Thursday, September 3, 2009
Wednesday, September 2, 2009
Breastfeeding-
Endometriosis
Endometriosis. It affects 6-10 % of all US women. They suffer from a disease that can in some cases be quite painful. And they are treated by a medical profession that is largely uninformed about endometriosis, a deficit that stems from the acceptance of an unproven theory from the 1920’s and a misinterpretation of clinical results.
What is this thing called endometriosis? One accepted definition: It is aberrant growth of. endometrium outside the uterus. Yet this is really an oxymoron.
Aberrant is defined as “straying from the right or normal way, deviating from the usual or natural type, i.e. atypical.”
But endometriosis not only involves abnormality of location, i.e. putting hormonally responsive tissue in the wrong place, but also an abnormality of the tissue itself. Endometriosis is not, contrary to fashionable thinking, exactly like the endometrium lining the inside of the uterus. It’s not the same thing as taking normal endometrium tissue out of the uterus and planting it say, on an ovary or abdominal wall. For one thing, the tissue’s hormonal receptor population shows far more variation, sometimes having a noticeably lower number of receptors than that found in endometrium. Not surprisingly, the endometriosis response to hormonal stimulation varies, bleeding is unpredictable. This means you then get a difference in visual appearance in endometriosis. Younger patients may present with subtle, often misdiagnosed lesions. A surgeon trying to treat endometriosis by attacking only the classical “black powder burn” lesion will miss out.
A Female Experience.
How is endometriosis likely to present? It doesn’t occur the same way in all patients. Pelvic pain is frequent and may accompany menses. Pain often starts 2-7 days before menses and worsens until flow diminishes. Painful intercourse is another troubling sign.
If endometriosal tissue invades the bowel, the patient may experience rectal pain and bleeding. Bowel cancer frequently presents in this fashion and patients with these symptoms should seek medical advice.
The longer endometriosis persists, the more continuous the pain becomes. The severity of the pain does not necessarily parallel the extant of disease spread in the body.
Inferility and Endometriosis.
Not infrequently endometriosis is identified as the cause of infertility, and patients seek treatment of the disease with the specific objective of achieving pregnancy. Often the pregnancy itself halts the endometriosis.
The impact of endometriosis on fertility often affects the treatment approach to human infertility. Even clinics such as the DePorres Clinic in Chicago, that work to achieve pregnancy by all natural methods requires careful investigation of pelvic pain or other manifestations of endometriosis. Patients often require referral and review of initial imaging studies including ultrasound, MRI and laproscopy. Many physicians advise young women with endometriosis to conceive as early as possible out of a concern that infertility from permanent damage of tubes may result from the disease process.
Treatment
We mentioned that pregnancy may be helpful in stopping the disease. But most patients will turn to drugs or surgery to cure endometriosis. Many excellent discussions of medical treatments of endometriosis may be found on the web. They can be effective in controlling pain in may patients. We mentioned that endometriosis is an important cause of infertility. While medications may control pain there is no evidence that such treatments will increase the likelihood of pregnancy. In general drugs are looked at as a short term solution and it is hoped that ongoing research will produce more acceptable drugs for long term use .(see below for latest developments in endometirial drugs.
Many patients turn to surgery as longterm solution.
One approach is to remove endometrial lesions; These procedures are frequently difficult to perform with success. Those of us who have worked alongside surgeons are familiar with their bewildered look on inspecting the peritoneal cavity in these patient. Faced with the multiple varied lesions that can accompany this disease they often make the hopeless statement: “No matter what I do it will recur.” Consider also what we said about the non classical appearance of endometrial lesions and it’s easy to see why these operations often fail to cure the patient of the disease.
Another surgical alternative is the removal of pelvic organs-a removal of uterus,tube and ovaries. Does it really work? Is it the best strategy for all patients?
Dr David Redwine a gynecologist at St Charles Medical Center in Bend, Oregon has argued against the claim that this organ removal procedure, called TAH, is a definitive treatment of endometriosis- you remove organs but not endometriosis; the disease is still present. The procedure may appear to be clinically successful, but the reasons for the success is not understood. This failure to understand what is happening affects the pain and suffering of the cases where the procedure simply doesn’t work.
According to Dr Redwine, the removal of pelvic organs eliminates all of the disease in only 4% of patients. This startling figure implies that the disease remains in 96% of patients with total hysterectomy. What is the significance of this?
First, if the remaining endometrial sites are superficial then no problems will result. The patient will consider the procedure a success even though the disease is still present. For the unfortunate others, where the disease remaining is not superficial, then symptoms still occur.
Putting this another way, in the 130,000 hysterectomies done each year 9,000 women are left symptomatic. And what of these woman who complain of endometrial pain after organ removal; how are they treated?
Some are advised that nothing can be done for them. After paying thousands of dollars for surgery in the hope that it would end their pain they are now simply told to “live through it.” Some are prescribed drugs that suppress ovulation-but they have no ovaries. What is really sad it that some patients are given psychiatric referral-“it’s impossible to have pain without organs-it’s all in your head.” It’s easy to see why some women simply give up looking for help with endometriosis. For all the talk of feminist empowerment, current society values the clinical problems of women less than the male or senior groups when it comes to responding to diseases like endometriosis.
Despite the acceptance of TAH, there is no scientific proof that hysterectomy is a definitive treatment for endometriosis. When it does work it is because the patient was fortunate to have only benign lesions remaining in the pelvis. There is also the possibility that the source of pain was really a condition in organs themselves and not due to endometriosis.
Tuesday, September 1, 2009
DIFFUGERE Nives.
arboribusque comae;"
It's late Autumn. The trees yet hold green, the leaves too stuborn to turn brown, redden and fall. Still the hours of daylight wane and the ground chills in early morning. And today Horace's ode, Diffugere makes its debut for the fifth year Latin class at St. Peters: diffugere- a poem that speaks of the beginnings of springtime. Some ten lines are carefully written on the blackboard in front of the all male class of 42 students. The Jesuit Master, a 26 year old instructor, wearing a black cassock reads the first line aloud:
"Diffugere nives, redeunt iam gramina campis..."
We are at a Jesuit College in Dublin, circa 1926. Earlier the class began with Veni Creator Spiritus, a prayer, a brief plea for guidance from the Holy Spirit that ended with the three-fold petition.
Ingressum instruas!
Progressum custodias!
Egressum impleas!
Teach us in our beginning.
Guide us as we progress.
Let us leave us fulfilled at the end of our session.
The word Jesuit, as used here, refers to the organization founded by Ignatius of Loyola, the Society of Jesus, once a major force in European Universities and even now something remains of an aura associated with the phrase " a Jesuit education." While the remnants of the Society are still active in education, the current institutions bear little resemblance to those of the past.
Early on, the Society took on education with great reluctantance. Yet the task was compatible with the Jesuit mission. The motto of the Jesuits, abbreviated as AMDG, is something every orthodox Jewish boy would recognize from the learning of the shema: " Thou shalt love thy God with thy whole- everything: mind, body, soul...all for the greater glory of God." Spiritual fathers reminded Jesuits in training that their future students should never think that they have devoted their lives, "given up the pleasures of the world simply to teach them the belles-artes. "Pere de Rochemonteix insists: "This then is the supreme purpose which the Jesuits have in their educational work; namely, to aid their neighbor to know and serve God. Placing the Faith and holiness of life in the foremost place, they must naturally pay attention above everything else to the religion and the virtue of their students."
The Jesuits, advocates of oral learning that they were, realized that care must be taken in reading Latin poetry to beginning students. Latin poetry was like English in that it was made up of lines. These lines, or verses, are in turn divided into feet, certain rhythmic patterns of syllables.
Consider the word "Diffugere." It contains four syllables. As Chris Jones notes, we have something like the sound of an engine turning over, the reader seems to struggle through the first three syllables, di-fu-ger, then hits the fourth, -re, and darts off into the next word, "nives" as the phrase then comes to completion, a natural rest.
Diffugere nives translates as "Snows scattered" or "Snows are dissolved."
The master may point out a few things about the verb, diffugere, sometimes encountered in the more clumsy form diffugerunt. The verb is intransitive (does not take an object; i.e. there is nothing receiving the action of the verb; i.e. the snow doesn't scatter anything.)
The Master notices the tense of the verb-perfect indicative active. Its form conveys the sense of an action completed, finished. Later, in drill sessions, the Master would use all forms of diffugere in the perfect tense. Perhaps he might show the more dramatic use of the perfect as an exhausted, totally over action using as an example Cicero's famed expression in announcing the execution of conspirators: vixerunt! "They have lived."
The Master now turns his attention to the balance of the first line and the short line that follows.
...redeunt iam gramina campis
arboribusque comae;
The verb here is redeunt from redere (to return).
To assist with learning vocabularly, the Master might transpose the text of the ode into comparable English-Latin structures.
gramina redeunt campis-grass returns to the fields
comae (redeunt) arboribus.-leaves (return) to the trees.
Putting it back in its original form, the student can appreciate how the verb works both phrases. The effect of the verb in the first phrase, gramina redeund campis, drives the second comae arboribus, but does so in a way that accomplishes both economy and grace. Hughes calls attention the the importance of the location and arrangement of words by the Latin authors noting that: " this is of such consequence that sometimes, if a single word is put out of its place, the whole thought seems to lose its force and fall flat."
These first two lines, though brief, have sufficed to introduce us to some essentials of the prelection, the traditional method of jesuit education. A definition of the prelection could be "the explanation beforehand of the lesson which the student has to study." The prelection has been called the most essential feature of the ratio studiorum, the traditional Jesuit guide for instruction.
In prelection, the master would of course instruct on the background of the poem and its author. In his 1892 publication, Loyola and the Educational System of the Jesuits, Hughes referring to the Jesuit Master, offers this description, believed to reflect common practice at the time:
"First, he will sketch, in the briefest way, the meaning of the author, and the connection between what has gone before and what is now to be explained. Then he will give a version of the period literally.
Diffugere, a work that nineteenth century poet A. E. Houseman called the most beautiful poem in ancient literature, inspires many comments on its meaning. The ode seems to say that if one is truly appreciative of nature, truly aware of the change of season, then one ends up with a poignant sense of what follows; one knows that what comes will not last. To fully greet Spring requires courage, not just hope.
These are of course mature thoughts. When a child begins a Summer vacation it seems like it will last forever. As we mature the sense of time grows on us. Summer is a measure of months; we feel the passing of years. Life is something limited, terminable. Diffugere is certainly a later work of Horace. It was in Book Four of the Odes, written sometime after the Centennial Hymn perhaps in 13 or 14 BC. To the minds of many, the Golden age of Latin literature ends with Horace. He survived long enough to note some diminishment of the promise of the great Augustan restoration. A hint of bitterness leaks through of the poem, an almost unmistakable suggestion that nothing better lies in store with the accumulation of seasons:
“Quis scit an adacient hodiernae crastina summae
tempora di superi?
Cuncta manus avidas fugient heredis, amico
quae dederis animo.”
“ Who knows whether the high Gods will add more tomorrows
to the sum of todays?”
Devote the whole sheaf to your own sweet will and thwart
the avid hands of your heir.”
The Jesuit master would not likely let this legitimate expression of the human condition go unexploited. The precepts of Pere Chossat in his book on the Jesuits of Avignon would bid the master: “Speak of God, in class, every chance you get; there will be no lack of opportunities if only you seize hold of them.” And here, in this poem, in the setting of the power and gracefulness of Horace, the opportunity arises to examine this legitimate human condition: the mortality of man, its irrevocability, its meaninglessness. This emptiness can be contrasted with the Divine destiny of the Christian soul. The attention invested here will prepare the student for greater appreciation of the emptiness found in the Confessions of St Augustine, in the writings of Thomas a Kempis and even in the work of Satre and contemporary authors.
When he returns home at the end of the school-day, what does the student find remaining after attending the prelection? Taking just the briefest look at his notes and readings, he will find some familiarity if not attraction with the poem discussed. He knew, at some deep interior way he knew that he had some intimacy with a great work. Much more effort was yet to come. Still, he made a good beginning at it all; and so have you for having read this far.
Chris Jones' article can be found at:http://www.latinlanguage.us/blog/index.php?blog=2&title=ligdiffugere_nives_l_ig&more=1&c=1&tb=1&pb=1