Complete hydrogenation is where this process continues until all the double bonds in the oil are saturated with hydrogen. In effect this creates a fully saturated fat which is now very hard at room temperature. Because there are no more double bonds, there are no trans fatty acids in this type of fat. This means that the fat is not as harmful to health as partially hydrogenated oil; however all essential fatty acids in the oil have been destroyed. Commonly tropical fats such as coconut fat and palm oil undergo this process, to make them more useful to food manufacturers. This is the type of vegetable fat that is often used in chocolate to make sure it melts at mouth temperature.

Partial hydrogenation is where the process is halted before the oil is totally saturated. This means the resulting fat is not as hard; it has a semi solid, spreadable texture. Many trans fatty acids are present in partially hydrogenated vegetable oil. The essential fatty acids in the oil are also damaged. The word “partially hydrogenated vegetable oil” is present on the label of very many processed foods. This type of fat is present in most margarines, vegetable shortening and processed food such as cakes, biscuits, donuts, crisps and hot chips.

Are there any benefits of hydrogenated oils?

These types of fats benefit the food industry greatly, but our health suffers as a consequence. Usually cheap oils are used for this purpose, such as canola, cottonseed, soy or corn oil, which generally do not have health benefits. It is usually too expensive to use olive oil in manufacturing processed food. Hydrogenated fats, being solid give some foods the required consistency; biscuits for instance are usually made from a solid fat like butter or margarine. Butter is more expensive to use than margarine, and it spoils much faster. Basically hydrogenated vegetable oil is used by the food industry because it is cheap, and gives the foods containing it a longer shelf life.

McDonalds replaced beef tallow with partially hydrogenated soybean oil in 1990. In September 2002 McDonalds promised to use healthier oil in its US stores by February 2003. However, nothing has been done so far: there are still six grams îf trans fat in a large serve of fries. In September 2004, McDonalds Australia began using a canola oil blend. This oil is 75 percent lower in saturated fat than their previous oil, but the trans fat content is not mentioned, and there are other potential problems with canola oil. The canola oil blend McDonalds use contains an antifoam agent called dimethyl polysiloxane.

*6/53/5*

For example, many courses of chemotherapy are given on a three-weekly cycle. You may discover with experience that there are points in the cycle when you feel the side-effects of the drugs most keenly, are particularly low, have very little energy and little desire for visitors or activity. At another point in the cycle, you may feel much stronger and want to be more active. Your medical team will advise you if you are likely to have low points in your cycle, but the effects of chemotherapy do vary from person to person. In the first cycle, however much information you are given beforehand, you won’t know from personal experience how you will be affected. Thereafter, your personal experience will be valuable in guiding your day-to-day life. For example, if you know you feel low on days 7 to 10 after your chemotherapy, you can plan ahead and take life very gently on those days. Keeping some form of diary may be useful, even if you just make a brief note each day of how you feel: ‘Day 15 – felt strong, went to work today’ or ‘Day 9 – nausea bad, couldn’t eat, slept badly’.

Judging the level of physical exercise or activity that is right for you may be tricky as your physical energy goes through unpredictable periods of improvement and decline. If you are well enough, it is good to exercise in some form if you can, but as gently as necessary – if a very short walk is enough, then don’t push yourself further. You are not trying to prove anything to anyone!

Ask your doctor’s guidance about your physical limitations and try to respect that advice. Your doctor will not be able to tell you exactly what you can and cannot do, but you may have questions about whether you can, for example, go swimming or play a round of golf or go to the gym. Your doctor should be able to advise you about any activities which should be avoided or approached with caution, or indeed, any which would be especially beneficial.

You might be eager to become more physically active again or you might be surprised by psychological hurdles which have to be crossed first. If an operation has caused some physical change or what you perceive to be a disfigurement, however minor, then this can change your attitude about your body and make you feel uncertain either about your physical capabilities or your willingness to have your body ‘on show’. If the prospect of undressing in the open changing room at the gym or swimming pool leaves you feeling very uncomfortable, then don’t force yourself into that particular activity. It is worth reiterating that there is no ‘right’ way to approach this – you must follow your instincts.

*56\118\2*

Your mental attitude can help you as you progress through your treatment. Although there is no medical evidence that a positive attitude will make any difference to the success of your treatment, it can help you to feel stronger about coping with your treatment and its side-effects and to take pleasure in those aspects of your everyday life which are still ‘normal’.

For some people, positive thinking comes naturally and they attack their cancer with the same vigour and determination they demonstrate in all areas of their life. For many others though, it is not a natural state of mind – perhaps you feel resigned to your cancer and take a stoical attitude, dealing with each day as it comes without actually making up your mind to fight the disease. For some men, trying not to be negative takes a huge effort, and there may be a danger of slipping into depression. This is a serious condition and it can affect your entire life, but it can be treated successfully with anti-depressant drugs. It is not uncommon among cancer patients, and is certainly not a condition which you should suffer in silence, even if you do feel awkward about approaching the subject.

Even if you have a basically positive attitude towards fighting your cancer, there will be times when you feel very low, and wonder whether there is any point in going through unpleasant treatments or putting up any fight at all. Everyone has periods when they feel overwhelmed by their cancer and wonder if they have the energy and will to battle against it any longer. Of course, it is impossible to feel positive all the time and it is very important not to feel guilty when you feel miserable and low. There will be days when you feel that you just don’t care any more, that you can’t be bothered to make any more effort. If your treatment is not progressing as well as you had hoped, you might think, There’s nothing I can do, so what have I got to feel positive about?’ At the same time, you might feel that you should put on a brave face for the benefit of family or friends. While this is bound to occur from time to time, it won’t help you to suppress your real feelings constantly – you do need someone to share your emotions with, to talk to, shout at and cry with.

In fact, as your treatment gets underway, you may feel a sense of relief that something is happening, and that you are no longer in limbo. Unexpectedly for many people, cancer wards and out-patient clinics are not the grim and gloomy places one might expect, so if you have been dreading your visits, especially as an in-patient, you may find this less gruelling than you had anticipated. In spite of that, you are bound to experience fears about how effectively your treatment is working, and look forward with trepidation to each X-ray or blood test which provides information about your progress. Some days you may feel physically good and mentally positive, and other days weak and unwell and miserable. During your journey through treatment, you will experience many emotions, some of which may be new to you or have been suppressed for years. They are all perfectly valid even if you feel foolish for being unusually ‘emotional’.

*44\118\2*

Developing the desire and the confidence to talk to doctors will take time, especially if, like many people, you feel slightly in awe of them or not sufficiently comfortable to talk naturally to them. First you have to want to talk and to ask questions. Then you have to get used to having conversations which do not necessarily tell you what you want to hear. If there is one doctor who you find more sympathetic and easier to talk to than the others involved in your treatment, you might start by talking to him or her. You may also need to work out (or ask!) which staff are most involved with your treatment and care and are therefore likely to be best informed about your particular situation.

As in any other aspect of life or work, some medical practitioners are easier to talk to than others. Do not be put off if a doctor does not appear particularly forthcoming and communicative: it may be that they are trying to judge just how much information you would like to be given or are able to absorb rather than simply bombarding you with medical jargon. The medical terms they use are likely to be unfamiliar at first, and it may be some time before you are fully conversant with them. Don’t be afraid to ask for more explanation, or for information to be repeated if you have not fully understood the first time. A glossary of some of the terms you may encounter is included at the end of the book.

Inevitably, you will think of important questions between consultations or hospital visits and it is very easy to forget them when you are face to face with your doctor. You will, of course, remember them as soon as your meeting is over! To avoid this problem, you may find it helpful to make a written note of your questions, and also of any problems which you experience between hospital visits or treatments. For example, if you are experiencing new or different pain, then your doctors may be able to prescribe alternative medication to combat this. (Obviously, if you are suffering serious pain then you should contact your doctor or hospital straight away.) Similarly, if you are having difficulty maintaining a reasonable diet or eating sufficient in quantity, it is important to let your doctor know as hospital dieticians may be able to offer you advice about boosting your diet. Some people find that a small notebook is easier than scraps of paper (which can easily get lost) for writing down short notes to use as an aide-memoire.

After my initial diagnosis, we never attended another consultation or meeting without a notebook and a list of questions. Helen, my partner, carried this notebook with her everywhere and Volume One soon filled with the details of test results, planned treatment, progress of treatment, changes in treatment – in fact, all the factual information passed on to us. We wrote down queries between hospital visits or as they occurred to us while I was in hospital, and often ran through our ‘agenda’ in the car on our way to consultations. In this sense, I suppose we treated them as we would a business meeting. It was also a tremendous help when we were discussing progress together or with, for example, my parents, because we always had something concrete to refer to.

*32\118\2*

The aim of curative radiotherapy treatment is to direct a very carefully measured dose of radiation to the area of the tumour and thereby to kill off the cancerous cells. The dose needs to be high enough to shrink the tumour but not so high that it also damages the surrounding normal, healthy tissue, which may be affected in the short term but should be able to repair itself in time. Some cancers respond very well to radiotherapy, and in some cases it may be sufficient to effect a cure.

Radiotherapy may also be used to shrink a tumour prior to an operation to surgically remove it, the aim being to make the surgeon’s job more straightforward. It has an important role, too, in cancers where surgery would not be possible.

There are two basic types of radiotherapy: external and internal. In neither type will you become permanently radioactive and, in the external type, you will not actually be in contact with radioactivity at any point.

It is most common for radiotherapy to be administered externally, by directing radiation at the tumour site using a radiotherapy machine, which looks very much like an X-ray machine. However, for some cancers radiotherapy is given internally, by temporarily placing a radioactive source either in or next to the tumour. Sometimes, it may be given in the form of a radioactive drink.

*20\118\2*

Cancer happens when a single normal cell starts behaving abnormally. The cell begins to divide and grow uncontrollably because the signals which tell it how to behave are not working properly. The same happens to the cells it produces but because these cells are so minute, the effect of their growth can remain undetected in the body at this stage. The place in the body where this abnormal growth begins is known as the primary site of the cancer and the resulting tumour as the primary tumour. Although there are many, many different cancers, they are generally described in terms of their site of origin, so that lung cancer refers to a tumour which originated in the lung.

The next stage in the development of the cancer is for the cells to invade the tissue which immediately surrounds them. Next they can circulate to other parts of the body via the bloodstream or lymph vessels, which both reach all parts of the body and therefore provide an easy means of ‘transport’ for the cancer cells. The cancer cells arrive at a new site in the body (which can be quite distant from the primary tumour) and again invade the surrounding tissue. The resulting tumour is known as a secondary tumour or metastasis, and is directly related to the primary tumour. For example, bowel cancer tends to spread via the vascular system to the liver. The secondary tumour in the liver is not referred to as cancer of the liver, but as a ‘secondary cancer of the bowel’. The distinction is important in understanding your cancer: in this example, the spread does not mean that you are suffering from cancer of the bowel and cancer of the liver. It is the ability of the cancer cells to travel around the body and invade other sites which makes cancer such a difficult disease to treat effectively. If it were simply a question of treating a single abnormal ‘lump’, then this could in many cases be removed surgically and the problem eliminated.

Different cancers spread and invade other sites in the body at varying rates, but the sites where they metastasize (form secondary cancers) tend to follow a pattern. For example, testicular cancer spreads first to the lymph nodes in the abdomen, sometimes to the lungs and in some cases to the liver or brain.

Although cancers are generally described by their site of origin, you may also encounter other terms used to describe your cancer, according to the type of tissue where it originated. The most common of these are:

Carcinoma

Carcinomas account for a large proportion of all cancers. A carcinoma is a cancer which originates in the epithelial cells of the body. This is a layer of lining or covering cells which is found in the lungs, the stomach and digestive system and also on the surface of the skin and in glands throughout the body.

Sarcoma

Sarcomas are less common. A sarcoma is a cancer which forms in the tissues which connect the parts of the body together – the bones, muscle, cartilage, tendon and so on.

Lymphoma

Lymphoma refers to the cancers which originate in the lymph nodes and lymphatic tissue, although some lymphomas can start in the bone marrow.

Leukaemia

Leukaemias are cancers of blood cells. They originate in the bone marrow and affect the white cells in the blood and, in turn, also the red cells. The white cells are important because they affect your body’s ability to fight infection and the red cells carry oxygen around the body.

A relatively small number of different cancers account for a high proportion of cases newly registered each year, the more common being the lung, colorectal, prostate and bladder cancers. These account for around half of the total cases and, as with many cancers, are most common in older men. The main exceptions to this for men are cancer of the testis whose incidence peaks before the age of 40, and the leukaemias which have two peaks, one before the age of 20 and the other around the age of 70.

*6\118\2*

An important part of a sex therapy program is for each partner to be responsible for his or her own pleasure—and to communicate his or her feelings. Marvin and Caroline welcomed this change. Focusing on different ways to have sensual pleasure was a wonderful development. “This helped us take the emphasis away from intercourse,” she says. Initially, the ban on intercourse was difficult, but the process of going through the exercises provided an unexpected bonus for Caroline. She found herself learning to be more comfortable with enjoying sensual and sexual pleasures which did not involve intercourse. Like many of us, although she “knew” such behavior was okay, she had not quite accepted it emotionally. But having Marvin caress her for a period of time without any expectation of intercourse helped her overcome her inhibitions about “that kind” of touching.

*182\184\8*

Years of living with ED can have a profound and far-reaching effect on the libidos of both men and women. When sex is absent, often the desire to have it again is sacrificed as well. Yet, when sexual function is restored—as it can be with the new oral medications—libido doesn’t automatically jump-start in both partners equally, much less simultaneously. For many men, the desire to have sex is a logical extension of being functional again. For women, however, the reality can be very different.

Many women have told me so. Their husbands or companions, ecstatic with the return of their potency, exhibit an intense longing for sex. But often the women don’t. It’s not, they explained to me, because they don’t feel attractive or because they no longer have feelings for their partners. Rather, it’s because they have adapted to their situation, integrating the loss of sex into their daily lives. And, they confess, the idea of accessing those dormant feelings can be daunting.

Their reaction is totally understandable. The longer they have lived with men who have ED, the harder it can be for them to tap into their own sexuality. As you read in Chapter 6, there are many ways to heighten intimacy between partners. But where libido is involved, the approach is somewhat different. The best place to start is inside your head.

*136\183\8*

The lifestyle recommendations in my virility-enhancement program have more than one application. Not only will they help prevent and, in some cases, treat, ED, they will actually make you feel and look better. And they will not only improve your sexual function, they may also save your life.

Research has shown that optimal sexual health depends on certain lifestyle choices. All affect the body, the flow of blood, and delivery of a pivotal element: oxygen. Although there are several major physical causes of ED, each one has an impact on oxygen flow. They are hypertension, high cholesterol, diabetes, stress, smoking, alcohol consumption, and lack of exercise. Without sufficient oxygen supply to the penis, an erection won’t happen. That’s because decreased oxygenation of penile tissue can cause progressive fibrosis—a permanent thickening and stiffening of tissue—of the gland. With more fibrous tissue than muscle tissue in the penis, this can cause the penis to actually shrink in size. The crucial oxygen pipeline can be severely limited or blocked by all of the conditions listed above—and all of them can be controlled, improved, or even eliminated through lifestyle changes.

*108\183\8*

Should doctors give patients who are not suffering from ED—but who nonetheless want to maximize their peak performance in every way—access to these new medications? They have already demanded them. One of my patients, a forty-two-year-old man with no erection problems, was insistent. He stated categorically that he wanted to see if he could turn back the clock and regain the rocklike hardness he had when he was twenty. His rationale was direct. “If it’s available,” he said, “why shouldn’t I use it, as long as it won’t hurt me?”

In another significant turn of events, one of my female patients, a very attractive forty-one-year-old divorcee who had heard of the pills, wanted to know if she could get a prescription for them. “If they are all that I’ve heard they are, I want to keep them in the night table, next to the condoms.”

*79\183\8*