Лечение Эссенциальной Гипертензии – Essential hypertension treatment

You will be anesthetized; this can happen several ways. Most likely, you’ll have either spinal or epidural anesthesia; with both forms, you remain conscious and aware of the procedure, even though you can’t feel it. In spinal anesthesia, you’ll have a shot of local anesthetic injected into the small of your back through the dura, the membrane lining the spinal cord, and into the spinal fluid. Within minutes, you’ll feel numb, relaxed and heavy from your waist to your toes. After surgery, you’ll be asked to lie flat in bed until the numbness goes away and you can move your legs again. This is important; sitting up too soon can cause a severe headache.

Epidural anesthesia is like having an IV tube hooked up to your back, instead of to a vein in your arm. A local anesthetic enters the body through a tiny plastic tube, inserted between the vertebrae of your spine near the small of your back. The epidural anesthetic (often used to provide pain relief in pregnant women during labor) bathes the area outside the membrane lining the spinal cord, temporarily numbing the nerves in your lower body. Unlike spinal anesthesia, which comes in one dose, epidural anesthesia can be given continuously. The area of numbness can be adjusted; so can the degree of pain relief. After surgery, this tube can also be used to administer pain relief for the first few days. One point about epidural anesthesia: It reduces the likelihood of blood clots in the legs, perhaps by boosting blood circulation in the legs during surgery.

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The diagnosis is official. You have prostate cancer. What do you do now? The stage of your cancer and your age and overall health all have a huge bearing on this important decision.

Prostate cancer grows relatively slowly. It can stay localized, or confined to the prostate, indefinitely—so a man can die with prostate cancer, and not of it. But once it escapes the prostate, cancer’s growth is relentless. It can no longer be cured. And once it has spread to bone, a man’s average life expectancy is about three years.

In studies of watchful waiting in men with small, moderately well-differentiated cancers (Gleason scores from 5 to 7) that appear to be localized to the prostate, this is what happens over time: In ten years, 40 percent of these men will have cancer that has spread to the bone; by fifteen years, 70 percent of these men will have cancer spread to bone.

What does this mean to you? Once again, we go back to your age, general health, and stage of cancer.

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In the long term, it’s unclear whether watchful waiting will actually result in a decrease in health care dollars, as some studies have claimed. A 65-year-old man has a 50-percent likelihood of living fifteen years. The Swedish study mentioned above suggests that even under the best circumstances, about half of men with untreated localized disease will live to see their cancer spread beyond the prostate, requiring further treatment for advanced disease. If these men decide to have hormonal treatment, the cost of this over two years, at hundreds of dollars a month, may be more than the expense of a radical prostatectomy (which is about $12 thousand). Also, the symptoms from advanced cancer and the side effects of hormonal treatment and chemotherapy can be much worse than the side effects that can accompany treatment for early disease.

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So even in the men who haven’t died of prostate cancer (yet) this statistic,( 13 percent of these men had died from the cancer) almost becomes a technicality. Certainly their lives aren’t the same as those of men without prostate cancer. It’s hard to enjoy old age when prostate cancer’s symptoms begin to affect your quality of life. Incredibly, one of these men who «demonstrated no evidence of disease progression before death» turned out, an autopsy revealed, to have died of prostate cancer. How could this be? Men with end-stage prostate cancer don’t usually drop dead without warning. They suffer, as do their loved ones who watch this happen. They become increasingly frail as the cancer eats away their bones. Life ebbs away over a period of time that seems at once fleeting and yet agonizingly slow. How, then, could someone die of this cancer and be classified as being without symptoms? This astounding statistic suggests that men in the Swedish health care system were not carefully watched and that the progression rates are probably higher than the 50 percent these investigators quoted. (It also sheds unsavory light on another statistic: Some of the most strenuous objections to aggressive treatment for prostate cancer have come from doctors in Sweden, where definitive treatment for this disease is not widespread. And—this comes as news to many—Sweden has the highest death rate from prostate cancer in the world!

In Sweden, half of the men who are diagnosed as having localized prostate cancer die from it, and 69 percent of men who live longer than 10 years also die of the disease.)

These statistics are particularly distressing to think about when you consider this: Today, when localized prostate cancer is diagnosed in men who have a lifespan longer than ten years, the decision not to offer these men potentially curable therapy may be a death sentence. Because in most patients, the disease is going to progress.

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Despite its «kinder, gentler» technique, some doctors question the value of laparoscopic pelvic lymphadenectomy. For one thing, minimally invasive or not, it’s still invasive, and it’s not without side effects. These don’t occur often, but they can be significant and may include injury to the bladder or bowel, internal bleeding, damage to blood vessels, gas embolism (when air, pumped into the abdomen, escapes into the bloodstream), or even, rarely, heart failure and death.

Is the procedure ultimately necessary? It has no therapeutic benefit—a doctor can’t cure a man’s prostate cancer by removing cancerous lymph nodes; once the cancer spreads to the lymph nodes, it always spreads to other sites, like bone, as well. Perhaps the most useful benefit of this procedure is that it can rule out surgery for a man who doesn’t need it—but so can careful staging.

Also, finding that the lymph nodes are cancer-free still does not mean a man’s cancer is curable. Say, for example, a man has a large, palpable cancer that invades the muscles in the pelvic side wall (stage T3 or C), a Gleason score of 8, and a PSA level of 30. Sadly, there is no reason for this man to go ahead with a lymph node dissection; his disease is already extensive, and treatment for him should be aimed at relieving symptoms and pain. To put this man through the rigors of a procedure that ultimately won’t help him is neither helpful nor kind.

And finally, when surgical candidates are carefully evaluated, only about 5 percent wind up having positive lymph nodes—so a separate procedure just to determine the state of the lymph nodes is probably unnecessary in most men. Even this number may decrease as doctors begin computing the results of the digital rectal exam, PSA and the Gleason score. Methods for determining the scope of prostate cancer are constantly being refined.

However, the laparoscopic pelvic lymph node dissection can be useful in some instances—in a man who’s scheduled to undergo a radical perineal prostatectomy, for example, instead of a retropubic operation. (With the perineal approach, the lymph nodes aren’t dissected.) Also, sometimes this procedure provides more information than the frozen sections obtained during prostatectomy, and this may be helpful in determining the state of cancer in a man with a high Gleason score (8, 9 or 10).

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When they begin going out, many young people fall in love, or at least what they think might be love, so they ask questions like this one.

Emotions can’t be weighed or measured and different people have different ideas of what it means to be in love. So we can’t give you a definite answer to this question. But we can share with you some of our thoughts on the subject.

We think it’s important to recognize the differences between infatuation and true love. Infatuation is an intense, exciting (and sometimes confusing or frightening) fireworks kind of feeling. We may be so wrapped up in our infatuation that it’s hard to think about anything else or even to eat. People sometimes mistake infatuation for love. But, infatuation doesn’t usually last very long; true love does. You may start out being infatuated and have it grow into true love. Or the infatuation may pass and you may discover that you weren’t really ‘right’ for each other after all. In addition, you don’t have to know someone very well in order to be infatuated. But in order to truly love someone, you have to know that person (both their good points and bad points) very well. In addition, infatuation can happen all of a sudden; true love takes more time.

Regardless of whether your relationship starts with an infatuation or develops more slowly and gradually, sooner or later love relationships go through a questioning stage, where one or both of you begin to question whether the relationship is really a good one. During this questioning stage, one or the other of you may decide to end the relationship. In our opinion it’s only after you go through this questioning stage and decide to stay together that you’re really on the road to true love.

If you’re uncertain about whether or not it’s true love, you might want to ask yourself the following questions.

Am I tired or unhappy most of the time?

Does the relationship seem like more of a problem than a joy?

Do I keep hoping that ‘maybe things will get better’?

Do either of us frequently ask, ‘Do you really love me?’

Do we find it impossible to spend a day together without having a fight?

Do I often have to be careful about expressing certain opinions for fear that he or she might get mad at me?

If you answer yes to one or more of these questions, then chances are that you’re not really in love after all and that it’s time to make a change in your relationship.

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This is another topic that always comes up when we talk in class about sexual and romantic feelings people have during their growing up years. ‘Homo’ means ‘same’ and, of course, ‘sexual’ refers to sex. Having homosexual feelings means having romantic or sexual thoughts, fantasies, dreams, attractions, crushes or experiences that involve someone who is the same sex as we are. Many boys and girls have homosexual thoughts or feelings or sexual experiences with someone of the same sex while they’re growing up.

If you have homosexual feelings or experiences as you’re growing up, you may realize that this is perfectly natural and normal, and you may not be at all worried about it. Or, you may feel somewhat confused or upset or even frightened about having these kinds of feelings or experiences. Perhaps you’ve heard people making jokes or using insulting slang terms when talking about homosexuality. If so, this may have caused you to wonder if your homosexual feelings or experiences are really OK. Perhaps you have heard someone say that homosexuality is morally wrong, sinful, unnatural, abnormal or a sign of mental illness. If so, this, too, may have made you wonder or worry about your own feelings. If you’ve heard any of these things (or even if you haven’t), we think it will be helpful for you to know the basic facts about homosexuality.

Although almost everyone has homosexual feelings or experiences at some time or another in their lives, we usually consider people to be homosexuals only if as adults their strongest romantic and sexual attractions are towards someone of the same sex or most of their actual sexual experiences involve someone of the same sex.

Both males and females may be homosexuals. Female homosexuals are also called lesbians. Gay is a non-insulting slang term for both male and female homosexuals. There have been homosexuals throughout history, and homosexuals come from all walks of life. People from any social class, ethnic background, religious affiliation, or economic level may be homosexual. Doctors, lawyers, lorry drivers, policemen, artists, business people, ministers, rabbis, priests, politicians, soccer players, married people, single people, parents – you name it – all sorts of people are homosexuals.

The majority of adults in our society are heterosexuals (people whose strongest romantic and sexual attractions are towards the opposite sex and whose actual sexual experiences mostly involve the opposite sex). However, about one in every ten adults is a homosexual. Although an adult is usually considered either a homosexual or a heterosexual, this doesn’t mean that he or she doesn’t sometimes have feelings or experiences in the other direction. Very few people are strictly homosexual or strictly heterosexual. Most of us have a mixture of feelings. For instance, most heterosexuals have at least some homosexual thoughts, feelings, fantasies, dreams, attractions, crushes, or sexual experiences at some time in their lives. In fact, over one-third of the males in this country will have a sexual experience with another male to the point of orgasm during their lives. Although the numbers are somewhat lower for females, many females also have this sort of sexual activity with another female some time during their lives.

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There are a number of things you can do to protect yourself or at least cut down on your chances of getting these diseases.

1. Don’t use injecting drugs, not even once. In fact, it’s best to stay away from all illegal drugs and alcohol, too, because they weaken the immune system, making you more susceptible to AIDS. They can also affect your judgement, so that you don’t follow STD prevention guidelines and, in some cases, using other illegal drugs leads to the use of injecting drugs.

2. Wait until you’re married or older to have sex. Experts agree that abstaining from (not having) sex is the best protection for young people.

3. If you do have sex, use a latex condom and spermicide. HIV may be able to pass through natural lambskin condoms, so always use a condom made of latex rubber. In addition, also use a spermicide (foam, jelly, cream, C-film or pessary), as the chemical it contains helps to kill the AIDS virus. It’s important to remember that condoms and spermicides are not 100 per cent effective in preventing AIDS and other STDs, so you must also follow the other guidelines.

4. Limit the number of sex partners that you have. The fewer partners you have, the lower your risk of getting AIDS or other STDs.

5. Look for STD symptoms. Although some STDs don’t produce noticeable symptoms, many do. So, check for STD symptoms (sores, rashes or redness on the sex organs, an unusual discharge from the penis or vagina) before you have sex. You don’t have to take out a magnifying glass and examine the person, but do make it a point to look.

6. Get to know a person well and discuss possible exposure to HIV before having sex. It usually takes six or more years for AIDS symptoms to show up. Most people currently infected with HIV aren’t yet aware of the fact that they’re infected. But they are contagious! So, you must ask about a person’s past sex life and whether the person or his/her past lovers may have been exposed to the virus either sexually or by sharing needles. If the person belongs to one of the groups among which HIV infection is most common, then you should insist on an HIV antibody test before you have sex. For more information on testing contact your Brook Advisory Centre.

7. Be aware of the fact that personal hygiene is very important. Wash your genitals every day and wear clean, cotton underwear. Avoid using deodorants, perfumes and strong or scented soaps on your genitals, as they can irritate and dry the skin, making it more susceptible to infection. Avoid synthetic underwear, tight jeans and other tight clothing, as they can cut down on air flow and keep the genital area damp, making it more susceptible to infection. Women should always wipe from front to back, away from the vagina, when going to the toilet, to avoid transferring germs from the rectum to the vagina.

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Legally, abortions can be done up to the point at which the baby would be capable of staying alive outside the mother’s body. This is about 28 weeks. Most abortions are done before the twelfth week. Late abortions occur only in exceptional circumstances, for example, where the baby is discovered late in pregnancy to have a serious abnormality or where the mother is a young teenager who didn’t realize she was pregnant until a few months had passed. Late abortions require more elaborate procedures which entail somewhat more risk, though even late abortion is a very safe procedure. However, doctors agree that the earlier the abortion is done, the better.

Suppose you do choose abortion, what happens then?

Once you’ve decided and the first doctor (your GP or the one at the place where you had the pregnancy test) has agreed to the request for an abortion, you will be referred to a hospital or clinic doctor who will perform the abortion. This second doctor also has to agree that you have legal grounds for abortion.

Whether or not you are able to get an abortion on the National Health Service will depend on the agreement of your doctor and the provision of abortion services in the area where you live. Family planning clinics may be able to help with the arrangements, and Brook Advisory Centres offer help for people seeking abortion through the NHS.

People who cannot obtain an NHS abortion will have to pay, usually at one of the pregnancy charities.

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A ‘perfect’ method of contraception would be one that was:

• very convenient and easy to use;

• totally safe and didn’t cause any side-effects or medical problems;

• 100 per cent effective (or at least highly effective) at preventing pregnancy.

Unfortunately, no method is perfect. Each method has its particular advantages and disadvantages. Some methods are very convenient to use, but aren’t as safe or effective as others. Other methods are totally safe, but aren’t always as convenient to use or as effective as others. Still other methods are highly effective at preventing pregnancy, but often aren’t as safe as some of the others. In the next few pages we’ll be comparing the different methods in terms of their convenience, their safety and side-effects, and their effectiveness.

Convenience-Methods like sterilization, the IUD and the injectable contraceptive are very convenient. After sterilization, a person needn’t bother about contraception ever again. Once the doctor inserts an IUD, the woman needn’t worry about protection against pregnancy again for three to five years (depending on the type of IUD). A single injection of the injectable contraceptive is good for two to three months.

Other methods are less easy to use. Natural Family Planning (NFP), for instance, requires users to keep temperature charts, to track their menstrual cycles on a calendar and to record daily observations of their cervical mucus. Although some people who use NFP say that it’s really no trouble once you make it part of your daily routine, this method does require more effort than others.

Of course, how convenient a method is often depends on the user. The pill is considered a very convenient, easy-to-use method by most women because all a woman has to do is swallow a pill and remember to take her pills according to schedule. But for women who have trouble remembering to take medications, the pill may be a very difficult method to use. Methods such as the condom, cap, diaphragm and spermicides are also considered convenient by some people, but highly inconvenient by others. For example, some people find it difficult to insert and remove a cap or diaphragm. Some find spermicides messy. Some find these methods difficult to use because they have trouble remembering to keep the devices handy and to use them each and every time they have sex. Some people find them inconvenient because using these methods interrupts their love-making and they feel that having to stop to use the method takes away from the romance of it all. Some find it difficult to use these methods because they are too shy or too embarrassed to tell their partners they need ‘time out’ to put their device in place. However, others incorporate the placing of the device or spermicide into their love-making, don’t feel at all shy about using these methods and don’t have any problems in using them. So, convenience, like beauty, is often in the eye of the beholder.

Convenience is an important consideration because if a person finds a method inconvenient or difficult to use, the chances of he or she using it improperly or neglecting to use it at all are much greater. And, of course, if a method isn’t used properly and consistently, it isn’t going to be effective. If convenience were the only consideration, then people would just pick the most convenient method. But, as we shall see, safety, side effects, and effectiveness are also important considerations.

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Emotional Changes during Childhood

We develop our basic attitudes about sexuality during childhood. As infants, we form attachments with our parents or other caregivers. How they bond with us is very important to the way we shape our future relationships. Whether they are warm, secure, and loving or cold, insecure, and indifferent affects how we develop our emotional lives into adulthood. Many of our earliest experiences with love and attachment directly reflect our bonds with our parents and caregivers.

Our parents are under a lot of social pressure to try to raise us to be sexually responsible individuals. Some parents try to stop any kind of sexual experimentation by children. They may become upset if they notice their child touching his or her genitals and might say things like «That’s not nice» or «Don’t touch yourself down there.» They may give nonverbal negative messages by slapping or pushing a child’s hand away from her or his genitals.

We may become confused if our parents encourage us to be proud of our growing bodies but discourage us from taking satisfaction in our genitals. Such disapproving messages may cause children to develop negative feelings about their bodies and themselves. The message they receive is that sexuality is bad and so are they.

On the other hand, parents can foster positive feelings about sexuality by acknowledging their children’s autoerotic pleasure. They can smile to their infants and coo, «That feels good, doesn’t it?» To older children, they can say, «I know that feels good, but that’s a private pleasure. We do that when we’re alone—in private.» These approving messages can help children develop positive feelings about their bodies and themselves. The message they receive is that sexuality is good and so are they.

Educational Needs and Responsibilities during Childhood

The sexual curiosity of a child may be surprising to us. It is a good idea to act calmly no matter how surprised we may be. We must be prepared to answer questions. If they are old enough to ask, then they
are old enough to receive an answer. When parents don’t know the answer, it helps to be honest and admit it. We can invite our children to help us look up the answer, or we can find it by ourselves.

The bottom line is to give the child an accurate and simple answer as soon as possible. In all our conversations with our children, we should try to use proper terminology for all body parts, including the vagina, penis, anus, and breasts. Using slang terms gives the impression that we think there is something shameful about these parts of the body.

By the time we are six years old, sex play between our friends and ourselves is a common way of being curious and learning about the differences in our bodies. «Playing doctor» is just one way that we learn about the physical differences between boys and girls while we satisfy our curiosity. We are also aware of the many social restrictions on our sexual expression, so we probably try to hide our activities from our parents and other adults.

One of the greatest responsibilities that our parents have during our childhood is to make sure we know what is socially appropriate behavior and what is not. Parents can integrate discussions about sexuality into family life in a balanced, frank, matter-of-fact way that allows them to deal with sexual topics openly, whenever appropriate. They can set reasonable limits on our sexual behavior as children just as they set rules for other behaviors. They can also present sexuality as a healthy and positive part of life as they present information about sexual risks and responsibilities.

A balanced view of sexual pleasure and responsibility will help children learn to develop positive decision-making skills.

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We begin our sexual journey through life in childhood. It continues through our adolescence, our young
adulthood, and our senior years. Our journey is shaped by gender, sexual orientation, disability, special needs, or lifestyles such as the religious life or the physical, emotional, and social changes we experience. The meanings of love, friendship, and life partnership may also change for us along the way. Although all of us are on this voyage, none of our adventures will be exactly the same.

Our sexual journey as children

As children, we may not think of ourselves as being on the beginning of a sexual journey, but we are. We may start our trip by just being curious about our bodies asking our parents where we came from, or noticing that
girls and boys are different from one another. Eventually, we notice the physical changes that our bodies are going through. The timing of the changes is different for each of us, but we all go through them.

Traditionally, childhood sexuality was seen incorrectly as either dangerous or nonexistent. Many still become uncomfortable with a child’s normal sexual interest. They may be concerned for various reasons:

• They worry that their children’s sex normal or is bad.

• They are uncertain or worried about how to deal with their children’s sexuality.

• They might be dealing with their own sexual conflicts.

• They fear their own normal curiosity about their children’s sexuality.

Rest assured that sexuality in childhood is normal and is also healthy and natural. Our sexual reflexes are already at work when we are babies. We experience and enjoy physical closeness with our parents through hugging, clinging, and cuddling. We are really too young to be aware of the connections that are being made to our sexuality. But we do learn that physical closeness and expressions of affection feel good.

Physical Changes during Childhood

As we grow, the physical changes in our bodies become quite obvious. We lose our baby fat and develop quite distinctive physical features. We learn to walk, talk, dress ourselves, and feed ourselves. We grow taller and stronger month by month. It happens to each of us at different rates. That’s why everyone in our fourth-grade class pictures seems to be of different heights.

These changes in growth are not the same as the changes that happen later during adolescence. They do, however, affect our sense of ourselves and our sense of our sexuality. Are we bigger than girls should be? Are we smaller than boys should be? The answers we learn can deeply affect our sense of our femininity or masculinity.

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Sexual Dysfunctions

Dysfunction means to not work well. A sexual dysfunction can be either physical or mental. Or it can be both. It means that a sexual process or response is not functioning normally. For example, if a man is not able to get an erection for some time, his penis is not functioning normally. This is commonly called impotence. It can be caused by physical problems—the penile tissue may be damaged, for example. It can also be caused by mental problems such as anxiety, fear, stress, and depression. For example, a man who is very fearful of impregnating a woman may not be able to get an erection. The correct term for impotence is inhibited arousal. In women, inhibited arousal results in a lack of lubrication. Inhibited arousal can also be caused by certain drugs and medications.

There are numerous sexual dysfunctions that affect our sexual abilities. Dysfunction can happen at any point during the first three phases of the sexual response cycle—desire, excitement, or plateau.

Health Conditions and Our Sexual Function

All illnesses and diseases can affect our sexuality. An illness can make us too exhausted to join in or enjoy sexual intimacy. It can also cause physical problems that affect our sexual response cycle and our ability to perform. Disease and illness also affect how we view our bodies. We can develop a poor body image if we feel our bodies are unhealthy, unattractive, or unresponsive.

Our sexuality is also affected by medications that are prescribed to treat illness and disease. Medications can affect us physically and psychologically. They can also affect how we view ourselves sexually and how we perform. Some medications have side effects that can decrease our sexual desire or performance. They may also be used, however, to treat illnesses such as depression that affect our moods and sense of ourselves. They may help us feel better about ourselves and positively affect our sex lives.

It is important for people who take medications to talk with their health care professionals about the effects any medication may have on their sex lives. Very often health care professionals fail to consider their patients’ sex lives. If they do not begin the conversation, make sure that you do.

In the table on the previous page, a few health conditions are listed with the effects these conditions may have on sexual health. If you need more information about these or other health concerns, contact a health care professional or visit your local library.

Our sexuality and our sexual bodies go through many changes during our lives. In the next chapter, we will look at some of those changes as they occur over the life span.

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With adolescence changes appear in the behaviour and the temperament of boys and girls. These changes are not due to innate sexual differences, or to hormones, but more to the way in which girls have been reared. Girls have been conditioned, by parents, by peers, by society, and through the media, to believe that they should be attractive, co-operative, sympathetic, and loving, while boys are taught to be competitive, ambitious, energetic, practical, and powerful. By adolescence, girls have been taught, and accept, that boys are better achievers (which is not true). They accept that boys will get the more interesting jobs and will rise to higher levels in their jobs (which is true).

In stories and on television most good things happen to the male characters, and they are usually the result of the man’s own initiative or action. When a good thing happens to a female character (and this occurs much less frequently) it is usually because of someone else’s initiative, or grows out of a situation in which the woman finds herself.

Many adolescent boys fear failure, but many, perhaps most, adolescent girls fear both failure and success. They fear success because it puts them into direct competition with men and may diminish their attractiveness to men. By accepting these views many girls diminish their potential; they believe that they have less ability than boys and will never achieve as much. They accept that women are ‘inferior’ to men. They accept the inevitability of patriarchy – that men will always dominate society, and that women will always be submissive.

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