NORMAL SLEEP PATTERNS

There is a great deal of individual variation in sleep patterns and requirements at all ages. What seems sufficient for one child is too little for another. All babies, children and adults go through specific sleep cycles. They move systematically from deep sleep to light sleep to REM (rapid eye movement) sleep. This cycle repeats itself about five times in 8 hours of sleep. Dreaming takes place in REM sleep, which seems to last about 10-20 minutes at a time.

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It is worth checking for those factors that can be treated amongst the ones I have mentioned above if you feel particularly tired and lacking in energy. For example, anaemia can be righted with a blood transfusion. The mineral disturbances mentioned can all be corrected if they are found. Perhaps your anti-cancer treatment can be modified—ask about cutting down doses for example. You should also consider stopping your anti-cancer treatment altogether. Weigh the costs you are now experiencing against the likely benefits — your decision may not be the same as when you first agreed to have the treatment. Then you were working on what you were told was likely, now you can reconsider in the light of what is actually happening to you.

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The earlier medical attention is sought, the easier it is to reduce the dislocation. Once the joint has been displaced for some time, rather strong muscular spasm is present, and it may be necessary to anaesthetise the patient to reduce the dislocation.

Simple dislocation of the finger joints can often be replaced by firm pulling of the end of the finger, and holding the wrist with the other hand.

It may be easier to do so immediately after the finger has been dislocated, and many sportsmen are quite adept at fixing their colleagues’ dislocated fingers.

The shoulder joint is a shallow “ball-and-socket” joint and is often subject to dislocation. Only a doctor should attempt its reduction because of damage to nerves and arteries through careless handling.

Some people develop recurrent dislocation of the shoulder, which may “come out” with only a very trivial injury. They become adept at replacing it.

An operation is available to correct recurrent dislocation of the shoulder.

A great deal of force is required to dislocate the knee or the hip, and these injuries are often seen in motor vehicle accidents. They are only to be handled by the expert.

First aid is to immobilise the injured part, relieving pain and treating shock.

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Ultrasound scanning may also be used in detecting gallstones.

Once the diagnosis is made, treatment will be recommended. Of course, this will depend on the symptoms from which the patient is suffering and whether any complications are present.

Large gallstones discovered accidentally, and which are causing no symptoms, are probably best left alone. Multiple small stones are better removed.

This is because they are prone to move and enter the common bile duct, obstructing it. Operation is then a matter of urgency and is more difficult and requires a longer convalesence.

Unfortunately, operation remains the main way of dealing with this problem. It usually only involves a stay of five to seven days in hospital.

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Unfortunately, there is no simple or effective treatment. If there is a definite cause for increased androgen activity it should be treated.

Drugs are sometimes used to counteract the androgen effect. Cortisone in small doses may be effective and the Pill is often used for the same reason. Sometimes, the two are combined. ”

In those who are both obese and hairy, reducing weight may restore the body’s hormonal balance and solve both problems.

In most cases, bleaching the offending hairs so they become less noticeable is acceptable only to a minority. Yet this can be combined with other treatment so that these methods need be used less frequently.

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All this isn’t to say that if your parents were overweight that you should resign yourself to being overweight. But it may help you understand why you have to watch your weight while other people seemingly don’t have to watch theirs.

So, if you were born with a tendency to be overweight, why does it matter what you eat? The answer is that foods (or more correctly, nutrients) are not equal in their effect on body weight. In particular the way the body responds to dietary fat makes matters worse. If you are overweight it is likely that the amount of fat you burn is small, relative to the amount of fat you store. Consequently, the more fat you eat, the more fat you store. Although this may sound logical, the ‘eat-more, store-more’ mechanism does not exist for all nutrients.

Amongst all four major sources of kilojoules in food, (protein, fat, carbohydrate and alcohol), fat is unique. When we increase our intake of protein, alcohol or carbohydrate the body’s response is to burn more of that particular energy source. Sensibly, the body matches the supply of fuel with the type of fuel burned. One of the fundamental differences between fat and carbohydrate is that fat tends to be stored whereas carbohydrate has a tendency to be burned. It is worth noting at this point that if your carbohydrate intake is low, it may reduce the amount of kilojoules you burn each day by 5 to 10 per cent While you may not have been born owning the best set of genes, you can still influence your weight by the lifestyle choices you make. The message is simply this: if you believe that you are at risk of being overweight, you should think seriously about minimising fat and eating more carbohydrate.

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One extrapolation of the effects of adaptations is that the metabolism might become ‘fixed’ in its energy/fat sparing mode from repeated weight loss and gain cycles. This is popularly expressed as an increasing difficulty in losing weight and increasing ease of regaining weight with each cycle. Usually these series of weight cycles take place over a period of several decades and the effects of increasing age on weight loss and gain may well explain most of this phenomenon. There is no evidence that the metabolism gets permanently stuck in an energy/fat sparing mode, but then again getting evidence to prove or disprove the hypothesis is very difficult. The theory, however, has been popularised by Cannon and Einzig in their best selling book Dieting Makes You Fat? and is also expressed in several recent ‘anti-dieting’ approaches. It is thus important to understand the extent of adaptation that occurs and possible ways of counteracting this.

Prentice and his group have studied energy sparing adaptations from a range of different energy level diets and concluded that the decrease in metabolic rate resulting from dieting, generally varies between 15-25 per cent. This is obviously large enough to slow down any ongoing fat loss. The decrease in metabolic rate is also generally proportionately greater than the decrease in body weight (at least in the early stages by about 3:1).

The changes in metabolic rate are probably mediated by a reduction in circulating thyroid hormone tri-iodothyrine (T3) and reductions in sympathetic nervous system activity. Thyroid hormone has been used to try to counteract the decline in RMR, but it has had so many negative effects on reducing muscle mass and causing medical problems that it is now not used for this purpose.

Prentice’s group have carried out a theoretical analysis on the long term effects on body weight of a number of different energy level diets. It is presumed that adaptive responses will be more vigorous if the energy deficit is greater and weight loss is faster, although there is not a lot of evidence to back this up. The response, however, does seem to be proportionally greater in leaner people and this was observed by Ancel Keys (whose quote is at the beginning of this chapter) who studied the metabolic responses to semi-starvation in lean men who were staging a hunger strike in the 1940s. He noted, as did Leibel, that one of the most marked adaptations to a significant negative energy balance is lethargy and a reduction in physical activity including spontaneous activity.

Dieting can elicit energy sparing adaptations almost immediately it is begun. The changes that occur over time to RMR during dieting and re-feeding (i.e. gradually increasing the food intake over time). There is an immediate decrease in RMR of around 5 per cent on day 1 of a diet. This continues at a decreasing rate over time to around 15-25 per cent. On re-feeding, as can be seen from the shaded bar on the right of figure 14.5, there is again an immediate jump in metabolic rate of around 5 per cent. This helps to explain the positive benefits of re-feeding, particularly in cases where patients have been on very low calorie diets for long periods. Gradual re-feeding can actually help them to lose fat, at least up to a certain point (which is probably around 1200-1500kcal per day) due to this gradual reduction of energy sparing and its effects on metabolism.

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