forms of oestrogen and the effects they have on the body. Some lower your blood pressure, while others do not alter it; some seem to affect moods more than others. These effects are especially pronounced in particular women.

When doctors talk of synthetic hormones, they are referring to hormones that are structurally different from those produced by the body and are not broken down or converted into other substances in the usual ways. One synthetic oestrogen widely prescribed for the treatment of menopausal symptoms until the mid-1980s, and still on the market, is Estigyn. This contains ethinyl oestradiol, a common component of the contraceptive pill and a far more powerful oestrogen, in terms of its effect on body tissues, than the natural oestrogens.

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It is unusual to experience aches in the muscles that are not the result of over-using the muscles, or of a viral infection such as influenza. However, they are a feature of post-viral syndrome or, if severe, they may indicate a disease known as polymyalgia rheumatica. Tension can produce muscle aches, especially in the neck, shoulders and face. Misaligned vertebra can also produce aches and pains in the back, shoulders and neck, and these may respond to treatment by an osteopath.

More generalized, but mild, muscle aches may also be a symptom of food intolerance, although this is unusual. One group of food-intolerant patients who regularly include muscle aches among their symptoms are hyperactive Children.

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On examining the life-style of such people we can generally find the following basic characteristics. Their life is simple and they are moderate in their ways. They work, but do not go without time spent in rest and relaxation. They do not go short on sleep and know how to retire, in the proper sense of the word, when night falls; indeed, they are able to shut out the impressions of the day and forget whatever worries there might be. In fact, such people have the ability to overcome the ups and downs of life with a calm and cheerful spirit and without worrying themselves sick. Any problems are tackled with determination and are soon solved.

Admittedly, this way of life cannot prevent old age but it does keep one young and flexible inside. Such people are content with the experience and maturity age has given them, knowing that these qualities compensate for their former youthful agility and energy. This attitude helps them to use their energy reserves moderately even at a highly advanced age, rather than squandering them in senseless pursuits. It is no doubt an art not to let the many worries and annoyances irritate and upset us too much and, instead, think more about the good and beautiful things, showing grateful appreciation for them. But this art can be learned and it is worthwhile doing so, since it helps to make the twilight of one’s life more pleasant and happy.

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Cancer specialists will tell you that cancer cells are cells that lack oxygen. Doctors specialising in rheumatism, arthritis, diabetes and similar diseases have also pointed to oxygen deficiency in their patients. We must therefore conclude that modern man may have money and all sorts of conveniences but he lacks oxygen. In fact, many diabetics would not enter a coma if they were made to increase their oxygen intake early enough.

Let me illustrate this by an experience I have already mentioned elsewhere in my publications. A doctor once spent his vacations in the mountains together with a diabetic friend. When he realised that his friend’s condition was threatening to send him into a coma he resorted to a ruse to save his life. Having no insulin on hand, the doctor could see the patient getting weaker and more listless and knew that the only way he could help was to oblige the man to walk faster, or better still, run, in order to get rid of the acetone in the lungs and make him inhale more oxygen. To force his friend to do this, the doctor had to try and make him angry and did this by whispering something in his ear! As expected, the sick man turned on his doctor friend furiously and then ran off as fast as his legs could carry him. The excitement and movement provided the man with the oxygen he needed to prevent him going into a coma. Later, when he found out that his friend had made him angry only in order to save his life, he was most grateful and both men rejoiced over the successful outcome.

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