BREAST FEEDING

Many benefits transpire from choosing nature’s method for infant feeding. Popularized by the La Leche League in a book called The Womanly Art of Breast Feeding, this routine is finding increasing acceptance among educated mothers and the thinking classes of society. Many scientific facts have amplified our understanding of the superiority for breast feeding over formula. In spite of infant formula propaganda, motivated by economic considerations, human milk and cow’s milk are very dissimilar. Only the water and lactose (milk sugar) contents resemble each other. The protein is different, with amino acid ratios that are quite distinct. Much less phenylalanine (a factor in the PKU syndrome, called phenylketonuria) is present in breast milk. The principal protein of cow’ s milk is beta- Lactoglobulin, while those of human milk are lysozyme and lactoferrin. The casein in the two milks are quite different. Fat content, cholesterol levels, and vitamins are likewise dissimilar.
Although technological tinkering has modified cow’s milk to make it less inappropriate for the human baby, hindsight proves the story of formula production to be a procession of errors. Additions and subtractions of Vitamin B6, Vitamin E, protein, sodium, and other substances have occurred. Various additives are employed in baby formulas, such as emulsifiers, thickening agents, and antioxidants. Although these are known not to be essential for nutrition, they seem for the most part to be lacking in normal breast milk.
Breast feeding affords considerable protection against infection, particularly the diarrheal diseases. Lack of cleanliness and contamination of bottles and formulas has produced a high mortality in developing nations where bottle feeding was introduced. Human milk is, moreover, rich in a wide range of “host resistance factors.” It contains Immunoglobulin A, which protects against a number of infections. Lysozyme, an enzyme particularly effective against viruses and bacteria, is rich in milk from the baby’s own mother. Factors that regulate the micro-organisms in the intestinal tract, as well as white blood cells (called macrophages), are there to combat diseaseproducing germs in the intestinal tract. A breast-fed baby develops a flora primarily of Lactobacilli, much different and more harmless than the normal germs resident in the intestine of a bottle-fed baby. Cow’s milk protein is the most common food allergen in infancy. About 1% of bottle-fed babies are affected by allergies to cow’s milk. These foreign cow (bovine) proteins enter the body through the relatively “open” young intestinal wall. In later childhood and adult life, these foreign proteins are normally broken down. However, in early infancy they are absorbed intact.
Breast feeding and the avoidance of semisolid foods—particularly eggs, meat, and wheat—until four to six months of age is considered the best protection against food allergies in infancy. Child spacing is relatively successful when the baby is breast fed full time. When the baby is totally nourished from his or her mother’s breast the menstrual period ordinarily does not return until at least six months after birth. A hormone called prolactin is secreted by the pituitary gland. This inhibits the onset of mother’s menstrual cycle. World estimates indicate that “lactation amenorrhea” has a larger statistical effect on large scale birth control than any other available contraceptive program! Breast feeding in Western cultures consists of a limited number of feedings, usually only in the daytime. Often the early use of solid foods will negate further this protective effect, explaining why many breast-feeding mothers become pregnant within the first year. Breast feeding has great economic implications. In all communities this form of nourishment conserves resources. Not only concerning the ingredients used in cow’s milk formulas, but also in canning tins and bottles, energy is consumed in production. Formula manufacturers have turned largely to the third world to promote their wares today. Sales personnel, dressed in white uniforms (milk nurses), enter the hospitals to give free packages of their artificial nutrition to mothers as they are about to leave. When mothers finally realize that they can neither afford the formula, or that it is unavailable, their breasts have already dried up. Then, thousands of babies lose their lives. One most important benefit of breast feeding, however, prevails in the emotional realm. An intense attachment between the mother and her infant was shown to be related to early contact. Called “bonding,” this occurrence is most significant during the first twenty four hours of life. Maladjustment developing later in the child, may be traced to the absence of this “mother— baby interaction” within the first few days after birth. Closer contact is more likely to occur when the mother breast feeds. She holds the baby more, cuddles it more, and is less likely, according to a number of surveys, to abuse the child physically subsequently.
In summary, then, we realize that there are many rewards to a natural birth and a natural feeding program. Whether the baby is born in a hospital or at home, reared on a farm or in the city, fed at the mother’ s breast or cradled at her side, both parents and babies will find happiness, health, and security in these simple, natural, satisfying approaches to parenthood.

HOME DELIVERIES (part two)

The newborn baby needs immediate care once the cord has been divided. He or she should be wrapped in warm dry blankets, and the head gently covered. A small cap made of stockinette helps to prevent heat loss from the scalp as well as the baby’s body. Prompt breathing and rapid delivery of oxygen to the tissues are enhanced when the newborn is kept warm. If the home is unusually cold, the child should be placed “skin-to-skin” upon the mother. Then, both should be wrapped in a blanket. The use of insulating “aluminum foil” may be helpful, but in such cases monitor the child’s temperature frequently with a thermometer to prevent overheating. Some newborns enjoy the experience of suckling, and will lay at their mother’s side to nurse for several minutes. A newborn baby who has been delivered with minimal trauma will have its eyes open, looking around. He or she may recognize the mother and “imprint” her image in their mind within hours after birth. This “bonding” is very important for the mother-and-child interaction, often conditioned by the immediate experience of the postpartum period.
Several emergency situations should be kept in mind. Their possibility, although rare, may require immediate intervention. The prolapse of the umbilical cord is one urgent complication. If the umbilical cord appears before the baby has been delivered, emergency rescue measures may help to save the infant’ s life. The head should be firmly pushed back into the birth canal, to prevent its pressing tightly against the cord, and thus obstructing the flow of blood to the baby. Usually a Cesarean section is indicated in such cases. If performed soon enough, surgery may save the life of the child.
Breech delivery sometimes presents unexpectedly. Either a foot, both feet, or the rump of the baby will appear at the opening of the birth canal. If this was the first pregnancy, the baby is particularly in danger. Ignorance concerning the size of the “aftercoming” head leads most physicians in a hospital setting to do a Cesarean section on the mother whose firstborn baby is a breech presentation. However, if the mother has delivered previous children, this baby could be delivered with the feet grasped and held by an assistant, elevated above the mother’s abdomen. Then, the baby is rotated so that the head can be delivered face down. Exert a gentle pulling with a finger in the baby’s mouth. When its chin appears at the entrance of the birth canal, help to deliver the head with minimal trauma. At times, premature babies come unanticipated in the home. They are particularly sensitive to heat loss, and should be kept very warm and close to the mother. Usually the tiniest ones are unable to suck well and must be tube fed. With practiced skill, this small feeding tube can be placed in the baby’ s stomach with each feeding. Give a small amount of breast milk for nourishment every two or three hours. Most premature infants should be cared for in a hospital with facilities for newborn intensive care.
Hemorrhage involving the mother is a serious emergency. Usually, this will occur immediately after the birth of the baby or within the first few hours. When the blood flow is bright red, there exists the possibility of an overlooked laceration. Look for it carefully. Pressure may help stop the bleeding until the patient can be transported to an emergency room. If there is no laceration, then the bleeding usually originates from the uterus. Firmly massage the softened dome of the uterus immediately, while applying an ice pack to the lower abdomen. This may help the uterus to contract. Place the infant at her breast to nurse and stimulate the release of oxytocin. This hormone aids in uterine contraction and shrinkage (involution). However, if bleeding is not immediately controlled, the mother should quickly be taken for emergency care. Blood transfusions and medications designed to contract the womb may be lifesaving.
Fever occurring immediately before or after childbirth may be ominous. It may indicate infection in the bladder, particularly if a catheter has been used. Occasionally, fever may be due to unrelated conditions, such as influenza or respiratory illness. However, it could emanate from infection of the womb itself. Urgent treatment may help to prevent blood poisoning and serious complications. Cooling measures, such as the hot blanket pack, will open the pores. On the other hand, a dripping wet sheet for evaporative cooling may be beneficial. Maintain careful records of the delivery, including the weight of the newborn, and the time and date of birth. Birth certificates may in most states be filed and signed by the individual who attended at the delivery, whether they are husband, friend, nurse-midwife, or physician. A drop of antibiotic ointment or 1% silver nitrate solution should be put in each eye of the newborn baby, required by state law to prevent gonorrhea infection.
After a brief rest the mother should walk, go to the bathroom, and take a shower if she feels able. Early physical activity after the delivery of a baby will enable her to gain strength as soon as possible. Exercise also helps to prevent complication such as venous clots (thrombosis), that formerly were common with prolonged bed rest. Textbooks of maternity nursing and midwifery describe in more detail the equipment needed for a home delivery and the most efficient setup of the bedroom.

HOME DELIVERIES (part one)

In European countries most babies are delivered at home. Until recent years in the United States, the same custom was true. Among idealistic college youth, natural living enthusiasts, and those with no insurance, home delivery still holds an attraction. Midwives and occasionally physicians usually attend these patients. Husbands, wives, nurses, and family physicians should
all become acquainted with the techniques of a home delivery. Either through planning or in an emergency, this knowledge may prove most useful.
First in importance is the recognition of labor. For several weeks prior to delivery there may be painless, irregularly spaced contractions. These so - called Braxton—Hicks contractions serve to firm up the uterus and, as it were, “prime” it for the main event. The baby typically “drops” several weeks before labor is to begin, as the head descends into the pelvis, creating a “lightening” sensation. Slight cervical dilation then follows, with increased secretion of mucus—like discharge.
When labor actually ensues, however, one of three changes heralds its onset. The loss of the mucus plug, at times coated with blood (bloody show), may coincide with the onset of labor. Second, the cervix begins to thin (called effacement) and dilate. Regular contractions then commence, usually coming every eight to ten minutes, lasting at least sixty seconds. They then increase in frequency, becoming quite intense. Labor contractions located in the low back may be extremely painful. They are commonly associated with an “occiput posterior” delivery. In this more challenging type of labor, the back of the head orients toward the mother’ s back, making passage through the birth canal during labor more difficult. The “bag of waters” (amniotic sac) may burst, causing a sudden flood of warm clear fluid. Occasionally, the escape of urine or a vaginal discharge may mimic the breaking of the water. This must be tested with pH paper (litmus or nitrazine). The amniotic fluid is always alkaline, turning nitrazine paper blue. When labor initiates itself by the breaking “bag of water,” it normally proceeds faster. In fact, it is important for the delivery to be accomplished within twenty-four hours after the water breaks, to lessen any risk of infection in the mother’s womb.
Labor usually progresses steadily through three distinct stages. The first stage consists of progressive cervical dilation and thinning (effacement). When the cervix is completely dilated, the opening is 10 cm. in diameter, the average diameter of a baby’s head. The second stage of labor begins when the head passes through the completely dilated cervix, and descends into the birth canal (vagina). The first appearance of the baby’ s head between the labia is called crowning. Progressive dilation of the vulva then occurs, requiring special self-control on the part of the mother. Periodic panting with each contraction, helps to avoid pushing the baby out too fast, thus preventing laceration of either vagina or cervix. If all goes smoothly at this point, the baby enters the world into the waiting hands of an attendant midwife or physician.
Your first maneuver, after the baby’ s head emerges, should be to clear its mouth and nose of mucus. A rubber suction bulb works excellently for this purpose. Clearing the airway of mucus should be performed thoroughly, with the baby’s head in a downward position (for a normal ‘‘face down” delivery).
Quickly check the baby’s neck for the umbilical cord. If a loop of the cord is discovered, slip it gently over the head to make the delivery of the shoulders and trunk easier. This helps prevent its strangling the baby, or accidentally tearing the cord. A hemorrhage would then result, depleting the baby of its precious blood. The upper shoulder of the infant is usually delivered first, followed by the lower. Finally, the rest of the body slips out easily. Continue holding the baby in a head down position, and suction the mouth and nose again. Wait “patiently” for the first cry and a few deep breaths that ventilate the lungs and bring a healthy pink color to the newborn body. The pulsing umbilical cord should be left alone for a minute or two, to allow further blood flow from the placenta into the baby. This acts as a mild “transfusion” to give the baby some of its own blood, which would otherwise be lost. “Stripping” the cord of its blood in this fashion retards the later development of anemia, commonly seen in babies a few months old. When the cord quits pulsating, it can be tied or clamped. In a normal home-like setting it is convenient to boil a clean white shoelace, and use this to tie the cord. About ¼ to ½ inch from the skin of the navel, tie the cord securely, with care taken to avoid pulling or traumatizing the umbilicus. Place two ties about an inch apart, the second one being further from the baby than the first tie. Then use a pair of sterilized scissors to cut between the cord ties. The third stage of labor involves the delivery of the placenta. The “afterbirth” follows within five to forty five minutes, and usually separates on its own accord with no manipulation required. If necessary, use your hand to gently massage the uterus. Another “push” on the mother’s part, and the placenta comes easily.
The uterus should again be massaged carefully. The baby can be positioned to nurse at mother’s breast. This enables both hormonal and neural mechanisms to contract the uterus and lessen the likelihood of hemorrhage. Periodically, for the next hour massage the uterus to keep it firm and
minimize bleeding. If there has been a laceration of the perineum during the delivery, it should be carefully inspected. If the tear is extremely small and not bleeding, it may be allowed to seal by merely lying still with the mother’s legs together for a few hours. All deeper lacerations, particularly those involving the muscle of the rectal sphincter should be sutured. Even if this means a trip to the emergency room or doctor’s office, it should be repaired, so complete healing
will occur. Then the rectum and birth canal will not lose their normal anatomic relationships, leading to incontinence or discharge. One most important qualification for a successful nurse-midwife is the ability to remain calm under pressure. The delivery of a baby is an exciting
time. All the attendants should continually remain alert, interested, and composed. Encouragement to the mother during the strenuous pushing stage can make all the difference between a successful home delivery and one that needs obstetrical assistance in a hospital. The use of forceps can often be avoided if mothers receive the proper coaching and encouragement during this labor stage. Patience in waiting for the placenta will likewise be rewarded. Although excited viewers may request to take pictures, it is much more important to attend to the physical needs of the newborn than obtain a few precious snapshots.

PRENATAL CARE (continued)

The mother’s diet should ideally be unrefined, with a unequivocal emphasis on whole grains, fresh fruits and vegetables, along with adequate amounts of water. Calcium intake can be secured through a liberal use of whole grain cereals, green leafy vegetables, and skim milk. The iron needed to maintain healthy red blood comes from such foods as: cereal grains; fruits— such as raisins, prunes, and strawberries; and dark green and yellow vegetables. At times, supplements are needed for those with deficient absorption of these important trace minerals. All other needed vitamins and minerals can be obtained easily from a diet of unrefined natural foods. The mother should eat a substantial breakfast. Energy needs for the day are best obtained at its beginning. One or two pieces of fresh fruit, a slice of whole wheat toast with peanut butter, a bowl of cereal such as shredded wheat, oatmeal, or granola, topped with fruit and soy milk make an excellent breakfast. For variety a healthful waffle, apple crisp, fruit sauces or muffins may be substituted. The mother who starts the day sharp with a good breakfast will keep going longer and maintain far better health than those who sleep in, nibble a little, then make up for it with evening snacks. Lunch should be carefully planned, so that the noon meal is as generous as breakfast. A vegetable or two, a baked potato, a bowl of soup, or a sandwich on whole wheat bread, with tossed salad, or a vegetable entree are some of the variations that bring the best of natural nutrients for better health to mothers. Vegetarian recipe books abound with suggestions for cooking these natural foods. Suppers should be light—fruit, fruit soup, zwieback, or homemade crackers are ideal. The evening meal should be completely digested several
hours before going to bed.
Exercise should be carefully planned, to keep the muscles strong and the joints limber. “Tailor sitting” helps the perineal muscles to relax and loosens the ligaments of the thighs. Arch the back from the hands and knees position to strengthen the postural muscles. This so-called “pelvic rocking” exercise is excellent for late pregnancy to minimize low back pain. Moreover, it helps promote an erect standing and walking posture. “Sitbacks,”— in which a person sits on the floor with the legs outstretched and leans back, then forward, then back, repeating several times—is an exercise designed to improve tone in the abdominal muscles. It benefits the tummy, while avoiding any danger of back strain so common in more traditional sit-ups. Practice a general routine of warm-up calisthenics each day to prevent muscle cramps and joint tightness, which could otherwise create problems later during labor. The very best exercise, however, for any pregnant mother is walking. Walk briskly one, two, or even three miles per day with your shoulders back, the arms swinging comfortably from the sides, and your head erect. This will pay dividends in fitness, health, and a feeling of vigorous well-being. The mother who walks during pregnancy may well breeze through labor. On the average, labor and delivery requires less time in a physically fit mother, when you can relax and cooperate with these forces of nature. Swimming, bicycling, gardening, and other mild activities are likewise beneficial during pregnancy to keep the muscles firm and the disposition gentle.
With the physical culture of your body, remember to cultivate the mind. Pregnancy is an ideal time to read books on child training and natural childbirth. You can secure the best mental preparation for motherhood in a context of Christian commitment that makes motherhood a partnership between you and your Maker. Such encouraging books as Child Guidance by Ellen G. White and Natural Childbirth and the Christian Family by Helen Wessel constitute valuable resources to every parent who is serious about successful childrearing, as well as child bearing.

PRENATAL CARE

Before your baby arrives, a great deal of care needs to be maintained to preserve the your best health. Although pregnancy is a normal physiologic event, many physicians treat it as a disease, and attempt to control too closely the behavior of the mother. Most women, however, can be taught the basics of hygiene during pregnancy. That means taking take responsibility for your own health.
During the monthly visits a pregnant lady makes to her midwife or physician, she will have a urine test for protein and sugar. Sugar in the urine raises a suspicion of diabetes. The diabetic mother is at increased risk during pregnancy, and has a greater likelihood of difficult labor, due to the predictably excessive size of her baby. Blood incompatibilities and hemorrhagic problems are more severe in a baby born to a diabetic mother. In addition, the stability of a mother’s diabetes is greatly influenced by her pregnancy. It could even trigger the death of a baby in utero, or a miscarriage, if care is not taken to control the diabetes with appropriate levels of insulin. Still, one can perform the simple test for urine sugar right in the home with commonly available strips of Tes Tape or Clinitest tablets, available at any pharmacy.
Toxemia in pregnancy has several facets. With the mother’s excessive accumulation of body tissue, fluid overload becomes generalized edema. Her weight may go up several pounds within a few days, creating puffiness not only in the ankles, but the hands, eyes, and occasionally her entire body. Along with this dilemma, the kidneys show signs of damage, losing large amounts of protein. A simple dip—stick urine test for protein may show 2+, 3+, or 4+ protein, implying heavy losses of this important substance. Third, the blood pressure rises, frequently producing symptoms of headache, painful pressure behind the eyes, or outright nosebleed. When these three manifestations of toxemia (hypertension, proteinuria, edema) occur late in pregnancy, it is crucial to evaluate the reflexes. Tap gently, for example, with the doctor’s little hammer on the tendon just below your knee. Then, for preventive treatment, secure a calm, quiet environment, strictly limit your salt intake, and eat adequate protein to replace the heavy losses. Prolonged bed rest in a darkened room is occasionally prudent to prevent external stimuli that could trigger seizures. Convulsions are the most frequent cause of death (for mother and child) when toxemia develops. This grave complication should be prevented, whenever possible. Modern management with I.V. administration of magnesium sulfate (Epsom salts) prevents most serious and life-threatening convulsions that could occur without warning.
For many timely reasons, during every pregnancy I recommend the routine measurement of weight and blood pressure on a monthly basis. Mothers, be sure to limit weight gain during pregnancy to approximately twenty five to thirty pounds. Extreme austerity in diet is not necessary, but neither is overindulgence and its resulting obesity a boon. Mothers who later breast feed their infants, find their weight returning to normal much sooner.
Nursing helps because it utilizes significant numbers of stored calories to manufacture milk. As a general rule, very little weight gain is advisable during the first three months of pregnancy, about two pounds per month in the second trimester, and one pound or more per week during the final three months. This adequacy of weight gain provides for a mother’s and child’s needs with plenty of nutrients that will build bone and blood, muscle and connective tissue. Even more importantly, good nutrition promotes health to the nervous system and brain of each developing fetus. Proper diet for every pregnant mother is vital. You should strictly avoid all use of alcoholic beverages, because of their toxic effect on your baby. Moreover, beverage alcohol sabotages your brain and will power. Tobacco should also be eliminated, for numerous reasons mentioned above. Coffee and tea are unnecessary, as every pregnant mother needs a calm environment without stimulants or any chemical that would weaken the nervous system.
Recent research shows caffeine definitely harmful to the unborn child, capable of transmitting a legacy of irritability to the high—risk offspring.

PROBLEMS IN EARLY PREGNANCY part 2

Vaginal bleeding sometimes occurs, even after pregnancy begins. Usually this appears scant and transient, but at times it may be profuse. When an actual hemorrhage develops after pregnancy has established, this constitutes an obvious threat of miscarriage. The presence of regular contractions and pelvic pain, combined with vaginal bleeding, should alert to this possibility. At times a miscarriage may occur with the complete passage of the placenta and the subsequent stoppage of bleeding. If incomplete expulsion of the placenta or fetal tissue occurs, a simple operation, called a D and C (dilation and curettage), should be performed, so the bleeding will stop and the uterus can return to its normal size. Fever in the presence of a miscarriage is a more ominous sign, as it probably indicates the presence of pelvic infection.
For treatment of threatened miscarriage, bed rest is always advisable. The absence of straining, standing, or moving about lessens the flow and usually decreases the likelihood of a miscarriage. Sexual intercourse should be avoided in early pregnancy, particularly near the times when a menstrual period would otherwise occur. Uterine cramping and the likelihood of miscarriage is greater at these cycles, for reasons yet unknown. Hormones are no longer given routinely to mothers threatened with miscarriage. They are powerless to stop the inevitable. Furthermore, progesterone concentrates may cause damage to the fetus, if it is carried to term. Scientists believe that many spontaneous miscarriages are the result of some chromosomal defect, which otherwise would have led to congenital deformity. They are eliminated by nature before the pregnancy goes too far. This is of considerable consolation to parents, suddenly disappointed by the premature loss of a long-looked-for baby. Most couples can wait a few months, then try again. One of the more troublesome conditions of early pregnancy, sometimes lasting for months, is an upset stomach. Called “morning sickness,” for obvious reasons, nausea and vomiting tends to herald the onset of pregnancy.
Although only a few ladies find it incapacitating, these symptoms tend to hinder proper nourishment, so important in the early months of pregnancy. This nausea may last throughout the day. On the other hand, it may be relieved by eating some crackers or other form of dry food. Frequently, the appetite completely changes, and the “lady-in-waiting” craves foods that were formerly disliked. In extreme cases this so-called pica (abnormal craving) is manifested by the “clay eating” habit of southerners, or the strange love for “pickles and ice cream” that ordinarily seems like a repulsive combination.
Mothers need to be careful that their appetites are controlled by reason when such cravings become abnormal. Where vomiting in pregnancy becomes persistent, hospitalization may prove necessary. One or two days of intravenous feedings is normally sufficient to bring back a normal digestion once again. Emotional contributions to this gastric problem are frequent. These can be related to ambivalence about being pregnant, or an underlying temperament of nervousness manifested in an unusually sensitive stomach. Nevertheless, the physiologic and hormonal changes that occur are profound. Such endocrine considerations may well explain these early digestive symptoms. A tolerance for food usually emerges by the fourth month, enabling a normal digestive tone to continue for the remainder of pregnancy.
Adequate fluid intake is vitally important from the start. It is suspected that the common, insufficient intake of water is one principal cause of persistent nausea and vomiting. Drink at least six to eight glasses of water per day, at whatever temperature is best tolerated by the sensitive stomach. If the mother avoids soups and creamed mixtures, and chews thoroughly a rather dry meal of whole grain crackers, breakfast cereals, or raw vegetables, her food will stay down better and permit the best nutrition at this critical stage.
Vaginal discharge is often troublesome during the latter months of pregnancy. This may be due to the parasite Trichomonas, but is more commonly caused by a buildup of yeast or Monilia (Candida albicans). Hormone changes combined with increased perineal moisture and warmth, create an environment favorable to the growth of these organisms. Diabetes mellitus, particularly aggravates the tendency to develop yeast infections. Administration of hormones such as the birth control pill may produce a diabetes-like state in non-pregnant women. However, pregnancy increases this trend. Nylon underwear, panty hose, and tight slacks tend to increase the propensity for vaginitis. This is because greater warmth and moisture are produced in the perineum when one wears those synthetic fabric materials. Air circulation around the body and “breathing” of the skin is impeded. Then it leads to the rapid multiplication of yeast germs with such unpleasant symptoms as discharge, burning, itching, and skin rash. Gentle vaginal douches, with a dilute vinegar solution (one tablespoon of white vinegar to one quart of warm water) can help decrease the discharge and restore normal acidity to the birth canal. Specific agents are available to help in acute stages (such as Massingill products). However, the intestinal tract always harbors these germs, so it is impossible to completely escape from them. Therefore, you will find it preferable to build up resistance and let improved health of the body create its own defense. Marital relations should be avoided, not only when discharge or infection
is present, but during any time of spotting or uterine cramping. Moreover, for at least four to six weeks prior to the birth of the baby, intimate relations should likewise be curtailed, since a significantly increased risk of infection in the amniotic fluid surrounding the baby has been linked to intercourse at this stage. Sexual continence at this critical time will be rewarded with better health, as well as peace of mind.

PROBLEMS IN EARLY PREGNANCY part 1

One of the earliest predicaments to confront a woman who has missed one or two periods, involves this all absorbing question, “Am I pregnant?” There are several simple techniques to determine pregnancy with reasonable certainty, right within one’s own home. A suspicion arises when there is a miss of the normal menstrual period. If menses have been regular for several months, then the intuition heightens. Many women have months when they skip the cycle normally. Others have periods too scant to notice. Then the diagnosis of pregnancy becomes more difficult.
Symptoms of pregnancy may be present. You may experience a feeling of nausea, typically in the morning. This is occasionally associated with prolonged vomiting lasting throughout the day. The breasts may swell and become more tender than is usually associated with the premenstrual state. A slight change may occur in the vaginal discharge. Occasionally, a woman who has had previous children just “feels pregnant.” In pregnancy after three to four months, a “lump” may actually be felt above the pubic bone, located in the lower abdomen. This is probably the enlarging womb. By five months gestation it will usually reach to the navel, with an obvious rounded prominence in the lower abdomen. Fetal movements may be sensed at four to four and a half months, though they are sometimes detected earlier by experienced mothers carrying their second or third child.
In most pharmacies today, you can purchase a urine pregnancy test kit. This analysis very simply measures the amount of HCG (Human Chorionic Gonadotropin), a hormone secreted by the developing placenta. A positive test for pregnancy develops within three to six weeks after conception. Use a concentrated morning urine sample for best reliability. If performed according to directions, these tests are quite dependable in confirming the suspicion of pregnancy.
Vague abdominal pains are sometimes felt in early pregnancy. Pelvic pain may occur from pressure on an enlarged ovary, or from a “tilted” uterus. As it enlarges, the organs become tighter in the pelvis, while the womb has not yet risen into the abdominal cavity. Pain could be related to constipation, or to cystitis. Usually, a bladder infection is characterized by burning combined with a frequent urge to urinate. Stretching of the ligaments that support the uterus may produce pain. In later months, the pressure of a fetal part on a pelvic nerve or a sudden shifting of the baby within the womb may give rise to such symptoms. Usually reassurance is all the patient needs. Severe pain or sudden changes in health status should be called to the attention of a physician immediately, however, since it could be an ectopic (tubal) pregnancy. If this goes unrecognized it could rupture, with internal hemorrhage and potential disaster. Appendicitis may occasionally be superimposed upon pregnancy, requiring early diagnosis and prompt surgical treatment as usual.

OTHER HORMONAL DISORDERS

Finally, we turn to the common endocrine glands that occasionally produce a disease. Many people are concerned about the function of the thyroid gland. This endocrine organ, located at the base of the neck just below the “Adam’s apple” (larynx) is an important regulator of the metabolism of the body. Its overactivity results in characteristic symptoms, such as a rapid pulse, bulging of the eyes, nervousness, tremor, and diarrhea.
Tumors of the thyroid gland, as well as the overproduction of the brain hormone stimulating the gland to produce excessive amounts of thyroid hormone may cause these problems. Blood tests are available to determine the level of thyroxine, the major hormone, as well as others circulating in the system.
Although stress may be a precipitating factor in the development of hyperthyroidism, a failure to respond to the recommended change in lifestyle with increased rest and physical exercise, should lead a person to seek medical counsel, as surgery is occasionally indicated.
Many more people are concerned about underactivity of the thyroid gland. This is often blamed for obesity but in reality is seldom the cause. A tendency to fluid retention, sluggishness, drying of the skin, constipation, and fluid retention should lead one to seek the appropriate blood tests and accurate diagnosis. The typical patient with advanced hypothyroidism, called myxedema, becomes very complacent, with subdued emotional responses and dull mental processes. This so-called “bovine placidity” is much less distressing to its possessor than to the patient’s associates.
Neurologic syndromes are occasionally mimicked by hypothyroidism. They normally clear rapidly with replacement therapy. Many different forms of thyroid medications are available, but should not be used unless a definite deficiency is diagnosed. In such case full hormone replacement becomes necessary, usually for life.

TRACE MINERALS

Many trace minerals are known to be essential to physiologic processes. It is not known in all cases that supplementation of these can cure specific diseases, but a few of the common sources are listed below. Zinc is widely distributed in foods, particularly breads, cereals, lentils, beans, and rice. This nutrient is essential to growth, as well as in repair and healing processes. Copper is abundant in raisins, whole grain cereals, dried legumes, and nuts. It also plays a role in blood production, tissue metabolism, bone development, and nerve function.
Cobalt is a component of vitamin B12 and comes from a variety of sources. Called hydroxycobalamin, vitamin B12 is a vital ingredient in blood cell formation as well as healthy nerve function. Deficiency of B12 produces the disorder pernicious anemia. Vitamin B12 is found in many animal products, such as milk, eggs, and cheese. It is absorbed in the small intestine (ileum), and requires a protein intrinsic factor for complete absorption. Intrinsic factor is found in the stomach. It is often deficient in people who have chronic gastritis or those who have had the major part of the stomach removed by surgery. Total vegetarians should be sure that their diet includes some vitamin B 12. Many breakfast cereals, soy milks, and meat substitutes are fortified with 12. It is available in tablet form. One microgram is sufficient for daily protection.
On the other hand, many vegans have gone for years without evidence of vitamin B12 deficiency. There is a urine test that can determine any presence of B12 deficiency. It is called urinary homocysteine and methylmalonic acid.
Both of these substances are metabolites of vitamin B12. Together with serum B12 measurements, these analyses are effective in screening vegetarians for any trace of B12 deficiency before problems appear. The anemia of vitamin B12 deficiency is macrocytic, meaning that the red blood cells are unusually large. More serious are the nerve and spinal cord disorders that develop. Neurologic signs include loss of position and vibration sensation, combined with sensations of numbness and tingling. Later, serious impairment of gait and bladder (sphincter) control are seen. Some of these symptoms may persist long after vitamin 12 is again replenished. Moreover, this neurologic damage may occur before any evidence of anemia, making diagnosis very difficult in early stages. Prevention is the watchword for vitamin B12 disorders.
Selenium, like vitamin E, protects against cellular damage and lowers the risk of cancer. Cereal grains are good sources of this mineral also. Manganese and magnesium affect a host of enzyme systems. They likewise come from whole grain cereals, as well as many vegetables. Nickel, silicon, fluorine, and many other minerals are also important to the body. Whole grain cereals are a major source of Chromium. It is also found in Brewer’s yeast. This mineral helps to improve glucose tolerance and is an important preventive against the development of diabetes.

VITAMIN DEFICIENCIES 2

Vitamin B6 deficiency is seen occasionally in individuals who eat very few plant foods. Seizures occur in babies fed formulas deficient in B6. This has especially been a problem when a relatively high kidney excretion develops during pregnancy, while a mother was given high dose supplements. A number of drugs interfere with vitamin B6 utilization, such as isoniazid, used in the treatment of tuberculosis. Eating a natural varied diet, it is not difficult to get plenty of pyridoxine. It is the vegetable source of vitamin B6. Scurvy is another vitamin deficiency with worldwide prevalence as well as a colorful history. This condition is caused by a deficiency of ascorbic acid, also called vitamin C. It was a common cause of mortality in sailors during the fifteenth and sixteenth centuries. James Lind, a British naval surgeon, developed a simple cure in 1747 by giving the sailors two oranges and one lemon every day. Their swollen gums, weakness, and bleeding tendencies responded dramatically, giving rise to the nickname, “Limeys.” In more recent times scurvy appears more commonly in alcoholics, food faddists, and the impoverished elderly living on a grossly unbalanced diet.
The principal manifestations of scurvy are hemorrhages in the skin, swollen and bleeding gums, aching muscles, fatigue, and emotional changes. These symptoms appear after two months of depletion. Appearing occasionally in children, scurvy produces tenderness and swelling in the legs. Extreme pain may be present. Finally, after the teeth erupt, swollen gums and bleeding develops. Skeletal changes show signs of growth retardation. In some cases of a vitamin-D deficiency syndrome, rickets, may co-exist.
A carefully taken feeding history is helpful for the diagnosis of infantile scurvy. After 46 months of age any infant fed solely with the bottle, using only boiled cow’s milk or a milk substitute, may develop this disease. Fresh orange juice or another dietary source of vitamin C is rapidly curative. Extremely high supplements of ascorbic acid are seldom necessary. They may produce an abnormal dependency, based on the development of increased excretion originating in the kidneys to compensate for this superabundance.
Large doses of vitamin C can also inactivate vitamin B12. That, at times, unfavorably affects reproduction. Vitamin A is primarily manufactured by the conversion of dietary betacarotene into the active form, retinol. One of the first symptoms of vitamin A deficiency is inability to see in reduced light (night blindness). A later change in the eye is the presence of dryness, xerophthalmia. The conjunctiva becomes opaque, the secretion of tears decreases, then a sticky secretion appears over the cornea, called the Bitot spot. This mark has the appearance of a flake of meringue. Further destruction of the cornea may occur, leading eventually to blindness.
In treating the acute disease, a supplement of vitamin A is recommended. The prevention of deficiency using a balanced diet containing green and yellow vegetables, fresh fruit, and vitamin-supplemented milk is entirely adequate. Green and yellow foods such as carrots, cantaloupe, squash, and dark green leafy vegetables are considered excellent sources for this vitamin.
A high intake of carotene appears in adults using carrot juice or a similar food concentrate excessively. Carotenemia may color the skin, but should not be confused with jaundice. It is considered harmless and will subside when the carotene intake is reduced. Hypervitaminosis A, on the other hand, can produce an acute toxicity. In infants, it presents as drowsiness, vomiting,
and other signs of increased intracranial pressure. Adults commonly develop a headache within hours after any injection of a toxic dose. Blurred vision, nausea, vomiting, or drowsiness may also develop. The skin peels and hair loss occurs. With chronic ingestion of high doses, liver changes resembling cirrhosis are seen. Psychiatric side effects manifest themselves, but prognosis is good when vitamin A ingestion ceases.
Vitamin E is the common name of a group of related fat-soluble vitamin, called tocopherols. They vary in their potency, with the alpha form being thought most active. A number of animals develop a Vitamin E deficiency syndrome, with deterioration in the muscle fibers, impaired reproduction, or anemia. Clinically, these insufficiencies are rare in adults. When the diet contains enough polyunsaturated fatty acids, plenty of dietary vitamin B is usually available. Unfortunately, optimistic expectations of many researchers have been disappointed in spite of the literature proclaiming the miracleworking powers of this vitamin. We do not know for certain whether vitamin B supplementation can favorably affect physical endurance, cardiac status, sexual potency, or longevity in individuals with normal blood levels of Vitamin B (tocopherols).
A number of vitamins affect the production of blood or its proper coagulation. Vitamin K is present in most edible vegetables, particularly the green leafy ones. A similar vitamin is also produced by intestinal bacteria. The gradual accumulation of vitamin K levels in a newborn baby explains easily why ancient recommendation for an eight-day circumcision was made to the Jews. Hemorrhagic disease of the newborn as well as in adults is prevented by proper blood levels of this vitamin. Vitamin B12, folic acid, and iron are also closely related to blood production and have been discussed in Chapter 4, dealing with the circulatory system.

VITAMIN DEFICIENCIES 1

Although definite diseases can be associated with the excess intake of certain vitamins, these are seldom seen on a large scale. Much more common are the deficiencies described below. Pellagra is a disease caused by the deficiency of niacin, one of the B vitamins. The name is derived from the rough skin characteristically seen crusting around the hands and neck. Painful burning of the mouth, shaking of the body, and less commonly, mental disturbances can result. Pellagra was common in the United States in the early 1900’s. A healthful diet was discovered to be curative. One of the essential amino acids, tryptophan, is converted into nicotinic acid, a counterpart of niacin. Deficiency of other nutrients sometimes complicates the disease. Individuals subsisting on a diet primarily of corn are predisposed to pellagra, since corn protein is low in tryptophan and most of the milling removes the vitamin.
Classically pellagra is characterized by the “three D’s” — diarrhea, dermatitis, and dementia. Certain earlier symptoms may develop, however, including loss of appetite, indigestion, weakness, burning in the mouth, and insomnia. Pellagra most commonly appears in the spring or early summer, when the dietary deficiencies of winter combines with renewed exposure to the sun seems to precipitate the outbreak. The skin problems begin to look much like a sunburn. Burning may be intense. Sun-exposed areas, such as the neck, arms, and hands are affected most commonly. Later the skin becomes brownish in color, then rough and scaly. Soreness of the mouth is typical, with inflammation of the tongue. Diarrhea may or may not be present. Mental disturbances usually begin with episodes of nervousness and tremor. Later there occurs confusion, depression, or even delirium.
Early replacement of the B-complex vitamin with high doses of niacinamide is recommended. This related substance does not cause unpleasant vascular flushing like nicotinic acid does. Most people can take them orally. As symptoms subside, all vitamins should all be obtained from a wellbalanced, varied diet of natural foods.
Thiamine Deficiency, called Beriberi, has been known to western medical science since the seventeenth century. Recognized first in the Orient, beriberi has been associated with a deficiency of thiamine. It commonly appears when the diet exclusively consists of polished rice. Cases are occasionally encountered in the United States, particularly in infants and in alcoholics. Three main types of this disease are identified. A chronic form called “dry beriberi” causes tenderness in the calf muscles and weakness in the legs. The acute form, “wet beriberi”, is characterized by cardiovascular changes, with edema, congestion of the lungs, and heart failure. In alcoholics, the brain damage may be irreversible. Beriberi in infants continues to be a health problem in the Far East, where a child may lose his voice, develop heart failure, or gastrointestinal changes with vomiting and constipation.
Adequate nutrition for the breast-feeding mother is particularly important for its prevention. The therapeutic response to Thiamine in infants and adults with beriberi involving the heart is dramatic. A rapid transition, however, should be made from vitamin supplementation to a diet containing adequate wheat germ, rice polishings, or whole grain cereals. This disease is entirely preventable, and reflects one of many conditions following the wake of the industrial revolution.
Riboflavin deficiency is still common in many developing countries. In the Unites States there appears to be a correlation between low income and riboflavin intake. Milk and certain vegetables are good sources of riboflavin. However, when the milk is exposed to direct sunlight a considerable amount of this vitamin is destroyed. Riboflavin is reduced when the food is treated
with alkali, such as we find in certain preservatives and the use of soda. Lack of riboflavin usually results in sores, developing at the corners of the mouth, inflammation of the tongue, and sore throat. Late findings affect the nerves, as well as the blood, with the development of anemia. Replacement of the vitamin rapidly reduces these changes.

MALNUTRITION

Although over-nutrition so characteristic of obesity could be considered a type of malnutrition, such diagnosis is usually reserved for the deficiency syndromes. In all parts of the world various deficiencies of vitamins, minerals, protein, or calories can be seen. Deficiencies are naturally more prevalent in countries where food supply is limited and poverty abounds. Careful analysis
of food intake and any form of intemperance—such as manifested in alcohol consumption, bizarre food practices, food faddism, or the abuse of drugs— are productive to evaluate these conditions. Repeated closely spaced pregnancies and psychological disturbances manifested by a change in food intake should be assessed. Chronic infection, anorexia, or diarrhea likewise may profoundly affect the nutrient balance.
Measurement of height and weight should never be omitted. These are the most commonly used measurements of growth in children and adolescents. Other body measurements include skin fold thickness, head circumference, and biochemical tests measuring blood levels of various nutrients, such as proteins, vitamins and minerals. At times, therapeutic trials of replacement nutrients play a role in the diagnosis of deficiencies. In general, however, nutrient stores must be depleted before low blood levels of any nutrients are found. Changes in the body chemistry and functional neurologic defects occur late in the course of a deficiency. Take a careful history for invaluable help in the initial phase of treatment. Then combine this with a high index of suspicion for various nutrient-related disorders. In spite of modern technology and transportation, there are still large areas in our world where famine is epidemic. In fact, the risk of mass starvation in many countries is all too real, and often associated with other diseases. Body changes during the starvation reflect physiologic attempts to adapt to undernutrition. Fat stores are utilized first in order to spare structural protein. Thus, body fat diminishes more rapidly than does muscle. Extensive losses occur later in other organs, especially the liver and intestines. Fortunately, the central nervous system and circulation maintain themselves, whatever the cost to less essential parts of the organism. The person during starvation also conserves calories by reducing his output of energy. Voluntary physical activity decreases, as does the metabolic rate. A semi-starved patient complains of feeling tired, irritable, and depressed. He may also show lack of ambition, and narrowing of interests, then develops muscle soreness and cramps. The hair begins to fall out, andcuts and wounds heal slowly. Cold temperatures are poorly tolerated.
Ultimately, the individual looks haggard, pale, and emaciated. At times swelling (edema), particularly of the eyelids and cheeks appear, masking the degree of weight loss. The pulse weakens and the eyes become dull, looking like unglazed porcelain. Without relief and too often alone, the hapless victim of starvation then dies on the street of some large city.
The rehabilitation diet for patients recovering from starvation must begin with small quantities of the simplest food, taken at frequent intervals. A natural diet is preferable to the use of “predigested” end products. Vitamin and protein supplementation are ordinarily unnecessary. General dietary allowances should be approximately 100% of those recommended on the basis of the patient’s “desirable” weight. Recovery from starvation, however, advances at a very slow pace. Weakness, fatigability and muscle aches, as well as depression, may persist for weeks to months. Recovery of strength and working capacity is slow. Eventually, recovery is sure, and a life has been saved.
Protein Calorie Malnutrition is another type of disorder seen in early childhood. One such syndrome, called kwashiorkor, appears most commonly between the ages of one and three years. This tragic disorder occurs frequently in Africa in children displaced from their mother’s breast by subsequent pregnancies. Conditioning factors, such as diarrhea, parasites, and skin rash may be seen. Edema is the principal sign. It is associated with low serum proteins. The child’s face may appear round and moon-like. The hair changes with lightening of color, straightening of curly hair, and stripes of lightened color that attest to oscillating levels of good and poor nutrition in the past.
The other major type of malnutrition is called nutritional marasmus. This compares with severe semi-starvation in adults. It most commonly affects infants during the first year of life. The most conspicuous features in marasmus are wasting of muscle and fat, with growth retardation. Affected infants appear prematurely old, and often suffer from vitamin deficiency. Both types of malnutrition respond to a careful feeding regimen of simple foods, given first at frequent intervals, containing both adequate protein and calories.

OBESITY 2

The dietary treatment of obesity constitutes our mainstay for successful therapy. It is crucial to maintain good nutritional balance with any diet chosen, especially limiting the calories sufficiently to lose weight. Crash diets should be discouraged, as a weight loss of 2-3 pounds weekly is quite
sufficient for most obese patients to regain their healthful profile without looking like a “dried prune.” I always emphasize the use of natural foods, such as fresh fruits, whole grain cereals, and vegetables. Modest limitations of salt intake helps prevent fluid retention. Avoid as much as possible all rich foods, such as gravies, sauces, salad dressings, and desserts containing much
sugar. Be sure to reduce fried foods, as fat contains 9 calories per gram compared with 4cal./gm, for most carbohydrates and proteins.
For individuals finding it difficult to maintain a low calorie diet continuously, a fast one day a week using limited amounts of clear liquids is encouraging. Some find it more satisfactory to restrict their food intake to two meals a day, usually with a hearty breakfast and lunch and little or no supper. I teach my patients that being hungry one-third of the time is better than being hungry all of the time. Thus, these people can accept a two-meala- day plan and profit thereby. It is not necessary, however, in most sensible reducing diets to be hungry in a physiologic sense at all. The use of natural foods in abundance will satisfy the appetite, particularly if a few olives or nuts are included for “satiety value.” Snacking should be eliminated. Some commonly used snacks may require a great amount of exercise to burn up the calories taken in this way. Exercise has also been endorsed as a method to increase caloric loss.
Although the stimulus to the circulation, as well as the balancing effect on the emotions are profound, a very minimal caloric effect is obtained with exercise, compared to the reduction in food intake. The metabolic rate, however, increases with exercise, sometimes lasting for hours. Obese subjects are prone to more sedentary patterns of behavior and often walk and work more slowly than their leaner counterparts. Motivational factors, goals, and an overall emphasis on physical fitness is important to achieve the very real benefits that exercise can make toward a weight reduction regimen. The use of appetite suppressants, amphetamines, hormones from the
thyroid gland and diuretics, are mentioned only to discourage their use. Their indulgence always upsets the balance of body chemistry and places a false emphasis upon “miracle drugs” rather than diet in treating the obese. More radical surgical procedures include the jejuno-ileal bypass (creating an unnatural shunt between two parts of the small intestines) and gastric stapling (where the stomach size is drastically reduced with a row of staples). Such measures should not even be considered unless a grave medical emergency exists. In such cases there are usually safer approaches, such as fasting or dental wiring. All of these do not reach the underlying cause,
namely dietary reeducation, emotional stabilization, and the promotion of overall physical fitness that are so essential to long-term success in weight control.
This more rational handling of obesity can be a challenging and rewarding discipline to both patients and health counselors. A person’s victory over appetite often proves the key to unlock many dimensions of fulfillment in emotional, as well as spiritual lines.

OBESITY 1

The single most prevalent metabolic disorder in countries where food supplies are abundant is obesity. A person is considered over weight if his weight exceeds the upper range of ideal weight for his body frame. He is considered obese if his weight exceeds by 15-20% his ideal weight. Obesity occurs when the caloric intake exceeds the energy requirement of the body for physical activity and growth, with resultant accumulation of fat. This excessive adipose tissue may be distributed generally over the body or may be localized. Hormones from the pituitary, thyroid, adrenal, and sex glands all play important roles in fat distribution.
For the most part, obesity is preventable. Unfortunately, however, the follow-through of treatment for prolonged periods is usually difficult. Relapse becomes extremely common.
The amount of body fat can be estimated from the measurement of skin fold thickness with calipers. Most commonly employed, however, are bathroom scales, and the commonly available tables for estimation of desirable weight with relative guidelines for determining obesity. Some
physiologists claim that certain persons are more efficient than others in their ability to digest, absorb, and utilize food. Although this theory is not completely substantiated it has been observed many times that some obese patients lose weight much easier than others, on a given caloric intake.
Direct study of fat cell size by biopsy and the subsequent measurement of the isolated calls permits calculation of the total number of fat cells in the body. The average non-obese adult has approximately 40 trillion fat cells. Individuals who develop obesity in the middle years of life develop larger fat cells. Those who develop obesity during their growing years increase fat cell numbers, as well as size. This potential of forming new fat cells, with excessive food intake during growth, enhances our emphasis on prevention in childhood. Most studies demonstrate weight loss in both types of obesity to be associated with reduction in cell size, but seldom are there actual loss of fat cells.
Psychological and cultural factors influence our tendency toward obesity. Certain persons may have abnormal appetites, using food as a substitute for satisfaction that ordinarily would be supplied in other ways. In this respect, these persons resemble somewhat the alcoholic, hence are often termed ‘foodaholics.”
Increased food intake may also result from depression or anxiety. The resulting obesity may increase a persons tendency toward isolation. Merely reducing food intake without understanding the underlying emotional problems is usually unsuccessful. Some cultural groups place great emphasis on food, developing habits of overeating at an early age. In fact, in some societies obesity is associated with success and even health. Education of individuals, families, and all ethnic groups in society is important to achieve proper understanding of fantastic health benefits obtained in weight reduction, also enabling the provision of emotional support during the transition.

WATER RETENTION

Adults who suddenly increase their body weight may have an increase in fatty (adipose) tissue, accumulation of fluid (edema) or both disorders. Weight gain in excess of two pounds per day usually implies excess fluid retention. It is easy to confirm this by comparing the body weight in the morning and then again in the evening. Weight gains of less than two pounds during one day usually will subside by the following morning. Fluid retention may disclose increased salt and water intake or decreased sodium and water secretion.
Checking weight changes from morning to evening often provides early evidence of disease. Dietary indiscretion, the use of diuretics, excessive intake of licorice root, or a cortisol-type drug preparation may also be responsible. A special type of fluid retention called cyclic edema occurs predominantly in women. This is characterized by periodic episodes of fluid retention, frequently accompanied by distention of the abdomen, Patients may weigh several pounds more in the evening than in the morning. Although there is some relation to the menstrual cycle, evidence suggests also that psychological and hormonal factors may be related. The treatment of cyclic edema includes restriction in salt intake, rest in the feet elevated (supine) position for several hours during the day, and the use of elastic stockings.

Careful medical work-up is sometimes indicated to evaluate underlying causes.

HYPOGLYCEMIA

Low blood sugar, usually called hypoglycemia, has many causes. The most common one relates to our fast-paced lifestyle. Excessive sugar intake, frequent snacking, and caffeine or cola beverages contribute to this frequent malady. When the blood glucose level falls rapidly, emergency “fight-orflight” stress responses take over. The individual feels weak, very hungry, and frequently becomes irrational. Emotional reactions to hypoglycemic episodes vary from agitated to angry, depressed to suicidal. Personalities change rapidly, but return to normal function with some form of food.
Rather than frequent feedings such as the “six meal a day” diet, I recommend the following regimen: First, begin the day with a wholesome, hearty breakfast. Some whole grain cereal, bread, nut butter, or fruit makes a great way to start the day. Avoid coffee and frequent snacks. They both aggravate any tendency to low blood sugar. Mealtimes should be at regular intervals, usually five or six hours apart. Stress factors can affect hypoglycemia. Exercise is a great way to reduce or relieve stress. Try for an hour or two of extra sleep at night. Or find a weekend for a refreshing minivacation.
Careful testing of your blood, including the five-hour Glucose Tolerance Test (GTT), may help your medical advisor to “fine-tune” your dietary and lifestyle regimen. Most individuals can overcome this metabolic imbalance, particularly the so-called reactive hypoglycemia. This type comes several hours after a meal or sugar-rich snack. It responds very well to the remedies mentioned above. Rarely, tumors of the pancreas may produce abnormal secretions of insulin. In such case the symptoms of hypoglycemia occur during a fast, often early in the morning. Removal of the tumor is necessary to cure this uncommon condition. Finally, diabetes mellitus may be associated with hypoglycemia. It occurs in the context of early diabetes, erroneously termed borderline. Overdoses of insulin will produce hypoglycemia. They occur during vigorous exercise or at night. Adjusting the insulin dosage along with dietary modification will level the blood glucose fluctuations in all but the most “brittle” diabetics.

DIABETES MELLITUS 2

This is associated first of all by the achieving and maintaining of an ideal body weight. Our third goal is the prevention or delay of the specific complications associated with diseases of the eye, kidney, and nerves. Finally, we try to stem the accelerating atherosclerosis to which the diabetic is particularly liable. Success in these therapies depends on how well the patient has been instructed and his conscientiousness in following directions. The avoidance of cigarette smoking, with regular daily exercise, the monitoring of the urine and blood sugar, cholesterol and triglycerides, blood pressure and body weight are all imperative. Basically, however, the treatment of diabetes revolves around an appropriate diet.
The dietary treatment must meet the basic nutritional requirements. These are usually the same as those of a nondiabetic patient and, of course, to be acceptable, taste, variety, economy, and other nutritional factors should be considered. The prevention of high blood sugar occurring after a meal is important to avoid aggravating the symptoms. On the other hand, if a person is taking insulin it is important to provide enough calories of the right type to prevent hypoglycemic reactions. Ideal body weight should be achieved as soon as possible. In order to delay the atherosclerotic complications, the diet should be low enough in fat and animal products to normalize the serum cholesterol and triglyceride levels.
The basic caloric requirement is dictated by age, ideal weight, physical activity, climate, and the patient’ s occupation. An approximate calculation can be obtained by multiplying the ideal weight in pounds by ten. Individuals who are less active or past middle age should reduce their calories somewhat. Meals should be regular, usually spaced 5-6 hours apart. They are ideally limited to two or three meals a day, the latter especially for those taking insulin. I recommend taking the greater number of calories at breakfast, in order to provide energy during the active part of the day. Suppers should be light, eaten several hours before going to bed.
Careful regulation of the insulin level can usually avoid the necessity of a bedtime snack. The fat content of the diet should definitely be reduced from the 40% eaten by the average American. Protein should also be reduced slightly. The remaining calories should be obtained from complex
carbohydrates. This can lower the insulin requirement dramatically, and in many maturity onset diabetics, make a need for the needle entirely unnecessary. Some dietary suggestions for diabetics, as used in my institution, are presented in the accompanying tables. Insulin therapy is usually necessary for diabetes of juvenile onset. Several types are available, having fast, intermediate, and long duration of action.
Most of the insulin used in the United States today contains 100 units per milliliter. This has helped considerably to standardize the syringes and simplify the self-administration of this hormone. Regular or crystalline insulin is the shortest acting and is usually used for emergencies. Its duration of action is 6 to 8 hours. Intermediate acting insulins, such as NPH or Lente have a peak effect in 8-12 hours and usually last for 24. The longer-acting insulins are seldom used. At times, a second small dose of intermediate insulin before bedtime is preferable to increasing the daily dose.
It is preferable to have a small amount of sugar spill in the urine during the day than achieve such rigid glucose control as to render the patient hungry all the time or prone to hypoglycemic reactions. Be sure to rotate the sites of injections and use sterile techniques in the administration of all insulin hormones. Although many diabetic patients develop antibodies to the insulin used, only a few, about 0.1% will develop insulin resistance. A regular exercise program helps, in combination with the low fat diet, to lower daily insulin requirement. Using the more convenient but less physiologic oral diabetic pills should be discouraged, because of numerous side effects, particularly an increased acceleration of vascular complications. Hope is definitely on the way for patients with diabetes, who will eat properly, exercise regularly, and keep their weight under control.

DIABETES MELLITUS 1

We now turn to the common problems of metabolism that can often be treated, controlled, or prevented in a home setting. Knowledge of sugar diabetes is important, because of its high prevalence. This disease has been recognized from antiquity. Both Greek and Chinese writings have mentioned it; and in the sixteenth century Paracelsus initiated the study of the chemistry of diabetic urine. The word mellitus, introduced by Thomas Willis one hundred years later, describes the sweetness of the diabetic urine, “as if imbued with honey.” This rapidly led to a dietary approach to this disease, until finally Langerhans, a medical student, in 1869 described the islets in the pancreas where the basic production of insulin occurs. Two Canadians, Banting and Best, finally prepared the extract from dog pancreas that was capable of reducing the elevated blood glucose level. A fascinating long history of discoveries marks the approaches to understanding and treating this common disorder.
It is estimated that there are about 200 million diabetics in the world and approximately 4.2 million in the United States. This disease is more frequent in older people. Hence, as the population grows and becomes older, diabetes will continue to increase. With treatment, the life expectancy of the diabetic is increasing, and since inheritance is an important factor, the more diabetics that have children, the greater will be the prevalence of this disease, Obesity is also on the rise and appears to precipitate diabetes among those predisposed to it.
Next to obesity and thyroid disorders, diabetes is the third most common problem in metabolism. Interrelated are the metabolic or hormone, and vascular or long-termed components of this disease. The latter consist of an accelerated arteriosclerosis that leads to premature aging and particularly affects the eyes and the kidneys. Gangrene of the foot, arteriosclerotic heart disease, blindness, and kidney failure (uremia) are the most frequent manifestations of the vascular syndrome. Statistically, the diabetic is faced, not only with a decreased life expectancy, but also with the eventual possibility of disabling complications.
The early detection of diabetes first involves a high index of suspicion. This disease is two and half times more frequent in relatives of known diabetics. Furthermore, 85% of diabetic patients were or are overweight. Four out of five diabetics are over 45 years of age. Mothers who deliver large babies have a high potential for the development of diabetes.The simplest screening test for this disorder is a urinalysis for sugar.
Measurement of the blood sugar (glucose) level in the fasting patient should also be encouraged as a screening tool. The five-hour Glucose Tolerance Test is less commonly performed for diabetes, but is usually used to diagnose and evaluate hypoglycemia. Pathologic changes occur with the passage of time in diabetes, and seem accelerated by failure to control this disease. The
islets of Langerhans in the pancreas typically deteriorate, resulting in the lack of insulin production. Atherosclerosis occurs earlier in a diabetic patient, often leading to coronary artery disease and stroke as the most frequent cause of death. These also occur from the lack of insulin production. The eyes show changes after 10 to 1 5 years of diabetes. Small retinal hemorrhages, dilated sacs in the weakened blood vessel (aneurysms), and waxy patches (exudates) develop.
Later a dangerous type of new blood vessel forms, then further hemorrhages and gradual or sudden loss of vision. Although marvelous advances in the diagnosis and treatment of these visual complications have been made, diabetic eye disease remains the second most frequent cause of blindness in the United States. Increased tendencies toward cataract formation also occur. In the kidney, characteristic damage to the filtering unit (glomerulus) progresses to destroy renal function. Infections of the kidney and urinary tract are common, and many patients go on to develop high blood pressure, serious loss of protein, and later kidney failure.
The symptoms of diabetes, as mentioned above, are multiple. Increased fatigability and weakness is common. The diagnosis is frequently suggested by history of increased thirst (polydipsia), increased urination (polyuria), and excessive hunger (polyphagia) in association with weight loss. Long standing disease is reflected in the pathologic changes mentioned above.
Two typical types of diabetes mellitus are seen. The juvenile onset type is characterized by a rapid onset, with instable diabetes, associated with loss of weight and strength, irritability, and the three “polys” mentioned above.
Insulin therapy is mandatory in this type of patient and long-term medical counseling is needed. The second type of diabetes is termed maturity onset. Frequently symptoms are minimal or absent at first. Weight loss or weight gain may be present. These may be increased tendency to urinary infections or Vaginitis. Blurred or decreased vision, anemia, loss of sensation, or other neurologic problems may send the patient to the physician. Since many patients are obese, the reduction of weight associated with a careful diet can bring a return of health to most people who will cooperate with simple health principles.
The treatment of diabetes involves several basic principles. Doctors aim to correct the underlying metabolic abnormalities and thereby reduce diabetic symptoms.

SYMPTOMS RELATED TO THE ENDOCRINE SYSTEM

We now present a few common symptoms and the possible relationships to specific endocrine diseases. Clinical experience is certainly important in interpreting these relationships. Nevertheless, the suspicion that there is something wrong is often the first step toward an accurate diagnosis.
Weakness and increased fatigability are without doubt the most frequent symptom of adults seeking medical diagnosis. In the majority, these complaints derive primarily from emotional or psychological disturbances. When hormone abnormalities are suspected, one should inquire first whether the symptoms have been accompanied by weight loss. If so, insufficiency of the adrenal gland, overactivity of the thyroid, and diabetes mellitus should be considered.
Adrenal insufficiency is usually accompanied by increased pigmentation, low blood pressure, and perhaps salt craving. Hyperthyroidism is suggested by goiter (enlargement of the thyroid gland), bulging eye changes, tremor, and heat intolerance. Sugar diabetes is usually accompanied by excessive urination and increased thirst. Without weight loss, but with symptoms of weakness and fatigability one could consider underactive thyroid, underactive pituitary gland, overactive parathyroid gland with high calcium levels, and hypersecretions of aldosterone, another hormone from the adrenal gland regulating the salt balance. The first of these are associated with hypoactive reflexes, intolerance to cold, dry skin. Hypopituitarism is suggested by delayed or absent menstrual cycle, impotence, decreased tolerance to cold, hypoglycemia, and low blood pressure. Hyperparathyroidism is usually associated with bone pain, kidney stones, and increased urination. Elevated aldosterone levels are accompanied by high blood pressure, muscle weakness, and signs of potassium depletion.
Menstrual irregularities are associated with four major hormone disturbances. Primary failure of the ovaries prior to a natural menopause is characterized by hot flushes, weight gain, emotional instability. Secondary ovarian failure, associated with reduced stimulating hormones from the
pituitary gland is often related to diseases in the thyroid or adrenal.
Underactive thyroid gland is often associated with excessive menstruation, as well as decreased flow. The final, but much more rare syndrome is seen in conjunction with adrenal gland dysfunction. The menstrual irregularities in this case are usually associated with increased muscle development, increased body hair (hirsutism) and other signs of masculinization. The use of birth control pills should always be investigated as a cause of menstrual irregularity.
Breast changes are also commonly associated with hormone disorders. Enlargement of the breast in males (gynecomastia) occurs normally at puberty and may persist through adolescence. Rarely, hormone-secreting tumors of the adrenal gland or testes may also produce these problems.
Several varieties of drugs may cause breast changes as well. Abnormal lactation (galactorrhea) is sometimes observed in-patients with tumors of the pituitary gland. A number of drugs, including some antihypertensive and tranquilizing preparations may also produce this problem. Hypertension may also be associated with hormone disorders, although it is more commonly related to stress, salt intake, and obesity. Cushing’s syndrome or adrenal gland excess can definitely cause high blood pressure and should be considered if unusual obesity, associated with a tendency to bruising, is present. An episodic hypertension is caused by secretion from the adrenal medullary tumor called pheochromocytoma. The picture of rapid heart rate, nervousness, sweating, although classic, is infrequent. Increased secretion of the parathyroid hormone or the adrenal hormone aldosterone can also cause hypertension, and should be excluded in complete diagnosis of the problem.
Obesity suggests the possibility of a hormone disturbance, but it is usually caused by habitually increased food intake or deep-seated emotional problems. Diabetes should definitely be investigated and excluded in the presence of obesity, particularly in adults. Thyroid disorders are commonly related and can be evaluated with simple blood measurements. One must also
consider the possibility of problems induced by hormone administration, as we see the frequent prescribing of cortisone preparations, thyroid or sex hormone in nonspecific therapies for varying symptoms. These so-called iatrogenic (physician caused) problems can often be improved by the discontinuance of the offending drug.

URINARY RETENTION

Inability to void may develop abruptly, but is usually preceded by a history of diminished size and force of the urinary system, hesitancy, nocturnal urination, and dribbling. Many of these individuals are older men, having developed gradual prostate enlargement, but scarring and stricture from infection in the urinary tract can also produce these symptoms.
One of the most important ways of relieving these conditions, short of actual surgical cure, is the use of the urinary catheter. Unless the obstruction is severe this soft, flexible tube with a rounded end can be passed successfully into the bladder in most people. The catheter should be sterilized, the opening of the urethra (meatus) cleansed carefully with antiseptic solution, and with appropriate lubrication the catheter passed gently into the bladder. Usually relief is obtained and this technique is easily learned at home thus allowing either for the necessary time to seek medical care or a chronic relief in older patients deemed unsuitable for surgery.
The Foley catheter, which contains an inflatable balloon, can be used for indwelling drainage of the bladder. This, connected to a closed, sterile system of collection can provide comfort for a longer time. However, infection mayresult from the presence of this foreign substance after only two to three days.
In association with gentle catheter placement techniques, bladder irrigation may be learned. Different patients require varying intervals between catheter change and this can often be prolonged by the use of irrigating solutions. Some of these inhibit bacterial formation and others improve patency of the catheter by reducing bladder sludge. All instrumentation of the bladder may produce hematuria or the presence of blood. Persistence of this and other urinary symptoms should cause a patient to seek counsel from a competent physician.
Although the urinary tract is complex and mysterious it is usually amenable to simple home remedies. The early use of these preventive measures can frequently restore health before chronic illness or disability becomes a problem.

TRAUMA TO THE KIDNEY

Injury to the urinary tract may at times produce blood in the urine. This is
particularly a problem in contact sports, since the kidneys are easily traumatized.
Long distance runners also frequently show signs of kidney damage
with elevated enzymes and blood in the urine. This may be related not only to
the metabolic breakdown of muscle during severe exercise, but also to the
dehydration that results from profound sweating. In most cases of urinary
trauma where the urethra, bladder, or ureters have not been ruptured bed rest
combined with hot packs and adequate fluid intake will produce a rapid cure.

KIDNEY FAILURE

Failure of the kidneys to form urine properly can be either of an acute or chronic nature. The acute types are called nephritis, referring to the inflammation of the functional kidney complex. This may occur in conjunction with a Strep. throat or other bacterial infection. At times it develops suddenly, associated with protein loss, edema, and high blood pressure. These cases need to be evaluated with laboratory tests and medical expertise. But several simple approaches are helpful.
First of all it is important to recognize the influence of diet on kidney function. Many years ago it was discovered that a high protein diet predisposes to kidney complications. For this reason it is wise to avoid an excess of animal products, particularly flesh foods. Adequate fluid intake is
also important. In treating these symptoms hot packs as well as hydration will be beneficial.
Chronic failure of the kidneys frequently produces metabolic disturbances in water, sodium, potassium, calcium, and acid-base balance. The onset of renal failure is usually insidious. Excessive formation of urine and passage of urine at night may be only signs at first. Later a patient complains of feeling weak, fatiguing easily, sleeping poorly, and becoming slightly breathless. The appetite is lost and there is a bad taste in the mouth. Nausea, especially in the morning or anemia may be present. With increasing kidney failure, a person becomes lethargic, may develop twitching of the limbs, hemorrhages, and eventually develops a breath with an odor of urine, dry skin, and if not treated may progress into a coma and die. Therapy of kidney failure demands an early determination of the cause.
The role of dietary protein is very important. To reduce the blood urea accumulation a good quality protein is used with restriction in quantity to around 20 gm. daily. Sweating treatments may help eliminate toxins through the pores. The most efficacious are usually the hot blanket pack or steam bath. However, the latter is not advised (contraindicated) in severe hypertension.
Scientific research has offered a number of artificial approaches to kidney disease, such as dialysis of the blood (hemodialysis) or abdominal (peritoneal) fluid, and even transplants from a healthy donor. All of these have hazards, however, and if approached early and controlled, many cases of chronic kidney failure can be arrested.

Involuntary loss of urine is a very troublesome symptom

This may occur in children and when associated with bed-wetting is usually termed enuresis. Up to 4-5 years of age this may be quite common, and when persistent usually indicates some psychological distress. Congenital defects in the formation of the urinary organs may contribute to this disorder, and they can be evaluated with a specific x-ray study, the intravenous pyelogram.
Most cases of childhood incontinence subside with the passage of years. Women of childbearing age may have incontinence after the delivery of a large baby. Or with successive pregnancies, the support of the bladder and urethra may be weakened, producing a hernia or prolapse called a cystocele. Often this is associated with stress incontinence on sneezing, coughing, or straining. The Kegel exercises described in the chapter on gynecology are often helpful in alleviating these symptoms. If persistent anatomic defect is demonstrated, surgical repair may be indicated to restore continence and alleviate the anxiety that inhibits social interaction.
Men seldom have incontinence until advanced age. This may occur at times after operations such as a prostatectomy. If the incontinence does not improve during convalescence it should be evaluated by a urologist since research centers have developed a number of surgical approaches to this troublesome problem. Mechanical devices to preserve social acceptance and self-confidence are also available.

URINARY INFECTION

Bacterial infections of the urinary tract are extremely common. Some are also notoriously resistant to treatment and thus likely to reoccur. Yet the majority of persons with urinary tract infections are unaware of it. On other occasions, infections take the form of an acute disease usually with characteristic symptoms. The commonest symptoms are pain on urination, urinary frequency, and a strong urge to void. More serious infections may produce fever, pain in the bladder region, or over the kidneys.
Many different causes can produce infection. The commonest of these come from the group of gram negative bacteria (such as E. coli) inhabiting the digestive tract. Cultures of the urine can usually pinpoint the exact offender. Most of the time these coliform bacteria gain access to the bladder through the urethra. Under normal circumstances the urine in the bladder is sterile and large numbers of bacteria can be cleared rapidly in both humans and animals. Slight physiologic alterations, however, may permit survival of as few as ten microorganisms, which multiply rapidly, then persist for prolonged periods. Some associated conditions that may contribute to the formation of urinary infections are as follows: One to four percent of females from childhood to the childbearing age may harbor bacteria in the bladder or urethra, sometimes without the presence of symptoms. In men urinary infections are quite rare below the age 50. Four to eight percent of pregnant women may have infections, some of them without symptoms. Diabetes is another contributing factor, particularly when sugar is present in the urine.
Any impediment to the free flow of urine—tumor, stricture, or stones— results in distention of the kidney and greatly increased frequency of urinary infection.
In fact, the reflux of urine in the bladder cavity up to the ureter occurring during voiding will contribute to more infections, particularly children. Infection of the lower urinary passages is sometimes initiated by bacteria carried on catheters or other instruments passed into the urethra and bladder. Sterile technique in catheter insertion can help to reduce this risk. Kidney diseases with resulting high blood pressure may also contribute at times to the lowered defense against infection. Once the diagnosis has been established, treatment can be begun at home.
The fluid intake should be increased, usually with water as well as Vitamin C or cranberry juice to render the urine more acid. A special protein found in cranberries and blueberries can combat most urinary tract infection by causing the causative germs to lose their grip on the bladder wall. Thus, the infective organisms become more amenable to bladder rinse-out with normal urination.
One glass of liquid per hour up to 12-16 cups per day is recommended. In at least half such cases, the urinary infection will clear itself, with symptoms subsiding over 24-48 hours. Increasing blood flow to the urinary organs, these hydrotherapy treatments aid the body in natural resistance to infection and the clearing of disease. Persistence of symptoms or the underlying presence of diabetes, high blood pressure, or chronic kidney disease should be evaluated with appropriate urine tests, cultures, and medical counsel.

URINARY STONES

Stones in the kidney or ureters may occur at any age, but are more common in the third and fourth decades. These calculi may be single or multiple, firmly lodged or free. Kidney stones often cause pain, produce blood in the urine, and symptoms of vague abdominal distress. Occasionally, even when large, stones may occur without symptoms, while causing serious and
insidious kidney damage.
Characteristically, as mentioned above, renal calculi cause severe, sharp flank pain, which is often acute in onset and present intermittently. A small stone being passed in the ureter creates painful colic and the patient usually moves about restlessly, vainly seeking relief. Blood is frequently present in the urine, but at times requires the microscope for its detection. Physical findings may be entirely normal, although tenderness, muscle spasm, or even a lump may be felt in the location.
It is important to search for the original cause of the stone, then attempt to correct it. Most stones after bladder passage can be analyzed to determine their composition. Some are composed of calcium salts; others of oxalate crystals, and less commonly uric acid or cystine may precipitate to form stones. Each of these causes needs to be ascertained in order to correct the
diet, avoiding future recurrence.
One of the commonest situations that sets the environment for an attack of colic is inadequate fluid intake. Normally our kidneys require at least one and a half to two quarts of fluid a day! That will maintain urine volume at diluted concentrations, to avoid the precipitation of these salts. A high consumption of milk may result in calcium precipitation and the formation of a stone. Ice cream, cheese, and soft drinks such as cola beverages, and foods high in oxalic acid may provide the situation where stones begin to crystallize.
Uric acid stones usually result from a high intake of purines, found in meats, particularly sweetbreads, and other flesh foods obtained from animal organs. Uric acid calculi are usually seen in combination with other symptoms of gout, a metabolic disease traditionally associated with indulgence in rich foods and alcohol. A discriminating, well-balanced diet associated with adequate fluid will usually bring relief to patients who form uric acid stones frequently.
The treatment of colic in the urinary tract usually begins at home. Drink a high intake of water, at least one glass of liquid hourly, and begin immediately. Urinary acidifying agents are helpful to deter stones of calcium or oxalate composition, while for uric acid stones the urine should be alkalinized. Vitamin C and cranberry juice are both good acidifying agents for the urine, and are also helpful in treating urinary infections. Diuretic herbs, such as Buchu tea may also be helpful, when combined with a high volume of fluids.
Relief of acute urinary pain can be obtained in a hot tub bath, or with intensely hot fomentations applied to the flank and hip region. At times when flank pain is severe, the treatments will not only modify the pain, but through reflex pathways may help to relax the ureter and alleviate the spasm. Most often the smaller stones (calculi) will pass down into the bladder, where they are then excreted. Since obstruction in the urinary tract can progressively damage the kidney, as well as be painfully disabling, any urinary stones that do not resolve promptly should be evaluated be a competent physician.
Newer diagnostic techniques using x-ray contrast, and cystoscopic basket stone retrieval, water immersion shock (sound) wave lithotripsy, and other types of surgery may be necessary to save the kidneys from permanent harm.

The PREVENTION of MALIGNANCY

Based upon the evidence currently available, it is my conviction that a rational plan can be designed to prevent most types of cancer. Summed up in one word, moderation, the preventive approach involves several factors:
Your diet should be simple, utilizing natural foods as much as possible. Adequate amounts of fruit, fresh vegetables, and whole grain cereals should be included together with some nuts and natural sources of dietary fats, such as olives, avocados, and a most sparing use of vegetable oil. Any excess of oil, sugar, salt, or any single food, especially refined ones, in the diet should be shunned.
The low-fat vegetarian diet has been associated clearly with an increased resistance to many types of cancer. When individuals abstain from milk and eggs, as well as meat, the cancer risk becomes even lower. Naturally these total vegetarians must have a considerable knowledge of nutrition in order to maintain balanced nutrition, and provide optimum vitamin and mineral intake to maintain excellent health. Thousands of discriminating consumers, however, are rapidly adopting a vegetarian lifestyle as fast as they are able to learn how to select and prepare the foods. In this change is found the key to preventing not only many cancers, but also atherosclerosis and numerous other diseases.
Reasonable amounts of exercise should be obtained daily for a lifestyle that is low in occupational stress, while satisfying and productive. A moderate exposure to sunlight prevents detrimental premalignant skin changes that many acquire as their skin ages. The use of a broad-brimmed hat, sunscreen lotions, and avoidance of excessive sun bathing can bring about vibrant health, without wearing out or prematurely aging the dwelling of skin we live in.
Temperance advocates for many years have proclaimed the key to prevent one most common cancer. Those who abstain completely from tobacco smoke, and even avoid settings where the involuntary inhalation of stale secondhand smoke is required, will reduce their risk of lung cancer dramatically. Even ex-smokers who quit before a cancer develops, have a much lower rate than the devotee who continues to use cigarettes. Although pipes and cigars may produce less lung cancer, they’re stronger forms of tobacco still show malignant potential in cancer of the lip, tongue, throat, and larynx far too often.
Chronic use of alcohol increases the risk of cancer in the breast and liver, as well as seriously irritating the stomach and several other organs. Exposure to drugs of all kinds, including sex hormones, antibiotics, anticancer agents, and coal tar preparations can increase the incidence of malignancies in many organs. True temperance requires us to dispense entirely with all things hurtful, and use in moderation those things healthful. This principle of moderation can help to prevent many cancers.
Routine physical examinations and periodic self-examination of the breasts and skin, with careful observation for the symptoms of cancer described above can detect abnormal lesions in the earliest possible stage, when surgical removal is a possibility. A regular annual physical should usually include the annual Pap smear, a biennial sigmoidoscopic examination, together with the appropriate laboratory testing for additional aid in early diagnosis. On the other hand, it may just give satisfying reassurance concerning one’s state of health.

SKIN CANCER

Although more skin cancers are seen than malignancies involving any other organ, this is least commonly a cause of cancer death. Inasmuch as the lesion can be seen with the naked eye in an early stage, the potential for cure is well over 90%. It is thought that the single most important factor in the cause of skin cancer is chronic exposure to ultraviolet light of the sunburn wavelength (UV-B). Individuals who are intensely pigmented are quite well protected from these rays. Fair-complexioned individuals and albinos should especially use sunscreen preparations. All should avoid unnecessary exposure to x-rays, coal tar products, and arsenic preparations known to be carcinogens.
Seventy-five percent of all skin cancers are of the basal cell carcinoma type. These rarely metastasize, but are locally invasive. The cancer typically begins as a noninflamed, smooth, waxy nodule. Usually a number of small blood vessels are visible near the surface. These nodules often ulcerate and form a crust. Biopsy and excision will confirm the diagnosis; as well as treat the lesion. Simple excision gives the best cosmetic results. Liquid nitrogen may be used for local freezing, called cryosurgery. In combination with curettage or electrocautery, a cure rate of more than 95% may be expected.
Squamous cell carcinoma is the second most common type, developing also from the surface layer of the skin, but having more propensity to metastasize. Most of these lesions are painless. They show up with firm, red plaques, displaying visible scales on the surface. They may arise from preexisting solar keratoses, premalignant lesions developing from repeated sunburn. Treatment is similar to that of basal cell lesions described above, namely removal.
Malignant melanoma is the most deadly type of skin cancer. They also are related to excessive sunburn and exposure. Pigmented moles are among the most common growths on the skin of humans. Some of these ultimately may change in their color, size, or hair pattern, which is often an early sign of their malignancy. Irregularities in surface pattern and varying colors are characteristic of the melanoma. Shades of red, white, or blue (no patriotism here) and other mixtures of brown and black, may indicate the development of this cancer.
Melanomas should always be removed with wide excision, since their propensity to spread to other organs, such as the liver, eye, and other areas of the skin is great. Therapy utilizing the immune mechanism (immunotherapy) has been used widely in the treatment of metastatic melanoma. Although still experimental these approaches offer an exciting alternative with less cost in toxicity to the individual. BCG vaccine, used for years to prevent tuberculosis, has found its place in the treatment of these melanomas with encouraging results in many cases.