All eyes need good light if they are to work well and without strain. This particularly applies to older eyes. A recent study of visual acuity in fifty-six old people (average age 76), both in their homes and in a controlled clinical setting, found that general levels of lighting were often so poor in the homes of elderly people that the number of people functioning as ‘blind’ was twice what it needed to be. Simply increasing the wattage of the lighting, they found, improved the vision of 82 per cent of the people. Don’t skimp on lighting. A 100-watt light bulb costs only pennies more a month to run than a 60-watt bulb.

As the eye ages, the lens becomes clouded and less pliable and the pupil decreases in size. Less light reaches the retina and near-focusing ability declines. Most people get glasses for their focusing problem but do little to increase the light that enters the eye. Research has found that the reduction of light reaching the retina is 50 per cent by the age of 50, and 66 per cent by age 60. Older eyes also react more slowly to changes in light levels, and because the cloudiness of the lens scatters light all around the inside of the eye, simply increasing the amount of light helps all this greatly. But this need for more light, especially at work, is not just confined to the old. Research shows that middle-aged workers need more light than do younger workers. An Ohio State University study found that 30-40-year-olds needed 17 per cent more contrast to see an object as clearly as 20-30-year-olds, and that those aged 60-70 needed two and a half times as much contrast to be able to see as well as the younger ones.

Older people, especially, are susceptible to glare and brightness. An older person facing a window all day at his or her desk is looking up at very bright light and then down at the work. This causes eye fatigue as the pupils enlarge and constrict. Also, when you look down with constricted pupils you will see very badly.

A way of seeing whether you are subjecting yourself to too much glare is to lay a mirror on your desk or table. If you can see a bright zone in the mirror when you are seated normally, it is a glare that could be causing you eye strain. Very highly-reflective surfaces can have the same effect too. Alter either the light or the furniture, whichever is easier, to overcome this problem.

When considering levels of illumination remember that intensity of light follows the inverse square law which means that moving a 25-watt bulb from 8 ft to 4 ft away is the equivalent of replacing it with a 100-watt bulb.

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Coping

The most important thing to realize is that you are not alone in trying to cope with this disease. There are many people ready to support you by listening, making suggestions and helping you to make choices about treatment.

Talk to your doctor. Tell her or him you feel alone. There are also self-help groups. The Endometriosis Association (Victoria) is a non-profit group set up to help all fellow sufferers. Do not be frightened to ask for help or advice.

For those entering a new relationship there is the problem of when to discuss endometriosis. You may think that a discussion ‘too soon’ in a new relationship will frighten off a potential partner. For those who suffer from painful intercourse there is the constant worry that a new partner may think that you are frigid or that you just do not find him sexually attractive.

Acceptance

For many of us it is necessary to talk through all of these emotions before we can come to terms with the fact that we do have a chronic disease and that this disease will probably cause disruption to our lives.

There is a light at the end of the tunnel. Once you have come to terms with your illness and accepted that you have a health problem you will feel better — both physically and emotionally.

You are going to face many hurdles and be forced to make choices or come to terms with decisions that will be difficult.

You may have to accept that you may never have children, that you may require further treatment at some stage, that your life may be disrupted at times, and that you will be faced with changes.

Decisions

With acceptance of your condition comes the need to make decisions. These decisions will undoubtedly affect your whole future and you really need to weigh up all your options very carefully. These decisions are going to affect your childbearing, your capabilities and your quality of life. Career and relationships will also be affected.

Understand that these decisions will not always be easy to make or to come to terms with.

As a guide, make sure that you are well informed and consider all your options carefully. Look at the side effects, the advantages and disadvantages, the possible outcomes, and your future.

Take time

Do not be rushed into making a decision. Do not be pushed into a decision that someone else has made for you. You are the one who must decide what you really want and what is best for you. You must list your priorities to include your options, treatment and personal needs. Think ahead.

Ask questions

Help yourself become well-informed by talking to your doctor, attending sessions run by self-help groups and using the resources offered by women’s health services.

Read as much as possible about endometriosis and talk to other sufferers. This will not only keep you well-informed but remind you that you are not alone.

Take control

It is your body and you have to live with your decisions. Carefully consider your doctor’s advice and take into account the information you have read. But remember the final decision should be yours.

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• Keep fires guarded. It is illegal to leave a child under 12 in a room with an unguarded fire.

• Keep pins, needles and scissors away from young children.

• Make sure bookshelves can’t be pulled over.

• Put electric flexes where people won’t trip over them but not under carpets.

• Replace flexes immediately if they are at all chafed or worn.

• Stand on something safe when dusting.

• Unplug the TV when going to bed or leaving the house.

• Never take the back off the TV or obstruct the ventilation slots.

• Keep all plastic bags away from children. This includes the inner sleeves of records.

• If you have young children, fit safety catches to all windows above ground level. Never leave

open without a safety catch a window in a room where a young child is playing.

• Never put mirrors over the mantelpiece. Clothes could catch fire while the wearer is looking

in the mirror.

• Don’t leave small objects lying around with small children about-they may swallow them

or put them in their ears or noses.

• Beware of catching fingers under sash windows and in doors.

• Never move an oil heater when it is alight. Position it where it cannot be knocked over.

• Electric convector heaters are safest for children’s bedrooms.

• When using paraffin heaters ensure that there is adequate ventilation.

• Close medicine containers and return them to the medicine cupboard at once after use.

• Don’t smoke in bed.

• Disconnect electric under-blankets before going to bed.

• Return electric under-blankets to the manufacturer for regular servicing. Never use one for

the very young or the old who wet the bed. They can, however, use electric over-blankets.

• Don’t leave sleeping pills by the bed – repeated doses can be taken accidentally.

• Loose mats should have non-slip backing strips.

• Never carry too heavy or too big a load up or down stairs. Keep a hand free to hold the rail or

banister.

• Use safety gates on the stairs with very young children about.

• Good lighting is essential-no dark corners.

• Don’t store rubbish or anything inflammable under the stairs.

• Never leave things lying on the stairs, and make sure the stair carpet is well fixed and has no

holes.

• Never meddle with gas or electrical installations. Call in an expert.

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This is the third most common fear. Our lack of understanding of the disorder accentuates this fear. We feel so much has already happened which we haven’t been able to control, and every day seems to bring with it new symptoms and new fears. We can’t help but feel the time will come when we will lose control completely. People fear they will faint, have an attack of diarrhoea, lose control of their bladder, be sick or literally lose control. Most of these symptoms are a result of the fight and flight response. The more we fear them, the more we turn on the adrenalin. Losing our fear of them turns it off. I will discuss how to in chapter eight.

Loss of control over body

We can feel as if we may lose control of our bowel or bladder, or that we will be sick. Nausea can become our constant companion, and if we look at all our symptoms it is no wonder. Our body does feel as if it is out of control.

When we imagine these events happening, we also imagine our embarrassment and humiliation. Naturally, this only increases the fear.

Again, I rarely meet anyone who has had these fears realised, although people speak of their ‘close calls’. When we learn panic anxiety management skills we can take back the power over the fear and anxiety and turn off the fight and flight response.

Literally losing control

This fear can be terrifying. People interpret it to mean they may act uncontrollably and hurt themselves or others. They don’t.

The fear of losing control completely comes from the loss of control we have already experienced. The harder we fight to get control, the more we lose control. Not over ourselves, but over our life.

I have never heard of anyone losing complete control over themselves. Again, if this was going to happen it would have happened with the first attack. It will not happen in the future. Recovery means letting go of the control we are fighting so hard to maintain. Letting go of this control means we gain control. Being in control means we will lose the fear of losing control completely.

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Withdrawal from medication, including anti-depressants, may mean a return of high levels of anxiety and panic attacks, and some of us may experience other symptoms of withdrawal. Withdrawal must be done under the supervision of a doctor. Cognitive behavioural techniques have been found to assist in withdrawal from tranquillisers and high success rates for withdrawal using these techniques have now been demonstrated (Otto et al. 1994). There are tranquilliser support groups in some states who can help to support us during this phase of our recovery. But remember, withdrawal must be done under medical supervision.

Medication, in any form, takes control and power away from us. It doesn’t teach us the necessary skills to gain control over our lives. In some cases it is necessary in the short term, but it is not a long-term answer.

Anti-depressants

Anti-depressants are now becoming widely used in the treatment of panic disorder/agoraphobia, with varying degrees of success in keeping the anxiety and the panic attacks at bay. While antidepressants are very important in helping to contain any reactive depression, they do not teach the necessary management skills. When medication is used, it should be in conjunction with other therapies.

As most people do not like taking medication of any sort, it is not unusual for people to simply stop taking it. This may have serious consequences. Withdrawal from any medication must be done under medical supervision.

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Agoraphobia is one such control. Developing agoraphobia has meant a lifetime of limitation for many people. Until the recognition of panic disorder as a separate condition in 1980, agoraphobia was considered to be a primary condition. Treatment was focused on it, instead of the disorder.

Agoraphobia used to be defined as fear of open spaces. In panic disorder, agoraphobia is now recognised as ‘anxiety about being in situations or places from which escape might be difficult or embarrassing, or in which help may not be available in the event of having an uncued or situationally predisposed attack’, and/or ‘the situation is endured with marked distress or anxiety … or may require the presence of a companion’ (APA 1994).

Agoraphobia in Social Phobia is avoidance behaviour ‘limited to’ social situations. In obsessive compulsive disorder it is avoidance behaviour relating to the particular obsessive thoughts and in post traumatic stress disorder it is avoidance of ‘stimuli’ related to the trauma (APA 1994). Although the avoidance behaviour is limited to the particular disorder, it can be all encompassing and people may become housebound.

Some people will become housebound, totally avoiding situations and/or places, from the first spontaneous attack. In other cases, avoidance behaviour may be gradual and increasingly restricting, or it may be permanently limited to one or two situations and/or places. People may have occasional panic attacks for years before avoidance behaviour sets in. In this case, the onset of avoidance behaviour is not a result of the panic attack itself, but is usually a fear of a new symptom of anxiety.

Agoraphobia can affect people in different degrees. It can also affect the same person in different degrees at different times. It is a multi-faceted and multi-contradictory condition.

Avoidance behaviour doesn’t mean we are not trying to ‘pull ourselves together’, nor does it mean we are giving in to the disorder. Avoidance behaviour is a defence against it, and it has been one of the few controls we’ve had.

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People suffering from post traumatic stress disorder can include Vietnam veterans, bushfire victims, victims of violent crime, sexual and/or physical abuse. People may experience flashbacks in which they believe they are actually living through the traumatic event again, or may have nightmares in which they relive the experience. They may also experience a cued attack when specific situation/s are reminiscent or similar to the traumatic event.

Panic disorder can be secondary to post traumatic stress disorder. On occasions people will seek treatment for their panic disorder but will be too frightened or ashamed to speak of the traumatic event which precipitated it. This is especially so in matters relating to childhood abuse. One English study showed 63.6% of young women with panic disorder who were interviewed for the study, came from ‘difficult childhood backgrounds’, which included ‘parental indifference, sexual and physical abuse’ (Brown et al 1993).

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Rosemary was 67 and lived alone. From time to time she suffered from bouts of depression as she had done for many years. At one stage, in her early fifties, the depression had been so bad that she had been admitted to hospital. But this was not her reason for seeking medical help now. She suffered from diarrhoea with pain and bloating, which had been diagnosed as irritable bowel syndrome. Her doctor had told her that there was nothing he could do for this problem, so she decided on private treatment from a doctor that a friend recommended. He put her on an elimination diet, and within two weeks her bowels were functioning normally, for the first time in many years. She also reported feeling much more cheerful, alert and confident than before, and the doctor assumed that this was an effect of losing her unpleasant bowel symptoms. What surprised them both was Rosemary’s reaction on retesting food. Milk taken at breakfast time produced itchy skin by lunchtime, and severe bloating and diarrhoea in the afternoon. A profound depression set in at the same time, despite the fact that she knew her bowel symptoms could now be controlled quite easily. The depression took two days to clear, but afterwards Rosemary felt as well as before, both mentally and physically. Two years later she is still very healthy on a milk-free diet, and no longer suffers from depression.

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If you think you are impotent, but you are not affected by any of the physical problems I’ve mentioned, the condition may be caused by stress, psychological problems, or anxiety that you’ve developed concerning sex. If, however, you believe your impotence is caused by a physical problem, see your doctor for advice and treatment. He will conduct a complete medical history and physical exam, as well as a number of tests, to determine the cause of your impotence. The exam will include a digital rectal exam, so he can check the prostate, and a manual exam of the testicles. He will also take your pulse in your abdomen and legs and perhaps do a sonogram, to check the amount of blood that is reaching your penis.

First, if you smoke or drink alcohol regularly, try cutting down or out completely to see if that affects your ability to achieve and maintain an erection. If your impotence has appeared suddenly, your physician may believe that a particular medication such as an antidepressant or antihypertensive is responsible; if this is the case, he will switch you over to another one that is just as effective but does not have the side effects. If you have become impotent over a period of time and your legs have felt cold and swollen lately, an underlying disease—most likely a vascular disease or diabetes mellitus—is responsible. And if you’ve noticed that your testicles or breasts have become larger, you may have an underlying endocrine disorder, such as thyroid disease. Treating a stroke, high blood pressure, heart disease, or cancer requires ongoing medication and lifestyle changes; once these are all in place, your impotence should disappear.

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Another common cause of diarrhea is a virus; the condition called gastroenteritis, an inflammation of the digestive system, is a form of viral diarrhea, and you will have some of the same symptoms as traveler’s diarrhea, such as muscle aches, fever, and cough, as well as an upset stomach that lasts for a few days. There is usually no blood in the stools.

Acute diarrhea can also be caused by a change in medication; most often, it’s the result of taking too many laxatives. In addition, antibiotics and antacids can cause diarrhea.

If you have diarrhea, ask yourself the following questions and be sure to communicate your answers to your doctor:

1. Do I have a fever?

2. Have 1 been vomiting?

3. Do I notice any blood in the stool?

4. Have I recently started or stopping taking a medication?

5. Have I changed my diet lately?

6. Have I been spending time in a different location, especially a foreign country?

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