The Twenty-Four Hour Mind – by Dr. Rosalind Cartwright
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We’ve reviewed books about sleep before, and even about dreaming, so what does this one have to offer that’s new?
Quite a lot, actually! Before Dr. Cartwright, there were mainly two models of sleep and dreaming:
- The “top-down” model of psychoanalysts: our minds shape our dreams which in turn reveal things about us as people
- The “bottom-up” model of neuroscientists: our brains need to go through regular maintaince cycles, of which vivid hallucinations are a quirky side-effect.
And now, as Dr. Cartwright puts it:
❝I will lay out a new [horizontal] psychological model of the twenty-four hour mind; that is, how the predominantly conscious (waking) and unconscious (sleeping) forms of mental behavior interact through the brain’s regular, but differently organized, states of waking, sleeping, and dreaming.❞
This she does in the exploratory style of a 224-page lecture, which sounds like it might be tedious, but is actually attention-grabbing and engaging throughout. This book is more of a page-turner than soporific bedtime reading!
Bottom line: if you’d like to know more about the effect your waking and sleeping brain have on each other (to include getting in between those and making adjutments as appropriate), this is very much an elucidating read!
Click here to check out The Twenty-Four Hour Mind, and learn more about yours!
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What’s the difference between period pain and endometriosis pain?
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Menstruation, or a period, is the bleeding that occurs about monthly in healthy people born with a uterus, from puberty to menopause. This happens when the endometrium, the tissue that lines the inside of the uterus, is shed.
Endometriosis is a condition that occurs when endometrium-like tissue is found outside the uterus, usually within the pelvic cavity. It is often considered a major cause of pelvic pain.
Pelvic pain significantly impacts quality of life. But how can you tell the difference between period pain and endometriosis?
Polina Zimmerman/Pexels Periods and period pain
Periods involve shedding the 4-6 millimetre-thick endometrial lining from the inside of the uterus.
As the lining detaches from the wall of the uterus, the blood vessels which previously supplied the lining bleed. The uterine muscles contract, expelling the blood and crumbled endometrium.
The crumbled endometrium and blood mostly pass through the cervix and vagina. But almost everyone back-bleeds via their fallopian tubes into their pelvic cavity. This is known as “retrograde menstruation”.
Most of the lining is shed through the vagina. Andrey_Popov/Shutterstock The process of menstrual shedding is caused by inflammatory substances, which also cause nausea, vomiting, diarrhoea, headaches, aches, pains, dizziness, feeling faint, as well as stimulating pain receptors.
These inflammatory substances are responsible for the pain and symptoms in the week before a period and the first few days.
For women with heavy periods, their worst days of pain are usually the heaviest days of their period, coinciding with more cramps to expel clots and more retrograde bleeding.
Many women also have pain when they are releasing an egg from their ovary at the time of ovulation. Ovulation or mid-cycle pain can be worse in those who bleed more, as those women are more likely to bleed into the ovulation follicle.
Around 90% of adolescents experience period pain. Among these adolescents, 20% will experience such severe period pain they need time off from school and miss activities. These symptoms are too often normalised, without validation or acknowledgement.
What about endometriosis?
Many symptoms have been attributed to endometriosis, including painful periods, pain with sex, bladder and bowel-related pain, low back pain and thigh pain.
Other pain-related conditions such migraines and chronic fatigue have also been linked to endometriosis. But these other pain-related symptoms occur equally often in people with pelvic pain who don’t have endometriosis.
One in five adolescents who menstrate experience severe symptoms. CGN089/Shutterstock Repeated, significant period and ovulation pain can eventually lead some people to develop persistent or chronic pelvic pain, which lasts longer than six months. This appears to occur through a process known as central sensitisation, where the brain becomes more sensitive to pain and other sensory stimuli.
Central sensitisation can occur in people with persistent pain, independent of the presence or absence of endometriosis.
Eventually, many people with period and/or persistent pelvic pain will have an operation called a laparoscopy, which allows surgeons to examine organs in the pelvis and abdomen, and diagnose and treat endometriosis.
Yet only 50% of those with identical pain symptoms who undergo a laparoscopy will end up having endometriosis.
Endometriosis is also found in pain-free women. So we cannot predict who does and doesn’t have endometriosis from symptoms alone.
How is this pain managed?
Endometriosis surgery usually involves removing lesions and adhesions. But at least 30% of people return to pre-surgery pain levels within six months or have more pain than before.
After surgery, emergency department presentations for pain are unchanged and 50% have repeat surgery within a few years.
Suppressing periods using hormonal therapies (such as continuous oral contraceptive pills or progesterone-only approaches) can suppress endometriosis and reduce or eliminate pain, independent of the presence or absence of endometriosis.
Not every type or dose of hormonal medications suits everyone, so medications need to be individualised.
The current gold-standard approach to manage persistent pelvic pain involves a multidisciplinary team approach, with the aim of achieving sustained remission and improving quality of life. This may include:
- physiotherapy for pelvic floor and other musculoskeletal problems
- management of bladder and bowel symptoms
- support for self-managing pain
- lifestyle changes including diet and exercise
- psychological or group therapy, as our moods, stress levels and childhood events can affect how we feel and experience pain.
Whether you have period pain, chronic pelvic pain or pain you think is associated with endometriosis, if you feel pain, it’s real. If it’s disrupting your life, you deserve to be taken seriously and treated as the whole person you are.
Sonia R. Grover, Senior Research Fellow, Murdoch Children’s Research Institute; Clinical Professor of Gynaecology, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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At The Heart Of Women’s Health
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A woman’s heart is a particular thing
For the longest time (and still to a large degree now), “women’s health” is assumed to refer to the health of organs found under a bikini. But there’s a lot more to it than that. We are whole people, with such things as brains and hearts and more.
Today (Valentine’s Day!) we’re focusing on the heart.
A quick recap:
We’ve talked previously about some of these sex differences when it comes to the heart, for example:
Heart Attack: His & Hers (Be Prepared!)
…but that’s fairly common knowledge at least amongst those who are attentive to such things, whereas…
…is much less common knowledge, especially with the ways statins are more likely to make things worse for a lot of women (not all though; see the article for some nuance about that).
We also talked about:
What Menopause Does To The Heart
…which is well worth reading too!
A question:
Why are women twice as likely to die from a heart attack as their age-equivalent male peers? Women develop heart disease later, but die from it sooner. Why is that?
That’s been a question scientists have been asking (and tentatively answering, as scientists do—hypotheses, theories, conclusions even sometimes) for 20 years now. Likely contributing factors include:
- A lack of public knowledge of the different symptoms
- A lack of confidence of bystanders to perform CPR on a woman
- A lack of public knowledge (including amongst prescribers) about the sex-related differences for statins
- A lack of women in cardiology, comparatively.
- A lack of attention to it, simply. Men get heart disease earlier, so it’s thought of as a “man thing”, by health providers as much as by individuals. Men get more regular cardiovascular check-ups, women get a mammogram and go.
Statistically, women are much more likely to die from heart disease than breast cancer:
- Breast cancer kills around 0.02% of us.
- Heart disease kills one in three.
And yet…
❝In a nationwide survey, only 22% of primary care doctors and 42% of cardiologists said they feel extremely well prepared to assess cardiovascular risks in women.
We are lagging in implementing risk prevention guidelines for women.
A lot of women are being told to just watch their cholesterol levels and see their doctor in a year. That’s a year of delayed care.❞
Source: The slowly evolving truth about heart disease and women
(there’s a lot more in that article than we have room for in ours, so do check it out!)
Some good news:
The “bystanders less likely to feel confident performing CPR on a woman” aspect may be helped by the deployment of new automatic external defibrillator, that works from four sides instead of one.
It’s called “double sequential external defibrillation”, and you can learn about it here:
A new emergency procedure for cardiac arrests aims to save more lives—here’s how it works
(it’s in use already in Canada and Aotearoa)
Gentlemen-readers, thank you for your attention to this one even if it was mostly not about you! Maybe someone you love will benefit from being aware of this
On a lighter note…
Since it’s Valentine’s Day, a little more on affairs of the heart…
Is chocolate good for the heart? And is it really an aphrodisiac?
We answered these questions and more in our previous main feature:
Chocolate & Health: Fact or Fiction?
Enjoy!
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3 Things Everyone Over 50 Must Do Daily for Healthy Feet
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Will Harlow, the over-50s specialist physio, wants you to be on a good footing:
Daily steps in the right direction
The three daily exercises recommended in the video are:
Exercise 1: Towel Scrunch
The towel scrunch exercise strengthens the flexor muscles in the feet, improving balance and improving contact with the ground. To do this exercise, sit on a chair with a towel placed on the floor beneath your toes while keeping your heels on the ground. Use only your toes to pull the towel toward your heel, scrunching it up as much as possible. This movement strengthens the arch of the foot and can help alleviate symptoms of flat feet. For best results, practice this exercise for 2–3 minutes once or twice daily. Once you’ve got the hand of doing it sitting, do it while standing.
Exercise 2: Big Toe Extension
Big toe extension is an essential exercise for maintaining foot mobility and improving walking kinesthetics by preventing stiffness in the big toe. To do this exercise, keep your foot flat on the floor and try to lift only your big toe while keeping the four other toes firmly pressed down. To be clear, we mean under its own power; not using your hands to help. Many people find this difficult initially, but it’s due to a loss of neural connection rather than muscle strength, so with practice, the ability to isolate the movement improves quite quickly. Perform 10 repetitions in a row, three times per day, for optimal benefits. Once you’ve got the hand of doing it sitting, do it while standing.
Exercise 3: Calf Stretch
The calf stretch is an important exercise for maintaining foot health by preventing tight calves, which can contribute to issues like plantar fasciitis and Morton’s neuroma. To do this stretch, place your hands against a wall for support and extend one leg straight behind you while keeping your other heel firmly on the floor. The front knee should be bent while the back leg remains straight, creating a stretch in the calf. Hold this position for 30 seconds (building up to that, if necessary). Since the effectiveness of stretching comes from frequency rather than duration, this stretch should be performed three to four times per day for the best results.
For more on each of these, plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Steps For Keeping Your Feet A Healthy Foundation ← this one’s about general habits, not exercises
Take care!
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Avocado Oil vs Olive Oil – Which is Healthier?
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Our Verdict
When comparing avocado oil to olive oil, we picked the olive oil.
Why?
Avocados and olives are both very healthy foods. However, when they are made into oils, there’s an important distinguishing factor:
Olive oil usually retains a lot of the micronutrients from the olives (including vitamins E and K), whereas no measurable micronutrients usually remain in avocado oil.
So while both olive oil and avocado oil have a similar (excellent; very heart-healthy!) lipids profile, the olive oil has some bonuses that the avocado oil doesn’t.
We haven’t written about the nutritional profiles of either avocados or olives yet, but here’s what we had to say on the different kinds of olive oil available:
And here’s an example of a good one on Amazon, for your convenience 😎
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Beetroot vs Carrot – Which is Healthier?
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Our Verdict
When comparing beetroot to carrot, we picked the carrot.
Why?
It was close! And beetroot does have its advantages, but we say carrot wins on balance.
In terms of macros, these two root vegetables are close to identical, down to both having 9.57g carbs per 100g, and 2.8g fiber per 100g. Technically, beetroot has a smidgen more protein, but nobody’s eating these for their tiny protein content.
When it comes to vitamins, it’s not close and the margins are mostly huge: carrots have a lot more of vitamins A, B1, B2, B3, B5, B6, C, E, K, and choline, while beetroot has more vitamin B9.
In the category of minerals, superficially it swings the other way, but the margins this time are small. Nevertheless, beetroot has more copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while carrots have more calcium.
This would make things, on balance, a tie: equal on macros, carrots win on vitamins, beetroot wins on minerals.
But because of the relative margins of difference, carrots win the day, because they’re almost as good as beetroot on those minerals, whereas beetroot doesn’t come close to carrot on the vitamins.
Want to learn more?
You might like to read:
From Apples to Bees, and high-fructose C’s: Which Sugars Are Healthier, And Which Are Just The Same?
Take care!
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I’ve been given opioids after surgery to take at home. What do I need to know?
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Opioids are commonly prescribed when you’re discharged from hospital after surgery to help manage pain at home.
These strong painkillers may have unwanted side effects or harms, such as constipation, drowsiness or the risk of dependence.
However, there are steps you can take to minimise those harms and use opioids more safely as you recover from surgery.
Flystock/Shutterstock Which types of opioids are most common?
The most commonly prescribed opioids after surgery in Australia are oxycodone (brand names include Endone, OxyNorm) and tapentadol (Palexia).
In fact, about half of new oxycodone prescriptions in Australia occur after a recent hospital visit.
Most commonly, people will be given immediate-release opioids for their pain. These are quick-acting and are used to manage short-term pain.
Because they work quickly, their dose can be easily adjusted to manage current pain levels. Your doctor will provide instructions on how to adjust the dosage based on your pain levels.
Then there are slow-release opioids, which are specially formulated to slowly release the dose over about half to a full day. These may have “sustained-release”, “controlled-release” or “extended-release” on the box.
Slow-release formulations are primarily used for chronic or long-term pain. The slow-release form means the medicine does not have to be taken as often. However, it takes longer to have an effect compared with immediate-release, so it is not commonly used after surgery.
Controlling your pain after surgery is important. This allows you get up and start moving sooner, and recover faster. Moving around sooner after surgery prevents muscle wasting and harms associated with immobility, such as bed sores and blood clots.
Everyone’s pain levels and needs for pain medicines are different. Pain levels also decrease as your surgical wound heals, so you may need to take less of your medicine as you recover.
But there are also risks
As mentioned above, side effects of opioids include constipation and feeling drowsy or nauseous. The drowsiness can also make you more likely to fall over.
Opioids prescribed to manage pain at home after surgery are usually prescribed for short-term use.
But up to one in ten Australians still take them up to four months after surgery. One study found people didn’t know how to safely stop taking opioids.
Such long-term opioid use may lead to dependence and overdose. It can also reduce the medicine’s effectiveness. That’s because your body becomes used to the opioid and needs more of it to have the same effect.
Dependency and side effects are also more common with slow-release opioids than immediate-release opioids. This is because people are usually on slow-release opioids for longer.
Then there are concerns about “leftover” opioids. One study found 40% of participants were prescribed more than twice the amount they needed.
This results in unused opioids at home, which can be dangerous to the person and their family. Storing leftover opioids at home increases the risk of taking too much, sharing with others inappropriately, and using without doctor supervision.
Don’t stockpile your leftover opioids in your medicine cupboard. Take them to your pharmacy for safe disposal. Archer Photo/Shutterstock How to mimimise the risks
Before using opioids, speak to your doctor or pharmacist about using over-the-counter pain medicines such as paracetamol or anti-inflammatories such as ibuprofen (for example, Nurofen, Brufen) or diclofenac (for example, Voltaren, Fenac).
These can be quite effective at controlling pain and will lessen your need for opioids. They can often be used instead of opioids, but in some cases a combination of both is needed.
Other techniques to manage pain include physiotherapy, exercise, heat packs or ice packs. Speak to your doctor or pharmacist to discuss which techniques would benefit you the most.
However, if you do need opioids, there are some ways to make sure you use them safely and effectively:
- ask for immediate-release rather than slow-release opioids to lower your risk of side effects
- do not drink alcohol or take sleeping tablets while on opioids. This can increase any drowsiness, and lead to reduced alertness and slower breathing
- as you may be at higher risk of falls, remove trip hazards from your home and make sure you can safely get up off the sofa or bed and to the bathroom or kitchen
- before starting opioids, have a plan in place with your doctor or pharmacist about how and when to stop taking them. Opioids after surgery are ideally taken at the lowest possible dose for the shortest length of time.
A heat pack may help with pain relief, so you end up using fewer painkillers. New Africa/Shutterstock If you’re concerned about side effects
If you are concerned about side effects while taking opioids, speak to your pharmacist or doctor. Side effects include:
- constipation – your pharmacist will be able to give you lifestyle advice and recommend laxatives
- drowsiness – do not drive or operate heavy machinery. If you’re trying to stay awake during the day, but keep falling asleep, your dose may be too high and you should contact your doctor
- weakness and slowed breathing – this may be a sign of a more serious side effect such as respiratory depression which requires medical attention. Contact your doctor immediately.
If you’re having trouble stopping opioids
Talk to your doctor or pharmacist if you’re having trouble stopping opioids. They can give you alternatives to manage the pain and provide advice on gradually lowering your dose.
You may experience withdrawal effects, such as agitation, anxiety and insomnia, but your doctor and pharmacist can help you manage these.
How about leftover opioids?
After you have finished using opioids, take any leftovers to your local pharmacy to dispose of them safely, free of charge.
Do not share opioids with others and keep them away from others in the house who do not need them, as opioids can cause unintended harms if not used under the supervision of a medical professional. This could include accidental ingestion by children.
For more information, speak to your pharmacist or doctor. Choosing Wisely Australia also has free online information about managing pain and opioid medicines.
Katelyn Jauregui, PhD Candidate and Clinical Pharmacist, School of Pharmacy, Faculty of Medicine and Health, University of Sydney; Asad Patanwala, Professor, Sydney School of Pharmacy, University of Sydney; Jonathan Penm, Senior lecturer, School of Pharmacy, University of Sydney, and Shania Liu, Postdoctoral Research Fellow, Faculty of Medicine and Dentistry, University of Alberta
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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