Antidepressants Blog

Pregnancy. Pregnancy and body weight increases are intertwined in a complicated pattern. Female fat stores have a primary function to provide energy for pregnancy and lactation. A pregnant woman requires approximately 130 000 kcal extra as the metabolic cost of pregnancy. Women who tend to put on too much fat in the early stages of pregnancy have been shown to keep this longer than those who do not put on excessive fat, or put on most fat later in the pregnancy. The recommended weight gain during pregnancy by the US medical specialists has risen from 7-Skg in the 1920s to 10-12kg in the 1970s. In 1989, the National Task Force on Prevention and Treatment of Obesity raised the recommendations to 14-16kg in 1995. However, there are now suggestions by some experts that this is too much and that the most recent recommendations are based simply on the modern average weight gain of pregnant women in the US. The previously recommended gain of 10-12kg has been suggested as a more appropriate health ideal for which to aim.

Breast-feeding is also known to be an effective form of fat burning, using up to 400kcal of energy per day. In one study carried out in the US, women who breast-fed for at least six months stayed leaner for up to two years than women who did not breast-feed at all or did so for less than six months. It has also been claimed that the risk of obesity increases with parity or the number of childbirths. This may be due to the repetitive exposure to the fat storing hormones of pregnancy, restrictions on physical activity or increased opportunity to eat more. In any case, for some women, pregnancy does appear to be a particularly high risk period for increases in obesity.

Research from the Stockholm Pregnancy and Weight Development Study in Sweden suggests that the greater the weight gain during pregnancy, the more likely the increase in post-partum body fat levels. Cessation of smoking with the onset of pregnancy may increase weight gain in the mother (although it certainly reduces the risk of birth complications in the baby). Those women who gained most weight during and after pregnancy were found to be those who had significantly changed their lifestyle from prepregnancy levels such as increased eating/snack eating and decreased levels of physical activity. Maintenance of physical activity through pregnancy and attention to nutrition, therefore, are most important to ensure a return to normal fat levels, but there are also special considerations for exercise which need to be considered. These are now available from most Health Departments.

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What happens to the space occupied by my uterus?

Women often wonder if an empty space remains after a hysterectomy, but you can be sure this does not occur. Organs such as the bladder, bowel and intestine reposition themselves and take up the space.

I have heard that some women get depressed after a hysterectomy. How likely is this to happen?

Recent studies suggest that, overall, rates of depression in women who have a hysterectomy are less than they were in the same women before they had the operation. In individual cases, however, depression may be increased due to complications of the operation or regrets about having it. Hysterectomy can actually reduce levels of depression in women for whom the operation relieves painful and heavy periods.

How can I improve my health before having a hysterectomy?

Avoid smoking, have regular physical activity, and keep your weight under control. Doing these things reduces the risks associated with surgery and post-operative complications. If you are having heavy bleeds, you should take iron supplements to increase your haemoglobin level.

Will I have an early menopause if I have a hysterectomy hut keep my ovaries?

In theory, removal of the uterus and cervix, but not the ovaries, should not produce menopause. The only change should be an end to your periods and removal of the problems that made the surgery necessary.

In practice, however, a significant number of women whose ovaries remain after this sort of hysterectomy do experience symptoms of menopause up to four years earlier than might be expected. Possible explanations are that the surgery inadvertently altered the blood supply to your ovaries, or the condition that caused you to have a hysterectomy in the first place, such as endometriosis or cysts, had already reduced the natural life of your ovaries.

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It is interesting to observe that some people fall asleep very easily, but some find it very difficult and need sleeping pills. Even the same person may fall asleep very easily at some times in his life but find it very difficult at other times. Why is this?

There are two sets of forces acting against each other which affect sleep onset One group of forces includes good sleep hygiene, falling asleep at the right time of the biological clock, and, of course, being sleepy. The other group of forces includes poor sleep hygiene, trying to fall asleep at the wrong time of the biological clock, being unable to handle stress effectively, and, of course, having a genetic makeup that is of poor quality for sleeping. It is important to increase those forces that facilitate sleep onset and to decrease those that oppose it.

Genetic make-up. Studies of identical twins show that much of our ability to sleep is coded in our genes. Identical twins, who have the same genes, have similar sleep patterns even if they live apart in different environments for years. Some people are born good sleepers and they can sleep at any time of the day and, in fact, anywhere. My wife is a good sleeper, and she could sleep easily at any time no matter what shift duty she was on when she was working as a nurse in the general hospital. My two daughters have different abilities to fall asleep. Melissa is more like me, whereas Melinda sleeps easily, very much like her mother. But for those of us who are not so lucky and have poor quality genes for sleep, we have to improve those factors that facilitate sleep onset so as to tip the balance in favour of the forces that bring about sleep.

Sleep hygiene. This is the most important force in facilitating sleep onset As discussed in chapter 15, Sleep Hygiene, caffeine is the number one enemy; absolutely no coffee or tea. The bedroom is reserved for sleep and sex and no other activities. Leave the clock under the bed, but set the alarm to the same time every morning, even on Sundays and public holidays. A regular waking up time in the morning is an important Zeitgeber for entraining our circadian rhythm to the 24 hour clock. Daytime exercises are good, as they increase the amounts of NREM sleep.

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When there is no clear cause for the condition, patients suffering from chronic pain are sometimes referred to a psychiatrist for his opinion. When these patients really unburden themselves they often disclose that they are preoccupied in thinking about some wrong they have done in the past. Over the years they have thought about it a great deal, and in thinking about it in this way, the wrong becomes greatly magnified. They have never told anyone about it. “This is something that I always thought I would bring with me to the grave.” And all the time there has been the thought, “Of course I shall be punished for it.” In the first place the pain may have arisen from some quite trivial cause; but once the pain is there, it soon becomes fixed. Only

half-consciously he thinks, “This is what I have been expecting; I knew it had to come; I am glad it has come at last and I shall get it over.” In a sense he is glad of the pain. By suffering the pain he will ease his conscience of the thing that he has done, and his mind will be at rest again.

On the one hand a patient in this situation wants to get rid of the pain because it hurts him, but on the other hand he wants to keep it, as it expiates his feeling of guilt. The pain lingers on, unrelieved by the various medicines he is given. Expiation never seems complete, so it continues until brought to light and worked through in psychotherapy.

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Q. What other forms of medication are used?

A. The Histamine ft-receptor antagonists are currently the most widely used drugs for peptic ulcers. Nevertheless, a form of medication called tri-potassium di-citrato bismuthate (colloidal bismuth) is also claimed to produce very good results. It is said to be about as effective as cimetidine, but until recently the only form available was an unpleasant tasting liquid which had a strong ammoniacal odour. It is now available as a chewable tablet and this has improved patient compliance. There is little doubt that if a person does not like his medication, , he often will not take it. He will invariably lie to the doctor and say he is taking the prescribed medication!

Q. Does it have adverse side effects?

A. Every medication has some side effects in someone as we have already pointed out. However, like cimetidine, these are small and fairly unimportant, at least in the known short term. It may stain porcelain teeth fillings, colour the tongue and cause the stools to turn a strange dark grey. It is taken well before meals. Its effect is negated by the presence in the stomach of food, milk or antacids, so it is essential these are not taken at the same time, or indeed probably within an hour or two either way.

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The operation most commonly used in an effort to permanently cure back troubles caused by one or more discs is spinal fusion. Much more popular in the United States than in this country, this is an operation in which two or more vertebrae are essentially welded together and any troublesome discs between them removed. There are various ways of performing this procedure, but the one used most nowadays involves both anterior and posterior fusion of the vertebrae, the spine being approached from the front (via the abdomen) and then through the back. The damaged disc is then replaced by a bone graft.

Just how good the results of spinal fusion are is still a matter for debate by experts as the operation so far has not been the subject of a properly-controlled trial. Certainly, there are many patients who have benefited greatly from spinal fusion; in other instances, the results have been less favourable. More may be known in a year or two about the true benefits – and risks – of spinal fusion as a trial to compare its results with those achieved through non-surgical rehabilitation programmes is being set up.

Laser disc decompression is an alternative way of dealing with bulging discs that is currently being pioneered in America, but it also remains the subject of some controversy about just how effective and free from long-term side-effects it is.

This method has proven itself useful in dealing with a disc that bulges but where no part of the disc’s soft centre is actually protruding from it, the pressure on the nerves resulting purely from the fact that the disc is larger than it would normally be.

Here’s how this procedure is performed. A silicon optical fibre is temporarily inserted into the disc. Energy from a laser is transmitted into the disc via the fibre and this causes the loss of water and some of the substance that makes up the centre of the disc. As the pressure within the disc is decreased because of the loss of material, it shrinks and pulls the offending bulge off the nerve root, so decreasing or eliminating the pain.

The procedure takes about 15 to 30 minutes, followed by two to three hours in the recovery room. The advantages of this method is that operating time and hospitalisation is kept to a minimum, and that it can be suitable for patients who are surgical risks, for example, those with heart trouble or age-related problems. The proponents of this approach say that there have been no major complications to date and the degree of success is about 80 per cent so far.

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Since there is now good evidence that deficiency of selenium in our diet encourages the development of cancer, many people are taking supplementary selenium in the form of a tablet every day. One must be careful not to take too much selenium, however, since it can be very toxic if taken in excess.

Morbidity and Mortality Weekly Report (33:157) contains the story of a 57-year-old woman who took one selenium tablet daily and, after 11 days of this dosage, began losing her hair and developed sore fingertips. Continuing with the selenium because, at the time, she did not know that is was causing her problems, she slowly lost all of her hair during the next two months and developed a discharge around her nails, all of which she later lost as well. In addition, she suffered with episodes of nausea and vomiting, a sour-milk breath odor, and increasingly severe fatigue.

Eventually, her doctor found that her selenium blood level was four times higher than normal, and that this, in turn, was due to the selenium tablets being more than 100 times stronger than advertised.

The tablets (now recalled from the market) had been distributed in 15 states coast to coast. Knowing what to look out for, we should be able to quickly recognize selenium overdosage and protect ourselves against this danger.

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It is not possible to make any definite recommendations about treatment. The following are some suggestions for normal healthy baby care. It is not known for certain whether these will prevent cot death but they do improve the care of normal babies. Before making any changes to the way you care for your baby, please check with your pediatrician or maternal health sister.

• Before becoming pregnant try to be as healthy as possible.

• Ensure good antenatal care.

• Do not use morphine or other hard drugs.

• Avoid maternal smoking during pregnancy as this can contribute to lower birth weight or premature babies who are believed to be more at risk.

• If possible, try to breast feed as this appears to reduce the possibility of respiratory infections.

• Do not give the baby certain antihistamines or “knock out drops” which have a sleep-inducing effect.

• Parents should consult their maternal and child health nurse or doctor as to the best sleeping position for their baby.

• Maintain a warm, even temperature for the baby. In winter, keep the baby’s room heated evenly or have it sleep in your room in order to keep a check on major fluctuations in temperature.

• Maintain a smoke-free environment. Research shows that babies living with smokers are more at risk as they inhale significant levels of carbon monoxide.

• Keep the nose and mouth free from obstructions.

• Ensure your child is immunized at the correct age.

• Try not to take the baby to crowded places during winter and avoid having people with colds handling the baby.

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“I wish I were back home with my own people. People I can understand. I’m not at home here. They say nasty things. Rude things. Call me “Old bastard”. But they seem to like me. I can’t understand. I’m not a bastard. I hate it. They laugh. It spoils my life. I wish I could go back to my own country.”

Local idiom and local slang are always confusing to the newcomer. His brain cannot integrate conflicting messages. They seem to like him, but still call him a bastard. Far from being a matter of vilification, ‘old bastard’ is a term of endearment in the Australian vernacular.

I remember, some years ago, the cool reception I received when I addressed the head nurse of an American hospital as ‘sister’. In Australian hospitals the word carries strong overtones of respect, while in America it is a term of familiarity.

In matters as simple as this, the misunderstanding can be rectified by simple explanation. But without such explanation, the individual lives in an atmosphere of uncertainty which can form a background for the development of stress.

If we are secure enough in ourselves these misinterpretations lose their ill effect. We can stand by, and assume there was something in the conversation which we did not understand correctly.

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The poison ivy plant is a vine which climbs on trees, hedges, or stone walls and has a leaf composed of three leaflets, two of which are opposite each other. The leaf is about three inches long, and its edges are either smooth or have notches. The plant is green in summer and turns red in the fall. In May and June it bears small clusters of greenish-white flowers which turn into white berries (not poisonous to eat) the size of a raisin during the fall. Its flowers and fruit clusters may remain on its branches after the leaves have fallen.

The poison sumac plant is a coarse woody shrub (which is known as swamp sumac) that never assumes the vine-like form of poison ivy. Its leaves are divided into from seven to thirteen pairs of leaflets, with a single leaflet at the end of the stem.

Poison oak (otherwise known as oak-leaf ivy) is a low-growing shrub which has slender, upright branches that bear leaflets similar to those of the oak tree and fruits similar to those of the poison ivy plant.

An unseen oil which coats the leaves of all of these plants may stick to the hands, shoes, or clothes of the person who touches them and may remain there for many months (strongly enough to revive the dermatitis). Smoke from a burning poison ivy plant may carry enough of this oil to cause irritation in the nose or eyes of a person standing in the vicinity of the fire.

The symptoms of poison ivy dermatitis are a slight redness in the skin followed by a mild itch which slowly increases in intensity. The redness may turn into tiny watery blisters after a few hours. These may burst, ooze, dribble over the skin, and become infected. The oozing material, however, does not spread the disease to other parts of the body or to other people. The blisters take about two weeks to heal without any medication.

Treatment of poison ivy dermatitis consists of washing the affected skin immediately with soap and water (to stop the oil from reaching the deep layers of the skin). If blisters have already formed, dressings of normal saline should be applied. If the blisters have become infected, the application should be tepid soaks of 1:10 Burrow’s solution. Antihistamines may also be used if local applications fail to bring relief. In severe cases, the only treatment that may help is prednisone taken by mouth.

A child should be taught the following:

a.     To identify poison ivy, poison sumac, and poison oak leaves

b.     That he should immediately wash the area that has touched the plants with soap and water

ñ     That poison ivy dermatitis may occur at any time during the year by contact with twigs of the dormant plant, but that the danger is greatest in spring and summer when the oil of the plant is abundant and lively

d.     That poison ivy dermatitis is not necessarily an allergic disease and that any child may get it

e.     That he may get poison ivy dermatitis by touching clothes or animals that have been contaminated with it, by inhaling the smoke of the burning plant, or by eating the buds of the plant

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