CANCER: PROTECTING THE PROSTATE

Prostate cancer is to men roughly what breast cancer is to women. Each is far and away the most prevalent cancer for its respective sex, and each is a solid second (behind lung cancer) in deaths caused. And just as its breast-based relative was for women, prostate cancer has become the emblem of middle-age male health angst. It seems like that plum-size gland is going to get you, sooner or later.

But doctors have noticed that men are taking another tip from women. They’re fighting back. Proof? Well, how often did you hear prostate cancer or the prostate itself even mentioned 15 years ago?

“Prostate cancer has come out of the closet,” Dr. Catalona says. “Everybody knows what a breast is, and everybody knows what a lung is. But until very recently a lot of men didn’t know what a prostate was, or where it was.”

For the record, your prostate gland surrounds the urethra at the base of your penis and helps produce the semen you’re so fond of giving away. It seems to be built to go partially wrong. It often starts to enlarge (benignly) in your forties, and from 30 percent to 50 percent of men in their forties and fifties have precancerous lesions on its surface. Not all develop into cancer, but those that do are, on average, diagnosed at age 72. But with new methods of detection, the age at diagnosis is decreasing.

You don’t have to die from prostate cancer. “The disease is definitely treatable,” says “warren Heston, Ph.D., director of the George M. O’Brien Urology Research Center at the Memorial Sloan-Kettering Cancer Center in New York City.” Early detection is very much a big key.”

But your best weapon against prostate cancer is not getting it in the first place. And, hey, most guys don’t. “About one in five men are diagnosed with prostate cancer in their lifetime,” Dr. Catalona estimates. “So the chances are 80 percent that you won’t be.”

Not the worst of odds. And you can make them better by adding the following prostate-specific weapons to your anti-cancer arsenal.

Whip up some spaghetti. Vegetables, in general, fight cancer. But it’s tomatoes that go right after prostate cancer, according to Dr. Giovannucci, who worked on the Harvard study that came up with this happy I news. Tomatoes are rich in the antioxidant lycopene, which may lower risk

of prostate cancer. “For prostate cancer, it’s important to include tomatoes in your diet-tomato sauce, in particular,” Dr. Giovannucci says. He suggests two one-cup servings a week.

Grab some soy, boy. Soy products are rich in genistein, a weak estrogen with antioxidant properties that, studies have shown, will slow the progression of prostate cancer. That may explain the fact that Japanese men eat a lot of soy and seldom get prostate cancer, while American men eat almost no soy and get lots of prostate cancer.

Get enough vitamin E. Dr. Heston points to a Finnish study that found that those who took 50 milligrams of vitamin E “actually had a 30 percent reduction in the development of full prostate cancer.” Dr. Heston suggests that getting your Daily Value of 30 international units, or about 20 milligrams, would be beneficial.

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PROCESS OF SNORING: THE UPPER AIRWAY

It is essential to have some familiarity with the anatomy of the upper airway to understand the process of snoring. The upper airway is generally regarded as extending from the opening of the nose and mouth to the large air passage known as the trachea. This main airway then subdivides into progressively smaller airways to facilitate delivery of oxygen to the lungs. The trachea itself is a resilient length of airway, well supported by cartilage and muscle, capable of withstanding collapse during normal breathing manoeuvres and protected to some extent from damage which can be inflicted to this susceptible section of the throat. The nasal and oral passages meet in a segment of the airway known as the pharynx with soft, fleshy and more compliant walls. It is the collapse of components of this section of the airway and subsequent vibration of the soft palate that causes the familiar sound of snoring.

The tone of the upper airway is controlled by several muscle groups. Some of these are under voluntary control such as the tongue and those muscles used for swallowing. Others have more subtle influence and although we have no voluntary control over them, they are essential for maintenance of upper airway integrity.

Inspiratory and expiratory efforts during normal breathing are accompanied by pressure fluctuations in the airway. The downward movement of the diaphragm during inspiration creates a negative pressure which sucks in air through the nose and mouth. Most of our airways are sufficiently reinforced to withstand the tendency to collapse under this pressure, with the exception of the less rigid walls of the pharynx which require an active involvement of muscles to remain open.

The process of breathing is a symphony of muscular coordination with large muscles drawing in air and expanding the chest while smaller muscles work to keep airways dilated. Other muscle groups take over for the reverse process of expiration.

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BREAST CANCER: DIAGNOSTIC INVESTIGATIONS CARRIED OUT

Ultrasonography

Ultrasonography – also known as ultrasound – is another imaging technique which, rather than using X-rays, involves passing high-frequency sound waves into the breast. It is the same process as that used for fetal scanning in pregnant women. When the sound waves meet a solid object within the breast, they are reflected back like an echo. The waves are processed by a computer, and a picture can be built up which is displayed on a screen and interpreted by someone trained in ultrasonography. The picture will show the normal glandular tissue and fat quite clearly, as well as any prominent ducts, cysts and tumours. Ultrasound is particularly useful in differentiating between fluid-filled cysts and solid lumps, and ideally should be used with mammography and fine needle aspiration to distinguish clearly between the two. It is the imaging investigation of choice when breast lumps are suspected in women below the age of 30. However, its use is not routine as it is a time-consuming process, is not able to detect calcium deposits, and its results are operator dependent.

Biopsy

Diagnosis of a breast lump often used to involve the surgical removal of a small piece of tissue. Although this is occasionally still necessary, there are now other techniques which can normally be used instead, which do not require a general anesthetic, and which can often be done by a surgeon at an out-patients’ clinic.

Fine needle aspiration biopsy

Fine needle aspiration is a cytological examination (i.e. one which involves the examination of cells) which is often helpful in confirming the diagnosis of a non-malignant tumour or cyst. However, although it can confirm that a suspicious lump is a cancer – and when a cancer is present it is rare for it to be missed using this technique – a negative result does not necessarily mean that it is not: the needle may have been inserted into normal tissue around a malignant tumour. Further tests may therefore be done to confirm a negative result.

The skin is usually wiped with an alcohol wipe prior to inserting a fine needle – about the same size as one that would be used to take blood from the arm – through the skin of the breast. The needle is repeatedly pushed into the lump, which the surgeon holds firmly between the fingers. Suction is applied to a syringe behind the needle and a few cells from the lump are sucked up through the needle and into the syringe. This sample of a small number of cells is then spread on a glass slide which is sent to the laboratory for examination under a microscope by a cytologist. Malignant and pre-malignant cells can be identified, as well as those from a benign lump or from normal breast tissue. Fluid aspirated from a cyst will also be sent to the laboratory in a bottle if it is at all suspicious.

You will be asked to press on the area once the needle has been withdrawn. This is simply to try to prevent serious bruising – which usually occurs despite this precaution and may last for several days or more. Therefore, as needle biopsies may cause swelling and bruising of the breast which may make palpation difficult and a mammogram unclear, they are better not done by a GP before a clinic visit.

Although a small minority of women does find the procedure painful, it is usually only uncomfortable. Local anesthetic is not used as it would destroy the cells the cytologist needs to make a diagnosis.

A non-palpable breast lump, i.e. one which cannot be felt, can be localized by ultrasound or by mammography using a special mammographic attachment which can guide the needle into the lump.

Tru-Cut biopsy

This is a histological examination which involves taking a slightly larger sample of solid tissue rather than cells. It is sometimes done when a fine needle aspiration biopsy of a palpable lump has proved unhelpful. It is used less commonly today than in the past, although some surgeons routinely perform Tru-Cut biopsies for all suspicious breast lumps.

The needle is of a wider bore than that used for fine needle aspiration, and it has another needle within it. Local anesthetic is usually used for this procedure, a small amount being placed into the skin over the site of the suspicious breast lump before the Tru-Cut needle is inserted. A long, very thin core of tissue is then removed as the needle is withdrawn, and is sent to the laboratory to be examined under a microscope.

Although a Tru-Cut biopsy is quite an accurate process, the tissue sample can only be taken from one site, and it is therefore possible for the needle to miss the appropriate part of the lump when it is inserted. This biopsy is more traumatic to the breast than a fine needle aspiration, and it is gradually being replaced by this cytological test.

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PREVENTIVE MEDICINE AND SOCIETY. CHADWICK’S PROPOSAL.

Edwin Chadwick (1800-1890) was a barrister who came to the same conclusion as Petty had done two hundred years before. He promoted the notion that disease amongst the poor was the major reason they couldn’t look after themselves. He maintained that the enormous level of government expenditure on Poor Law relief would be dramatically reduced if the poor were healthy. In this rather roundabout economic, as opposed to medical, way he became the father of British and American public health. His report, The Sanitary Conditions of the Labouring Population of Great Britain (1842), made the awful conditions of working people so apparent to the upper classes that they simply had to listen. He showed that, while the upper classes lived on average to the age of 44 and while only one in ten of their children died in the first year of life, the comparable figures for the working classes were 22 years and one child in four. He maintained that a cleaner environment with decent water supplies and adequate sewage disposal were the answers.

Chadwick proposed the formation of a centralized public health authority with a full-time staff, and after several years of debate the Public Health Act of 1845 established a three-man General Board of Health. But even once water and sewage systems were widely introduced it was still clear that these weren’t the total answer to health, and slowly it became apparent that housing, food, working conditions and personal health services were just as important.

Chadwick’s influence didn’t stop at sewage and water mains though-he pushed for an even greater link between ‘health’ and ‘welfare’. Even though there was already a definite move towards community services and the realization that health was a national asset, the puritan work ethic still ruled supreme and the fear was that anyone and everyone would rather receive welfare than work. This meant that welfare benefits put the person in a position lower than ‘the situation of the dependent labourer of the humblest sort’. It is ironic that even today ‘health’ and ‘welfare’ are still bound together in the same bureaucratic machinery both in the UK and the US even though they are uneasy bedfellows much of the time.

But in spite of often conflicting pulls, public health made great strides in the last quarter of the nineteenth century. The work on bacteria by Pasteur and Koch took scientific endeavor a giant leap forward and placed the whole of disease on a different plane from supplying clean water and the disposal of sewage. Quite quickly it became apparent that public health measures were far more effective in controlling almost all common infectious diseases than was curative, personal medicine, and the seeds of medical discontent were sown that are still with us to this day.

When public health officials were making such an enormous impact on the nation’s health doctors were relatively powerless to achieve much. The emphasis on sanitation, the absence of doctors from major decision-making bodies and the link between public health and ‘welfare’ made public health unattractive and unrewarding to doctors.

Unfortunately, there were more fundamental problems too-problems which we still have today. In the nineteenth century voluntary hospitals were preoccupied with treating disease and they had a monopoly of medical education dating back a century. Clinical medicine, then as now, attracted interventionists whereas what preventive medicine needed was people who were happy with an absence of disease. Prevention seemed dull by comparison with the glamour of effecting cures, and even today when so many of the medical profession pay lip-service to the importance of prevention only a tiny fraction (1 -2 per cent in the UK) of any westernized nation’s health budget is spent on prevention -mainly because medicine has become almost entirely an active, interventionist profession.

Interestingly, the Hippocratic Oath itself could also be said to be an enemy of public health and prevention, insisting as it does that doctors put the needs of their patients before anything else. Doctors from the Middle Ages onwards (until the advent of the National Health Service in the UK, and still in the US today) have been private entrepreneurs selling their skills on a one-off basis to anyone who could afford them. So it was at the turn of the century in the UK. Doctors were wedded to a group of individuals who provided their personal income and it was clearly in their interests to ensure that nothing they did professionally jeopardised their patients’ health and their own livelihood. Patients felt that in such a system they were paying for highly personalised care and didn’t want to hear about ‘bad news’ outside this one-to-one doctor/ patient contract. This contrasts sharply with medicine in Eastern Europe where the physician’s first duty is to strengthen the State by maintaining the health of its people. Everything in the doctor/patient relationship is secondary to this. Although most of us in the West find this approach unpalatable the benefit is that public health measures are more easily accepted and acted upon.

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BATHING FOR YOUR SKIN: AROMATIC BATHS

The Romans were the masters of the bath. To receive maximum benefits before taking a herbal bath use a body rub or dry skin brushing to help to eliminate dead skin cells and get the circulation going. When planning to pamper yourself with an aromatic bath, create the atmosphere for your ritual. Place essential oils into your bath, light some candles, have some relaxtion music playing and most impotant put a note on the door please do not disturb.

After a bath it is best not to dry off, wrap yourself in a towel or robe.

Aromatic Baths

The fragrance of essential oils will uplift, calm and soothe the emotions.

Basic Recipe: Fill bath with water, then add 4-8 drops of essential oils, agitate water well to disperse the essential oil. Soak for 10-20 minutes. Essential oils can be diluted in milk before adding to bath water.

Recommended Herbs and Essential Oils for Aromatic Bathing. A tepid bath is best, and the essential oils or herbs should be added once the bath is run.

Relaxing herbs: basil, catnip, calendula, chamomile, cowslip flowers, lavender, lovage, lime flowers, hyssop, marshmallow, rosemary, valerian, vervain, yarrow.

Essential oils: lavender, orange, ylang ylang, bergamot, cedarwood, geranium, cypress.

Refreshing herbs: bay leaf, elder flower, comfrey. fennel, hyssop, lavender, lemon balm, lovage, nettle, peppermint, rosemary, sage, thyme,

Essential oils: lemon, orange, bergamot, lavender, pine, peppermint, lemongrass.

Eease aches herbs: angelica, bay leaf, chamomile, horsetail, hyssop, ladies mantle, lovage, marigold, marjoram, honey suckle, sage, St. John’s wort, rosemary, yarrow.

Essential Oils: lavender, rosemary, pine, eucalyptus, juniper, marjoram, peppermint, fennel, tea tree.

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