March 12th, 2009
There are two ways that you can improve your chances of remaining well as you grow older: by looking after your health, and by health screening.
There are a few extra things to keep in mind if you’re over 60 years of age.
Diet
Good nutrition is always important. It’s hard to know just how important particular types of diet are in maintaining health. Around the world, people who have widely varying diets are now living to a ripe old age. Japan and Sweden have the highest life expectancy, with diets that could hardly be more different. Australia is close behind. The French, renowned for the richness of their cuisine and their wine consumption, also have excellent life expectancy.
If you’ve reached the age of 70 and you’re in good health, what you’ve been eating so far hasn’t done you any harm. Most people of this age will have grown up being taught that meat and dairy produce were good for you and bread and potatoes were the ‘baddies’. The new dietary guidelines are different, but they are based on a modern understanding of nutrition so it makes sense to follow them.
One big advantage of the new guidelines is that they advise you to increase the amount of fibre in your diet. This reduces the risk of constipation, which for some people increases as they grow older.
If you have problems with chewing, see your dentist promptly. Inability to chew properly used to be one of the main causes of malnutrition in older people.
The most important thing about food is to enjoy it. Eat enough of a mixture of foods that you like to maintain a healthy weight. Your doctor will advise you about healthy weight range for your height.
Try to choose foods from the Diet Pyramid to ensure that you obtain all the nutrients you need for good health. This will help increase your resistance to infection and keep you feeling healthy and vital.
Special dietary restrictions are only necessary if you develop gout, diabetes, or any other health condition that is diet influenced, or if you need any medicines (for example certain diuretics) that don’t combine well with some foods. Your doctor will tell you if you need a special diet.
Heavy drinking is very destructive, but there’s no evidence that a relaxing drink in the evenings and a glass of wine with dinner will do you any harm.
Exercise
The longer you keep fit, the longer you’ll be able to enjoy an active life. Exercise is good for the body and the soul, but as we get older it must be tempered with moderation to be kind to our ageing muscles (including our heart muscle) and joints, and to allow for any health disorders that develop. Hectic aerobic sessions at the gym and marathon training are definitely unwise for the over-fifties. Walking is considered the best exercise, and a brisk walk of 20 minutes or more at least every second day (better every day) will keep you fit and feeling good.
If this has happened to you, it’s very important for your physical and psychological health to overcome the incontinence and resume walking and any other exercise you enjoy.
Stopping smoking is wise at any age.
Health care
It’s likely that most of us will need to see our doctors more as we grow older, so it’s important to have a general practitioner that we trust and get on well with: someone who will answer questions clearly and explain any tests, diagnoses or treatments.
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March 12th, 2009
Some STDs caused by bacteria share or overlap in the way they are transmitted, the effects they produce and their treatments, so it’s convenient to consider them together. The most important of these are gonorrhoea and chlamydia. Pelvic inflammatory disease (PID) may be caused by either infection alone, other micro-organisms, or any combination of these.
Gonorrhoea
Gonorrhoea is caused by a bacterium called Neisseria gonorrhoeae. The disease and its association with sex has been known for hundreds of years, however until 1889 the germ that causes it wasn’t recognized. It’s named after its discoverer, Dr Albert Neisser. Another name for gonorrhoea was clap. The term ‘clap’ was used for centuries and is thought to be derived from the Les Clapier district of Paris where many prostitutes worked.
What is chlamydia?
This is a family of bacteria that is widespread in nature and causes a variety of illnesses in animals and birds. One species, Chlamydia trachomatis, is exclusive to humans. There are many different subtypes of this chlamydia. Some sub-types cause trachoma, a serious eye infection that can lead to blindness. Most sub-types of Chlamydia trachomatis can be sexually transmitted to cause a range of infections in the female and male genital and lower urinary tracts, and from mothers to cause serious infection in newborn babies.
Though there is plenty of evidence that chlamydia has been causing disease since ancient times, it wasn’t identified until 1940, and it wasn’t until around 1980 that simple and reliable tests for it were developed. Since then, it’s been discovered that sexually transmitted genital tract, urethral and rectal infections due to chlamydia are very common in women and men.
At present there is thought to be a worldwide epidemic of chlamydial infection. This is often called the ‘silent epidemic’, because most infected people have minimal or no symptoms and can pass on the infection unwittingly.
Gonorrhoea and chlamydia attack only certain cells in the body: the columnar epithelial cells such as those that line the cervix, uterus, fallopian tubes, urethra, rectum and epididymis. These parts are all prone to infection during unprotected sexual intercourse with an infected person. A woman is more likely to be infected during one episode of sexual intercourse with an infected man than vice versa.
After invading a columnar cell, the germs begin to multiply and continue to do so until the cell bursts. The bacteria released invade nearby cells, and so the process goes on. The organisms can’t survive for long outside columnar cells because they need the energy produced by these cells to live and grow, but once infection is established in a lining membrane, inflammation develops and spreads in the tissues beneath the columnar cells, leading to pus formation and scarring.
Other bacteria that may cause similar effects to gonorrhoea and chlamydia include Ureaplasma unrealyticum and Mycoplasma hominis. Most people carry these germs in their genital tracts without them causing disease (in this situation treatment is not usually advised), but in some circumstances they can overgrow and cause inflammation. If someone has symptoms and signs of inflammation in the genital tract and only these germs can be demonstrated, they are assumed to be the cause and are treated.
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March 12th, 2009
Breast size and shape
As already discussed, many women are unhappy about certain features of their breasts. Because of their powerful sexual significance in our society, breasts seem to be a greater source of dissatisfaction than most other body features.
It’s easy to say that we should accept our bodies as they are and that people love us for our whole selves whatever the size of our breasts, the colour of our hair, the shape of our noses and so on. This type of statement doesn’t make much of an impression on the woman who’s been embarrassed since her early teens because of her big bosom, or the young woman with one breast twice the size of the other, or the woman whose breasts droop so much after her first pregnancy that she won’t undress in front of her husband.
I agree with the ideology that people should accept and love us for ourselves, warts and all. But unfortunately many people can’t love themselves if they feel that they have a physical feature that is freakish or ugly: they become depressed and withdrawn. I believe that there are many instances where the benefits of cosmetic surgery, in terms of improved self-esteem and confidence, outweigh any amount of ideological argument.
A skilled, caring surgeon and thorough counselling are the most important factors in ensuring satisfactory results.
Should we wear bras?
This question would never have arisen between about 1910 and the mid-1960s when all women wore bras, either to flatten and conceal breasts in the ‘flapper’ era, or to mould them into the fashionable shape of the 1940s-60s.
Today, the main advantage of a bra is that it supports the weight of the breasts, thus preventing premature stretching of the fibrous ligaments that anchor the breasts to the chest wall. Support is more important for heavy breasts, especially in the following circumstances:
• during adolescence if the breasts become large rapidly. A firm bra with non-stretch straps can help to reduce the number and size of stretch marks on the underside of the breast. Adolescent girls with small breasts don’t need a bra • during pregnancy and breast-feeding, when enlargement of the breasts puts additional strain on the supporting ligaments
• if you have tender breasts, a firm bra usually helps
• a bra is a good idea during active sports to cushion jolting movements of the breasts.
Louise’s story
Louise at the age of 22 was 164 cm tall and weighed 49 kg. Her bust measurement was 101 cm and she wore a D cup bra. She had lost 9 kg weight since the age of 18 – ‘I lost weight everywhere except from my bust’. All her clothes, including bras and bathers, had to be specially made. She had endured wolf whistles and jokes about her breasts since her early teens. She had come to think of herself as a freak and had become socially withdrawn and depressed. She had never accepted an invitation for a date.
Her parents and her family doctor suggested that she consider surgery for breast reduction. She consulted a surgeon who counselled her carefully about all aspects of the surgery and its likely physical and emotional effects, and decided to go ahead. Five years later she’s happily married with a baby son (whom she’s breast-feeding).
Louise’s story may sound extreme, but extremes are not so rare. It’s also a success story. You’ll all have heard cosmetic surgery stories that don t end happily, either physically or psychologically or both. If you’re considering surgery to change any part of your body, make sure that you’re aware of all possible outcomes. Two opinions are a good idea.
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March 12th, 2009
The Pill causes thrush
No, Candida albicans causes it. It used to be thought that the Pill caused changes in the vaginal environment (specifically, reduced acidity or increased glycogen) that could encourage overgrowth of Candida. It’s now known that the Pill by itself doesn’t significantly change the vaginal environment. Women on (or not on) the Pill who have quite severe thrush will have normal vaginal acidity as long as there is no bacterial infection present in addition to the Candida.
A possible explanation for the apparent increase in thrush among some Pill-takers (and most women get it no more frequently on than off the Pill) is that increased sexual activity may increase the risk of introducing infection from self or partner.
Thrash can be cured by locally applying or eating yoghurt
This belief arose from the notion that if lots of competition was provided in the form of the lactobacillus in yoghurt, it would clobber the Candida. However, the lactobacillus feeds on milk sugars only, and dies very quickly in the vagina and bowel, and on skin. That means it wouldn’t be around for long enough to provide competition for Candida.
Candidiasis is a modem disease
A side-effect of using antibiotics
Candida has been found in the tombs of ancient Egypt and was described as a cause of skin, vaginal and mouth infections in medical textbooks written well before the advent of antibiotics. It’s hard to know whether it causes infections in more people now than previously. People are certainly more prone to fungal infection while they’re taking broad-spectrum antibiotics, but not generally after the antibiotics are stopped unless they have continuing immune suppression through severe illness or if they’re receiving immune suppressant drugs to prevent rejection of organ transplants. Perhaps for some people, the stress of modern living increases susceptibility to all infections, including those that are fungal.
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March 12th, 2009
Oestrogen
Lack of oestrogen is the most important factor in the development of osteoporosis in women. Oestrogen decreases bone breakdown, prevents loss of calcium via the kidneys and improves absorption of calcium from the bowel. Even with enough exercise and calcium, women who lack oestrogen before or after the menopause will lose more bone more rapidly that those who don’t.
Health authorities now recognize the importance of oestrogen replacement in maintaining older women’s health, especially in the prevention of osteoporosis. However, some women don’t want to use HRT, and it would be overkill to recommend that all women take oestrogen to prevent fractures when two out of three postmenopausal women won’t suffer the symptoms of osteoporosis. It’s generally possible to predict whether a woman is at increased risk.
Techniques have been devised to measure bone density and the degree of bone loss from osteoporosis. These tests may be used to identify early those at higher risk of fractures in later life so that vigorous steps can be taken to prevent further bone loss. Your doctor might suggest such tests if you seem to be at high risk, though many doctors skip the tests and encourage all middle-aged women to begin and maintain a routine that will prevent them from ever suffering disability from osteoporosis. This means having enough exercise and calcium, and hormone replacement if needed.
For women who can’t take oestrogen, other medications may be helpful. Calcitonin (a hormone produced in the thyroid gland) and calcitriol (a type of vitamin D) have been used with some success in the prevention and treatment of osteoporosis, but they are not suitable for everyone and should be used only under supervision of a specialist in osteoporosis. Anabolic steroids seem to relieve the symptoms of established osteoporosis and slow down or halt the process, but also may have unwanted side-effects in some cases.
Other risk factors
Other factors can influence the risk of fractures from osteoporosis.
Body build
Thin women are at greater risk than plump women. Body fat can convert hormones from the adrenal gland into oestrogen: not as much as the ovaries produce before menopause, but enough to slow down bone loss. Also, the bones of heavier women are more stimulated by the greater weight they support. Short women are at greater risk than tall women, because they have less bone mass and so lose relatively more bone as they age.
Family history
Our genes determine our body shape and height, and family habits of diet and exercise may also be important factors in the development of osteoporosis.
Drugs and smoking
Certain drugs promote bone loss, mi through their effects on body calcium. These are alcohol, some diuretic anticonvulsants, thyroid hormone, cortisone and tetracycline antibiotics. Women who are prescribed these drugs for a long time will have been warned by their doctors that they may need more calcium.
Cigarette smoking encourages bone to by increasing the rate of oestrogen breakdown in the body and perhaps the rate of calcium loss in urine.
Amenorrhoea
Women who’ve had long episodes amenorrhoea between puberty and menopause are more likely to begin postmenopausal years with reduced bone strength.
Until recently one in three women coil expect to suffer a fracture from osteoporosis if they lived beyond 65 years. Now we can help prevent osteoporosis from casing disability by maintaining healthy bones before menopause, and by continuing adequate exercise, taking enough calcium and using HRT if needed, after menopause. If you’re around the age of 50, discuss these measures with your doctor.
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