Still, Dean said, “The significance of fibrocystic changes isn’t that it may increase the risk of breast cancer for some women; the significance is that because there is thickness and many lumps it may be harder to detect cancer at an early stage.”

Laya said, “That’s why we urge women to get good screenings and to do monthly exams so they’ll notice any changes early. Women should get an annual breast exam by a competent physician, who should spend three to five minutes examining each breast to do it properly.”

But for most women with fibrocystic breast change, the worst thing they will have to contend with is the pain associated with the condition.The breasts often feel swollen, tender and lumpy for several days, particularly in the week before and during menstruation. For some women, the pain is so extreme they have to avoid exercise or lying on their stomach.

Finding a Treatment
Treatment recommendations vary. Little scientific evidence exists to support any suggestions, such as taking vitamin E or reducing caffeine intake. There is one treatment, though, that Laya, Vetto and Dean can all agree on — taking evening primrose oil daily.

They also say that while there’s not much scientific proof, many patients report relief when they use less caffeine and salt, and stop smoking.For example, Goodan, who at 46 no longer suffers with fibrocystic changes, says she had no further problems after having the larger cysts aspirated and reducing her caffeine intake.

In the meantime, researchers are still trying to determine what causes the condition. “It appears it can be genetic and that there’s some relation to high-fat diets.

I do a lot of clinics in Asia, and there are very few cases of fibrocystic changes, but when people from those countries immigrate to the U.S., they’ll often develop the changes. We think we know what it’s related to, we just haven’t been able to identify a cause yet,” Vetto said.

Finding a cause has a bigger purpose than reducing pain for women with the condition, Laya points out.”If you could figure out what leads cells to become atypical, you’d have a lot of answers leading to what causes breast cancer to develop,” she said.

The scare was for naught, as fibrocystic breast change (sometimes mislabeled fibrocystic breast disease) is the most common cause of benign lumps in women ages 30 to 50. About half of all women will have “lumpy breasts,” and the pain, tenderness and swelling that goes with them, at some point in their lives, according to the American Cancer Society.

And those are just the women who seek out doctors’ advice, said Dr. John Vetto, assistant professor of surgery in oncology at the Oregon Center for Health Sciences. In reality, all women have fibrocystic breast changes in varying degrees, he said.

“That’s why it’s inappropriate to call it a disease ? if everybody has it, how can it be a disease? That term is outdated and only frightens women when it’s used,” Vetto said.

Understanding Breast Changes
While not completely understood, researchers believe fibrocystic breast change is caused by fluctuations in hormone levels. During every menstrual cycle, hormonal stimulation causes the breast tissue to swell, the milk glands and ducts to enlarge and the breasts to retain water before returning to normal. Repeated episodes of stimulation can cause the tissue to become firmer and create packets of fluid, or cysts.

The condition, which is usually found in both breasts, “may feel like an irregularly shaped area of thicker tissue with a lumpy or ridge-like surface ? [or like] tiny beads scattered throughout the breasts,” according to American Cancer Society literature.

But if the cysts are larger, that doesn’t necessarily mean there is reason to worry.

“I see women with golf-ball sized cysts every week. It’s very common,” said Judy Dean, a board-certified member of the American Women’s Medical

Association and radiologist in Santa Barbara, Calif. However, she said that women with more severe cases of fibrocystic breast change sometimes tend to ignore their lumps.

“They’re so used to it, they think ‘Oh, I have another cyst I’ll have to get aspirated. I’ll do that next month, or the next month,’ and that’s not good. You don’t want to panic, especially if you have a history of cysts, but you need to get it checked out within a week because it might be malignant,” Dean warned.

A.Encephalitis is a potentially serious infection of the brain. The symptoms include fever, headache and confusion. At its most serious, patients may slip into a coma and die. The overall death rate varies with the type of microbe causing the infection, but it is on the order of about 10 percent of the cases severe enough to cause symptoms. However, most infections are not even recognized, because the symptoms are vague or nonexistent.

A. When people discuss encephalitis, they are most often talking about viral encephalitis, though in rare cases the disease can be caused by bacteria, particularly those that also cause meningitis (infection of the covering of the brain and spinal cord). The principal group of encephalitis viruses are the so-called “arboviruses.” This name refers to the fact that these viruses are transmitted to humans by arthropods such as insects and spiders. In the United States, the most common causes of arthropod-borne encephalitis are the St. Louis encephalitis virus and the La Crosse virus.

Public-health authorities first thought that the recent outbreak in New York was due to the St. Louis encephalitis virus. (Despite the name, this microbe causes disease virtually anywhere in the United States.) Today, however, the U.S. Centers for Disease Control states that the cause of the New York outbreak was a “West Nile-like” virus. Whether this is truly the West Nile virus is not fully known. Nevertheless, these are the first documented infections with that virus or one like it occurring in the United States.

The West Nile virus (like the St. Louis encephalitis virus) is transmitted by mosquitoes. The West Nile infection typically occurs in Africa, Asia and the Middle East. The signs and symptoms of the disease are similar to other forms of viral encephalitis. There is no specific treatment for the virus, though patients may need intravenous fluids, a ventilator to assist breathing, antibiotics for any bacterial infection that may arise, special nutritional care, and close monitoring for neurologic changes, which may require a shunt to be placed in the brain. The prognosis of this disease is variable, though most patients will recover.

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There are numerous reports of patients with OSAHS who are completely cured when they lose a sufficient amount of weight. It is, therefore, recommended that a person who is overweight and has OSAHS should consult a physician to help develop an individualized weight-loss program.

Most patients with OSAHS who are motivated to take good care of themselves can live perfectly full and active lives. In addition to being treated for OSAHS, it is also helpful to find a routine that might make sleep quality better. This means that you should go to bed and wake up at the same time every day of the week.

You should have a regular “getting ready for bed” routine that helps you to relax and unwind for the day. Patients with OSAHS should avoid alcohol because it makes apneas and hypopneas worse. Although alcohol may help you fall asleep, it ruins sleep later in the night.

Patients also should determine the number of hours of sleep they need in order to function fully and they should stick to this number every night.

Many patients with OSAHS have problems with insomnia because their sleep has been poor for such a long time that they have bad sleep habits and are accustomed to sleeping at odd hours.

One should remember that until a person is treated adequately for OSAHS, he or she is at risk of falling asleep driving. No one should drive a car while feeling groggy, sleepy or tired.

According to macrobiotic philosophy, everything in nature reflects the yin/yang principle: male/female, night/day, cold/heat, love/hate. Certain foods are yin (expansive) or yang (contracted). For example, rice is yang, fruits are yin. The macrobiotic ideal is to maintain the balance between these forces, eat a balanced diet and live a balanced, harmonious life.

In order to achieve this, Michio Kushi, on the Macrobiotics Online Web site and in other publications, recommends the following:

Meditate for deeper awareness.
Stay mentally and physically active.
Practice gratitude, especially at meals.

Live each day happily. Keep personal relationships smooth and happy. Take a daily walk in nature. Keep your home in good order with daily house and yard work.

Minimize television and computer use.
Keep plants in your home.
Sing a happy song every day.

Although ovarian cancer most often occurs after menopause, between 3% to 17% of cases occur in younger women. Women who develop ovarian cancer before age 40 are more likely to have “borderline” type tumors, and these women — as well as patients with early ovarian carcinoma — can be treated conservatively with an excellent prognosis, according to Dr. Linda R. Duska of Massachusetts General Hospital in Boston. In conservative surgery, the uterus and one ovary is left intact.

“We had a number of successful pregnancies following borderline cancers and even following invasive cancers if they were stage 1,” Duska told Reuters Health.

However, to reduce risk of cancer recurrence, surgical removal of the remaining ovary should be considered once these women have completed childbearing, Duska and colleagues report in the June 15th issue of the journal Cancer.

The researchers reviewed the medical records and pathology reports from 92 women, aged 40 or younger, who were diagnosed with epithelial ovarian cancer or borderline epithelial ovarian tumors at Massachusetts General Hospital between 1980 and 1996.

However, younger women with more advanced cancer need to be treated just as aggressively as older women, the investigators report. In the study of younger women, the 5-year survival rate in women with advanced ovarian cancer was 23%, a similar rate to that reported in postmenopausal women. Young women with late-stage ovarian cancer “need to be treated aggressively because their young age does not confer an improved prognosis,” the authors write.

“Four out of five other studies have suggested that if you were less than age 40 and developed ovarian cancer, your prognosis was better than if you were the normal age for ovarian cancer which is between age 50 and 60,” said Duska. “Our findings suggest that if you have advanced stage invasive cancer, it doesn’t matter how old you are. Prognosis is still terrible.”

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Owens and Matthews studied sleep disturbances in healthy middle-age women and found that overall, 42 percent of these women reported some difficulty sleeping. Women not taking hormone replacement therapy especially reported significantly worsened problems with sleep. While only 12 percent of women reported sleep problems at a premenopausal evaluation, more than double that amount (26 percent) reported sleep problems at a post-menopausal evaluation.

How do sleep problems affect us?
Sleep problems can seriously affect quality of life as well as productivity and safety. When we are exhausted, it may affect our mood, our relationships and our work. We may not be as sharp as usual, and our attention and reflexes may be dulled. Anyone who has been driving and noticed themselves fading behind the wheel can remember the resulting adrenaline surge when we realize that we might have had a serious accident.

Persons with inadequate or unsatisfying sleep have been shown to report more health problems than those without sleep problems. In addition, women with sleep problems are at increased risk for mood or anxiety disorders such as depression and also for cardiovascular disease.

Are all perimenopausal and menopausal sleep problems due to hormonal fluctuations?
Absolutely not. Insomnia may be caused by environmental or hormonal factors but may also be due to drug effects or other medical or psychiatric problems. For example, as we age, our thyroid gland may also undergo changes. Also, increased body weight may be associated with a potentially very serious condition known as sleep apnea. These changes may first be expressed as difficulty sleeping. Therefore it is important that your healthcare provider determine the cause of your sleeping disorder so that customized and appropriate therapy can be given.

What medications can cause sleep problems?
Many different prescription and nonpresciption drugs have been associated with sleep problems. Some of these medications include: alcohol, caffeine, nicotine, some hypertension medications, corticosteroids, decongestants, diuretics, leuprolide acetate, L©dopa, methyldopa, oral contraceptives, some seizure medications, progesterone and some thyroid and asthma medications.

My healthcare provider told me to keep a sleep diary. What should I keep track of?
Often, a sleep diary can be useful to help identify sleep problems. This diary should keep track of bed and awakening times; what you eat and when you eat; use of alcohol; any over-the-counter or prescription medications, tobacco or caffeine; when you exercise; and sleep duration and quality. Your bed partner may also provide important information that can help to make a diagnosis. For example, do you snore and do you kick or move around?

Any simple, non-pharmacologic suggestions for possibly improving sleep?
Avoid or minimize naps and try to go to bed and get up at the same time each day.
Exercise regularly, but don’t exercise right before bedtime.
Keep the bedroom comfortably cool in temperature.
Don’t eat heavy meals right before bedtime.
Minimize or eliminate evening caffeine or alcohol.
Try to use the bedroom only as a place for sleep and sex (and only if you so desire the latter).
During bedtime, keep the bedroom quiet and dark.

If you can’t sleep, don’t lay there torturing yourself! Instead, get up and try to do some quiet nonstimulating activity outside the bedroom, until you feel you can get to sleep.

Always inform your healthcare provider that you are having difficulty sleeping so that she/he can try to help you.

Here’s how it’s done. To check for the irregular pulse of atrial fibrillation, use two fingers to find the pulse point on the inside of your wrist. Stand or sit quietly, concentrating on the pulse until you are conscious of its rhythm. Then, tap your foot, nod your head, or perform some other rhythmic action to match the beat (see graphic). Most people have a fairly steady pulse that follows a regular cadence, only occasionally missing or rushing a beat. If you have atrial fibrillation, your pulse will feel extremely variable, without any pattern or regularity to the rhythm or size of beats.

If you ever detect a highly irregular heartbeat, see your doctor right away, if only to rule out a problem. Atrial fibrillation is treatable with medication and electrical therapy, as well as preventive steps such as avoiding alcohol and caffeine. To head off dangerous clots, most people will also be given a blood thinner, which is among the measures that allow people to live comfortably with this common disorder.

Analgesics can be successful, effective in curing a lot of kinds of pain, such as earaches, pain after surgery, back pain, pain from arthritis. Medication for pain are medicines which you may order no prescription.

Illustration: Tim Vining

Even healthy people can develop atrial fibrillation, though it’s most common in those whose hearts have been damaged by coronary artery disease, high blood pressure, or valve problems. In this rhythm disorder, the heart’s two upper chambers (atria) don’t beat in a coordinated fashion. Instead, they quiver and race, interfering with the heart’s ability to pump effectively. That’s risky for people with heart failure, whose weakened hearts already have trouble pumping.

But there’s an even greater risk for anyone with atrial fibrillation: Blood that should move briskly through the atria collects there instead, forming clots and posing the threat of stroke if a clot reaches the brain. Strokes occur in about 80,000 atrial fibrillation patients annually, accounting for 15 percent of all strokes.

So it’s crucial to know if you have atrial fibrillation, especially if you’re over age 65 or have heart disease. But because atrial fibrillation often comes and goes, and because the palpitations, dizziness, and fatigue it causes may go unnoticed, the disorder might be missed during a regular medical checkup.

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Specifically, Duncan recommends:

Don’t try to do too much — While it’s normal to have hopes about how clean and well decorated your home will be, how effortless and enjoyable elegant meal preparation will be, how many special holiday parties and community events your family will attend and how much you’ll enjoy visiting with welcoming friends and family, ask yourself if you’ve set your sights too high. If so, give yourself a break by lowering them to a more achievable level.
Don’t expect to give every family member and friend “the perfect gift” — Gifts from the heart don’t need to be expensive or extensive. And credit debt doesn’t need to be extended either. Consider nonmaterial gifts for adult family members and friends, and focus on giving each child one or two of the presents they most desire within your holiday budget.

Plan well in advance — With your family and friends, make a detailed, prioritized list of items and activities that are most important to you and your family. If a calm, peaceful holiday is your priority, focus on activities that you truly enjoy.

Don’t do activities just for tradition’s sake. Pace yourself — Don’t take on more activities than you can handle reasonably and still enjoy the holiday.

Involve each member of the household in carrying out decorating, food preparation, cleaning and clean-up activities. Even very young children can contribute and will gain valuable life skills in doing so.
Extend the season — If the post-holiday blues affect you, spread your holiday activities out into the New Year. Bake, shop, visit family and friends, or enjoy your holiday music until the next celebration rolls around.