The discovery that women with PMS have low serotonin levels in the brain has led doctors to try drugs which raise serotonin. These drugs are known collectively as antidepressants. The best known is Prozac (chemical name fluoxetine).

One of the first studies of Prozac in PMS looked at 21 women with premenstrual depression. They took Prozac or a dummy pill for three months. After that they swapped treatments. None of the women, or the doctors treating them, knew which drugs each woman was taking until after the study had finished.

There was a striking reduction in symptoms in the women taking Prozac compared with those on placebo. Symptoms quickly returned in the majority of women once the Prozac therapy had ended.

The New Zealand researchers who conducted the study said that the work had supported the theory that PMS was in part caused by low serotonin in the brain as well as showing that this drug could be effective in treating severe PMS.

The current recommended dose of Prozac is 20mg a day by mouth and most doctors would restrict it to women who had severe psychological symptoms, such as depression/ as part of their PMS.

Tranquillizers – drugs that treat anxiety – are rarely used for PMS nowadays as it is recognized that they can be addictive. One of the best known examples is Valium. They often cause more problems than they solve and would only be prescribed for a very short time – days rather than weeks.

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Dextropropoxyphene is a synthetic opioid agonist structurally related to methadone. Dextropropoxyphene is indicated for mild to moderate pain. It should be used with caution in patients with significant hepatic or renal impairment and in the elderly, in whom accumulation of the drug or its metabolite, norpropoxyphene, may predispose to toxicity. The side effects are similar to other opioid drugs. A small proportion of patients develop light-headedness, dysphoria and confusion at standard doses, necessitating changing to a different drug. Dextropropoxyphene is commercially available as napsylate alone or as hydrochloride with paracetamol.

Fentanyl-Fentanyl is a synthetic opioid agonist used for perioperative pain. It can be given by the IV, IM, SC, ED or transdermal routes. It has a short duration of action (0.5-lh) and can be used for painful procedures or to prevent incident pain. Fentanyl 0.1 mg is equivalent to morphine 10 mg IM. Patients intolerant of morphine and requiring parenteral therapy can be treated by continuous IV or SC infusion, although the latter is limited to lower doses because of the volumes required.

Fentanyl is the first opioid drug to be marketed for transdermal use. Fentanyl is absorbed from a Transdermal Therapeutic System’, each patch providing analgesia for 72 hours. After application of the first patch the plasma concentration of fentanyl rises slowly and does not peak for 12-24 hours; other analgesia will be required during this time. The amount of fentanyl absorbed varies between patients. There will be continued release of drug from the ‘reservoir’ in the subcutaneous tissues for about 24 hours after the patch is removed. The starting dose, as described in the product information and package insert, is calculated from the previous 24 hour requirement of oral morphine or equivalent. Transdermal fentanyl is effective in patients intolerant of oral morphine or unable to take it because of dysphagia or drowsiness. It is particularly useful in renal failure.

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The dengue virus is continually slipping across the Texas border from Mexico, but it does not spread within the United States, probably because people on the Texas side spend most of their time in mosquito-proof houses, cars, and workplaces. By keeping people inside mosquito-proof structures, computers and televisions may help curb the spread—the virus becomes stranded like a traveler in an airport in which all flights have been canceled.

Similar evidence comes from a different disease at the other end of the border between the United States and Mexico. Bloody diarrhea killed thousands of people from Mexico south through Guatemala during the late 1960s and early 1970s. But besides a few tourists who brought home a life-threatening infection, the epidemic hardly affected U.S. residents. Some people were infected by those who brought the lethal bacteria north of the Mexican border, but as with dengue, the chain of infection petered out on its own, this time probably because even the poorest U.S. citizens tend to have good access to drinking water that is free from fecal contamination.

The medical history lesson of the twentieth century is that people in rich countries are protected against many of the worst infectious diseases because of infrastructure.

Mosquito-proof housing, sewage disposal, basic hygiene, and clean water protect us better than any surveillance system. Countries without such protective infrastructure are vulnerable. But would an early warning system reduce their vulnerability?

The recent Latin American experience with cholera provides some insight. Remembering the nineteenth-century experience—”en los tiempos del colera,” as Gabriel Garcia Marquez put

it—Latin America braced for cholera’s return during the 1970s. The threat seemed imminent as a new cholera pandemic flowed northward from Indonesia in the 1960s, to India in the west and to China and the Philippines in the east. By the early 1970s it had spread through the Middle East and into Africa. The front spread wherever food and water were poorly protected from fecal contamination. By the mid-1970s it had reached the western countries of sub-Saharan Africa. Latin America now seemed particularly vulnerable because the infrastructure that could protect the richer countries was absent from most of Latin America. The Atlantic Ocean lay between South America and cholera-ridden West Africa, but the Atlantic was an insufficient barrier in the nineteenth century; it could not be trusted to provide a barrier in the twentieth century, when it could be traversed by jumbo jets in a few hours. Yet the pandemic did not spread into Latin America in the 1970s, nor in the 1980s.

It did in the 1990s. It entered Latin America by the back door, arriving in Lima, Peru, in January 1991. Within a year it had spread throughout South and Central America, and it shows no sign of leaving. Its toll during the 1990s was over a million cases and tens of thousands of deaths.

The poor countries did not need an early warning system for cholera. They had decades of lead time. Rather, they needed the infrastructure of the rich countries—but not the entire infrastructure. They needed then, and most still need, the two keys to protection: clean water and adequate waste disposal. No country with these two assets has suffered much from cholera. Even in Latin America this generalization holds. Chile, for example, ranks relatively high in water quality and waste disposal. Within two months after the first cholera cases showed up in Lima, the disease entered Santiago, Chile. Then again about a year later, it entered Chile’s northern provinces. During the first few years of cholera’s visitation, Peru reported over a hundred thousand cases. Chile, Peru’s next-door neighbor, reported under a hundred. In 1994, when Peru reported about 25,000 cases, Chile reported one.

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Not only can ads and models be demoralizing, but so can a lot of the clothing being sold today. If you look around a “juniors” department, where teenagers and young women traditionally have shopped, you’ll notice that much of what’s available is extremely flimsy and skimpy— even more so than during the miniskirt era—so that any young woman with even the slightest bit of extra padding is going to feel self-conscious in a lot of the garments. Reports one parent of a teenager: “The skirts available are either very long, as in evening wear, or very short, as in women-of-the-night wear, with no easy-to-move-around-in middle ground. If a girl wants a comfortable dress to wear to school, forget it.” The next size category up, “misses” clothing, also offers women a lot of body-baring items, such as cropped or tank tops and garments made out of stretchy or thin material. Some fashion writers feel that this trend is a result of clothing manufacturers trying to cut costs; it’s cheaper to use thin material and less of it. In addition, by relying on stretchy synthetic material rather than something like linen, the manufacturer can get away with offering only a few sizes of an item—small, medium, and large—rather than a more extensive collection of numbered sizes. Whatever the reason, the fashion trends today are not kind to women looking for clothes that are forgiving to a less-than-perfect body. Says one person connected with the fashion industry: “You currently have a lot of women going around feeling bad because they look bad in clothes. It never occurs to them that the problem is the shoddy clothes!”

Even children’s departments are selling a lot of skimpy, “sexy”-type clothing for little girls. Parents report having to resort to catalog shopping, particularly from European catalogs, for functional and appropriate clothing for girls and teenagers.

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With defense mechanisms keeping your emotions in check, you may go through a period of outward adjustment and, indeed, be determined to go on with your life as if nothing bad had happened. Sometimes this apparent return to normalcy takes the form of getting into a new relationship. Unfortunately, relationships that begin when you are “on the rebound” are rife with problems—including sexual ones. Because you are still numbing your feelings while unconsciously preoccupied with your loss, and because your conditions for satisfying sex are rarely met right away by a new partner, sexual failures are commonplace. And because your emotional state affects your judgment, you are more likely to make poor choices, ending up with an emotionally, as well as sexually, incompatible partner.

If you have chosen a partner quickly in order to replace your loss, what you feel for your new partner may be confusing. You may be attempting to have sex with someone whom you don’t care about very much. Emotional attachment and satisfying sex are frequently linked and so you may find sex with your new partner distant and unsatisfying. As a result, your desire drops. Or you may care a great deal about your new partner, but you may be protecting yourself from new losses by maintaining a certain amount of distance, and suppressing desire, as Denise did, in order to do that.

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With hectic lifestyles, long working hours and social functions, eating out can become a treadmill of rich foods, indigestion and sleepless nights from over-consumption. In general, eating out can be a health hazard that becomes impossible to avoid.

Many men ask me how to choose from a menu when eating out to ensure good nutrition (and maintain vitality) without sacrificing taste. Following the simple principles below can help you to survive the restaurant scene and still enjoy the social benefits.

If you are not eating until late, try to eat a snack before you go out, preferably a protein snack such as some tuna on a slice of bread, soup, or even a milkshake with added protein in the form of whey powder. This will prevent you eating lots of bread when you arrive or eating fat-filled canapes. It will also help you to avoid drinking too much wine or beer before eating, which will heighten your cravings for food before the evening has even begun. This process is particularly important to follow before a cocktail party after work, for example.

Pace your drinking by ordering gin and tonic or campari and soda or vodka and tonic before you go onto wine. There is less sugar in these drinks and your weight will be controlled more without the refined sugars of wine and beer.

Always drink water with your wine and ask for some lemon to squeeze into the water. This helps digestion.

Choose an entree that has some form of protein, as you do not know how long the main dish may take to serve. There will be a temptation to eat lots of bread and drink more wine in between courses if you are very hungry. Minestrone soup, or a fish, chicken or duck entree are ideal and will take longer to digest while you are waiting for your main course. Try and choose an entree that is not filled with fat or fried.

A raw salad with a protein is always useful at the beginning of a meal to get the digestive juices working well. This follows the same principle as a bitter drink: traditionally, a bitter drink such as campari and soda is taken before a meal to stimulate the digestive organs to better assimilate the meal to follow.

If you are watching your weight do not eat bread. If you must, eat a bowl of steamed vegetables with your entree instead of bread. Keep the olive oil dips and butter away from the table. They are too tempting, especially if there is a delicious crusty loaf sitting there as well!

When choosing a main dish, lean towards a protein: fish, chicken, red meat (only twice a week) or legumes with added vegetables. Choose one carbohydrate like potatoes or rice and make sure you have both cooked and raw vegetables to both maintain health and satisfy hunger. I notice that if men just order a protein and salad without any carbohydrate or vegetables, they often then fill up on dessert as they are still hungry. The body is then overloaded with refined sugar that will not only cause weight gain but often disrupts sleeping.

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OLIVE REMEDY: Complete exhaustion of body & mind, unable to do any further work due to fatigue. Tired physically, having done lot of manual work. Tired mentally after having done lot of brain work or “fed up” having done uninteresting and monotonous work for some length of time. Drained of all strength after prolonged sickness with restricted or unbalanced diet; after lack of sleep attending to a sick relative and after continuous working overtime after, office hours.

PINE REMEDY: Self condemnation. “Guilt-complex”. Blames himself even for faults of others. Over-conscientious; always tries to improve his work, and never satisfied with his own achievements. Even when trying his best to improve the lot of his fellow men, if he falls ill, he would still blame himself for not doing enough in his noble mission. He is, so to say, always on the look out for an excuse to blame himself. He can never be happy as if he is allergic to happiness.

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