Antidepressants Blog

Breast pain, or mastalgia, is a symptom rather than a disease, usually of a minor breast condition but occasionally of a more serious one. Although most malignant tumours are relatively painless, the presence of breast pain does not necessarily indicate a benign condition.

Breast pain can sometimes be severe, and some women who suffer from it cannot bear to be touched or cuddled. It may be cyclical, related to the menstrual cycle and occurring before or during a period, or non-cyclical, having no obvious menstrual association.

Cyclical breast pain

Cyclical breast pain can often be relieved by taking painkillers such as aspirin, paracetamol, codeine or stronger drugs which can be prescribed by your doctor. If the breast tissue is inflamed, aspirin will help to deal with this as it has anti-inflammatory as well as pain-killing properties.

Some women find evening primrose oil an effective treatment for cyclical breast pain, and there are some convincing studies which support its use. However, there is controversy amongst members of the medical profession about whether or not this is a placebo effect – the oil itself having no medicinal properties but being effective for those who believe it will be.

For the treatment of very severe period-related breast pain, there are several hormonal agents available, including the contraceptive pill. The sex hormone progesterone can be given in its natural form as Cyclogest pessaries or as one of several synthetic derivatives known as progestogens. Natural or synthetic oestrogens can also be effective. Other drugs may be prescribed which interfere with the action of the sex hormones produced by the body, for example danazol or bromocriptine, but these can cause fluid retention and headaches and make many women feel generally unwell. They are therefore often given as a last resort for cyclical breast pain which cannot be treated by other means.

Non-cyclical breast pain

This type of breast pain is often more difficult to treat, but in many cases it does tend to improve with time. It is sometimes a symptom of a fairly common condition called Tietze’s disease, a mild form of arthritis which affects the cartilage between the ends of the ribs and the breastbone. The pain this causes in the chest wall can be mistaken for pain in the breast.

Good breast support with a well-fitting bra, aspirin, and possibly evening primrose oil may be effective in the treatment of this type of breast pain.

Non-cyclical breast pain can also be referred pain from another problem such as a frozen shoulder, a wry neck or twisted back. It can also be due to infection by a virus which attacks the muscles. These causes will have to be excluded. Nevertheless, there is often no underlying cause for non-cyclical breast pain, which can be severe.

Pain may also accompany some of the conditions described below, although other symptoms and signs are likely to be apparent.

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Historically, the prevention of disease has been the greatest and most important contribution to the health of the western world but simply to think of preventive medicine in terms of public health is far too narrow a perspective today.

The first phase of preventive medicine was indeed this rather authoritarian, organizational public health approach. It was based on the need to control infectious illnesses using environmental control imposed on people ‘for the good of the community’. In this way clean water became the norm, sewers took away waste, food was inspected and its quality improved, and pest-infested slums were cleared. All of this did wonders for life expectancy. In white women in the US life expectancy increased from 40 years in 1855 to 55 years in 1920. Almost all of this increased life-span came about because of the reduction in infant death rates. Little, if any, change was made to the longevity of those who survived to middle life. In 1855 a 45-year-old American could expect to live another 24.6 years and in 1910 the figure was 25.5 years. Hardly a stunning advance!

As well as the giant steps forward being taken in sanitation, immunology began to blossom as a medical growth area and diphtheria, whooping cough, measles, polio and smallpox came under control.

Initially this era of prevention was characterized by individual heroism and leadership together with more health laws. The amount of voluntary action on the part of the public was minimal. Certainly immunization required the individual to turn up to be vaccinated but otherwise preventive medicine was a ‘painless’ procedure that was done to an individual.

The second phase in the development of preventive medicine actually started before the ending of the first and came with the discovery of anaesthesia and antiseptics. Phase two, then, was that made possible by increasing technology and financial investment. Undoubtedly the greatest triggers to the growth of medical knowledge were the two world wars in this century. Knowledge of anaesthesia and antiseptics lay dormant until the vast number of operations done in World War I made advances necessary on an unprecedented scale. By World War II sulpha drugs (1935) and penicillin (1940) had been developed and the modern pharmaceutical industry as we know it was born. This opened up for the first time the idea of massive capital investment in the health field. In the first phase of the growth of prevention, public health measures were seen as a way of improving the nation’s strength and wealth and a way of maintaining a vigorous population which could produce goods and services in a fast-growing capitalist society. In the second phase the goal of a healthy population became obscured as the health industry took on a life of its own. Today, doctors make the financial decisions which control this vast industry and often they make them in splendid isolation-thinking only in the context of their relationship with an individual patient.

This has led to the enormous sickness industry we now see. Yet for all this so-called advance and expenditure the life-span of a five-year-old has increased by only 2.9 years since 1940. The limits to this kind of medicine are all too apparent. It has been calculated that the elimination of all cancers of the cervix, for example, as a cause of death would add only three-tenths of a year of life to that which the average woman currently enjoys. If after fifty years of screening and gynecological examinations her fate is that of many old people-to live alone in relative poverty-just how valuable are these extra three and a half months to her anyway?

The third phase of preventive medicine is now with us, as we start to consider health in the context of our environment-in short, man in his ecological setting. The excitement and drama of the last forty years’ growth in medicine is beginning to wear thin and people are beginning to look at prevention in personal terms-as something they actually have a hand in and for which they have a responsibility.

It has been calculated that more disease, disability and premature death could be prevented by eliminating alcohol and tobacco abuse and by restricting the use of cars than by any foreseeable increase in expenditure on health. But it is not true that individuals are solely to blame now that doctors can do so little to help. The medical profession can’t shrug its shoulders and say, ‘Look what we’ve done for you, you should be grateful.’ It is no new concept that the choice as to how an individual uses his or her life rests with him or her. But the fact that there is a personal responsibility for health does not absolve doctors, nurses, politicians or administrators from responsibility, nor does it free them to ignore prevention on the grounds that it is something the individual ought to be doing for him or herself.

Phase three of the story of prevention involves the individual taking the dominant role-and this is what this book is about: personal prevention.

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Essential oils: can be used for compresses to amplify the treatments, the oils can be diluted into water, olive oil, or cold pressed vegetable oils and vinegar’s. Compresses can be used hot or cold to increase the healing process.

Hot compresses: when applied can increase the blood flow which will hasten the healing process. It is used for abscesses, arthritic pain, earache, fractures, muscular spasm, chronic pain, rheumatism, reduce inflammation and to stimulate particular organs.

Hot and cold compresses: can reduce the level of blood flowing to the area which aids healing. Can be used for bruises, bumps and sprains. Always start with a hot compress and finish with a cold one.

Cold compresses: when applied can decrease the amount of blood collecting around a wound, which can reduce bruising, swelling, inflammation, acute pain, sprains and for bums or to reduce hot conditions and has a calming affect. You may alter or add to herbal compresses with vinegar, kombucha, clay or urine depending on the treatment. For more detailed information the book Water Medicine is recommended.

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The proteins in wheat flour – which include gluten – are what makes wheat good for bread-making. Trying to make bread without wheat involves finding a substitute for this protein.

Gluten-free bread is available in some healthfood shops – at a price. Or you can buy a gluten-free flour and make your own. Those with coeliac disease can get some gluten-free products on prescription.

Gluten-free flours are made from a mixture of different flours, eg maize flour, potato flour, soya flour, split pea flour, rice flour, rice bran, carob flour, corn starch and ground almonds. You can improvise with simple mixtures of your own – eg one part rice flour, to one part soya or gram flour, to one part potato flour. The mixture must always include at least one type of high-protein flour, such as soya, gram or lentil. Use yeast and make in the ordinary way, but without kneading the bread. It will have a heavier

texture than ordinary bread, and may taste better toasted. If you have to avoid yeast as well, it is possible to make soda bread using gluten-free flour. The manufacturers of gluten-free flour usually supply recipes for use with their particular flour mix, and these should be followed for good results.

Bear in mind that most gluten-free mixes contain soya flour or other bean-derived flours. Make sure you are not eating soya and related foods too regularly, especially if you are vegetarian – they feature in most commercial meat substitutes, ‘vegeburgers’ and instant meals.

Rye bread may be a useful substitute for some people, because rye is also rich in protein, though it cannot rival wheat. Because the two are closely related, those who are sensitive to wheat quite often react to rye as well. If you buy rye bread from a local bakery be sure to check that it is 100 per cent rye – speak to the manager, and ask to be notified if they change the composition of the bread. Rye flour often contains some wheat anyway, because wheat grows as a weed in fields of rye.

Rye crispbread can be eaten as long as it is pure rye – some now have wheat bran added.

Oatcakes are available from most good supermarkets, delicatessans and healthfood shops. Oats are preferable to rye since they are less likely to cross-react with wheat. Check the label, as some contain milk or sugar.

Rice cakes and rice crackers are available from healthfood shops. The ‘cakes’ are actually savoury – something like a crispbread, but made from puffed grains of rice. They taste much nicer than they look.

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Allowed:

Wholemeal brefiad

Milk, butter, most types of cheese

Shredded wheat, puffed wheat, and other cereals that have no sugar or

colouring Any fresh, unprocessed meat Any fresh, unprocessed fish Potatoes Rice

Beans and lentils

Any vegetables – eat plenty of green leafy vegetables and salads

Any fresh fruit, except pineapple and papaya

Pastry – if homemade

Any unsweetened fruit juice

Herb teas, except mate and redbush

Not allowed:

Alcoholic drinks, including alcohol-free beers and wines

Food cooked in beer, wine etc

Coffee

Tea, including green tea, jasmine tea etc

Cola drinks

Chocolate

Sugar and all sugar-containing foods Artificial sweeteners

Vinegar and pickles (except in small quantities)

Margarine

All food additives

Smoked fish or meat

Bacon and ham

Continental sausages

Very ripe cheeses

Take-away food

Restaurant food (except very occasionally) Bran

Any very salty food

Aspirin and related drugs

Curries and other very spicy food

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In some people, certain enzymes are either in short supply, or they fail to work properly because their structure is abnormal. Such people are said to have ‘enzyme deficiencies’. Some deficiencies have no obvious effects, because there are other enzymes that can ‘cover’ for the missing one – the body often has more than one option, especially when it comes to digestion and detoxification. Other deficiencies are far more damaging, because the enzyme is the only one that can do that particular job, and toxic substances build up in the body if it is ineffectual.

Enzyme deficiencies have been known for many years. The more serious ones become noticeable soon after a child is born, or after it is weaned, and can kill or severely disable the child unless treated. The usual treatment is a special diet, which excludes foods that the child cannot deal with. The most widespread enzyme deficiency of this type is phenylketonuria; all babies are tested for this soon after they are born. Another example of a major enzyme deficiency is a shortage of the enzyme lactase, which breaks down the sugar in milk. Both of these enzyme defects are very rare – phenylketonuria only affects one baby in 12,000.

In recent years, it has become clear that there may be other, less noticeable, forms of enzyme deficiency. Some of these have come to light when certain patients reacted very badly to particular medicinal drugs – it turned out that they were less able to detoxify them than most people. Special chemical ‘probes’ have been developed in an effort to detect such patients – these are non-toxic compounds that are processed by the same enzymes, and which can readily be measured. The ‘probe’ is given to the patient, and the level is later measured (in the blood or urine) to see how thoroughly well the drug has been broken down.

When these probes are tried out on people with food intolerance, they produce interesting results. Such people are much more likely to be deficient/or some enzymes than healthy people are – they do metabolize the drugs, but more slowly. However, there Js no single enzyme which is defective in all food-intolerant individuals – or if there is, it has yet to be found. With enzyme defects, as with everything else, it looks as if food intolerance is a ‘mixed bag’.

One interesting factor to emerge from these experiments concerns patients who are sensitive to man-made chemicals, as well as food. In this group, an even higher percentage are enzyme-deficient than among those with food intolerance alone. For one enzyme, 90 per cent of such patients were deficient, compared with 80 per cent of those with food intolerance, and 20 per cent of the population at large. Interestingly enough, a high proportion of those with food allergy – 64 per cent – also showed a deficiency.

The fact that some apparently healthy people are deficient for these same enzymes is revealing. This clearly shows that a single enzyme defect of this type could not be the sole cause of food intolerance. Those who suffer from food intolerance must have other underlying problems as well – perhaps a shortage of another enzyme, or a leaky gut wall, or some other problem entirely. It is tempting to speculate that people with multiple sensitivities (foods and chemicals) are defective for a whole range of enzymes, making them much more susceptible to environmental factors. But at present, there are too few studies of enzyme deficiency to know if this is likely.

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If there is little or no improvement on the diet, then it may be because there is a general yeast sensitivity, due to candidiasis. Continue with the diet as before, but cut out all yeast-containing foods. These are listed in Table 6.

It is sometimes claimed that the Candida derives nourishment from yeasts in food, but this is not the case. The reason for avoiding yeast is simply that you may be sensitive to it. The distinction is important, because if you are very sensitive to yeast, even the smallest amount can make you ill, so scrupulous avoidance is necessary, especially at first.

If there is a partial reponse to this diet, then it is a positive sign, and you should consider going on to Step 4. If there is no reponse at all, the most likely explanation is that Candida is not a factor, and it might be a good idea to try an elimination diet instead at this point, if food intolerance is suspected. But keep in mind the possibility that Candida is the culprit – some cases of candidiasis need far more stringent treatment than that described so far.

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Henceforth, a disease could only be described as an allergy if the immune system was demonstrably involved.

The way to demonstrate immune system involvement was by a skin-prick test. This involved making a purified extract of the allergen. A small amount of the extract was then inserted under the skin, by scratching or pricking it. If the area came up in a bump with a large area of red itchy skin around it, then an immune reaction had occurred.

It had become clear that patients with certain diseases were likely to give positive skin-prick tests. These diseases were hay-fever, asthma (breathlessness with wheezing episodes), and non-seasonal or perennial rhinitis (constant runny or congested nose). Also linked with positive skin-prick tests, although to a lesser extent, were urticaria or hives (a rash that resembles nettle-stings) and one type of eczema (areas of red, itchy, flaky skin). Moreover, these five disorders often seemed to go together, either in individuals or in families.

These became the only legitimate subjects for study as far as orthodox allergists were concerned, and they are still described as the classical allergic disorders. Included in their ranks was a type of reaction to food that was very violent and came on rapidly after eating the allergen, often within minutes. The symptoms produced included swelling of the lips, mouth and tongue, urticaria (nettle-rash), vomiting and, in severe cases, collapse or anaphylactic shock – the reaction that Jane experienced when she ate peanuts in the restaurant cheesecake. In these cases, too, there was almost always a positive reaction to a skin-prick test with the suspect food.

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