Alternative Medicine

A number of terms have been used to describe the diverse group of therapies that fall outside conventional medical practice. The term chosen often says something for the attitudes of the person using it. For example, we have fringe medicine, alternative medicine and complementary medicine as descriptions suggesting differing degrees of distances from the orthodox practice of medicine.

What, then, truly distinguishes the orthodox from the unorthodox in medicine? The answer to this question gives important clues to the reason for the existence of alternative therapies and for their increasing attractiveness to some people. Firstly, alternative therapies can be distinguished by the fact that they are not usually taught at medical schools, are not used by the orthodox practitioner and are not under the direct control of the medical establishment. The medical profession is conservative in its attitudes and has a firm philosophical base in scientific orthodoxy. This excludes and to some extent encourages alternative therapies based on different philosophies and practised by therapists outside its control. The second distinguishing feature is that alternative medicine generally attempts to stimulate the patient's constitution to fight on its own behalf rather than combating disease with drugs or surgery. This is philosophically attractive to many people who see the increasingly sophisticated and scientific nature of modern medicine as inhuman. Thirdly, alternative therapies are generally based on principles which are not accepted by scientific orthodoxy; and the success of its treatments are usually not able to be consistently and statistically demonstrated in the orthodox scientific way. Of course, any therapy can be expected to have some success as a result of chance variations and of suggestion. This latter, the placebo effect is well recognised; and it and chance are allowed for in the design of modern drug trials.

The types of alternative medicine fall into three main groups according to their emphasis on body, mind and spirit. Those with an emphasis on the body include naturopathy (disease can be avoided by eating only that which is natural and uncontaminated and by living the most natural life), herbalism (certain plants are claimed to have therapeutic benefit in specific conditions), homeopathy (diseases are treated with vanishingly small quantities of medication designed to boost the body's own defences), osteopathy and chiropractic (spinal manipulation is used to correct supposed derangements of nerves and blood vessels to restore health not only to the spine but also to other part of the body) and acupuncture (physical stimulation of points on the body surface restore normal energy flows in the body). Those with an emphasis on the mind include yoga (the mind can exert control over all the body's functions in health and illness) intervention of an outside force (usually divine and intangible) together with some degree of faith on the part of the sufferer.

When alternative therapies have submitted themselves to orthodox scientific scrutiny, treatment modalities such as acupuncture and hypnotherapy have found at least some acceptance by the orthodox practitioner though well-designed studies are rare and tend to show little benefit over placebo. The majority, have either refused the test or failed it. It is as well to keep an open mind about alternative medicine, but not so wide that your brains fall out.

Cervical Smears and Breast Awareness

Breast Awareness

Breast self-examination is a technique taught to women to examine their breasts once a month to detect a lump that might represent an early cancer. Nine out of 10 lumps found by women themselves turn out to be benign, not malignant, but it was thought that by earlier detection the mortality rate from breast cancer would be decreased. Analysis of studies have not actually found this to be so, and there is still controversy over this aspect of breast cancer screening.

However, for individual women it is probably of benefit to be aware of the normal texture and anatomy of their own breasts. For this reason it is suggested that after each period women over the age of 30, or 25 if her mother or sister had breast cancer, feel their breasts and if they notice a change or lump to come to the Medical Centre for a check. It is unlikely to be a cancer but should it be so, then by detecting it earlier than otherwise might have occurred, the necessary surgery may be less radical.

Cervical Smears

The cervix is the neck of the uterus or womb and it protrudes into the top end of the vagina. It can easily be examined by a doctor or nurse using a device called a speculum. Cancer of the cervix may be triggered by a sexually transmitted virus. Certainly it only occurs in women who have been or are sexually active. The cell changes leading to cancer develop very slowly over a number of years in the surface cells of the cervix. It is these cells which are sampled by scraping the surface of the cervix during a cervical smear test. The cells obtained are examined in the laboratory under a microscope and deviations from normal can be detected. Any cell changes can thus be detected well before actual cancer develops and the abnormal area of cervix can be easily and permanently treated using simple techniques such as freezing. Five to 10 percent of smears done are technically unsatisfactory and have to be repeated.

The most important things about cervical smear testing are firstly that it is a very simple procedure and secondly it does work in the prevention of cancer. If you have ever been sexually active, you should have your first smear at the age of 20. The smear test should be repeated one year later and if both these tests are normal then repeat tests every three years are sufficient, right through to age 65. The very disappointing fact of the matter is that least half of those women diagnosed as having cervical cancer in New Zealand have never had a smear test - the message is obviously not getting through to everyone.

Contraception

This article aims to give an outline of contraceptive methods available with comment on effectiveness, benefits, risk and costs. It obviously cannot be comprehensive in the space available but should help you to narrow down your choices. While there is an enormous amount known about the various methods, there are also areas of uncertainly, because the possibilities for well-controlled experiments using consenting human subjects are obviously limited.

First, a few facts to help in the understanding of what follows. The beginning of the menstrual cycle is timed from the first day of bleeding and during the first half of a typical cycle of 28 to 30 days, the lining of the womb increases in thickness and an egg matures in the ovary to be released at about day 14. For about 72 hours after this, fertilisation of the egg by a male sperm is possible. If this occurs, the fertilised egg implants itself in the mature lining of the womb at about day 20., hormone changes take place and a pregnancy begins. If no fertilisation or implantation occurs, different hormone changes take place, the lining of the womb is cast off with some bleeding and a period begins.

In general, the egg is released (ovulation) about 14 days before the onset of the next period, so that if someone normally has a 34 instead of a 28-day cycle, ovulation occurs at about day 20 with implantation of about day 26. All these figures are very approximate, but we can say that intercourse without contraception at about the time of ovulation gives a one in five chance of pregnancy as opposed to a chance of two percent to four percent for a single intercourse at any time in the cycle. About half of all couples having intercourse with average frequency will have conceived in five months and well over 70 percent in a year.

Conception can be prevented or hindered by stopping sperm and egg from meeting, stopping ovulation, stopping implantation and by choosing to have intercourse at a time when ovulation is less likely to occur, or a combination of these. In assessing how effective a method is at preventing pregnancy, we count the number of pregnancies that occur in a hundred women in a year and express the rate as "per hundred women years".

Methods

Spermicides - These are chemical which kill sperms and come mixed into cream, jelly, foam or pessaries (shaped tablets which melt or foam when put into the vagina). The creams, jellies and foam are supplied with a suitable syringe or applicator so that they can be put well into the vagina. The pessaries are usually inserted with the finger in the same way as a tampon. All can be bought over the counter or prescribed by a doctor. Used alone, the failure rate is about 10 to 15 per hundred women years though one type of foam, Delfen foam, may be a little better than this because it provides a temporary physical as well as chemical barrier. Most of them are slightly acid and so may provide some protection against yeast infections of the vagina. Some creams are lightly perfumed and a few people may be sensitive to this or object to the consistency, smell, or even taste. There does not seem to be any substantial risks to using spermicides other than the risks of pregnancy.

Condom

This is a sheath of latex rubber about 0.3mm thick, about 20cm long and 4cm wide which is unrolled onto the erect penis before there is any contact between the penis and vagina. Its elasticity holds it in place and prevents any semen from leaking out. Condoms are very strong and breakage of those made to American or UK standards should be a rare event. Most problems are due to insufficient lubrication or use of a damaging oily lubricant leading to breakage or to the condom slipping off because it was not completely unrolled onto the penis. Even those sold as lubricated do not really provide sufficient lubrication and it is always advisable to use condoms with a spermicide, preferably a foam or jelly rather than pessaries which do not provide much lubrication. Some brands of condom are coated with a spermicide which also kills the AIDS virus, but it seems that the quantity is too little to be very effective for either purpose.

Condoms may be bought from many supermarkets, and all chemists in packets of three, six or twelve. The many different brands are all roughly the same size. Claims that a particular brand will enhance your sex life because of its thickness, surface texture, colour or shape should be accepted with a largish pinch of salt.

Condoms used alone have a failure rate of about five per hundred women years and one suspects that most pregnancies result from non-use rather than from failure of the condom itself. Used properly with an effective spermicide the failure rate should be less than one per hundred women years.

Condoms give a lot of protection against most sexually transmitted diseases including AIDS, are reasonably cheap, need little skill to use and have no unwanted effects except in the occasional person who is allergic to rubber. On the other hand they can be inhibiting, especially if you're already a bit nervous, and many men do not like the inevitable reduction in sensation. For others, this can be an advantage. In view of the AIDS risk we would advise you to use a condom whether or not you need contraception unless you are absolutely sure your new partner's sexual history has been free of risky activity.

Diaphragm

This is a soft and flexible dome of thin rubber about 75mm diameter and about 25mm high with a springy rim. It is put into the vagina before intercourse so that it covers the neck of the womb (cervix) and prevents any sperm entering and swimming on to fertilise an egg. Its springiness and suction hold it in place and neither partner should be aware of it if it is properly fitted. It is removed a minimum of six hours after intercourse. It is only a little more difficult to put in and remove than a tampon and most people find it easy to use though it does need a trained doctor or nurse to fit the correct size and explain its use. It should always be used with a spermicide and this is usually placed inside the diaphragm before putting it into the vagina. If you have intercourse again before removing it you should insert more spermicide with an applicator.

A diaphragm can be bought over the counter at a chemist but is more commonly obtained with a prescription after fitting by a trained person. Its fitting should be checked after any substantial weight gain, after pregnancy and in any case every two years.

The failure rate of the diaphragm when used with a spermicide is about three to five pregnancies per hundred woman years.

Diaphragm users tend to have more urinary infections than users of other methods. It does not seem to have other unwanted effects. While it needs a little practice to learn how to use it, it can be put in an hour or two before intercourse and forgotten about until due for removal.

Standard Pill

The standard contraceptive pill is a mixture of two synthetic female hormones which prevent eggs being released from the ovaries and incidentally slow down the maturation of the womb lining. The pills come in packs of 28 pills with the day on which you should take each pill clearly marked. You take hormone pills for 21 days and then dummy pills or no pills for a further seven days after which you start the next pack. During the time that you take the dummy pills you have a period which is usually shorter and lighter than usual. People who have period pain and premenstrual tension often find that it is much improved.

The pill can be obtained only with a doctor's prescription. Several brands are now fully subsidised but other brands have a part charge.

Taken correctly, the pill has a failure rate of less than three to four pregnancies per thousand women years, ie about 10 times better than the diaphragm or condom. If taken late or not at all, or vomited up or lost through a prolonged, severe attack of diarrhoea, it may fail. Two sorts of antibiotics, neither in very common use, and some anti-epilepsy medications, definitely reduce the effectiveness of the pill. The case against some other antibiotics is very much weaker.

As implied above, the pill is not suitable for women on some sort of antibiotics and on some anti-epilepsy medication. Women who have raised blood pressure should not use it. Women with migraines should discuss its use with their doctor, particularly if they have classical and severe migraine. It is not an ideal method for those with infrequent, scant periods. There is a fuller discussion of the risk and benefits of the combined pill in the next section.

Mini-Pill

This contains only a progestogen hormone and is taken continuously. It works mainly by making the mucus in the neck of the womb (cervix) hostile to the passage of sperm. People with raised blood pressure or migraine may take it, usually without problems, but it is mainly used by women who are breastfeeding, as the standard pill often interferes with milk production. Whereas the standard pill has to be taken within twelve hours of the same time each day, timing has to be much more precise with the mini-pill and even then it has a failure rate of one to two per hundred women years. Women who have had unacceptable minor side effects on the standard pill are often happer on the mini-pill.

Injection

This is an injection of a progestogen hormone, MPA, which is given in a form that releases the hormone over three to six months. Its main advantages are that it requires thought about contraception only once every three months and has an effectiveness approaching that of the standard pill.

The commonest side effect is that periods stop altogether while some women get irregular spotting and bleeding which is sometimes prolonged. The latter is very difficult to deal with as one cannot 'switch off' the effect of the hormone depot. While it was once widely used in the UK and Australasia, concerns about its safety were ill-founded and it is now preferred by an increasing number of women in New Zealand.

Emergency Contraception

This involves taking one high-dose progesterone pill after intercourse followed 12 hours later by one more. It may have an anti-ovulation effect, but it probably works in most cases by making the lining of the womb unsuitable for implantation of a fertilised egg. Nausea is a possible side effect of this treatment and sometimes an anti-nausea pill will be given before each emergency contraceptive pill. It is important to take the emergency contraceptive pill within 72 hours.

This is obviously a method for occasional rather than regular or often repeated use. It has a failure rate per single use of between 0.2 and two percent but people are at risk of pregnancy only around the time of ovulation; and a recent study suggests failure rate at this time is about 25 percent. There is no reason to think that it carries any long-term risks to the user's health, and there is no evidence to show adverse effects on the foetus if the method should fail. There are no long or short-term risk to the user.

If you have risked pregnancy and wish to consider using the emergency contraceptive pill, you should see a doctor within 72 hours.

A third option is to fit an IUCD, which can be done up to five days after unprotected sex. This method is not suitable for everyone and we advise you to discuss it with your doctor.

I.U.C.D.

This means intra-uterine contraceptive device and is a device nowadays made of plastic and copper shaped to fit in the cavity of the womb (uterus). It works by making the lining of the womb unsuitable for implantation of the fertilised egg. A doctor has to insert it and, when it is no longer required, remove it. Its main advantage is that once inserted it can be left for five years before replacement and that the woman does not have to remember to do anything to remain contraceptively safe. However, for most students it is not a method of choice because of the difficulties of inserting an I.U.C.D. in someone who has never had a child. The I.U.CDs currently available do not seem to have the problems with infection shown by the notorious Dalkon Shield, but it is definitely not suitable for anyone exposed to the risk of sexually transmitted diseases. Many women in a stable long-term relationship find it an excellent method to use once they have completed their families although sterilisation operations are now the preferred method for men and women in New Zealand. The I.U.C.D. has a failure rate of around one pregnancy per hundred women per year.

Natural Methods

These rely on attempts to estimate when ovulation occurs. One then avoids intercourse for a few days either side of ovulation time to give a margin of safety. If a woman has very regular periods she can make a very good guestimate of ovulation time simply by using a calendar to count back 14 days from the estimated time of onset of her next period. Unfortunately for the method, ovulation can also occur at other times.

During the first half of the menstrual cycle, a woman's body temperature is relatively low. At ovulation, it takes a slight dip and then rises to a new plateau for the remainder of the cycle. By measuring the temperature ver::{20D04FE0-3AEA-1069-A2D8-08002B30309D}\y carefully at rest first thing in the morning and plotting it on a chart she can, provided she has no colds, flus, emotional upset, etc, often estimate when ovulation has occurred. Many women unfortunately do not show the typical pattern of temperature change.

As the time of ovulation approaches, the mucus in the vagina becomes clear, slippery and can be drawn out into strings. Ovulation occurs within 24 hours of the last day on which this occurs.

For women who for religious or other reasons cannot use any other method of contraception, a combination of these 'natural' methods is much better than nothing at all, but is likely to have a substantial failure rate. This can be improved upon with excellent instruction and the best instructors are those who are using the method themselves.

Making a Choice

Most students will probably elect to see a doctor at the Medical Centre. We hope that this article will give you at least a basis of discussing your choice, though in practice we find that most people have made up their minds by the time they visit the service. Others may prefer to see their family doctors, visit a Family Planning Clinic or make contact with the Natural Family Planning Association. Telephone numbers may be found for all these in the telephone directory. Most people want to know "is it effective and is it safe?" and it should be clear from what we have written that both safety and effectiveness are relative terms. You may have to balance one against the other, bearing in mind that if a method fails you, abortion carries a risk to life and health and that about one out of 3500 pregnant women die during their pregnancy (more if accidental death is included).

Until a few years ago, the obvious first choice for most female students was the standard pill because of its effectiveness and safety (notwithstanding sometimes muddled and inaccurate articles in the popular press). Some may feel that there are as-yet-unknown effects of the pill on the body, others that pill production is part of a conspiracy on the part of the male-dominated pharmaceutical industry. Having reviewed quite a lot of the enormous amount of primary literature on the pill we do not think that either view is likely to be correct. It does seem that people who have reservations about a method tend not to use it carefully.

The diaphragm used to be a very popular method of contraception until the pill arrived on the scene and a substantial minority of students use it, often combined with another method like the calendar method or condoms.

The rise of the AIDS spectre should make one think about condom use. The only ones who do not need to do so are the those who have and intend ever to have only one sexual partner and whose partner is of a like mind. AIDS has found its way into the heterosexual community in New Zealand and is likely to increase. Our advice is clear: if you or your partner have had other sexual partners you should consider using condoms irrespective of whether you are using any other method of contraception.

Contraceptives: Oral, Benefits and Risk

From time to time sensational articles appear in the lay press about risks of oral contraception but rarely is emphasis given to the benefits of using this method of contraception. Oral contraceptives have been in use now for over 30 years but unfortunately much of the information we have about risks relates to older types of pills in which the dose of hormones were relatively high. In some areas, risk is impossible at this stage to assess with any accuracy and we have to make do with the information that we have.

The first and most obvious benefit is very effective contraception so that the pregnancy rate is around about three pregnancies per one thousand women users per year. The costs of an unwanted pregnancy are high in both health and emotional terms and the efficacy of the oral contraceptive must be regarded as a major clinical and not just a social benefit. Obviously, since pregnancies are very uncommon when using the pill, it follows that complications of pregnancy are also extremely rare.

There is clear evidence that the use of the pill reduces pelvic inflammatory disease by 50 percent and as this condition has a high rate of subsequent infertility, this must be regarded as a major social and clinical benefit. Cancer of the body of the womb and of the ovaries are also much reduced in incidence by the pill. One of the major causes of illness and days lost from work in modern society is period pain and premenstrual tension. In most pill users, both these conditions are greatly improved.

Although a great deal is now known about pill-related risks of heart attacks, strokes and raised blood pressure, this can be summarised for the purposes of the student population at least by saying that users aged under 30 years who smoke and non-smoking users under the age of 35 years do not appear to face any increased risk. However, for smokers, particularly overweight smokers over the age of 30, risks rise quite sharply. About one in 20 users show some rise in blood pressure and it is for this reason that blood pressure checks every year are advisable. Most OCs increase the risk of a woman developing a blood clot. This risk is very small but some women have a higher personal risk that others. Without the use of OCs approximately one young woman in 30,000 per year will develop a blood clot and most of these will make a full recovery.

Recent studies show that for women using the newer contraceptives containing desogestrel and gestodene their risk is two in 10,000 per year. For other OCs the risk is one in 10,000 per year. In pregnancy however, the risk is six in 10,000 per year, rising to 12 in 10,000 in the week the baby is born.

Before being prescribed a contraceptive, these issues will be discussed to ensure the most appropriate contraceptive for you is advised.

An early American study suggested that there was a much increased rate of a rare form of benign liver tumour but a subsequent British study has failed to identify a single case of liver tumour of this type occurring in contraceptive users.

Many indicators of increased incidence of cancer of the neck of the womb (cervix) have now been identified, most of them relating to sexual activity, eg early age at first intercourse, early first pregnancy, multiple sexual partners, cervical wart virus infection, cervical herpes virus infection and a number of non-sexual factors such as cigarette smoking. Most studies have failed to confirm any adverse or protective effects of the pill on cancer of the neck of the womb once all the various factors have been taken into account. The same can be said for breast cancer; again most studies show no evidence of any pill-related risk.

However, in two studies reported in October 1983, there was a suggestion that the risk of breast cancer in long-term oral contraceptive users was increased fourfold after five years of use of certain types of pill with a high progestogen component. The study of cancer of the neck of the womb appears to show a similar increase incidence related to length of use of the pill but both studies were subsequently severely criticised both on methodology and analysis. A very large study on breast cancer and the pill, published in November 1986, failed to show any association between pill use and later cancer of the breast but a further study published in May 1989 suggested that there is an increased rate of breast cancer in the under-35s, though Cancer Registry statistics in the UK fail to confirm this. It does not seem likely that there will be any very long-term effects of oral contraception that are not already known. In general, the increased risk of cancer of the breast and cancer of the neck of the womb are slight if indeed they exist at all. However, it makes good sense on general grounds for all women to have regular cervical smear tests.

After stopping the pill, there is a delay in return to normal fertility of about three months on average. In about eight percent of users the delay may be as long as three years, especially in women who have never been pregnant.

Many other minor side effects have been reported for the oral contraceptive pill, as indeed are reported for any sort of medication. However, with modern preparations the incidence of such side effects is very low and its is generally possible to find a pill which will suit each particular individual. As knowledge of side effects improves, no doubt it will be possible to further lower the risks of pill taking by excluding people known to be at high risk. In the student population age group, such risks are very low in any case.

Pregnancy, Unplanned

If this does happen it is wise to see a doctor early to discuss what assistance can be given. This includes counselling with one of the social workers attached to Palmerston North Hospital who work especially on pregnancy-related problems.

If your decision is to have abortion (termination of pregnancy), a report is required from the doctor and from the social worker who will make the arrangements with Wellington Hospital. While there are no changes for New Zealand residents, most international students will face a charge of more than $1000 for an abortion.

There are many pressures felt by the pregnant student and the Medical Centre will support and arrange ongoing care whatever you decide to do.

Testicle Topics

This section has been written to highlight two very important conditions that affect males in the student age group. With both conditions, early and prompt treatment can have a significant and beneficial long-term outcome. In both cases the message is simple, don't delay seeking medical advice.

Acute, severe scrotal pain coming on suddenly is always an urgent problem because it is most likely to be testicular torsion. This is a condition in which the testicle twists on its cord, cutting off its own blood supply. Unfortunately, after a few hours, the pain may subside, thus deceiving you into thinking the condition is subsiding whereas in reality it is a sign that death of the testis is imminent. If the torsion is not relieved within six hours from the time of onset, the testis is then probably gangrenous and will not survive.

With this particular condition, delay in seeing a doctor of just a few hours could make the difference between a testis surviving or not. Don't put up with severe scrotal pain; see a doctor immediately.

The other condition that needs to be discussed is testicular cancer. Again, delay in receiving treatment can have a significant impact on the final outcome.

Failure to seek medical advice is the most common reason for the late diagnosis of testicular cancer. On average men wait 14 weeks from first noticing a symptom before consulting a doctor. Probably the most important factor here is a failure to realise that cancer can attack at this site and at an early age compared with most other cancers.

While cancers of all types are rare in young men, of those that do occur in the 15-25 year age group, nearly a quarter are testicular. In the age group 25-40 years, testicular cancer is the second most common cancer behind malignant melanoma. This is very important to remember. At your stage of life testicular cancer is a real issue.

With testicular cancer the early clues are found in one of your testicles. They are usually obvious and easy to find, so watch out for any one or more of these signs:

  • A hard lump on the front or side of the testicle
  • Swelling or enlargement
  • An increase in firmness
  • Pain or discomfort
  • An unusual difference between one testicle and the other.

If you are going to pick up signs of trouble you need to know what your testicles normally feel like. Testicular self-examination should be done regularly, about once a month, during or shortly after a shower or bath when the scrotal skin is relaxed. Hold your testicles in your hands so that you can feel their size and weight. It is quite normal to have one larger than the other, or higher than the other, but they should be about the same weight. Feel each testicle and roll it between your thumb and finger. It should feel smooth all over. You will feel a soft, tender, sausage-like tube towards the back of the testicle. This is normal and is called the epididymidis.

If you do notice anything unusual about your testicles, particularly a hard lump, you should come and see us at the Medical Centre as soon as possible. Testicular cancer is a serious disease, but when it is discovered and treated early there is usually a complete cure.

Dental Care

This is your own responsibility. We don't provide it or fund it. For Community Services Card holders, the Palmerston North Hospital Dental Unit does provide a low cost service and either ask at our reception desk for the application form that you must complete or ask for it during your consultation with a doctor or nurse.

An annual dental check-up can prevent you needing more expensive treatment later. Regular brushing helps keep the cost down. If you can be bothered, at least daily use of dental floss will help to prevent decay between the teeth as well as keeping the gums healthy. Wisdom teeth occasionally give trouble when they're breaking through the gums. Regular, full doses of Disprin or paracetamol helps relieve the discomfort. If you need anything other than emergency treatment to your wisdom teeth, it makes sense to have this done during a vacation rather than during term time and the person who arranges non-urgent treatment to coincide with exams will be looked at askance.

If you get severe toothache at the weekend, the Emergency Department at the hospital holds a list of dentists prepared to see patients urgently, but be prepared for a hefty bill.

Hops and Vines, Hemp and Tobacco

Alcohol

Alcohol is a powerful toxic drug which strangely most of us enjoy from time to time in a happy social way. Alcohol is a depressant to the brain and in large quantities leads to unconsciousness. Among the first areas of activity to be affected are inhibitions and then judgement and motor coordination. If you take only two or three drinks slowly, usually you experience only the merry effect, beyond this, hopefully the ill effects will be no more than embarrassment, a hangover and a budget deficit. However, without control there could be the trauma of a pregnancy or the tragedy of a car smash. You are still responsible for your actions even when 'under the influence'.

Women are more susceptible to the effects of alcohol partly because their bodies have a higher proportion of fatty tissue.

Some prescribed or bought medicines will increase the effect of alcohol, especially antihistamines, which are commonly used for allergies and in cold remedies. If you are already feeling depressed, alcohol may well increase your gloomy feeling. The combination of alcohol and cannabis is a big accident risk.

Heavy regular use of alcohol can lead to addiction with dire social effects such as the inability to keep a job or a relationship as well as physical effects, especially on brain, liver and heart. The decision to use alcohol responsibly is part of a more fundamental decision to use life responsibly. We owe it to ourselves to make an informed choice about alcohol use, a choice which expresses our individuality not our pliability.

Cannabis

The important component of the hemp plant which affects the mood and perception of the user is called THC. Like alcohol it is a depressant drug. THC is found in increasing concentrations in marijuana or grass up to eight percent, hashish up to 15 percent and hashish oil up to 60 percent THC. The affects of cannabis vary according to the amount taken, the way it is taken, the user's body size, previous experience of it, personality and mood at the time. There may be a feeling of wellbeing. However, cannabis slows reaction time and information processing, impairs attention and short-term memory. It clearly does not assist learning or logical thinking or problem solving and in some circumstances, such as driving, could be disastrous.

Problems associated with regular use of cannabis include reduced memory and motivation and possible dependence. Respiratory illnesses such as bronchitis are increased as with tobacco.

Tobacco

This is a drug which is more addictive than many restricted or illegal substances such as cocaine, and physically it is extremely harmful. It is the physical addiction which makes tobacco smoking very difficult to stop. Unfortunately it was in widespread, socially approved use before the 1950s when the first incriminating evidence appeared of its lethal effects.

There is no safe level of smoking. Even passive smoking, ie inhaling someone else's tobacco smoke whether at work, in the pub or at home, is also damaging. Children are thus very vulnerable.

Tobacco smoke includes:

Nicotine - a highly addictive drug.

Tar - the tasty part which blackens lungs and includes at least 42 cancer-causing chemicals.

Carbon monoxide - blocks oxygen from heart and brain, ruins fitness. One cigarette gives the brain more carbon monoxide than 10 hours on a busy street.

Irritant chemicals - which damage the linings of the respiratory passages.

Many people who die middle-aged now do so because of their smoking. The health problems caused by smoking include:

Cancer - lung cancer in particular, but also many other cancers are more frequent.

Coronary heart disease - smoking is a major risk factor for a heart attack through narrowing of the coronary arteries which supply the heart muscle.

Other arteries - these can also be blocked, leading to loss of blood supply to part of the brain or to a foot.

Lung problems - smoking leads to the disabling breathlessness of chronic bronchitis and emphysema. This can be especially severe if the smoker also has asthma.

Unborn babies - smoking by a pregnant mother reduces the growth and health of the baby in utero.

It is very frustrating to see so much unnecessary illness in the older members of our population. The increase in smokefree public places is pleasing. Smoking is forbidden in all Massey buildings and is restricted to designated areas outside buildings in campus.

Malignant Melanoma (Moles)

At the beginning and end of each academic year, we see many people who want us to check their skin for malignant melanoma (MM), often because they are going to be working in the sun or have recently been working in the sun. While MM is easily cured in its early stages, it is not easy to recognise at an early stage and so much of our efforts at reducing its incidence must go towards prevention.

MM is not common in the early twenties, although it is the commonest malignant disease in this age group. About 60 percent of malignant moles are new moles and the other 40 percent occur in pre-existing moles, so that we treat a new mole appearing after puberty with great suspicion. The best guide we have in dealing with existing moles is not their appearance, but their behaviour. In general, if the patient is sure that a coloured mole is new or has changed in some way, we advise its removal, so that its exact type can be determined. The overwhelming majority of moles that we remove turn out to be perfectly benign, though some turn out to be 'dysplastic moles' which are best thought of as reflecting an 'at risk' skin type. To put things another way, the cost of detecting MM at an early stage is many minor operations which in retrospect turn out to have been unnecessary.

We cannot as doctors notice change in your skin, but you can. For the person who burns easily or who has a great many moles, it may provide some peace of mind to get a friend to take some well-focused and exposed colour photographs of the face, the fronts and backs of the upper trunk and the arms and legs. Doing so provides a baseline from which you can spot changed or new moles.

The sort of changes you may notice are:

in size, especially if it grows larger rapidly;

in colour, especially if it develops multiple shades of blue-black or you note that colour has spread from a previously sharp edge into the surrounding skin;

in shape, especially if it develops an irregular outline when you know it used to be regular;

in height, especially if it used to be flat. A raised mole in itself is not any special significance; it is the change that is important;

in the surrounding skin, especially redness and swelling or if coloured satellites develop around a mole;

of surface texture such as scaliness, oozing or bleeding;

in sensation such as persistent itchiness, tenderness or a sticky feeling.

Having sunburn, especially in childhood, seems to be one of the risk indicators for MM, so it is important to avoid sunburn. It is scarcely an exaggeration to say that tanned skin is damaged skin. The best sunscreens are clothing and a broad-brimmed (at least 12cm) hat. You can burn through wet clothing or cloth that when held up allows you to see the shape of objects through it.

Sunscreen creams are second best and it is important that you know what the sunscreen factor number means. To take an example, suppose you normally burn after 10 minutes in the noon summer sun. If you apply a factor 15 sunscreen, you will accumulate a burning dose of sun after 15 times 10 minutes, or about two and a half hours. You CANNOT get another two and a half hours by applying more sunscreen. You have had your daily dose of sun and you will burn if you stay exposed to the sun. You may burn more slowly, but you will burn.

While it may help you to look good on the beach to acquire a tan on a sunbed before your holiday, there is some evidence that the rays used in sunbeds place your skin at more risk than if you had acquired the same tan in the sun.

Even on an overcast day, about 60 or 70 percent of the damaging rays can penetrate the cloud, so in late spring through to early autumn, cover up or seek the shade, especially when the sun is at its highest between 11am and 4pm. Remember to slip on a shirt, slap on a hat and slop on sunscreen if you cannot avoid being exposed to the sun's rays. It makes much more sense that expecting your doctor to spot an early MM just by looking at it. We repeat: we are not good at it. Late ones are easy to recognise, but late is often very late with malignant melanoma.

Physiotherapy

The Student Health & Counseling Service provides facilities for a private physiotherapy practice, Churchyard Physiotherapy, to attend and provide services at the university. Churchyard physiotherapists are available to see both Massey University students and staff, and information on appointments and a schedule of fees can be found here.

Patients are normally referred to the physiotherapists by the doctors in this practice although, for accident-related matters, if doctor appointments are short, you can make an appointment to see the physiotherapists directly. If required, the physiotherapists will refer you to a doctor. Appointments can be made by contacting either the Student Health & Counseling Service on 06 350 5533 or Churchyard Physiotherapy on 06 354 8008.

 

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