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| Sunday, 22 February 2004 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius Fear of sexual intercourse Dr. Sampath R. Nanayakkara Sexual union between man and woman has been practised since our species began. Yet ignorance about the act of love remains incredibly widespread.
The nervousness of the women to have sexual union is a medical conditions known as "vaginismus" - which means contraction spasm of the muscles around the vagina. Women who are nervous about sex are sometimes so completely unable to relax that sexual union is more or less impossible. Under normal circumstances, the muscles around the opening of the vagina are fairly taut, but relax under the stimulus of sexual excitation and do not cause any pain or discomfort. At the same time, the lubricant fluids secreted by various parts of the female genital tract greatly facilitate entry. In "vaginismus", however, there is no relaxation of the muscles, and little or no secretion of fluid. Attempts at sexual union by the male partner under these circumstances cause pain and make the muscles to contract even more tightly. In extreme cases, the patient may be so frightened that the mildest attempts cause her quite involuntarily, to protect herself. This tragic state of affairs, may lead to marital disharmony and ill-will and psychosomatri illnesses in most of the females. Treatment of vaginismus consist first of all in making sure there is no painful vaginal disorder present in the female which might be responsible for precipitating attacks. Next the doctor will have a frank discussion and counselling with both husband and wife, to find out some ways in which they can overcome the difficulty. In addition to general advice on sex techniques, he may suggest the use of lubricant cream or a cream containing a mild local anaesthetic. The most important thing in preventing this problem is the premarital counselling by a doctor. Your family doctor is the best. Every mother should have some sort of sex education and when the time comes she should educate her daughter using her own experience as well, before marriage takes place. If this advice is not forthcoming, a couple about to get married, should consult their family doctor for "pre marital counselling" before their wedding. ##### Normal coronary angiogram in patients with chest pain by Dr. D.P. Atukorale Coronary angiography (coronary arteriography) is the study of the anatomy of the coronary arteries which are visualized by x-ray by injecting contrast material (dye) into the coronary arteries. It is common knowledge that coronary arteries supply oxygen and other nutrients to the heart muscle.
Coronary angiogram is the only way of telling how great the coronary problem at present and establishes whether the patient will be best helped by medical management or by angioplasty (PTCA) or by coronary artery surgery (CABG). Coronary angio is thus a necessary part of the planning of coronary angioplasty or coronary artery surgery (CABG) that significantly improves the life expectancy and quality of life for certain groups of patients. There is a very small risk involved with the procedure of coronary angiography. That is why the doctors get the patient or patient's guardian to sign a consent form after explaining the risk of the procedure. Very rarely (one in 10000 cases) especially in cases of serious coronary artery disease the patient can get a cardiac arrest and die. The heart develops serious rhythm disturbances such as ventricular fibrillation in one per cent of patients undergoing coronary angiography and morbidity and mortality due to the procedure is very low in the hands of expert and experienced cardiologists. In Sri Lanka coronary angios are performed after admission of the patients to the hospital whereas in some countries such as U.K., it is done as an out patient department procedure. In the private sector, it costs about Rs. 30,000 for above procedure. In the Institute of Cardiology, National Hospital, Colombo, the waiting period is 2 to 6 weeks whereas in more developed countries such as U.K., waiting period is 1-2 years and these delays provide ample time for adverse changes in lifestyle, work pattern and even losing the job, restriction of social and leisure activity and disruption of family life. In some countries such as U.K. some patients get heart attacks and die while awaiting coronary angiography. When coronary angiogram is necessary Majority of cardiologists subject patients with chest pain to coronary angiography when their exercise ECGs are abnormal. Some cardiologists subject all heart attack (myocardial infarction) patients to an exercise ECG, two to six weeks after a heart attack and if the exercise ECG is strongly positive, they are subjected to coronary angio, with a view to angioplasty or CABG if there are angiographic indications. If the patient is not willing to undergo angioplasty or CABG, coronary angioplasty is best avoided as the above procedure is not a risk free investigations.There are some cardiologists who subject patients to coronary angio if the patient has troubling systems even if the exercise ECG is normal. 20 to 30 per cent of all coronary angios in patients with chest pain are normal i.e. show normal coronary anatomy. Normal coronary angiogram are more common in female patients with chest pain than male patients. The use of coronary angiography can itself contribute to symptoms in these patient sand non-organic factors are often over - looked in these cases. There are rare instances where the patient with chest pain requests the cardiologist to do coronary angio. Cardiologists should select patients for coronary angio with care and should prepare the patient for the possibility of normal finding. The cardiologist should identify patients with high risk when they advise patients to undergo coronary angiography and in cases with severe coronary artery disease the cardiologist should request a cardiac surgeon to be on stand - by duty for surgery (CABG) is the need arises, immediately after angio. ##### Exercise and your Heart by Asanga Wijayaratne, Director - Physical Education Dept. There is no threshold of activity that you have to reach before you can benefit from physical activity. Even with a little activity you will be better than none!! Physical activity halves the risk of developing coronary heart disease. Among people who have heart attacks, those who have been physically active are twice as likely to survive the heart attack compared to people who have not been active. Physical activity as part of a rehabilitation programme reduces the risk of dying after a heart attack by 20 per cent. Physical activity also reduces your risk of having a stroke. It helps lower your blood pressure, and reduces the risk of diabetes. It helps you to lose weight if you are overweight or obese. Physical Activity also gives you: More energy, Relief from stress, and a lower risk of osteoporosis. (Thinning of the bones) Why physical activity is important . Physical activity helps improve your blood cholesterol levels. Physical activity raises HDL cholesterol (High density lipoprotein the 'protective' cholesterol), but does not affect LDL cholesterol levels (Low density lipoprotein. The more 'harmful' cholesterol). However, in order to maintain the benefit in HDL cholesterol, you have to make sure that you do regular physical activity. . It helps prevent blood clotting. A heart attack usually occurs when blood clots form in the coronary arteries. Regular exercise helps to prevent blood clotting.. It helps to lower high blood pressure, and prevent high blood pressure. Regular, moderate rhythmic exercise such as walking or swimming helps to reduce blood pressure in people with high blood pressure. this sort of exercise may also prevent high blood pressure from developing. . Regular physical activity plays an important part in maintaining or reaching a healthy weight. The amount of activity you do is as important as the food you eat, because being a healthy weight means balancing the energy taken in to the body (the calories in your food and drink) with the energy you use up (as activity). Also, people who are obese are more likely to have high blood pressure and raised blood cholesterol levels. Diabetes and exercise Men who have diabetes are two to three times more likely to get coronary heart disease than those without diabetes. Women with diabetes are four to five times more likely to get it. If you already have diabetes, physical activity can help to reduce the amount of medicines or injections you need to take. Moderate rhythmic exercise appears to reduce the risk of developing diabetes in middle aged people, whether or not they are obese. Exercise helps after you have had a heart attack. Stress, depression and anxiety all appear to slow down recovery after the heart attack. There is some evidence to show that physical activity may help to relieve depression and anxiety, and therefore speed up recovery. Types of Exercises Different types of physical activity contribute differently to health. The type of exercise that benefits the heart is called 'aerobic'. Aerobic activity is any repetitive, rhythmic exercise involving large muscle groups. examples of aerobic activity include walking, cycling, swimming and dancing. Aerobic activity increases the body's demand for oxygen and adds to the workload of the heart and lungs, making the heart and circulation more efficient and helping to develop endurance. The other main type of exercise called Isometric. Isometric exercises are those in which muscle tension is produced without moving a joint - for example. When pushing against a wall. These exercises produce good, local strength gain. However, they do little for your heart and circulation. In fact, people with heart disease or high blood pressure should avoid doing isometric exercises because they increase your blood pressure, and put your heart under stress. Aerobic activity in which the body also bears its own weight - as for example in walking but not swimming can help to prevent osteoporosis (thinning of the bones). Isometric exercise may also have the same effect. ##### Nature's oils and pain management Pain management remains one of the biggest challenges in medical care today. Physicians are increasingly looking to explore pain management from a whole person perspective, taking into account the multidimensional nature of the pain experience.
Headaches, migraines and musculoskeletal problems were amongst the top reported conditions. Within this same category, stress, anxiety and insomnia are listed along with arthritis and rheumatism. Direct effects of aromatherapy Aromatherapy can work in direct and practical ways to reduce pain perception and its effects may be observed for both acute and chronic pain. essential oils are fragrant, active and concentrated substances extracted from aromatic plants by the processes of distillation or expression. These are the principal tools of the aromatherapist and have a wide range of confirmed effects. With regard to pain relief, certain essential oils may be used to exert a number of effects, for example to influence neuronal firing and transmission, interact with potentiating factors such as key inflammatory mediators or create a counter-irritant stimulus to block pain transmission. Indirect effects of aromatherapy A typical aromatherapy treatment involves case history taking followed by selection and application of a number of essential oils appropriate for the individual. Application methods during the treatment itself frequently involve massage with the relevant essential oils diluted in a vegetable oil base. A general observation of the person in pain is that they are often 'trapped in the moment' with pain being the focus of their attention. Aromatherapy is a powerful sensory experience. Anxiety is the most common factor associated with the pain experience, in particular the fear of pain or the fear of more pain. This not only serves to heighten pain perception but also affects the person's individual coping strategy. Aromatherapy excels in the field of anxiety and response can be established over several treatment sessions. Depression is a feature of most chronic painful conditions. There is a growing body of compelling evidence to demonstrate that at pleasant fragrance can alleviate depression and reduce the need for medication. Sleep deprivation is another common feature with pain creating an alarm state that affects arousal and wakefulness. Postural, behavioural and social changes as a result of a pain pose further problems. Aromatherapy massage assists the person to relax sufficiently to allow and encourage gentle mobilisation of the affected areas. The therapist-client relationship is fundamental to supporting the person in pain. When treating the person in pain, the person is often under the simultaneous care of their doctor or other health care practitioner (e.g. osteopath, chiropractor), necessitating close liaison between all health professionals. (Courtesy: 'Technique International') ##### How much alcohol can people drink? Dr. R.A.R. Perera, Consultant Psychologist Alcohol is a substance that is drunk because it induces feelings of increased confidence and relaxation. Recent studies on the effects of alcohol on physical health have revealed important facts useful to Sri Lankans who consume alcohol in excess.
Much attention has focused on how alcohol consumption affects the risk of heart disease, which accounts for a large fraction of deaths among males between 40-60 years of age.It is difficult to escape the conclusion that alcohol confers some protection against heart disease. The suggestion that alcohol has a heart protective action is also plausible. Alcohol increases: high-density (good cholesterol) cholesterol levels, the reduces fibrinogen levels and platelets, (which causes stickiness in the blood). Advice to patients The harmful effects associated with drinking (physical and psychological damage, accidents, crime and violence, social disorder, family breakdown, reduced economic production) are well known. These effects are caused by a combination of intoxication, chronic high intake and alcohol dependence. Advice to the public how much they can safely drink must balance the benefits against these harmful effects.In countries like United Kingdom and United States the advice given is that men should drink less than 21 units / week and women less than 14 units / week. One unit is 8 grams of alcohol, approximately equivalent to half a pint of beer, a small glass of wine or sherry, of a single shot of spirits in the measures commonly used in reputed pubs. The origins of these limits are obscure, but they were endorsed in 1980 by medical bodies such as the Royal College of Physicians, the Royal College of Psychiatrists, and the British Medical Association. There are problems in specifying quantities. . The risk associated with consumption varies between individuals. . Estimates made by drinkers of the amount they have consumed are inaccurate. . Some people might see limit as a target for drinking, rather than ceiling.Although these arguments are valid, following them is to deny guidance to individuals who seek it, while colluding with heavy drinkers in finding reasons why they should not decrease their consumption. Guidance on drinking that specify quantities, therefore, is more useful than guidance that not.A study done in United Kingdom in 1994 involving 12,321 male doctors as subjects showed that mortality rises with more than 21 units. The few studies that have been made of women suggest that for them mortality rates starts at a lower level (14 units).It is wrong, however, to base advice on mortality rates alone. Alcohol is associated with considerable morbidity to the drinker and to the family, and social problems. The relationship between these harmful effects and consumption level must be considered when formulating guidance on low-risk drinking levels. |
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| Editorial | Security Produced by Lake House |
There is no doubt that the result of this state of ignorance is the
occurrence of sexual frustration and psychological problems in married
couples. It is probable that very few of the people with sexual problems
ever have the courage to go to a doctor and talk about them.
Sending a catheter to coronary arteries is one of the most skilled jobs
in medicine and is now done routinely and with little risk in most of the
cardiology units in the world. The coronary catheter is passed either
through the femoral artery of the lower limb or bracheal artery of the
upper limb by percutaneous approach under local anaesthesia and radio-apaque
dye is injected into each of the coronary arteries and multiple views in
different projections are taken. Occlusion of coronary arteries which are
nearly always caused by atherosclerosis are shown in the angiogram.
Aromatherapy may offer a significant way forward as a complementary or
alternative form of pain relief for a number of people. In 2001, a survey
of UK aromatherapy organisations explored the most common conditions
reported by therapists as responding positively to aromatherapy.
A 12-year study (1978-1990) done in United States of America on 276,802
men aged 40 - 59 found that, men who drink little alcohol had a much
better chance of avoiding death from certain diseases like heart disease
and stroke. People who drink lot of alcohol and those drink none had high
rate of death from heart disease and stroke. The people who drank more had
a higher death rate from diseases like liver disease, accidents and some
cancers.
