Healthy Live Tips

Sex Hormones Are Not Just for Baby-Making

2010-05-16T09:58:00.000-07:00

The preceding discussion notwithstanding, the ovary is more than just a storehouse for eggs. The bioidentical hormones that it produces ensure that our bodies will function properly throughout our lives, not just during our reproductive years.
I mentioned earlier that bioidentical hormones travel in the bloodstream to cells and tissues throughout the body, powerfully affecting our health. But once hormones reach their intended destinations, you may wonder, how do they actually exert their effects? Cells that depend on hormones to function properly have protein molecules called hormone receptors that act like tiny ignition starters. And the hormones, logically enough, act like tiny keys. When a hormone—say estrogen— encounters a cell that has a receptor for estrogen, it’s like when you put your key into your car’s ignition and turn it on to start the engine. When estrogen binds to and turns on the estrogen receptor, it stimulates the cell to produce a cascade of proteins that influence its behavior.
Estrogen receptors are found not only in the cells of reproductive organs, such as the uterus and breast, but also in the cells of the liver, digestive system, urinary tract, heart, blood vessels, bone, skin, and the brain.
The exact effect of estrogen depends on the type of cell that it encounters. For example, in the uterus and breast, estrogen’s main effect is to cause the cells that line the uterus and the milk ducts to grow and divide in preparation for pregnancy. In the liver, estrogen acts to control the production of cholesterol in ways that influence the buildup of harmful fatty deposits in the arteries. In the skeleton, estrogen preserves bone strength by helping to maintain the proper balance between bone buildup and bone breakdown. And in other parts of the body, estrogen appears to play a role in the regulation of body temperature, the ability to recall information from memory, and the elasticity of arteries and skin. This is only a partial list of estrogen’s effects.
When estrogen levels drop, the rate of bone loss accelerates rapidly. Indeed, the average woman loses 2 to 3 percent of bone mass a year for the first three years after menopause. As a result, osteoporosis is much more common in the decades after menopause. A woman’s risk of heart disease also increases sharply after menopause, but estrogen’s role in this process is still under study.
Two types of estrogen receptors—alpha and beta—have been identified. Scientists have known about the alpha receptor since the 1950s, but the beta receptor was identified only in 1996. In general, there are more alpha receptors in the reproductive organs (e.g., uterus and breast) and the liver, while beta receptors are more abundant in other tissues, such as bone and blood vessels. Estradiol appears to bind equally well to both types of receptors, while estrone binds preferentially to the alpha receptor and estriol to the beta receptor. We do not fully understand the role of the two types of estrogen receptors, their exact functions, or how they relate to the benefits and risks of our natural estrogen or the estrogen in traditional hormone therapies for menopause.
Nevertheless, recognition of differences in receptors has allowed pharmaceutical companies to manufacture a new class of medicines called selective estrogen receptor modulators (SERMs)—or, to use the more glamorous name, “designer hormones”—that act on one or the other of these receptors to selectively block or stimulate estrogen-like action in various tissues.
One of the first SERMs to be developed was tamoxifen. Known by its trade name Nolvadex and also available as a generic, tamoxifen is prescribed to treat breast cancer and prevent its recurrence in women with a history of the disease and to prevent its development in women at high risk. In the breast, tamoxifen acts as an antiestrogen by binding to the alpha receptor, thus preventing estrogen from accessing it. In other parts of the body, however, tamoxifen acts like estrogen. Another SERM, raloxifene, known by its trade name Evista, is approved for prevention of bone thinning in women after menopause and is being studied as a way to prevent breast cancer. In a recent “head-to-head” trial, raloxifene and tamoxifen provided similar protection against breast cancer but raloxifene had fewer risks. Both of theseSERMs increase hot flashes and the risk of blood clots, however. In the future, watch for additional developments with SERMs, which could eventually be designed to ease symptoms of menopause and protect bone and heart health without adding to the risk of breast cancer.
As with estrogen, receptors for progesterone also come in at least two forms. However, even less is known about their precise roles and functions, or how this information could be used to develop safer or more effective forms of hormone replacement therapy.
In addition to estrogen and progesterone, generally known as the female sex hormones, the ovaries, along with the adrenal glands, produce small amounts of male sex hormones known as androgens, including testosterone. Testosterone levels in women are only one-tenth as high as in men. Androgens are thought to work in concert with estrogen to maintain a woman’s sex drive, bone and muscle health, energy level, and psychological well-being. Indeed, androgen receptors are found in many of the same cells that have estrogen receptors.
Interestingly, a large proportion of the androgens produced by the ovary and adrenal gland are converted to estrogen by an enzyme called aromatase found in fat and muscle. (Other organs that contain aromatase include the brain, hair, skin, and bone marrow.) After menopause, this conversion actually represents the main source of estrogen in women. Because aromatase is found in fat cells, women who are overweight or obese tend to have higher levels of estrogen than thinner women.
At the same time, because muscle cells are also rich in aromatase, women with more muscle mass are more likely to have higher estrogen levels than their scrawnier counterparts. This is thought to be why heavier women, and women who keep their muscles active with physical activity, may be less likely to suffer from certain symptoms of menopause.
In recent years, medicines called aromatase inhibitors—anastrozole (Arimidex) and letrozole (Femara)—have been approved to treat women with early-stage breast cancer. These medicines work by blocking the aromatase enzyme, thus preventing the conversion of androgens to estrogen in fat, muscle, and other tissues. Together with tamoxifen, aromatase inhibitors form a powerful new arsenal to fight breast cancer. (Not all breast cancer cells have estrogen receptors, though. These medicines stifle the growth of breast cancer cells that have estrogen receptors but do not affect the growth of breast cancers that lack estrogen receptors.)

PROBLEMS IN EARLY PREGNANCY

2008-11-18T14:26:00.000-08:00

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.
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.

Anesthesia

2008-09-12T23:53:00.000-07:00

One of the oldest forms of medical treatment is described in Genesis 2:18, 21-23, where the Creator Himself “caused a deep sleep” to come upon Adam while He took out the rib, closed up the incision, and made a “help meet for him.” Relief of pain is intimately associated with the rendering of needful medical care. This is one of the physician’s cardinal responsibilities.
For certain patients, some forms of severe pain may be life threatening. However, in the case of most effective pain relieving medications, addiction can occur, with distortion of mental imagery to the point of serious impairment. Thus, it is wise to look for the simplest methods of relieving pain when attempting to perform surgery.
Probably the oldest form of pain relief is refrigeration anesthesia. Extremities can be rendered pain free with ice packs. This is particularly valuable in the case of vascular disease where cardiac and circulatory impairment makes general anesthesia risky. During the World War II, army medics discovered that troops suffering from frostbite might save their limbs if the extremity remained frozen until medical care could be secured. This observation influenced all currently accepted first aid for frostbite used in our country.
In order to properly administer refrigeration anesthesia, the extremity needs to be cooled to the point of numbness, while keeping the remainder of the body warm to avoid a general drop in emperature, chilling, or agitation. Ice packs or snow can be used to progressively cool an xtremity, either a hand or foot. If the surgery is to be localized to the arm or leg, place the pack
just above the site of amputation. This reduces blood loss and allows for a careful, meticulous dissection of the tissue. Broken bones can be set with refrigeration. In the case of a simple fracture of the hand or wrist, immerse the extremity in ice water for one-half hour or more. This will allow manipulation and bone setting to be done quite painlessly.
Refrigeration can also be used topically in the removal of warts, moles, and other skin lesions. Dry ice or liquid nitrogen can be applied with a cotton applicator to freeze a small area and render it numb to pin prick.
A second method of anesthesia is the application of gradual pressure on a nerve. The ulnar nerve at the elbow (funny bone) is quite amenable to pressure. Quite often in certain positions a foot or a hand has been known to “go to sleep” due to stretching or pressure on an affected nerve. nowledge of neuroanatomy can utilize this principle favorably for surgery to an extremity.
Counterirritation can also be applied with electric stimulation near the point of incision. This can utilize DC current, but it is more effective with a pulsed generator, such as rehabilitation centers employ in treatment of chronic pain. Desensitization can be obtained with liniments and ointments, mustard packs or plasters. Even animal surgery has been performed using
counterirritation, e.g., the “twitch” on the nose of horses. Finally, it is helpful to understand some of the common injectable anesthetics that are used locally for the relief of pain. These are used both in dental and surgical care. But they have some side effects and potential allergic reactions. Injectable narcotics should always be avoided, as they leave behind serious effects on the brain. They are not only difficult to metabolize, but because of their tendency to produce euphoria can become rapidly addicting. On rare occasions for major procedures, general anesthesia may be necessary. The gaseous agent used in these cases should be that which is most rapidly metabolized and least toxic to the system. Nitrous oxide and oxygen are commonly employed together to relieve mild pain. Although ether is quite flammable, it still remains the safest form of general anesthesia, due to its rapid clearing from the blood by the way of the lungs and relatively low toxicity to the liver and other organs. Open drop techniques in a well ventilated area can be used, but for safety reasons general anesthesia ideally should be performed in a hospital. Newer anesthetic agents (Halothane, Ethrane, etc.), although more likely to cause toxicity, are less dangerous to the heart and usually nonflammable. Regional blocks, local nerve blocks, and spinal anesthesia have their places in hospital settings but it is beyond the scope of this book to detail their applications.

Suturing

2008-09-11T22:46:00.000-07:00

Considerable practice is required to suture incisions and lacerations quickly and accurately. Yet these skills are not beyond the reach of the average layman gifted with manual dexterity or an interest in mastering the art. If possible, practice your suturing techniques on a piece of sponge rubber, upholstery, or even a pillow. Some surgeons become skilled in knot tying, practicing on door handles or in the automobile while traveling. The accompanying diagrams, located on pages 178 to 189, help demonstrate the principles of the three basic methods of surgical knot tying. The one described as an “instrument tie” utilizes a hemostat or needle holder, while the others require only skillful fingers for proper use. I would suggest that a novice begin with the two-handed tie and instrument tie, adding more complex forms as skill is gained.
Avoid tying the sutures so tightly that insufficient blood flow to the skin edges results. This would cause delayed and incomplete healing of the wound.
“Approximate, don’t strangulate” is the watch word for closure of lacerations with sutures. Human bites, animal bites, and lacerations opened longer than 12 hours, or those grossly contaminated are not sutured, but allowed to granulate and heal by secondary intention.
The placement of sutures and selection of suture material will be described in the following sections, as the various types of lacerations and their special care are considered. In a home-like setting it is possible to make the appropriate needles, like bending a sewing needle, sharpening the point in a chisel fashion to better penetrate the skin. Silk or cotton can be boiled along with the needle, thus sterilizing it for use in suturing. Prepared packages, that come already sterile, are available from suture manufacturing companies and can be obtained in various sizes and needle styles. Remember to consult the suture use manual for aid in selecting the appropriate sutures.

Wound Care

2008-09-10T22:42:00.000-07:00

There are three basic methods by which a wound heals itself. Primary Intention is the usual type of healing when an incision or laceration is closed immediately to allow close adherence of the opposing skin edges and subcutaneous layers. This permits healing from side to side with the east amount of scarring and pain. The rate of healing of our skin depends on its blood supply and the presence or absence of pressure, tension, and infection. The facial skin, with its rich blood supply, can heal in 3-5 days, while a thickened area of skin with less nutritive potential, such as the back or feet, may require two weeks or more. If sutures are placed, it is important to know how long healing will require to avoid too early removal and wound separation.
Secondary healing of a wound occurs when the laceration is too large to be closed or is infected and must be left open. A general principle of laceration treatment is this. A wound that has been open more than 8-12 hours is never sutured, since infection may already have developed. In uch case, granulation occurs with the formation of a specialized tissue across the wound, and later coverage with new skin. Some deformity and scarring usually occurs. Nevertheless, with the exception of very large ulcers, the skin healing is usually complete. Understandably, this akes longer. Proper care of the wound to prevent or treat infection will serve to hasten the healing process.
The third method involves the initial formation of granulation tissue, then a secondary closure of the wound with sutures. This accelerates the healing in large open lesions and is usually used hen a surgical wound, for some reason, separates and must be closed again. Even more scarring takes place as a rule, but the healing is usually complete.
Some essential factors in wound healing are the presence of adequate protein, vitamins, oxygen, and the prevention of infection. It is generally recognized that the normal rate of healing in a perfectly healthy patient is the optimum rate that can be obtained. Wounds do not heal as well in anemic patients. With a normal complement of white blood cells the healing of a sterile wound is not impaired. However, when infection is present delayed healing does occur. Swelling (edema), whether local or general, appears to interfere with the healing process. Older individuals take onger to heal than the young. Endocrine factors, such as the possible deficiency of thyroid or growth hormone, or adrenal dysfunction, may retard or interfere with the healing process.
Local factors are important. According to Van’t Hoff’s law, reactions occur more rapidly when the temperature is increased. Conversely, hypothermia will delay wound healing in most areas, lthough cold is sometimes used for pain control. The areas of the skin which have the best blood supply, such as the face and neck, normally heal the fastest. Fat persons tend to heal more slowly, and their wounds tend to separate more often than in people of normal weight. Skin utures are usually left in longer. Cleanly incised wounds will heal more rapidly than irregular jagged lacerations. The presence of a blood clot or hematoma may interfere with proper wound healing by preventing close contact of the walls of the wound, and thus there forms a pocket, called “dead space.” Infected fluids, pus, and foreign bodies will all retard the healing of these wounds. It is critical to cleanse the wound of all foreign debris, irrigating it thoroughly before any suturing is attempted. Suture material is also important in the care of wounds. Although stainless steel is the least reactive, it is difficult to handle and remove. The absorption of foreign material, such as gut, silk, cotton, and nylon will occur slowly, in the order that they are here
mentioned. Newer sutures of nylon, Dacron, and Teflon last longer and cause less reaction, but are not suitable everywhere. A suture use manual may be consulted to aid in selecting ppropriate materials. The suture manufacturer’s suggestion of needle size, type, and techniques should also be consulted.

Caries

2008-09-09T23:07:00.000-07:00

Tooth decay (dental caries) starts with the destruction of the enamel cap by micro-organisms
present in the oral cavity and adherent to the tooth surface. This leads to exposure of the underlying dentin to the oral environment and to its destruction by bacterial proteolytic enzymes. The dental management is the way of teeth manage. Caries will not occur that somebody have a good dental management.
Enamel caries will not be visible in routinely prepared histologic sections as this tissue dissolves
completely during decalcification. In ground sections made from undecalcified teeth, microscopic
examination under transmitted light will reveal optical alterations related to decreased mineral content of a still-intact crystalline structure.
These alterations tend to occur over a coneshaped area having its base on the surface and its point towards the amelo-dentinal junction. With increasing loss of minerals from the enamel structure, this tissue will disintegrate. The dental consultant can make some suggestion about the caries.
Sometimes, this destroyed enamel will contain so much organic material that it is still present in decalcified sections where it is visible as a basophilic amorphous mass.
The initial carious lesion in dentin afflicts the tubuli that serve as a highway for bacteria to spread into the dentin. As the tubules of the carious dentin become more distended due to breakdown of their walls by the proteolytic enzymes excreted by the invading bacteria, they may fuse and form spindle-shaped cavities perpendicular to the tubules. Fusion of afflicted tubules over a longer distance may also create spindle-shaped cavities in the same direction as the tubuli run. Through the continued loss of dentin between the tubules, its inner structure crumbles away .
When caries is not halted by dental treatment, bacteria and their toxic products will reach the
soft inner part of the tooth, the dental pulp, and evoke an inflammatory response . Subsequently,
the pulp dies and toxic substances from the pulp space diffuse through the apical foramen into
the adjacent periapical part of the periodontal ligament and surrounding jaw bone. Periapical
disease will now ensue. If the root surface of a tooth is exposed due to periodontal disease, the root-covering caries may also be the victim of carious decay. At this site, the bacteria penetrate into the cementum using the collagen fibres that once anchored the tooth in its tooth socket as pathways. The dental consultants can make solution about it.

Antisepsis

2008-09-09T22:39:00.000-07:00

One of the outstanding advances that medical science has made in the past hundred years is the establishment of antiseptic principles in the practice of surgery. Milestone discoveries were the germ theory by Pasteur and Koch, the emphasis on hand washing by Semmelweis, and the principles of antisepsis by Lister. To understand the relationship between infective agents and disease has allowed the art and science of surgery to develop many new techniques, as well as life-saving procedures.
Fundamentally, the principles of antisepsis deal not only with the presence or absence of germs, but also with the resistance of the person (host) to their invasion. The acid mantle of the skin and our body’s resident normal flora constitute an important barrier to the growth of disease-producing germs. Enzymatic protection by lysozyme in the nasal secretions, tears, saliva, and other mucous membranes affords a defense of marvelous significance and complexity.
From simple wound care to most complicated surgery, every individual should know how to avoid contamination by harmful germs. During the 19th century in Austria, Doctor Semmelweis began to encourage hand washing, requiring this of his residents after each post-mortem examination and before contact with maternity patients. The death rate from infection dropped
precipitously. Although this brilliant physician was persecuted by his own profession for these “strange” doctrines, decades later he was acclaimed a medical trailblazer. Without doubt, the washing of hands is as important to safe surgery, as the use of water internally is to fighting fever.
It is especially important to know how to wash the hands and prepare them to handle diseased or injured tissues. Usually before surgery, a soft disinfected bristle brush is used to scrub the hands starting first around each finger, the ends and sides of the fingernails, the palm and backside of the hand, the wrist, and then the forearm. To prepare for a delicate operation, ten minutes of this type of scrubbing is required, typically with an antibacterial soap. Sterile rubber or latex gloves should then be worn. Disinfectants such as organic iodine (Betadine), hexachlorophene (Phisohex), or other antibacterial soaps are used to prepare the patient’s skin for the incision. Where this is not available, soap and water are employed, however the scrubbing must be prolonged. It is well to remember, moreover, that the mere washing of the hands with any substance does not guarantee a totally germ-free skin.
Sweating is especially common under rubber or latex gloves, with the natural bacteria present in hair follicles and around the nails. Thus the bacterial count is only transiently suppressed, while our real line of defense is our body’ sresistance. Several routines and techniques of skin preparation will be described in the accompanying table.
In the treatment of skin wounds, copious irrigation with water is essential, With some force, the stream of water is directed at the contaminated areas. The wound is thereby cleansed, allowing germs, foreign debris, and blood clots to be washed away, making the area clean for closure or suturing. Preparation of the skin with appropriate antiseptics is also helpful. Proper nutrition to the injured area includes abundant oxygen and vitamin C to aid wound healing. Elimination of refined sugar assists in fighting infection. These measures, together with the avoidance of tobacco and other harmful substances that impair oxygen supply, will enable healing to occur rapidly.

The Inflammation Theory of Aging

2008-07-24T19:32:00.000-07:00

The majority of the free radicals are derived from oxygen. Thus, theb damage being done by these free radicals is known as oxidative damage. When a cell has a high level of free radicals present, we call this oxidative stress, and oxidative stress leads to the production of chemicals that create inflammation within the cell. This process is a vicious cycle, as free radicals can initiate inflammation and inflammation can initiate the production of free radicals.The scientists who argue in favor of the free-radical theory of aging must now go beyond this premise if we are to stop and help reverse cellular degeneration. Free radicals exist only for a nanosecond and therefore do very little direct damage to cellular molecules. However, what they do accomplish, in their very brief life, is the initiation of an inflammatory cascade, which can continue for hours or even days.The long life of the inflammatory cascade results in most of the cellular damage that leads to aging and age-related diseases. Fortunately for us, our bodies already contain certain defenses against free radicals and inflammation. Our bodies can actually make a variety of enzyme antioxidants that suppress or alter free radicals. (An enzyme is a protein that accelerates the rate of chemical reactions.) They are referred to as endogenous antioxidants because they are made internally by the body. Another way of obtaining antioxidants is through our diet or by taking nutritional supplements. We call these exogenous antioxidants because they come from outside of the body.We are all familiar with many of these antioxidants, such as vitamins C and E, as well as the multitude of phytonutrients that are available in fresh fruits and vegetables.Antioxidants are critical in anti-aging medicine because they act as natural anti-inflammatories, giving us protection against the inflammation initiated by free radicals that causes cellular damage. When this damage occurs internally to our vital organs, such as the brain, it results in problems such as Parkinson’s disease, Alzheimer’s, and dementia. It can also damage the lungs, resulting in decreased respiratory function, as well as the heart and the kidneys.And it is not just our internal organs that suffer. Free-radical damage and inflammation is apparent in our appearance with each passing year. It manifests in very visible damage to skin, resulting in the thinning of the skin, deep lines, wrinkles, sagging, and loss of tone, texture, and radiance. Negative changes in our muscle mass, known as sarcopenia, along with the loss of critical bone mass (osteopenia and osteoporosis), also occur. Each of these changes, whether external or internal, is the initial result of damage on a molecular and cellular level.

Disorders of the Augmented Breast

2008-07-24T10:36:00.000-07:00

At least 4 million American women have had breast implants. Breast augmentation is performed by placing implants under the pectoralis muscle or, less desirably, in the subcutaneous tissue of the breast. Most implants are made of an outer silicone shell filled with a silicone gel, saline, or some combination of the two. Capsule contraction or scarring around the implant develops in about 15–25% of patients, leading to a firmness and distortion of the breast that can be painful. Some require removal of the implant and surrounding capsule. The FDA has reapproved silicone implants for augmentation cosmetic surgery.
mplant rupture may occur in as many as 5–10% of women, and bleeding of gel through the capsule is noted even more commonly. Although silicone gel may be an immunologic stimulant, there is no increase in autoimmune disorders in patients with such implants. The FDA has advised symptomatic women with ruptured implants to discuss possible surgical removal with their physicians. However, women who are asymptomatic and have no evidence of rupture of a silicone gel prosthesis should probably not undergo removal of the implant. Women with symptoms of autoimmune illnesses should address the possibility of removal with their practitioner.
Studies have failed to show any association between implants and an increased incidence of breast cancer. However, breast cancer may develop in a patient with a silicone gel prosthesis, as it does in women without them. Detection in patients with implants is more difficult because mammography is less able to detect early lesions. However, after a woman who had mastectomy undergoes breast reconstruction with implants, the prosthesis should be placed retropectorally. Local recurrence of cancer is usually cutaneous or subcutaneous and is easily detected by palpation.
If a cancer develops in a patient with implants, it should be treated in the same manner as in women without implants. Such women should be offered the option of mastectomy or breast-conserving therapy, which may require removal or replacement of the implant. Radiotherapy of the augmented breast often results in marked capsular contracture. Adjuvant treatments should be given for the same indications as for women who have no implants.

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Hair Treatments

2008-07-23T10:16:00.000-07:00

Hair treatments can consist of methods to curl, straighten, bleach, hair loss and dye the hair. These treatments may or may not cause damage to the hair cuticle and shaft. The variates for hair treatments include Absent/Not Apparent, Dyed, Bleached, Permed, Combination, and Other. The variate Absent/Not Apparent refers to hairs that appear to have had no treatment with regard to color and curl. The variate Dyed refers to hairs that show evidence of artificial coloring. The variate Bleached refers to hairs that have been treated to remove the natural hair color. The variate Permed refers to hairs that have been treated to alter the natural curl. The variate Combination refers to hairs that have been treated using more than one of the previously discussed hair loss treatment methods (e.g., some hairs may have been bleached and subsequently dyed during the same treatment process).
The variate Other refers to hairs that appear to be treated, but the observed treatment cannot be categorized as dyed, bleached, or permed.
The result of some treatments may be apparent using light microscopy, while others are not as easily detected. A hair that has been dyed may be apparent by the presence of a demarcation line, or a sharp boundary between the treated portion of the hair and the naturally pigmented newly grown portion. A dyed hair may also exhibit the dye color in the cuticle. A dyed hair also will be apparent by the uniformity of the color distribution. Some hair examiners may recognize a dyed hair based on their observation that the color of the subject hair is not typical of naturally colored hair.
The bleaching of hair may result from an artificial bleaching process, or it may result from natural exposure to the sun. A hair that has been bleached from exposure to sun is often referred to as a solar-bleached hair. A bleached hair may be recognized by the presence of a demarcation line between the treated portion and the naturally pigmented newly grown portion. The bleached portion may contain no pigment granules, or it may contain significantly fewer pigment granules than the natural portion. The demarcation line of solar-bleached hair typically is not as distinct as the demarcation line of artificially bleached hair. Repeated dyeing and bleaching of a hair may result in several lines of demarcation that might render a hair as being
unusual, resulting in a hair comparison that might have greater significance.
Hair Loss Product help the damage to the hair cuticle and shaft.The observation that a questioned hair and known hairs have received the same treatment may add to the strength of a hair comparison, but the widespread use of hair treatments may also limit the significance of the correspondence.
Permanent waved hairs sometimes may have buckles or bends in the hair shaft due to the use of perm curlers. These buckles may present themselves at roughly even intervals along the hair shaft due to the manner in which the hair is wrapped around the curler. Artificially straightened hairs sometimes may be recognized by the simple observation that a straight hair has
a cross-sectional shape (e.g., oval, flat) that is more consistent with curly hair.

Regional Human Hair Characteristic Variates

2008-07-23T10:08:00.000-07:00

The older terms “Mongoloid,” “Caucasoid,” and “Negroid” used to describe the major population groups of humankind are replaced in this atlas with the more modern terms East Asian, European, and African (meaning sub-Saharan African), respectively. These terms were adapted from Brace.
The populations of the Indian subcontinent are allied with the European populations in terms of anthropological kinship.However, the scalp hair of the Indian subcontinent populations is more closely allied with the hair type of the East Asian populations, as is the scalp hair of the native populations of North, Central, and South America. Although the native populations of the Americas are allied with the East Asians anthropologically, many of the populations of Mexico and the other countries of Central and South America are of mixed heritage, so the scalp hair of these populations may represent characteristics consistent with those of a mixed heritage.
Forensic anthropologists rely primarily on skeletal analysis for an accurate estimate of original geographic origins. The depth of skin pigmentation has considerable overlap between individuals of African, European, and East Asian geographical origin, as does hair form among individuals of European, African and East Asian populations. Hair color, form, and degree of curl, however, can provide an indication of the geographical ancestry of the individual from whom a questioned hair originated. Those indications of the geographical heritage of an individual who is the source of a questioned hair can be of considerable value in the forensic examination of human hair, particularly with regard to providing investigative leads as to the possible regional ancestry of the individual from whom a questioned hair originated.

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General Dentist : Patient Evaluation and Medical History

2008-07-22T09:28:00.000-07:00

To provide the general dentist with specific information about oral surgery procedures that are performed daily in general dentists’ offices. Some advanced information is also given to provide the more experienced general dentist the opportunity to further his or her skills and knowledge. The ability of a general dentist to perform these procedures is based on a number of factors. Some dentists have a great interest in surgery, while others have very little interest. Some dentists have had a general practice residency or other postgraduate training or experience; others may not have had the opportunity.
Some are in areas that have little or no support from a specialist, which makes some surgery mandatory in their practices. Currently, it is accepted that regardless of who performs dental procedures, be they a generalist or a specialist, the standards of care are the same. If a general dentist wants to include the removal of third molars in his or her practice, he or she will usually need more training than that provided in Dental Management.
Just having the desire to do this procedure will not, in and of itself, qualify a person. The best thing a general dentist can do is to first obtain additional training. Surgical expertise is improved by taking postgraduate courses. The Dental Consultant then learns to diagnose the less complicated procedures and does them with supervision until they are performed well. State laws do not discriminate between a general dentist and a specialist. A license gives the same perogative to a generalist that an oral surgeon has to extract teeth.
Therefore, the generalist has a greater responsibility to acquire training and knowledge if he or she expects to do more complex procedures. This responsibility includes not only receiving instruction in step-by-step surgical techniques, but also the medical management of such patients and any complications that might arise. Surgical skill is only part of the equation.
The judgment of the practitioner in making appropriate decisions regarding the patient’s total condition is vital when doing surgical procedures. Anxiety management should be addressed before the surgical procedure is started. Will sedation be needed to accomplish the treatment? Some patients require sedation in order to make them feel comfortable about the surgery. The dentist who doesn’t fully understand the many facets of treating an extremely anxious and medically compromised patient should find an appropriate network of specialists in medicine
and/or dentistry and then use a multidisciplinary team approach.
Dental Consultant must never forget the human elements of kindness, compassion, and caring.
The patient wants to be treated just like any person would want to be treated. Dentists need to have enough insight into the patients’ fears and concerns to be able to calm and reassure them that they can handle any and all contingencies with competence. A little compassion and empathy go a long way in today’s “rushed” society.

Persistent Pulmonary Hypertension of the Newborn

2008-07-22T07:34:00.001-07:00

Persistent pulmonary hypertension of the newborn (PPHN) occurs in an estimated 1 or 2 infants per 1000 live births and is associated with substantial morbidity and mortality. Despite treatment, 10 to 20 percent of affected infants will not survive. Newborns with PPHN are typically full-term or near-term infants without associated congenital anomalies who present shortly after birth with severe respiratory failure requiring intubation and mechanical ventilation. This disruption of the normal fetal-to-neonatal circulatory transition is characterized by postnatal persistence of elevated pulmonary vascular resistance, resulting in right-toleft shunting of blood through fetal channels (the patent ductus arteriosus, foramen ovale, or both), diminished pulmonary blood flow, and profound hypoxemia.
Paxil is a popular antidepressant that has a number of distressing and dangerous side effect, birth defect, pregnancy risks, birth injuries, and may even cause death. Dangers of persistent primary hypertension in newborns also called PPHN.
Even though Paxil is used mainly to treat depression, many doctors use it to treat panic disorders, anxiety, and post traumatic stress disorder in almost 17 million people around the world. Unfortunately, the Food and Drug Administration advised doctors that prescribing Paxil to children and teenagers could significantly increase the likelihood of violence and suicidal tendencies.Paxil Attorneys California is one of legal specialist about that.
It is important to replicate these findings in other studies. In addition, further research should
assess the relationship of different types and dosages of SSRIs with PPHN and with milder respiratory complications in newborns. Studies should also be undertaken to investigate whether there is any association between SSRIs and PPHN in the offspring of women who discontinue SSRI use late in pregnancy. Furthermore, to better identify patients who may be at risk, investigations should explore interactions between environmental and genetic factors, the latter including polymorphisms affecting the production or regulation of enzymes involved in the metabolism of SSRIs, as well as mutations related to PPHN.http://www.pphnlawyers.com/

The Impact of Alcohol : The heart and the circulatory system

2008-07-15T09:42:00.000-07:00

Lichtenstein (2003) states that 15 million deaths in the late 1990s could be attributed to cardiovascular disease. The American Heart Association has pointed out that coronary heart disease and the related cardiovascular disease is the number-one killer in the US, accounting for almost one in two deaths among Americans and more deaths than are caused by all the forms of cancer combined. The impact on disability and the attendant economic loss are enormous.
Atherosclerosis (‘hardening of the arteries’) is the term used to describe a number of pathological events occurring in arteries and which are responsible for coronary heart disease, stroke and diseases of the peripheral circulatory system (Fisher 1991). Atheroma (from the Greek ather = porridge) comprises deposits of fatty material on the walls of arteries – a material comprising cholesterol, triglycerides, brous tissue and red blood cells. As it builds it restricts blood ow and if this is in the coronary artery then heart attack and death may follow, as the heart muscle does not receive suf cient oxygen. Atheroma has also been associated with the development of cataracts, macular degeneration in the retina and the development of cancers (Emerit et al. 1991; Tunick et al. 1994). If the atheroma accumulation (plaque) is ruptured a blood clot may form which not only can accelerate the blockage of the artery concerned but also may break loose and plug another artery, increasing the risk of heart attack or, if the newly blocked artery is in the brain, a stroke.
Plainly, the intake of saturated fats and cholesterol increases the risk, although it must be realised that four- fths of the cholesterol is made in our bodies and does not come through the diet. The quantity of cholesterol produced is increased in proportion to the level of saturated fatty acids in the diet (polyunsaturated fatty acids reduce blood cholesterol), and also the trans saturated fatty acids, i.e. those that are produced industrially by catalytic hydrogenation (Krisetherton 1995). High sugar intake can lead to high formation of saturated fats in the body. Indeed, any imbalance in metabolism such that there is an excess of calories over those needed to sustain the body will lead to an accumulation of fat. Obesity, hypertension, diabetes, sedentary living and the use of cigarettes all increase the risk of atherosclerosis.
As cholesterol and other lipids such as the triglycerides are insoluble in aqueous systems, they are transported through the body by combination with proteins, as lipoproteins. The principal carrier of cholesterol is low-density lipoprotein (LDL) and there is a strong positive correlation between its level and the risk of atherosclerosis. Hence LDL is frequently referred to as ‘bad cholesterol’. A lower percentage (20–30%) of the blood cholesterol is in the form of high-density
lipoprotein (HDL), which is responsible for transporting cholesterol away from the arteries to the liver where it is metabolised. This role has caused HDL to be named ‘good cholesterol’, such that high levels of HDL appear to afford protection against heart attack. Thus there is an inverse correlation between levels of HDL and atherosclerosis.

Alcohol : Direct and indirect impacts on body health

2008-07-14T09:34:00.000-07:00

There are at least two ways in which an alcoholic beverage such as beer might impact bene cially on the body: rst, through a direct physiological impact on bodily tissues and functions (which will be focused upon here); second, through indirect impact, but founded equally on a physiological interaction. The mellowing in uence that moderate consumption of alcohol has, with its calming and relaxing impact, will of itself have a sparing effect on stress-related illnesses (Morrell 2000). Cleophas (1999) concludes that there is a signi cant psychological component in the bene cial relationship between moderate alcohol consumption and mortality.
In either instance it will be recognised that excessive alcohol consumption will shift the status quo in a negative direction. We will address the incontrovertible direct damage to body organs that can be caused by overconsumption, and there is no denying the antisocial impact of excessive alcohol consumption in terms of behavioural changes and drink driving. One problem emphasised by many writers is the impact of underreporting alcohol consumption.
Dr Thomas Stuttaford (who for years has written a most engaging column in The Times) presents a fascinating experiential account of the likely reasons why his patients in rural Norfolk enjoyed a lesser incidence of cardiovascular problems and tended to live longer than did their counterparts in London (Stuttaford 1997). First, they had enjoyed less sedentary lives, with less dependence on the automobile. Second, they took aspirin daily to counter the osteoarthritis brought on by working in soggy agricultural conditions. Third, they weren’t teetotallers. And their chosen drink was beer, with the occasional celebratory whisky. It is of course not possible to con rm with any certainty that there was a causal link between any of those three factors and Stuttaford’s observations on mortality. Indeed, the reader will recognise the dif culty of pursuing robust research in this entire area, for the simple reason that studies relating health to any type of food intake must inherently try to remove as many interfering factors as possible and this is not easy:

Additional methodological problems are presented by a number of ‘confounding
factors’ such as age, sex, body mass index, diet, physical activity, smoking, coffee
consumption, educational attainment, type A/B behaviour, socio-economic status,
and medical history, that may be factors in particular health problems in persons who have been the subjects of the reported studies. For example, a generally
poor nutritional condition could possibly play a signi cant role in various health
problems associated with heavy drinkers.
Butterworth (1993)

Studies based on individuals’ reporting of their dietary intake are not as controlled as those in which feeding trials are performed with laboratory rats with de ned diets. Yet, of course, what is observed with a rat does not necessarily extrapolate to the human. We must critically evaluate the breadth of evidence that is presented. Most assume that if suf cient evidence of diverse origin is offered then ‘there must be something in it’. Much of the attention that has been paid to the impact of alcohol on the body has been for its negative effect on those who abuse it. These effects are amply described in the Oxford Textbook of Medicine (Weatherall et al. 1996) and, in more prosaic form, by Stuttaford (1997). In the discussions that follow I refer to these impacts and the reader is referred to those texts for more information.

The Impact of Alcohol on Health

2008-07-13T09:18:00.000-07:00

The effect alcohol, including in the form of beer, might have on the overall state of healthfulness of the body. What harm might it do and might it actually do some good? And let us start from a baseline statement that alcohol is relatively non-toxic, with an oral LD50 for the rat of 13.7 g/kg (i.e. the amount of ethanol which will kill half of the animals in an experimental population) (Bakalinsky and Penner 2003) Increasingly the evidence is that there appear to be bene ts in drinking beer (and other types of alcoholic beverage). Guallar-Castillon et al. (2001) concluded that the consumption of total alcohol (wine and beer) was associated with a lower prevalence of sub- optimal health. Hospitalisation is less acute for daily moderate drinkers (Longnecker & McMahon 1988), especially for women who had consumed between 29 and 42 alcoholic beverages in the fortnight prior to lling in the questionnaire. Artalejo et al.
(2000) found that moderate drinkers in Spain were less likely than abstainers to use healthcare services. Meanwhile Wiley and Camacho (1980) showed that moderate alcohol consumption (17–45 drinks per month) was associated with the most favourable adjusted health scores.
Beer drinkers were shown by Richman and Warren (1985) to have signi cantly lower rates of morbidity (sickness) than expected – one drink per day giving 15% less disability than was the case for the general population. There will be those reading this who will not be able to countenance such ndings.
If these people nd it hard to swallow that drinkers, imbibing in moderation, could be less ill, then they might note that they have certainly not been shown to be more sick. However, we must stress always that many of these studies are dealing with correlation, not necessarily causality. Some will argue that there may be other confounding factors not explored in the studies, and that those who tend to drink in moderation may have other lifestyle attributes that are the true reason for their enhanced healthiness. However, the sheer frequency of studies that have demonstrated the bene ts of restricted alcohol intake, weigh heavily in support of the merits of sensible drinking.
In the mid-1990s, the Department of Health within the British government addressed the matter of recommended safe limits for drinking. After (we presume) careful consideration of the scienti c and medical evidence available up to that stage, they increased the recommended limit for men from 21 units to 28 units per week, with the advice to
women being to drink no more than 21 units per week (previously it had been 14). They stressed that the daily maximum should be 4 units and that binge drinking (the equivalent of taking all of the weekly allocation at one sitting) is absolutely undesirable.
Individuals differ substantially in their bodily response to alcohol. Various factors will play a role, including body weight, general state of health, amount of activity, and whether the alcohol is being consumed on its own or alongside food. The UK guidelines are precisely that: blueprints to give some guidance to people to judge sensibly what is and what is not an advisable amount of alcohol to consume. They are not recommendations to drink: they are certainly not instructions. Rather they are a common-sense judgement on what is likely to be healthful for a sensible and healthy adult. And the fact that the levels were increased is testimony to the burgeoning evidence that there is real merit in moderate consumption of alcohol.
The author of a newspaper article in California once highlighted the number of times I had invoked the word ‘moderation’ when she interviewed me. I make no apology for using the word again here (particularly as a glance at the thesaurus in my computer offers the word temperance as a suggested alternative!). As the reader should surmise from what follows, there is more than ample evidence for the harmful effects of sustained, heavy intake of alcohol in all its forms. However, it will be noted that the serious ailments are primarily associated with extreme alcoholism, and a consequence of vastly more alcohol ingestion than is the norm for the great majority of adults.

Beer: a vice or a staple part of the diet?

2008-07-12T09:11:00.000-07:00

Were we able to transport ourselves back to the Middle Ages and enquire in England, Flanders, Bavaria or Bohemia about the key features of the popular diet, ale or beer would unquestioningly and unhesitatingly be listed alongside meat, bread, milk and vegetables. The questioner would be regarded as being mightily peculiar if he or she were to question ale’s legitimate place on the table. It was neither a comfort food nor an extravagance. It was an integral part of the food intake in all walks of society. In eighth-century England a monk might consume eight pints of ale a day. Beer in Britain has long been considered to be a key part of the diet, as much so as wine in France. Henry Brougham MP (Brougham 1830) said that ‘To the poor the beer is next to a necessity of life.’
Over 50 years ago the nutritive value of beer was emphasised. An admittedly weakish beer [3% alcohol by volume (ABV) in the austere early post-war years] was claimed to provide 200 calories and a fth of a working man’s requirement for calcium, phosphorus,nicotinic acid and ribo avin (Bunker 1947). The satisfaction of having at least part of one’s dietary intake in a pleasurable form was not sneered at then.
Perhaps the rst person to conduct a serious study of the impact of abstinence, moderation and excessive drinking on health was statistician Raymond Pearl. On the basis of interviews with over 2000 workers in Baltimore, he concluded almost 80 years ago that on average moderate drinkers lived longer than abstainers and much longer than those who were heavy drinkers (Pearl 1926).
Yet now, at the dawn of the twenty- rst century, beer-drinking is regarded in many societies as a vice. It is surely astonishing that in the United States it is possible to buy cigarettes at the age of 18, but it is not legal to purchase alcohol until the age of 21. It would be a struggle to identify any merit associated with smoking, with the possible exception of its role as an anxiety relaxant. By contrast there is accumulating evidence that alcohol, including beer, in moderation can have a bene cial impact on health and wellbeing.
In passing, let us consider the legal age at which, in the US, it is possible to partake of other activities that surely might be considered a genuine risk to health and wellbeing, not only for the partaker but also for those around them. A child may legally drive a car, with relatively few restrictions, at the age of 16. More alarmingly, 35 states in the US have no licensing or registration requirements for guns (www.soros.org/crime/ higlights.htm). Seven states lack a legal minimum age for buying a ri e or shotgun from an unlicensed dealer, while six states have no legal minimum age for a child to possess a handgun. In ve states there is a minimum age – 16 in New York, Georgia, Vermont and Alaska, and just 14 in Montana. But the minimum legal age for drinking alcohol in all 50 states is 21!
Opinions about the relative merits and de-merits of smoking, driving, guns and alcohol will of course differ between individuals. Certainly if we consider the respective virtues of smoking, weapon use and alcohol (in restraint), then it seems to this author that there may be a warped set of priorities in one country at least. Nonetheless beer is the second most popular drink in the United States, with annual average per capita consumption at 357 8-ounce servings, after sodas and other soft drinks (861) (Beverage Digest 1998). Worldwide production of beer in 1999 ran at 0.13 billion litres.

Several drugs and hormones have an effect on body weight.

2008-07-08T22:11:00.000-07:00

Some hormones cause weight gain and others cause weight loss. Hormones that cause weight gain are of particular interest, because if researchers can study and understand how they work, they may be able to develop drugs that can interact with these hormones in a way that makes it easier for people to lose weight. Insulin is a hormone that helps turn glucose (the sugar found in food) into energy the body can use. High levels of insulin lead to weight gain, although the reason why is not fully understood. Drugs used to treat diabetes, such as insulin and medications that make the body produce more insulin, cause weight gain. Obese people often have higher levels of naturally occurring insulin than their leaner counterparts.
Female hormones, like progesterone and estrogen, are associated with weight gain. Obese women most commonly begin to gain weight after puberty, when their bodies begin to produce these hormones. Birth control pills contain estrogen and progesterone, and are associated with weight gain. Today, birth control pills cause less weight gain than in previous years because they contain lower levels of estrogen. Some women may gain more weight than usual during pregnancy, up to 110 pounds (50 kg), which may be related to differences in their hormone levels during pregnancy, as compared to other pregnant women. Women who gain excessive weight during pregnancy may never fully lose this weight. Changes in hormone levels also occur during menopause. These hormone changes lead to a change in fat distribution, including increased central obesity (fat around the midsection or waist). This fat distribution is associated with increased health risks, especially heart disease.
Thyroid hormones increase metabolism and cause weight loss. People with the disease hypothyroidism (underactivity of the thyroid gland) have a smaller amount of thyroid hormone. People with hypothyroidism are predisposed to weight gain.When these individuals are treated with a drug that contains thyroid hormones, they lose weight. Thyroid hormones are dangerous in very high levels and must be monitored closely when taken. An excess of thyroid hormones in the blood can lead to several health problems, including high blood pressure, nervousness, insomnia (trouble sleeping), menstrual cycle changes, heart palpitations (the feeling that the heart is pounding), and fever. Several hormones that may play a role in weight gain have recently been discovered. One of these is leptin, a newly discovered hormone produced in fatty tissue. Increased leptin decreases food intake and increases metabolism in rats and, according to some early studies, in humans as well. Other hormones released by the stomach—including neuropeptide Y, cholecystokinin (CCK), enterostatin, and polypeptide Y 3-36— tell the body it has consumed enough food and should stop eating. Another hormone, ghrelin, is produced by the
stomach. Ghrelin signals hunger and increases appetite.
Ghrelin concentrations increase in response to weight loss. This may make ghrelin partly responsible for people gaining weight back after a successful diet. Table 2.2 lists some of the hormones that influence body weight. Clearly, many hormones affect body weight. Some of these hormones are known, and some have not yet been discovered. By studying these hormones researchers can better understand what causes people to gain and lose weight. Eventually, researchers may be able to develop drugs that can change levels of these hormones in the body, thus giving people who are overweight or obese another weapon in the weight loss battle. Intensive study is required to identify the possible negative effects of increasing or decreasing the level of hormones in the body.

HEALTH RISKS ASSOCIATED WITH OBESITY

2008-07-07T21:27:00.000-07:00

Obesity is currently the second leading cause of preventable death in the United States.1 Being overweight and obese can contribute to death by causing or worsening many different diseases, including but not limited to:

High blood pressure;
High cholesterol (overweight individuals often have higher levels of “bad” cholesterol and lower levels of “good” cholesterol);
Obstructive sleep apnea (a condition where a person may stop breathing for a period of time while sleeping);
Rheumatoid arthritis and osteoarthritis;
Certain types of cancer, including breast, esophageal, stomach, colorectal, endometrial, and kidney cancer;
In women: menstrual disturbances, infertility problems, and an increased incidence of birth defects in children;
Increased daytime sleepiness and heat intolerance;
Obesity may also contribute to gallbladder disease, gout, breathing problems, increased incidence of infections, liver diseases, and increased pain, especially in the lower back and knees.

Two of the biggest health problems that overweight individuals face are a greatly elevated risk of heart disease and stroke. The American Heart Association (AHA) has found a direct link between these health conditions and being overweight. Heart disease is now the number-one killer of women in the United States, and the rise of overweight and obesity can be directly correlated to it.
A person’s risk of developing these health conditions increases as his or her BMI increases, so obese individuals are at higher risk than overweight individuals. Weight loss of even 10 to 15 pounds (4.5 to 6.8 kg) in adults and children can decrease the risk of developing health problems such as diabetes and hypertension. This weight loss can also help to control or lessen the severity of these conditions in patients already afflicted with these conditions. As previously noted, adults with central obesity are at higher risk of developing many of these conditions than are people with evenly distributed body fat.
Obese children also have an increased incidence of health problems.As the prevalence of obesity has increased in children, there has been a similar rise in diseases that were previously rare in children, including type II diabetes and hypertension (high blood pressure). There is a high incidence of obesity among children with asthma, which may indicate a link between the two conditions. There is also an increase in bone and joint complications in obese children. During childhood, bone and cartilage is still growing and developing, and is not strong enough to bear excess weight.

The Link between Weight and Health

2008-07-06T21:19:00.000-07:00

Weight and health are strongly related to each other. Disease risk goes up slowly as weight gain pushes you out of the healthy weight range and into the overweight range.Your risk of disease and death increase significantly if extra weight puts you in the obese range. One study reported that obesity in middle age reduces life expectancy by seven years.
The list of weight-related diseases continues to grow. Increased weight raises blood lipids (cholesterol and triglycerides) and blood pressure, which are heart disease risk factors.Weight gain impairs the body’s ability to handle glucose (blood sugar) and contributes to a prediabetic condition called insulin resistance. Other medical conditions that are associated with increased weight include certain cancers, osteoarthritis of the knees and other weight-bearing joints, gastrointestinal tract disturbances, interrupted sleep and sleep apnea, and reduced fertility.To date, obesity has been linked with more than thirty medical conditions.
As weight goes out of the healthy range, risk increases for
• Heart disease
• High blood pressure
• Stroke
• Diabetes
• Several forms of cancer
• Metabolic syndrome (Syndrome X)
• Gallbladder disease
• Gout

It is not just big gains that carry ill health effects—the consequences of gradual or modest weight gain add up quickly. Even 10 or 20 extra pounds increases the risk of death among adults, as shown in a large study published in the New England Journal of Medicine.A recently published study found that just a 5% increase in the BMI over time had a negative impact on simple body functions like walking. Research on women, weight gain, and cancer found that women who gained 21 to 30 pounds since age 18 and were not on hormone replacement therapy were 40% more likely to get breast cancer than women who had gained no more than 5 pounds. The risk increased as the women’s weight increased. Similarly, another study found an 8% increase in the
risk of postmenopausal breast cancer for every 11 pounds gained.

Developing a Good Relationship with Your Doctor

2008-07-03T22:50:00.000-07:00

In the past, many people saw the same doctor for years—sometimes for most of their lives. Today, people are much more mobile, making a long-standing patient-doctor relationship more difficult. People move to new locations, accept new jobs, and change healthcare coverage. Any of these situations may require a change of doctors. Some health plans restrict your choice of doctors to those who participate in their plans. Seeing a specialist may entail getting a referral from your primary care doctor. Choosing a new doctor takes more than just a word-of-mouth recommendation from a friend. You need to think carefully about what you are looking for when changing doctors. The area of medicine in which a doctor specializes is an important consideration. If you have a particular medical problem, such as heart disease, you will probably want to see a cardiologist (a doctor who specializes in diseases of the heart). If you are generally healthy, an internist (a doctor who specializes in the care of adults) or a family physician is probably the best choice. You may also prefer a male doctor over a female doctor. Some people choose medical assistant which he or she admits patients. The location of the doctor’s office also is a factor. It should be easy to reach from your home or workplace, especially if you rely on public transportation.
Once you have narrowed your choices, find out more about the medical assistant school you are considering. Important information includes where they trained, how long they have been practicing, and their specialty area and whether they have been certified by the board in that specialty.
medical assistant schools needs to communicate well with you by fully answering all of your questions and explaining medical terms and procedures in language you can understand. they also needs to treat you with respect and keep waiting times to a minimum. If you feel that you are not getting all the information you need to follow medical assistant instructions or that your appointment times are too rushed to address all of your medical concerns, Keeping an established relationshipis much easier and more valuable than starting all over again.

Environmental Factors,Causes of Obesity

2008-07-03T21:13:00.000-07:00

Along with genetics, environmental factors have been found to contribute to obesity. In particular, increased food consumption and an inactive (sedentary) lifestyle are environmental factors that very closely correlate with an increased risk of obesity. Americans have an ever-increasing number of energydense foods, packaged in enormous portions, conveniently available at low cost. Energy-dense foods contain large numbers of calories in very small portions. These foods promote the overconsumption of calories. Americans also consume 40% of their calories from fats, which is well above the level recommended by the American Heart Association (AHA). Fats are an extremely energy-dense form of nutrition. The AHA recommends that adults obtain less than 30% of their daily calories from fat. In the United States and in other developed countries, modern technology allows people to be less active in their daily tasks, since many things today are automated and do not require manual labor. For example, years ago people walked to most places. Today, people have access to cars and public transportation to take them to these same places, thus limiting the need for physical activity.
Decreases in physical activity can lead to weight gain. Ultimately, all the calories you eat are not utilized, or burned off. Calories that are not utilized are stored as fat tissue, which can lead to weight gain. Sedentary behavior is on the rise now that technology and automation are so widely available. All of the modern conveniences we now have accessible to us have eliminated the need for individuals to perform much of the physical activity that was once required for daily tasks at work and home (Table 2.1). Computers, cable and satellite television, movies on demand, and high-tech toys like video game systems have led to a decrease in physical activity in people of all ages. Reduced physical education requirements in schools across the nation have also caused physical activity to decline among adolescents. The CDC estimates that 70% of adults in the United States fail to meet minimal recommendations for physical activity. It also estimates that
about one-third of people over the age of 18 get no leisuretime physical activity at all.
Other environmental factors that have been linked to obesity are lower economic class, lower education level, and cessation (quitting) of smoking. The link between economic level, educational background, and obesity is not clear. One theory is that a person who is illiterate may not be able to read labels on food and may not be aware he or she is consuming high-fat, high-calorie foods that can lead to obesity.High-fat, high-calorie foods, such as the food served at most fast-food restaurants, are formulated to be cheap and great tasting. This food is readily available and affordable for people with lower incomes and it is speculated that these people may consume more of this type of food, which can lead to obesity.
People who quit smoking are also likely to gain weight and potentially become obese. It is believed that the nicotine withdrawal a person experiences when he or she quits smoking causes an increase in appetite that leads to an increased intake of calories and, thus, weight gain. This trade-off is not an easy one to handle. The harmful effects of smoking are many and include lung cancer, bronchitis (an infection of the tube that brings air to the lungs), and emphysema (a condition that results in labored breathing and increased risk of infections). Many people who quit smoking trade one health risk (smoking) for another (obesity) because they gain weight.

Genetics,Causes of Obesity

2008-07-03T21:11:00.000-07:00

Genetics clearly play a role in obesity. It has been noted that an
adopted child’s body weight is usually more similar to the body
weight of his or her biological parents than that of his or her
adopted parents. Identical twins usually have similar occurrences
of obesity. Studies have also shown that fraternal twins
do not show this same likelihood of obesity; when one twin is
overweight, the other is very often not. These examples help
demonstrate that genetics play a significant role in obesity.
Researchers participating in the Human Obesity Gene
Map project are in the early stages of determining which genes
contribute to obesity in people. Several alterations in normal
genes have been discovered in laboratory rodents and linked to
obesity in these animals. These genes include the ob or lep gene
and the Agouti gene. Researchers are working to find out if
these same genes contribute to obesity in humans.
Not all people who have obesity genes will be overweight.
Conversely, some people who are overweight will not have
these genes. This is because environmental factors also play
a major role in causing overweight and obesity.

WHEN ARE DIET PILLS, ERECTION, HAIR GROW DRUG RECOMMENDED?

2008-07-03T20:39:00.000-07:00

DIET PILSS NEED?
Overall, in carefully selected patients, a doctor may prescribe appropriate drugs to be used in conjunction with diet and exercise to achieve weight loss. The only drugs recommended for use by the National Heart, Lung, and Blood Institute (NHLBI) are those that have been approved by the U.S. Food and Drug Administration (FDA). FDA-approved drugs have been studied and determined to be safe and effective for some, but not all, people.
According to the NHLBI, people who are appropriate candidates and should consider taking diet pills are adults with a BMI of greater than 30 kg/m2 or those with a BMI of higher than 27 kg/m2 who have health problems related to being overweight. Diet pills, like any other medication, have risks associated with their use. Therefore, diet pills should only be used by people who are at high risk of developing weight-related health problems. For people who are obese or overweight, the benefits of weight loss are generally greater than the risks associated with taking slimming pills. Several slimming pills have been studied for use in children; however, doctors only recommend using them in extreme situations.
The National Institutes of Health (NIH) has established guidelines on the use of diet pills. These guidelines are used by health-care practitioners both within and outside the United States. The information contained in these guidelines helps to determine who should and should not use weight loss medications. This is important because people who use diet pills inappropriately risk potentially devastating effects on their health.
ERECTION DRUGS NEED?
When a man is aroused, nerve signals are sent from the brain and around the penis. These nerve signals cause chemicals to be released that relax the muscles in the penis. Normally, these muscles are constricted so that blood cannot flow into the penis. When these muscles relax, large amounts of blood are able to enter the penis, causing an erection. An erection is reversed when another chemical (known as phosphodiesterase type 5 [PDE5]) breaks down the chemicals that caused the muscles to relax in the first place. This causes the muscles in the penis to constrict again as blood leaves the penis. Cialis works by blocking PDE5. When PDE5 is blocked, more of the chemicals responsible for the erection remain, so the muscles in the penis do not constrict. This allows blood to stay in the penis longer, which allows the man to maintain an erection.
HAIR GROW DRUGS NEED?
With at least forty treatments for baldness patented in 1996 and $200 million budgeted for clinical trials in 1997, you'd think someone might have figured out by now why men lose hair. But the lab guys know only one big thing: Hair follicles shrink and die. They've proved that this tragedy is triggered by the body's especially potent testosterone derivative, DHT. But researchers can still only theorize about why the perfectly normal presence of DHT leaves some otherwise healthy men mourning their hair as it swirls down the drain.
Propecia, the next treatment to grind its way through the FDA-approval machinery, probably within the year, will be Merck's promising finasteride tablet, Propecia. Finasteride inhibits the enzyme that turns testosterone into DHT--the first domino in the chain reaction that ends in follicle death. It first appeared in the guise of Proscar, a drug that combats prostate enlargement, another problem caused by DHT. Merck's trial results have raised high hopes for Propecia's effectiveness: More than half of those treated had "clinically significant increases in growth of new hair." Some baldsters, wanting to get the jump on the approval process, are already cadging prescriptions for Proscar from their physicians.

HEAT AND DRUG STABILITY

2008-06-27T00:01:00.000-07:00

The variety of different body matrices that can be analyzed to determine the presence or absence of different psychoactive substances is extensive, ranging from semen to cerumen. There are, however, practical limitations to the extent to which different biological samples can be used, and the mechanism of collection and supervision of samples are critical to the procedure. This focuses on those biological samples that are commonly used for testing within various drug treatment settings, namely, urine, saliva, blood, and hair. Urinalysis is routinely used in hospitalbased services, blood in forensic environments, hair analysis for medicolegal cases, and saliva tests have been used in the prison services and outreach units. Many would advocate that the assessment of psychoactive drug use could reliably be achieved using self-report from the drug user (client). However,the drug rehabilitation are issues around the method of inquiry the context, purpose, interviewer characteristics, etc. that may bias self-report. Circumstances where the drug user sees the self-report to the inquirer about drug use as influential on his own continued treatment or possible loss of privileges are particular examples.
With a focus on alcohol rehab, Allan has recommended that patients presenting with anxiety and alcohol dependence should first be detoxified and reassessed after 6 weeks when only an expected 10% will be found to have persistent symptoms amounting to an anxiety state. The persistent anxiety can then be treated using conventional pharmacological or behavioral methods. She points out that patients may resist such an approach, preferring to deal with their psychological distress before tackling their substance use. People who are dependent on alcohol or other drugs usually succumb to a number of financial, family, health, and relationship problems, and it is not surprising that many will complain of depression; again it is not surprising that 80% or more will recover within a few weeks of abstinence without recourse to antidepressant treatment.

The drug being tested for and the period of time that the clinician wishes to consider influence
the choice of body fluid. Blood and, to a lesser degree, saliva are likely to give the most accurate
measurement of drugs currently active in the system, whereas urine provides a somewhat broader time period, but with less quantitative accuracy. Hair provides a substantially longer time frame. The routine drug testing strategy most widely adopted is to send urine samples to a laboratory for an initial screen to detect psychoactive drugs of interest. Analysis is performed using a semiautomated commercially available immunoassay or thin layer chromatography (TOXILAB) test. Several types of the former test exist and include radioimmunoassay, RIA:Europ/DPC, enzymemediated immunoassay test, Syva:EMIT, and fluorescence polarization immunoassay, FPIA. Recently, several rapid detection devices (near patient test, NPT) for drugs of abuse screening have been marketed in the U.K. Such tests offer a more rapid turnaround of results to aid clinical decision making.
However, all initial drug screen tests are nonspecific and identify only in a nonquantitative fashion the class of drug present, e.g., opiates, amphetamines, or benzodiazepines, etc. Ideally, any positive test result should then be confirmed by a second test working on different physicochemical principles to the screening test. Gas and liquid chromatography with mass spectrometric detection are regarded as the “gold standard” and are favored where legally defensible results are required. It cannot be overemphasized that the confirmation of drug screening test results is essential. For amphetamine-specific immunoassays, the confirmation test provides the opportunity to differentiate legitimate medicines. For instance, pseudoephedrine and phentermine give a positive test result (cross-react) with tests for illicit drugs like amphetamine and methylenedioxymethamphetamine, MDMA. For opiate drugs, initial immunoassay tests for morphine crossreact with codeine, dihydrocodeine, pholcodeine, 6-monoactetylmorphine (6-MAM), morphine glucuronide, and morphine-6-glucuronide. Consequently, if more than one of these substances is present in a urine sample, the test result will relate to the concentration of the sum of all these opiates and their metabolites. In this way an inaccurate picture of the window-of-detection of opiate drugs in urine may be concluded. The clinical benefit of the confirmation test is that it is able to verify the specific substance(s) present. For example, a confirmation test can detect the presence of 6-MAM, the only specific indicator (metabolite) of heroin use .

Management of Drug Abuse

2008-06-26T23:19:00.000-07:00

The management of complications from drug abuse demands a variety of skills from airway management to control of seizures and shock. Several reviews have addressed the issues of general resuscitation and toxidromes.
The purpose of Drug rehab is to present a series of management strategies for the emergency physician or other clinical personnel caring for patients with acute complications from drug abuse. Immediate interventions (e.g., resuscitation and stabilization), secondary interventions (e.g., emergency care after the patient is stable), as well as diagnostic workup (e.g., laboratory data, imaging), and disposition of the patient are discussed. This is proposes a variety of treatment approaches based on a review of the pertinent literature and clinical experience. A general treatment approach based on symptom complex (i.e., seizures, coma, hyperthermia) is presented since initial management decisions frequently have to be made without the benefit of a reliable history. This is followed by a brief review of the each particular drug of abuse (i.e., psychostimulants, opiates, hallucinogens).
It should be emphasized that the adverse reaction to a drug may depend on the unique characteristics of an individual (i.e., presence of cardiovascular disease) as well as the type of drug abused. These protocols serve as guidelines only and an individualized approach to management should be made whenever possible. In the setting of drug overdose, coma usually reflects global depression of the brain’s cerebral cortex. This can be a direct effect of the drug on specific neurotransmitters or receptors or an indirect process such as trauma or asphyxia. Treatment deals largely with maintaining a functional airway, the administration of potential antidotes, and evaluation for underlying medical conditions. The following section describes the Drug rehab thats appropriate use of antidotes and the approach to the patient with a decreased level of consciousness from drug abuse.
Level vs. content of consciousness: It is often useful to distinguish between the level and the content of consciousness. Alertness and wakefulness refer to the level of consciousness; awareness is a reflection of the content of consciousness. In referring to coma, stupor, and lethargy here we address the level of consciousness as it applies to the drug-abusing patient along a clinical spectrum with deep coma on one end, stupor in the middle, and lethargy representing a mildly decreased level of consciousness. Agitation, delirium, and psychosis are addressed in a subsequent section with a greater focus on content of consciousness, i.e., presence or absence of hallucinations, paranoia, severe depression, etc. Attributes of a good antidote The ideal antidote should be safe, effective, rapidly acting, and easy to administer. It should also have low abuse potential, and act as long as the intoxicating drug.
The following standard antidotes are of potentially great benefit and little harm in all patients. Thiamine: Thiamine is an important cofactor for several metabolic enzymes that are vital for the metabolism of carbohydrates and for the proper function of the pentose–phosphate pathway.When thiamine is absent or deficient, Wernicke’s encephalopathy, classically described as a triad of oculomotor abnormalities, ataxia, and global confusion, may result. Although Wernicke’s is rare, empiric treatment for this disease is safe, inexpensive (wholesale price of 100 mg of thiamine is approximately $1), and cost-effective.

Nimodipine: Cocaine is known to decrease reuptake of serotonin, which is believed to play a
role in cocaine-induced headaches and may be associated with cocaine-induced vasoconstriction.
Rothrock et al. reported on three cases of amphetamine-related stroke: in one case a 35-year-old abuser had 20 episodes of transient right hemiparesis occurring within minutes of inhaling methamphetamine; later he developed permanent right hemiparesis. In animal studies,
intravenous methamphetamine administration has resulted in narrowing of the middle cerebral
artery branches within 19 min.While the pharmacologic approaches to cerebral vasospasm are varied, the calcium-channel blocker nimodipine has been used widely with proven efficacy in preventing vasospasm associated with hemorrhagic stroke.No studies looking at this issue in the setting of drug-induced hemorrhagic stroke exist. Although two animal studies found that nimodipine potentiated the toxicity of cocaine and amphetamines in rats, it is felt that in selected
patients the risk–benefit ratio may favor nimodipine administration. Such populations may include the drug-abusing patient who is experiencing transient ischemic attacks closely temporally related to substance abuse or who has had a documented subarachnoid hemorrhage associated with cerebral vasospasm. Recent reports suggest no benefit of nifedipine in ischemic strokes of any type.

BREAST FEEDING

2008-05-28T15:14:00.000-07:00

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)

2008-05-27T15:12:00.000-07:00

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)

2008-05-26T14:57:00.000-07:00

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)

2008-05-25T14:57:00.000-07:00

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

2008-05-24T14:57:00.000-07:00

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

2008-05-23T14:56:00.000-07:00

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

2008-05-22T14:56:00.000-07:00

OTHER HORMONAL DISORDERS

2008-05-21T14:28:00.000-07:00

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

2008-05-20T14:22:00.000-07:00

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

2008-05-19T14:42:00.000-07:00

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

2008-05-18T14:15:00.000-07:00

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

2008-05-17T14:13:00.000-07:00

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

2008-05-16T13:59:00.001-07:00

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

2008-05-15T01:34:00.000-07:00

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

2008-05-14T12:40:00.000-07:00

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

2008-05-13T13:53:00.000-07:00

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

2008-05-12T01:30:00.000-07:00

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

2008-05-11T01:19:00.000-07:00

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

2008-05-10T01:11:00.000-07:00

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

2008-05-09T01:06:00.001-07:00

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

2008-05-08T00:53:00.000-07:00

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

2008-05-07T00:49:00.000-07:00

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

2008-05-06T00:48:00.000-07:00

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

2008-05-05T00:45:00.000-07:00

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

2008-05-04T00:44:00.000-07:00

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

2008-05-03T00:42:00.000-07:00

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

2008-05-02T00:40:00.000-07:00

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.

LEUKEMIA

2008-05-01T00:39:00.000-07:00

Cancer involving the blood and bone marrow is most often seen in children. Several types of leukemia are described, based upon the type of blood cells involved and their appearance under the microscope. Samples from the blood and bone marrow are usually compared. Ionizing radiation, whether from nuclear sources or x-ray therapy, is clearly associated with an increased incidence of these leukemias. Chemical agents, such as the anticancer drugs and occupational exposure to benzal have been associated with increased leukemia. Some hereditary factors have
also been linked with this disease.
Most interesting is the firmly established viral theory in relation to acute leukemia. In rodents, fowls, cats, and monkeys certain viruses are known to cause leukemia when experimentally inoculated. These animals can pass viruses to their offspring through the ovum or shed it in their milk or other secretions, thereby transmitting it to unaffected animals. Again it makes one wonder how much leukemia may actually be transmitted to human beings through the use of animal foods, such as meat, eggs or milk. Milk is increasingly suspect for cancer viruses, especially the bovine leukemia virus (BLV) and the bovine immunodeficiency virus (BIV, a relative of HIV).
A disease in chickens (fowl leukosis) is estimated to affect up to 15% of the birds used for food, and many cases escape the casual inspection at the mass production slaughterhouse. The virus definitely passes into the egg, and can infect a baby chick even before hatching. It would take very high or prolonged cooking temperatures to be sure the virus was inactivated in eggs used for food. In spite of the fact that the common treatment of leukemia today is with cellular poisons (cytotoxic drugs), it is my hope that a much more physiologic treatment will soon become available, and, in the right setting be demonstrated as superior.
Combining a proper diet with the judicious use of fever therapy should induce the appropriate antibodies to aid in virus destruction and the maintenance of health, as well as a decrease in complications. This type of therapy has been used with increasing success in the treatment of related tumors, such as Hodgkin’s disease, chronic lymphocytic leukemia, and some other lymphomas. These closely related malignancies all seem to have a common viral origin. Thus, they should respond to the intermittent induction of high fever, However, it must be given in a controlled setting for safety.

LUNG CANCER

2008-04-30T00:36:00.000-07:00

Cancer of the lung is the most common cancer in men and increasing rapidly among women in the United States. There are a number of types of lung cancer, but the most common is called bronchogenic, since it originates in the bronchial tubes. By far, the most common cause of lung cancer is tobacco smoking with the risk directly proportionate to the number of cigarettes smoked and the amount of inhaling. It appears that in the tobacco tar, we find not only benz-0-pyrene, but also dozens of other cancerproducing chemicals, as well as other substances that sensitize the tissues to the destructive action of these agents. Over a period of years the hapless smoker accumulates an increasing amount of tar, until some of the lining cells, which at first increase in number as a protective measure, finally become transformed into malignant cells, which invade local tissues and eventually metastasize.
Extensive research on tobacco was sponsored by The American Cancer Society. Also, momentous publications by the recent Surgeon General of the United States, especially his dynamic governmental Report on Smoking and Health, underscore clearly the detrimental effects of tobacco use and its potential for producing malignancy in vital organs. In spite of many medical and surgical advances in the treatment of advanced cancer, lung cancer still takes the lives of about 95% of its victims. Tragically, most cases are discovered too late for any hope of cure, although this disease is almost entirely preventable.
An individual developing cancer of the lung may have no symptoms at all until the cancer is far advanced. Others develop a cough that may be confused with the smoker’s cough of chronic bronchitis. At times the expectorated mucous may contain blood, a rather late sign in the development of this cancer. Some unfortunate cases have spread to involve vital blood vessels, the brain, or bones before adequate diagnosis has been made. Occasionally, the removal of the lung or part of a lobe may eradicate the tumor early enough to effect a cure.

CANCER of the UTERUS and CERVIX

2008-04-29T00:33:00.000-07:00

Routine screening has decreases the incidence of cervical cancer in recent years. Called the “Pap smear”, this screening tool developed by Dr.Papanicoleau has allowed for the early detection of change in the cells of the cervix. Being less common in nuns, in Jewish women, and in those with less sexual activity, this type of cancer merits great interest from a preventive standpoint. A virus similar to the Herpes virus that causes cold sores has been implicated in the development of some of these cancers.
More and more nurses, as well as many midwives are learning how to take these smears, thus increasing the acceptance of the pap smear to many women as well as making the procedure more available. It certainly should be part of an annual examination from the time of marriage on through life. Early diagnosis with surgical removal of the uterus and cervix can well be curative.
Cancer of the lining of the womb (endometrium) is less common, but is still taking many lives. This has definitely been related to the use of estrogens, the female hormone used traditionally to lighten symptoms of the menopause.
Avoidance of these hormone preparations, as well as prompt medical treatment in the event of unusual menstrual flow can provide the early diagnosis needed. An outpatient procedure, using techniques similar to the pap smear (e.g. Vabra aspiration, or the Pipelle) can with less expense and discomfort provide the reassurance needed to evaluate this bleeding.

CANCER of the GASTROINTESTINAL TRACT

2008-04-28T00:31:00.000-07:00

For the last three decades, cancer of the stomach has been decreasing in frequency in the United States. It remains high in Japan and certain other Oriental nations, and is probably related to the intake of certain foods, some highly seasoned, and others extremely hot. The second most common type of cancer in our country is cancer of the colon and rectum. This often produces a change in bowel habits, the stools becoming more constipated or of small caliber. Bleeding from the rectum is occasionally seen. This is usually red when the tumor growth is low in the colon and darker, brown to black (called melena) when the lesion is high in the colon or coming from the small intestine or stomach. This color change is due to the partial digestion of blood products by bacteria and enzymes in the bowel.
The rectal examination is helpful in detection of many cancers in their early stages. A ten-inch tube with attached light, called a sigmoidoscope can be used to look into the lower bowel, where nearly three-fourths of the cancers are seen. This should be done in conjunction with a complete annual exam for individuals over the age of 40. A new technology in fiber optic viewing, called endoscopy, has developed instruments that can examine the stomach and duodenum (gastroscopy), and the entire colon (colonoscopy).
These procedures are often done on an outpatient basis, and provide even more adequate confirmation than the traditional barium x-rays. The cause of these colon cancers is still somewhat uncertain. It is felt that a high fiber diet, which increases the rapidity of transit through the bowel, will decrease the incidence of cancer. This is probably because the waste products contain many toxins. In contact with the mucous lining of the bowel these can cause irritation and eventual malignant change in the cells. A number of foods, most notably meat, contains toxins (carcinogens) that can be directly associated with cancer. The benz-0-pyrene in a charcoal-broiled steak may be equivalent to that found in about 600 cigarettes. Methylcholanthrene is also a dangerous substance found in many types of meat. Recently discovered is the chemical malonaldehyde, which seems to be increased when the meat is cooked! Certain vegetables are not exempt from association with cancer. Moldy corn, peanuts, soybeans, and other seeds contain a factor called aflatoxin, which has been associated with liver cancer in several countries. It is interesting to note that the incidence of cancer is increasing in many fish that inhabit polluted streams and rivers. Problems with meat inspection also contribute to risk of cancer, in that certain portions of an animal carcass may be preserved for food, while another part of the animal may have actual malignancy.
All of these danger signals are turning more food buyers to a vegetarian diet. In fact the numbers are growing rapidly in the United Kingdom, where a disease called bovine spongiform encephalopathy was discovered in 1985. It will undoubtedly spread to other nations. Often called the “mad cow disease,” this condition results from using animal products such as a bone meal in cattle feed. The cows after a few years go crazy, and become violent. A virus-like particle called a PRION is found in the animal’s brain. Currently it is resistant to most germ killing procedures, including boiling, radiation, and disinfectants. Modern cancer virus research points out the “ounce of prevention” at your supermarket being worth much more than “pounds of cure” in the hospital. Another bit of good news in the treatment of cancer of the colon is that some types can be removed without radical resection of the organ. Many snares, cauteries, and forceps have been devised to remove these cancers from the rectum through the sigmoidoscope. Sometimes when the malignancy is present only as a growth on a stalk, the area involved can be followed with periodic examinations. Other times the removal of a portion of the colon is necessary to effect the cure. The possibility of metastasis to the lymph nodes or liver makes it important to achieve early diagnosis and therapy, if life is to be maximally prolonged.

BREAST CANCER

2008-04-27T00:29:00.000-07:00

Cancer of the breast is the leading cancer among women in Western countries. It appears that this cancer is caused by one of several viruses and is increased in certain population groups. As mentioned before women who breast-feed their babies seem to be protected. Those with fibrocystic disease, a condition where the mammary glands enlarge and become engorged with sacs of fluid have an increased risk of breast malignancy.
Recent evidence points to the intake of caffeinated beverages, such as coffee, tea, and colas as factors in the production of this fibrocystic change. Beverage alcohol is believed to be one major risk factor in breast cancer. Men may also have breast cancer, but it is about 1/125th as common. Periodic self examination is an excellent aid to early detection of breast cancer, especially if it remains the same throughout the menstrual cycle.
A great deal of controversy is raging in the medical world concerning the best treatment for breast cancer. Some types seem to be adequately treated by locally excising the tumor. The removal of a portion of the breast obviously preserves normal anatomy and is far less mutilating than the more traditional radical mastectomy.
Many types of breast cancer are quite adequately treated and often cured by a modified approach removing the breast only, while preserving the muscles in the chest and dissecting the lymph glands in the arm pit only when the risk of metastasis is high. This to me seems like a much more “middle-ofthe- road” approach, avoiding the extensive mutilation and more serious
complications of the radical surgery commonly performed.

BENIGN TUMORS

2008-04-26T00:25:00.000-07:00

Benign tumor growths, although not true cancers, share some of their same characteristics, such as viral causation, transformation of cells, and autonomous growth. A number of specific viruses are known to cause benign tumors. They are by far the most common of any new growths a person might have.
Warts are benign tumors that occur in almost any location. They are very common on the hands. However, in spite of folklore rumors, they are not caused by handling frogs! A wart virus penetrates the skin and transforms dermal cells causing this unusual growth. When it occurs on the sole of the foot, around the nail beds, or in the genital organs, it may be difficult to eradicate, even quite painful.
Warts can usually be frozen with liquid nitrogen, or may be removed chemically, such as with strong acids. Many physicians prefer to destroy the wart with an electric current (cautery) after appropriately anesthetizing the skin. Many of these can be successfully frozen or removed at home, if appropriate antiseptic precautions are observed.
Skin tags and papillomas are growths that protrude from the skin or mucous membrane. Some of these can be tied off with a strong silk string, while others with a larger base require local excision, freezing technique, or chemical cautery. Soft lumps of varying sizes under the skin are often lipomas, fatty tumors that usually develop autonomously in the fatty tissue beneath the skin. Sometimes for cosmetic reasons these are removed by a simple surgical procedure done under local anesthesia. Fibrous tumors (fibromas) and various types of moles also can be removed to prevent cosmetic blemish, irritation, or the avoidance of further growth.

Anaphylactic Shock

2008-03-20T14:11:00.000-07:00

Anaphylactic shock is a highly dangerous allergic manifestation that occurs when an individual has an immediate life-threatening reaction to contact, ingestion, or injection of an allergen. This rarely occurs with food allergy, but is most commonly associated with drugs. Penicillin injections have periodically produced this severe type of anaphylactic shock.
Stings from hornets, honey bees, bumblebees, and yellow jackets in sensitized individuals can provoke anaphylactic reactions. Even inhalation of allergens, such as antibiotic powder, or caster bean flour, may cause anaphylaxis.
Symptoms occur within seconds to minutes after the substance enters into the body, when precipitous drop in blood pressure occurs. Frequently there is difficulty breathing, profuse sweating, and sudden generalized vascular relaxation that causes faintness. In fatal cases stoppage of the heart or respiration follows.
Prompt emergency resuscitative measures are necessary to save the life of a victim in anaphylactic shock. Subcutaneous injection of adrenalin in the appropriate dosage (based on body size) is life saving in such a situation, while general first aid measures involving adequate airway, artificial respiration, and closed chest cardiac massage are instituted. Increasing
anaphylactic cases of this nature has brought physicians to adopt a more conservative attitude in the administration of antibiotics by injection. Bee sting allergy kits are available for those sensitized individuals who live with this ever present threat of danger.

Food Allergies

2008-03-18T14:03:00.000-07:00

There is probably no area more controversial and perplexing as suspected allergies connected with food. These range from sensitivity to food additives, such as coloring, preservatives, and other foreign chemicals, to plant sources, to actual hypersensitivity to protein and other constituents of fruits, grains, nuts, vegetables, or animal foods. Careful detective work and long-term adherence to dietary regimens are frequently necessary to first diagnose and then live with food allergies.
It is my belief that the stage is set for many food allergies by feeding patterns in infancy, such as the early introduction of solid foods, the widespread use of cow’s s milk in prepared formulas, and the relative lack of mother interest in prolonged breast feeding. Maternal use of drugs which
sensitize the babies in utero or during the breast-feeding period can also prepare the way for allergic responses to develop.
The most common allergy that occurs in infancy is a sensitivity to cow’s milk. This is often manifested in diarrhea, unusual regurgitation, excessive gas or colic, or a “failure to thrive.” Usually a change to soymilk formula if breast feeding is not available will stabilize the situation, although rarely more restricted and specific formulas have to be devised.
A majority of the black and oriental races and lesser percentages of Caucasians are sensitive to cow’s s milk even in adult life. This, however, is due to the deficiency of lactase, an enzyme which helps to split milk sugar (lactose) and render it available for absorption. Diarrhea, excessive gas, and an acid stool are produced. Simply abstaining from milk is curative. You must always suspect the diagnosis in order to apply the proper remedy at once, thus removing the cause.
Other people are truly allergic to the proteins of cow’s milk and find unpleasant symptoms, such as frequent sinus or nasal congestion, related to the intake of milk. Please note, however, that skin scratch tests for food allergies are notoriously unreliable as indicators of an individual’s s sensitivity to the eating of these foods. It appears that the skin is just not a parallel indicator with the gastrointestinal tract. The only way to be certain in diagnosing food allergies is through trying an elimination diet.
Next to milk as a cause of allergy, chocolate and wheat lead the list. Usually the grains are less common allergens, but berries (such as strawberries), nuts, shellfish, eggs, and many other foods can produce similar symptoms. It is believed by some that symptoms resembling hypoglycemia,
such as episodic weakness and certain mental aberrations (anxiety, panic attacks, depression, etc.) may be related to food allergies. It must be acknowledged, though, full proof is lacking to completely confirm this theory as yet. Nevertheless, eliminating the offending food, then gradually progressing from a limited diet to a more liberal intake of varied foods will help bring a return of health and strength, with fewer physical symptoms and more emotional stability.
Sulfites are added to foods to serve a variety of purposes. They preserve food by killing bacteria and yeasts. They retain color and apparent freshness by acting as antioxidant. They may also be used to sterilize containers and arrest fermentation in alcoholic drinks. The label may contain any of the following listings, all various types of sulfites: sulfur dioxide, sodium sulfite, sodium bisulfite, potassium bisulfite, sodium metabisulfite and potassium metabisulfite. Many people are allergic to sulfites, reacting with skin rash or asthmatic wheezing.
Carefully test for allergies with a medically approved method. RAST (Radio Allergo Sorbent Test) testing offers an easy way to evaluate the blood for immediate immune reactive (IgE) factors. The more definitive, though expensive, ELISA/ACT TM (Enzyme Linked Immune Sorbent Assay / Advanced Cell Test) measures both immediate and delayed responsiveness to over 300 foods and environmental chemicals. Additional detailed evaluations, however, may require a period of observation and careful dietary therapy in a sanitarium or preventive lifestyle institution to isolate specific factors or undertake dietary trials.

Hives, or urticaria, is a very common manifestation of hypersensitivity

2008-03-16T05:30:00.000-07:00

The disease itself is manifested by the sudden appearance of reddened areas, which rapidly become welts, being distributed generally over the body or localized to the face, neck’s or extremities. Intense itching is usually present. The lesions often migrate and change their appearance rapidly. The rash, however, usually does not blister or weep unless scratching has abraded the skin and allowed the entrance of germs.
Food allergies can sometimes cause hives. Very frequently an allergy to strawberries, shellfish, or some less common food can trigger a sudden onset of this rash. Reaction to substances such as wheat, milk, or eggs is more rare. It is necessary to avoid the food if one wishes to eliminate the symptom.
Several drugs can also cause hives. This condition is usually termed a drug allergy. The most common producers of this drug reaction are Penicillin and related antibiotics. Sulfa drugs and pharmaceuticals from nearly every major class of medicinal agent can produce an urticarial reaction in the sensitized individual. Babies seldom get hives unless a drug has been present in the milk or they have had previous exposure. But it is frequently seen in children and adults
with no particular preference as to age, sex, or race. The result of stress at both conscious and subconscious levels may trigger a sudden onset of urticaria. However, in up to 50% of the cases the exact source cannot be detected with certainty. It is very worthwhile to look for the cause, however, and consider any substance that is inhaled, ingested, or contacted by the skin
as a possible factor to exclude.
Treatment of hives should first begin with reassurance. This condition is self-limited and is usually neither life threatening nor contagious. The intense itching can be relieved considerably by cool baths with the addition of one cup starch or oatmeal powder (Aveeno), or alternately using 1/2 cup baking soda. Lotions may be helpful to reduce the symptoms. Try ice packs for local lesions. Antihistamines seem to counteract the reaction, but usually are not necessary as the condition commonly disappears within hours.
An exception to this may occur with bee sting allergy. If an individual is highly allergic to the sting of a honey bee, wasp, hornet, or yellow jacket, the reaction with hives will be immediate and generalized. Not only should ice and/ or moistened charcoal be applied to the site of the sting, but in emergencies the administration of adrenalin or a similar substance is necessary to prevent rapid progression into the swelling of the respiratory passages or the sudden development of shock. Since bee sting hypersensitivity can be lethal, careful diagnosis and prompt treatment is essential. Moreover, in such cases, desensitization injections can permit greater freedom in outdoor life and remove the fear that often grips parents as well as children who live with this threat of danger.

Hay fever or allergic rhinitis is a hypersensitivity disease involving the nose and sinuses

2008-03-14T05:24:00.000-07:00

Hay fever or allergic rhinitis is a hypersensitivity disease involving the nose and sinuses, The mucous membrane becomes inflamed in response to an allergic substance and produces a watery, profuse discharge associated with increased tearing, itching of the eyes, and sneezing. This condition is usually seasonal, with the peak incidence corresponding to the presence of the offending allergenic inhalants. Pollens of trees, grasses, wildflowers, and other weeds are the most common culprits in producing this allergy. Some people are affected by danders, the particles produced from the skin of animals or hair from cats, dogs, horses, etc. House dust, molds, feathers, and even certain foods can produce hay fever. The appearance of the inner mucous lining of the nose is usually pale and thin, as opposed to upper respiratory infections where the mucus becomes thick, and the mucous membrane reddened and swollen.
Usually it is quite helpful for the allergy sufferer to know and identify the offenders. Scratch tests are usually helpful in evaluating the type of sensitivity. Intradermal injections are more commonly done by ear, nose, and throat specialists or allergists. However, the simpler and less expensive scratch tests are usually sufficient to establish the cause and initiate desensitization therapy. Recent advances in the use of allergy shots have allowed a more rapid desensitization procedure that is replacing the traditional year-round technique. The hay fever sufferer will find relief from the plentiful use of tissues, by placing cool compresses over the nose and sinus areas. Frequent nasal irrigation with cool saline (sniffing or spraying the salty solution) will help remove entrapped pollens and other particles, and clear the nasal passages of the allergy—producing substances. When the allergy is due to Bermuda grass or ragweed, activities outdoors such as yard work and lawn mowing may require the use of a mask. An appropriate respiratory filter can trap these pollens and minimize the symptoms, while still allowing work outside. Botanical identification of certain plants, such as ragweed, goldenrod, and various trees, grasses, and wildflowers will interest the pursuit of further nature study, while cautiously avoiding fields and forests where the prime offenders abound.
The chronic use of antihistamines and nasal sprays is to be discouraged, as side effects are frequent and troublesome. Excessive drowsiness, disturbance of digestive secretions, and the “rebound phenomenon” associated with nasal reaction to decongestants are all avoidable with this emphasis on natural remedies. Further attention to the diet, or in unusual cases, the relocation to a different climate may be necessary to bring hay fever and its troublesome symptoms under control.

Asthma,This allergic disease of the respiratory system primarily affects the lungs

2008-03-12T05:14:00.000-07:00

This allergic disease of the respiratory system primarily affects the lungs. At the end of each tiny air tube that reaches the lung is the alveolus, where gas exchange occurs. Here oxygen enters the red blood cells to be exchanged for carbon dioxide, which is then exhaled. The bronchial tubes that form the large and small air passages have a smooth specialized muscle in them that constricts under certain conditions. In contrast, with the smooth muscle of the artery walls, these bronchial muscles dilate in response to adrenalin and constrict in the presence of histamine as well as other chemical mediators of allergies. A condition described as bronchial asthma occurs when there is spasm of the bronchial tubes, leading to obstruction in the airway. Usually there is also excess mucus accumulation and thickening of the mucus’s making it more tenacious and difficult to clear.
The asthmatic patient, then, primarily has an air hunger, with musical wheezes in the lung. These can be heard easily with a stethoscope over the chest and in more severe asthmatic crises becomes audible to the unaided ear. A number of conditions can produce these symptoms. There are certain drugs that can create an allergic reaction, as well as many industrial inhalants that irritate the lungs. A few people react to food allergies with the production of asthma’s though this is less common. Most frequently, the asthmatic sufferer reacts to inhaled particles in the air, called allergens, which may be of a biologic nature or inanimate particles. House dust is an example of the latter. Danders from cats, dogs, horses, feathers, or down also can produce wheezing. Commonly seen in the spring, summer, and fall are allergies to various inhaled pollens. Although some people primarily suffer from hay fever, others are affected in their lungs. The inhalation of pollens, such as those from pine trees in the spring, wildflowers in the summertime,
ragweed or goldenrod in the fall, may produce characteristic responses. These are related to the number of particles inhaled and the efficiency of the nasal filtering mechanism. Emotions can also trigger allergies. I remember vividly the experience of a teenage girl who suffered a violent asthma attack in a hospital when she remembered with nostalgia her dear pet cat at home alone! Moreover, numerous infections in the lung are seen in conjunction with asthma. These are usually termed asthmatic bronchitis. Frequently seen in childhood, they are often associated with an upper respiratory infection. A physiologic approach to asthma then involves several factors. The secretions should be thinned with a copious fluid intake’s preferably by the oral route. Inhalations of cool moist air can often help in the clearing of secretions and the thinning of this very sticky mucous material. Gentle coughing assists in expelling of the mucous plugs, but this should be done in combination with the inhalation of humidified cool air. The use of a stem vaporizer is to be discouraged, as this often adds to the swelling and edema formation in the bronchial tubes. Hydrotherapy is important in the treatment of asthma. Often the adrenal glands can be stimulated early in the disease by a quick ice rub to the spine in the upper back, associated with brisk tapping (percussion) over the adrenal area. This stimulation of the sympathetic nervous system results in the discharge of enough adrenalin to counteract the acute effects in beginning stages, as well as induce dilation of the bronchial tubes.
Prolonged hot packs to the chest can sometimes be effective in relaxing both the respiratory muscles and the patient’s s nerves. This must be repeated several times, and will often abort the acute asthmatic attack and eliminate the need for medication. Inhalation therapy with the use of bronchial dilators and theophylline derivatives are often used in a hospital setting. Sometimes mullein tea or other teas containing theophylline can be used with some effectiveness to further aid in combating the bronchial spasm. As in any disease, a thorough attempt to discover the cause’s then as far as possible eliminate it’s will reward the asthmatic sufferer with an increase of comfort and removal of those conditions that progresses in the advanced case too often leading to emphysema.

Evidence on the Role of the Mediterranean Diet as a Whole in Longevity

2008-03-11T03:27:00.000-07:00

In a study undertaken in Greece, an overall nutritional score describing the traditional Mediterranean Diet and particularly the Greek version of it, and based on the eight characteristics of this diet, was a priori defined. The investigators reported that adherence to the traditional diet, as reflected by the nutritional score, favorably affected life expectancy among elderly people. Furthermore, when the individual components of this score were examined, they had weak and generally nonsignificant associations with survival, in contrast to the overall score, which had a substantial and significant effect. The favorable effect of the Mediterranean Diet on the survival of the elderly, assessed again through a score based on the eight characteristics of
this diet, was also shown in a study conducted in Spain.
Results of studies of the Mediterranean Diet in Mediterranean populations, however, may be confounded by the likely association of adult diet with early life nutritional patterns and culture-specific psychosocial variables such as social support. A study performed in Denmark, however, provided similar results, and so did a study examining the diets of Greek-Australians and Anglo-Celt Australians.

Fish , Cereal and Legumes on mediterranean Diet

2008-03-10T03:23:00.000-07:00

Fish

Though fish consumption varied widely both between and within Mediterranean countries, fish was by far preferred over meat in the traditional Mediterranean Diet. Fish consumption is associated with reduced coronary heart and cerebrovascular mortality, though a recent review of cohort studies suggests that the effect is more evident among high-risk groups only.A possible mechanism is the beneficial role of n-3 fatty acids on blood clotting and triglyceride levels.

Cereals and legumes
Cereals form the basis of the Mediterranean Diet pyramid and legumes are listed among the important compounds of diet in the Mediterranean region. Overall, there is substantial epidemiologic evidence that whole grains are associated with decreased risk of coronary artery disease and some cancers. The role of legumes in these diseases appears promising, but is as yet inconclusive, although it appears that frequent consumption of legumes and derivatives is associated with reduced levels of LDL cholesterol in the blood. Complex carbohydrates derived from whole wheat bread, other cereal products, and legumes, which are plentiful in the Mediterranean Diet, are only weakly conducive to postprandial hyperglycemia, which could be
important in the pathogenesis of metabolic and other diseases.

Olive oil ON mediterranean diet

2008-03-09T03:18:00.000-07:00

By definition, olive oil is a central component of the diet in the Mediterranean basin. The Greek version of the Mediterranean Diet and, to a lesser extent, the other versions of this diet, are dominated by the consumption of olive oil. Olive oil is the only vegetable oil obtained from whole fruit rather than from seeds. As compared with other vegetable oils, olive oil has a peculiar fatty acid composition (percentage (mol/mol) of methyl esters): oleic acid (56.0–83.0), palmitic acid (7.5–20.0), linoleic acid (3.5–20.0), stearic acid (0.5–3.5), palmitoleic acid (0.3–3.5), linolenic acid (0.0–1.5), myristic acid (0.0–0.05), and other fatty acids in minute amounts. Olive oil also contains, in total concentration of about 2% of the oil, several other minor compounds, among which tocopherols, carotenoids, and phenolic compounds have powerful antioxidant properties.Extra virgin olive oil is particularly rich in phenols.The exact mechanism of action of flavonoids and other polyphenols has not been established, but they are believed to act as free radical scavengers that may play a role in forfeiting some early steps in the carcinogenic process.
There is converging evidence that olive oil conveys some form of protection against breast cancer as well as data suggesting that olive oil may reduce the risk of endometrial and ovarian cancers.A recent report indicates that monounsaturated lipids, mostly from olive oil, is associated with a statistically significant decrease in the risk of sporadic colorectal cancer with wild-type ki-ras genotype. With respect to cardiovascular diseases, it has been established that monounsaturated lipids, the main type of lipid in olive oil, affect HDL cholesterol more favorably
than do polyunsaturated lipids, and substantially more favorably than do carbohydrates, making olive oil an optimal energy-generating nutrient.Furthermore, vitamin E, which exists in olive oil, has been reported to reduce the risk of CHD.
The antioxidant activity of olive oil has been clearly demonstrated in vitro and it is likely that the responsible compounds also block oxidation of low density lipoprotein (LDL) cholesterol, the preeminent risk factor for atherosclerosis. Finally, with respect to other chronic conditions, a study from Greece suggests that consumption of olive oil-derived monounsaturated lipids may increase bone mineral density and reduce the risk of osteoporosis.

Vegetables and fruits oN the Mediterranean Diet

2008-03-08T02:58:00.000-08:00

Consumption of vegetables and fruits has been systematically found to reduce the risk of most forms of cancer, although the responsible compounds or processes have not yet been established. High consumption of vegetables and fruits is typical among Mediterraneans and helps explain the relatively low incidence of several forms of cancer in the region. Some of the earliest studies demonstrating this inverse association have been reported from Mediterranean countries, particularly from Greece, where the consumption of vegetables has been and remains exceptionally high. Thus, in 1983, it was reported that high consumption of vegetables and, independently, low consumption of red meat substantially reduce the risk for cancer of the large bowel. Two years later, the results of another study indicated that individuals consuming high quantities of raw vegetables and citrus fruits, as well as whole-grain bread, were less likely to be affected by cancer of the stomach. Another study from Greece21 was the first to point out that consumption of vegetables was inversely associated with breast cancer risk, an association that was later confirmed by several researchers. The connection was also noticed in a larger investigation in Greece.A protective effect of vegetables and fruits against cancer of various sites
has been documented in a number of epidemiological studies in the Greek population.
An effect of fruits was more evident with respect to lung cancer,whereas crude fiber, mostly from vegetables, was the discriminatory protective agent in studies of ovarian and pancreatic cancers.Fruits and vegetables were also the only food groups inversely associated with cancer of the endometrium and adenocarcinoma of the esophagus, although these associations were not always significant. It should be pointed out that, in most of the previously mentioned studies,
the associations with particular micronutrients, including ß-carotene and vitamin C, were generally not as strong as those with vegetables and fruits as a whole. The protective effect of vegetables and fruits against malignancies of various sites has also been documented in a series of case-control studies conducted in Italy. The results of these studies are summarized in a review by La Vecchia and Tavani,who point out that the association is generally most marked for epithelial cancers, apparently stronger for those of the digestive and respiratory tracts, and somewhat weaker for hormone-related cancers. Studies conducted in other parts of the world have also supported a protective role of fruits and vegetables against different forms of cancer.
In fact, such associations represent the main thrust of nutritional epidemiology of cancer.
With respect to cardiovascular diseases, studies in Greece have also provided evidence that high intake of total carbohydrates and crude fiber, reflecting a high intake of vegetables and fruits, is beneficial against atherosclerosis, as manifested in peripheral arterial occlusive disease and CHD.These findings have been supported by the results of other large and sophisticated investigations, and are compatible with a generalized beneficial effect of a diet rich in antioxidant substances.
They could, however, also be explained in terms of the homocysteine hypothesis. Recently, accumulated evidence on the deleterious role of plasma homocysteine levels on CHD risk, provides solid biologic foundation for the inverse association between consumption of vegetables on the one hand, and CHD and peripheral arterial disease on the other, as homocysteine levels are reduced by folic acid, which is found mainly in vegetables.

Musculoskeletal Pain

2008-03-07T04:40:00.000-08:00

Pain involving the ligaments and muscles is often seen in athletic injuries. When the ligament is torn, the injury is called a sprain. This often occurs in the ankle, the knee, the low back, or shoulder. Muscles that are bruised often become painful and when the injury is considerable, that is called a strain. These small ligaments and muscle fibers may actually be torn, but heal without any residual weakness, after a short period of rest. Inflammation of the bursa (bursitis) may occur as the result of trauma, arthritis, infection or other disorders. Common locations include the shoulder, hip, knee, elbow and heel. Severe local pain and tenderness is often present. Sometimes calcium deposits are seen on x-ray. Immediate application of cold in the form of snow or an ice bag is one of the most helpful remedies, followed by mild exercise and gentle hot and cold compresses, after the acute inflammation subsides.
The tendon sheath of the hand or wrist may become inflamed, Some of these are due to constriction of tendons or nerves, and may require surgery. In the wrist this is called carpal tunnel syndrome. Others are seen in conjunction with rheumatoid arthritis, discussed in chapter five. A number of metabolic problems can produce skeletal pain, muscle cramps, or deep visceral pain. The sudden restriction of oxygen supply, disorders of the adrenal glands, and the so-called autoimmune diseases, may produce severe weakness or muscle pain.
Three forms of vascular obstruction particularly deserve mention. Arteriosclerosis of the large and medium sized arteries is the most common vascular disease of man. This often leads to pain in the muscles, particularly in the legs induced by exercise (intermittent claudication). Diabetic patients are particularly susceptible. Often the pulses in the lower extremities are reduced.
Changes occur in the skin with hair loss, deterioration of the nails, and even gangrene. Buerger’s disease (thromboangiitis obliterans) is a disease of young and middle-aged male cigarette smokers. This hypersensitivity to tobacco produces spasm in the small vessels of the hands and feet. Sometimes a smoker is so addicted to nicotine, that he continues to pursue the habit, in
spite of progressive gangrene and amputation of fingers, feet, legs, and even hands. I have often seen these unnecessarily handicapped patients suffering the terrible sequels of nicotine addiction. Raynaud’s disease is often caused by cold. Women are most commonly afflicted. With exposure to cold, their fingers become white, then blue, and finally red. Pain and tingling are common during this crisis, due to the lack of blood supply. Exercising by whirling the arm in a windmill motion can help to bring blood to the involved areas. Another occupational complication of a similar nature may produce ulceration in fingertips or toes. These are more commonly seen in smokers and those with auto-immune disorders. Obstruction of the lymphatic return may produce a type of edema, associated with pain. Also, thrombosis of the veins is usually painful,
involving the overlying skin with redness and swelling. When larger veins are involved, the muscle and entire extremity is very painful. Most of these pain syndromes can be approached effectively by the intelligent home health observer. With a knowledge of anatomy and
physiology, and a few simple remedies, they can bring relief to many cases. It is important first to ascertain the cause of these pain responses. Wrong habits may need to be corrected. Then nature is assisted in her efforts to restore right conditions within the nerves, muscles, and other involved organs. The relief of pain will always evoke profound gratitude from chronic sufferers. Its study can challenge the layman or specialist for at least a lifetime.

BACK PAIN

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Pain in the lower back, as well as the neck is very common in America. Many related, but distinct conditions can produce discomfort here. Disease of the spine, although less common than other problems, is often related to injury. An auto accident or sudden fall, causing acute flexion of the back, may compress and fracture one of the vertebral bodies. It may be an early sign of osteoporosis, thinning of the bones due to calcium deficiency. X-ray is often necessary to diagnose this condition accurately. Immobilization on a straight board, with the avoidance of any flexion, standing, or walking is extremely important First Aid in dealing with these acute injuries. Braces, which keep the back in extension, are often worn for several months in the treatment of a fractured spine.
Local pain in the low back can be caused by any process, which irritates nerve endings. Straining of the muscles, protrusion of a disc, rupture of a ligament, and many less common problems can injure the tissues and aggravate this pain. Tenderness is usually found upon pressure in the region involved. Associated muscle spasm may produce pain around the involved area. At times, the pain may be referred or projected into regions lying in the area of the associated nerve roots. For example, pain produced by diseases in the upper part of the lumbar spine is usually referred to the front of the thighs and legs. That from the lower part of the lumbar spine, is referred to the buttocks, posterior thighs, and calves. Radicular or root pain has some similar characteristics, but usually is much more intense and is often aggravated by a cough, sneeze, or strain. Any motion, which stretches the nerve, such as straight leg raising, may have a similar effect.
Proper examination of the back is an art requiring considerable knowledge of muscle, nerve and skeletal anatomy. Often tenderness over the lumbosacral junction, the sacroiliac joint, the costovertebral angle over the kidneys, or a specific vertebra can help the examiner in accurate diagnosis. The usual testing of the blood, urine, and x-rays of the back are often adjuncts in understanding the cause. Appropriate exercises may then be used, together with rest or the use of moist heat in bringing relief to all but the most stubborn condition. Special problems may be treated effectively in a lifestyle center.

ABDOMINAL PAIN

2008-03-06T02:34:00.000-08:00

The correct interpretation of acute abdominal pain is one of the most challenging demands made of any physician. Sometimes proper therapy requires urgent action. A great deal of experience and judgment is needed to elucidate the cause.
A number of mechanisms can produce abdominal pain. Inflammation of the lining of the abdomen (peritoneum) can produce pain of steady, aching character. This pain is usually located directly over the inflamed area and the area will also be quite tender. Release of a small amount of stomach acid will cause much more pain than even contaminated intestinal contents will when
the appendix ruptures.
Another type of pain occurs in the distention or obstruction of hollow organs. This is usually intermittent or cramping in nature. Colic in the abdomen can be produced from obstruction of bile duct, the gallbladder, the ureters, or the intestines. Since all of these may cause vomiting, the location of the pain and other related symptoms must be considered in arriving at a rapid diagnosis. Finally, it is important to consider the blood vessels in the abdomen as causes of potential pain. An out pouching of the aorta (aneurysm) may produce pain, developing slowly, increasing gradually, or in a sudden rupture, may become quite catastrophic. Abdominal angina occurs when the vascular supply to the intestines becomes clogged with cholesterol deposits and this pain, similar to the angina pectoris of the heart, occurs following a heavy meal.
Referred pain from the chest, the spine, or the pelvic organs, may also make diagnosis difficult. Compression or irritation of nerve roots in the spine is usually intensified by coughing, sneezing, or straining. Pressure on the genital organs will usually be very painful and show the origin immediately of this referred pain. Respiratory origin is usually indicated by obvious interference with breathing.
It is important to become acquainted with the clinical pictures of these various abdominal problems. Knowledge of anatomy of abdominal organs, as well as their function is essential in understanding abdominal pain. Some types can be treated safely at home. In these cases, moist heat and temporary abstinence from food is often helpful. There are conditions requiring surgical
intervention. Basically keeping in mind these possibilities will help an individual to seek a physician promptly at the appropriate time while avoiding unnecessary dependence on drugs or expensive diagnostic testing in the more self-limited and trivial conditions.

CHEST PAIN

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There is very little parallel between the severity of chest pain and the seriousness of its cause. A frequent problem exists in distinguishing trivial disorders from coronary artery disease or other serious health hazards. It is important to avoid the long tradition now shown to be myth, that pain beneath the left breast or radiating into the left arm is always of cardiac origin.
Such pain is often observed in patients who are tense, easily fatigued, or anxious.
Oxygen deficiency of the heart muscle can produce pain. This is the syndrome medically termed angina pectoris. When the oxygen supply is deficient in relation to the need, pain will develop in the heart muscle. This may be aggravated by exercise, or occur during a stressful situation, or after a heavy meal. Atherosclerosis (narrowing) of the coronary arteries is the most common cause. Spasms of the small cardiac vessels may also trigger this pain (angina), which usually subsides with a short rest.
Pain in the esophagus usually results from acid irritation of the lining (mucous membrane) of the esophagus. Spasm of the swallowing muscles or the presence of obstruction can also produce this deep chest pain. Accompanying symptoms of difficult swallowing, regurgitation, and weight loss direct attention to the esophagus. Pain in the pleura or the lining of the lung is very common. It results from stretching of the inflamed membrane and occurs in viral, as well as bacterial, pneumonia. Sometimes air in the chest cavity (pneumothorax) and tumors can mimic this type of pain. Inflammation of the outer covering of the heart (pericarditis) can also produce it. It is usually aggravated by coughing or deep breathing. Sometimes swallowing or a change in bodily position produces the same type of pain, Applications of moist heat and rest are important in the relief of these deeper pains.
Tension is also a common cause of chest wall pain. Usually the discomfort is experienced as a sense of tightness, sometimes called aching. It may occur on various occasions and in different areas of the chest, and is usually associated with fatigue or emotional strain. It is important to distinguish these and the above categories of chest pain from various abdominal problems,
some of which are described below.

TENSION HEADACHE

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This type of headache usually occurs over both sides of the head and often settles at the base of the neck. A fullness, tightness, or pressure is often described. Sometimes these headaches show the peculiarity of being continuous day and night for long periods of time. Sustained muscle tension, as well as vascular changes may be involved. Sometimes a similar headache may follow injury (auto accidents, head trauma) and gradually resolves over many months.
Simple remedies may be used with success in the treatment of headache. A person should lie down in a quiet area, apply a cold compress to the head, and seek to put the mind at rest. Often a drink of water or mild nerve-calming tea such as catnip or chamomile tea can relax the person until the headache passes. More severe types of headaches can be treated with the hot foot bath.
This is described in the section on hydrotherapy. Adding mustard to the foot bath may also bring relief through acting as a counterirritant as well as pulling blood to the lower extremities (called derivation) to relieve congestion in the head. Extra hours for sleep, daily nature walks, or a change of pace may be needed. General hygienic recommendations for a more healthful diet, systematic exercise, and improved stress control are valuable preventives.

MIGRAINE

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The term migraine refers to periodic, throbbing headaches on one side of the head, which usually begins in childhood or adolescence, and occur with diminishing frequency during advancing years. Sometimes, along with the headache, nausea and vomiting may actually disable the affected individual for several hours each time the migraine occurs. Some variations are seen. Many are forced to lie down and to shun light and noise for what they call a “sick headache.” Other milder forms do not require withdrawal from accustomed activities. Between attacks the migraine sufferer is essentially normal. In fact, the headache seems to be brought on during the “let down” period after many days of hard work or stress. Spasm in the blood vessels has been implicated
and many powerful hormones are often released that perpetuate discomfort
for several hours.

HEADACHE

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The term headache encompasses all aches and pains associated in the head. Along with fatigue, hunger, and thirst, headache represents man’s most frequent discomfort. It must always be kept in mind that headache is a symptom, not a disease, and its cause should always be ascertained. Some types of headaches are quite easy to diagnose. Infection or blockage of sinuses is usually accompanied by pain over the sinus area and in the forehead. It is often associated with tenderness of the skin in the same area.
Sometimes the head seems to throb. Often headaches tend to return at the same hour of the day. Headache originating in the eye is usually located near the eye or in the forehead. It is of steady, aching type and tends to follow prolonged use of the eyes in close work. Muscle imbalance is often involved. A careful examination of the eyes by your doctor is recommended.
Headaches accompanying diseases of the ligaments, muscles, and joints in the upper spine are usually referred to the back of the head and nap of the neck. Later in life, these pains are seen frequently in arthritis and also tend to occur after whiplash injuries. Massage very deeply in the area and you may disclose the presence of tender nodules near the insertion of the neck muscles.
Moist heat, as well as skillfully performed massage is particularly helpful in relieving this type of pain.
The headache of irritation in the meninges or coverings of the brain, is usually of an acute onset and becomes severe, deep seated, and constant. Usually this occurs in conjunction with fever. Whenever the neck becomes stiff, immediate consultation with a physician is recommended. Both meningeal infections or brain hemorrhages can cause this type of pain. Lumbar puncture in about 20% of normal patients may produce a transient headache. Usually this is relieved in the lying position and subsides after a few days.

LABORATORY TESTING

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Most laboratories today require requisitions from a physician to run various tests. New self-care home kits are now available for many screening tests, which can be done at home. Some of these are as follows: pregnancy test, blood cholesterol, blood glucose, and stool testing for occult blood. The latter is useful to periodically evaluate possible blood loss, as well as causes for anemia. Urine testing for protein or sugar, and fasting blood sugar measurements, are good screening tests for diabetes. These tests can be done on a group basis at health fairs, and for a considerably reduced cost.
Cholesterol and triglyceride evaluations are periodically performed in coronary screening programs, and occasionally, it is possible to secure chest x-rays, electrocardiograms, and even treadmill tests from public health groups or private groups screening for cardiovascular disease. Sometimes the YMCA, religious camp meetings, or special health fairs in shopping centers will provide these tests at a very reasonable cost. Cooperative physicians may provide other laboratory determinations in the case of acute disease.

How The Skin Works

2008-03-02T00:34:00.000-08:00

The largest organ of the body is the skin. Some writers have called it “keyboard of the hydrotherapist.” Through the numerous blood vessels and nerves of our skin, and their reflex connections with the internal organs, practically every organ of the body can be influenced by applications of heat or cold to the skin surface. Small muscle bundles are found in the dermis, connected with the hair follicles. Contraction of these arrectores pilorum muscles cause the hair to stand erect, producing a peculiar roughness of the skin known as “goose flesh.” Applications of cold or sensations of chilliness can bring this condition. With cold, the skin also becomes blanched, as blood squeezes out of the vessels by this muscular contraction. An enormous network of lymphatic vessels, veins, and capillaries is present. These tiny tubes that constantly convey fluid back to the heart contain thousands of valves and nerve fibers. This gives them the ability to
shift blood flow from one area to another.
Several times a minute, changes occur in the diameter of our blood vessels. As they contract and become smaller, blood is forced onward. During the relaxing or dilating phase, they fill with blood. This “pumping” action is another powerful factor in the circulation of these vital fluids. It is sometimes called the “peripheral heart.” Circulation slows when the nerve control of these vessels is interfered with, and the extremity becomes dusky in color and cold. Paralysis succeeding a stroke, infectious diseases, and even emotional problems can alter the flow of blood in the skin. This adds to the burden on our heart, making it work under a disadvantage. Contrasting temperatures of hydrotherapy treatments produce powerful circulatory reactions, which enhance these rhythmic changes and alternating contractions in the blood vessels of the skin. Massage also aids the return of lymph to the heart, and briefly empties the veins when it is done properly. Movement of a limb by active exercise likewise enhances the circulation. Since the body weight is 1/13 blood and about1/4 lymph (interstitial fluid), a large amount of fluid can be affected when hydrotherapy applications are given. Results are seen in the body as a whole.
Sweat glands are found throughout the entire skin, but are especially numerous in the underarms (axillae), the palms, and the soles. It is estimated that 1 square cm. of skin on the palm may have about 3,000 of these tiny “mouths.” Estimating the total surface of their ducts at 11,000 square feet, it appears obvious that this secretory function is of considerable importance.
Sweat is about 98% water, but contains small traces of impurities, which are thrown off from the skin. It also contains assorted salts, such as sodium chloride. About twice as much water is excreted by the skin as the lungs give off each day! When the excretory function of the kidneys is diseased, the sweat becomes loaded with toxins. Unfortunately, the sweat glands may also be diseased when kidney afflictions are of long duration. To encourage free perspiration during a hydrotherapy treatment, it is appropriate to drink water before and during the applications. Hot drinks are very helpful. An environment that is warm, comfortable, quiet, and free of stress is likewise beneficial.
Certain diseases produce such alteration in the ability of sweat glands to eliminate heat that extreme precautions must be made in giving these treatments. Extensive burns may destroy the skin nerves and abolish normal reflexes that occur in response to temperature. Alcohol intoxication may obliterate the response to heat, making heat stroke a distinct possibility if appropriate precautions are not taken. Reflex effects on distant organs are also influenced by damage to nerve endings in the skin. The perception of heat and cold, our control of circulation, and the beneficial effect derived from hydrotherapy treatments may be compromised in numerous diseases. Careful observation and study are essential, along with medical consultation
where indicated.

TYPES OF THERAPY

2008-03-01T02:08:00.000-08:00

In the privacy of your home, there are several types of therapy that deserve particular attention. Naturally, it is our instinctive tendency to look for the simplest way of getting well. Often people resort to drugs in an attempt to cure themselves, only to find that the drug has changed the form and location the disease, producing new symptoms or complications that might even be worse than the original disease. Furthermore, the expense of drugs, together with their long term risk are reason for great caution in their use by the home health practitioner.
Diet is an extremely important type of home treatment. In case of illness, the patient’s diet should be simpler than is usually eaten. Sometimes a fruit fast for a few days will help a person recover without a grain of medicine.
Juices have a more limited place. Sometimes skipping a meal and drinking water or fruit juice will allow nature a chance to build up defenses against the invader. This should be done at mealtimes, not drinking juices all through the day.
Herb teas have a valued place in healing. Hence, a special chapter is being devoted to their use. Medicinal teas are usually prepared by mixing one teaspoon of the herb in a cup of boiling water and allowing it to steep for three to five minutes, until the tea is ready. The herb is strained out before drinking. Other herbal beverages made with parsley or comfrey, create the so called “green drink,” which is popular in health food stores today. There are many common symptoms that can be treated safely with herbs, making it unnecessary to consult a physician nearly as often as we do these days.
Hydrotherapy seems to be the most neglected home remedy. These treatments involve the use of water, and include such remedies as the hot half bath, cold shower, cold mitten friction, contrast bath, the heating compress, and other therapies discussed in chapters devoted to the specific treatments. Hydrotherapy offers a powerful technique of shifting the circulation in your
body. Its purpose is to decongest certain areas, then improve the ability of an organ to fight infection and overcome any invasion of germs. Perfect health depends upon perfect circulation. Water therapy is one of the most valuable ways to achieve this goal.
Exercise is also a valuable remedy in the treatment of many diseases, particularly those of degenerative nature. The chapters on heart disease, vascular disease, respiratory problems, and nervous disorders will particularly contain advice in regard to therapeutic exercise.
Sunlight, fresh air, abstinence from harmful substances, rest, and the mind healing influence of trusting in Divine power are also powerful remedies that one can use in the home to combat disease and restore right conditions within the system. We will apply these in the next chapter to approach the subject of pain, one of the most common symptoms that afflicts mankind.

RATIONAL APPROACHES to ILLNESS

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In dealing with any disease, the first step toward diagnosis is found in the health history and its interpretation. All facts of significance in the lifestyle of the individual up to the time of illness should be evaluated as possible contributors to the present problem. Allergies to drugs, foods, or
environmental factors should also be evaluated in the face of present illness. Second, the careful analysis of the illness under question with all of its various symptoms, including other factors that have ensued from the first onset to the present need to be considered. Most diseases fit certain patterns. As organ systems and their disorders are discussed, these patterns will become obvious. Thus, the intelligent interpretation of a medical history provides one of the most valuable clues to understand illness and its proper diagnosis.
Remember this one caution in the proper interpretation of health history. Accurate recall for the patient is very important. However, most sick individuals color their subjective awareness of symptoms with substantial concern over the consequences of illness to their families. Fear of disease, disability, and even death may affect the person’s response to the otherwise clear question or stimulus. Although the story of every illness is extremely important, in most cases, it is not definitive, but rather narrows the number of diagnostic possibilities, and thus guides any subsequent investigation. A physician’s skill, knowledge, wisdom, and experience are most clearly evidenced in his history taking. Likewise, the thorough analysis of symptoms in home health care will provide your best clues toward understanding disease.

Imaging regional cerebral blood flow

2008-01-24T07:17:00.000-08:00

The evidence we have examined indicates that meaningful neural events may entail activity in a distributed network in such a manner that at each of the cortical loci involved there is coherent activation of neurons in an area extending over several millimetres. One corollary of this is that the patterns of activation are accessible to macroscopic imaging techniques that measure local changes in regional cerebral blood flow (rCBF) associated with changes in the metabolic requirements of active neurons. Techniques such as PET and fMRI can be used to provide images of rCBF with a spatial resolution of several millimetres. SPET provides images of rCBF with somewhat less sensitivity and resolution. It is likely that the demand for increased rCBF during neuronal firing will be greatest in the vicinity of the synapses, since synaptic processes consume a substantial amount of energy.
In principle, the activation of either excitatory neurons or inhibitory neurons can cause an increase in rCBF. In practice, it is likely that whenever neurons in a particular cortical location are engaged in meaningful processing, local circuits that include both excitatory and inhibitory neurons will be active, since a combination of excitatory and inhibitory neurotransmission would generally be required to produce meaningful temporal and spatial patterns of neural activity.
None the less, because the major long-range fibres that bring specific information from a distant site to the local circuit are excitatory glutamatergic fibres, and these incoming fibres usually form synapses with many local neurons it is reasonable to assume that an increase in local CBF reflects an increase in excitatory input to that location, while a decrease in local CBF reflects a decrease in excitatory input to that location.
Studies using PET confirm that mental processes are associated with activation at a distributed set of cerebral loci, with relatively extensive activation at each locus. For example, in studies of word generation carried out in collaboration with colleagues at Hammersmith Hospital (Frith et al, 1991a, 1991b), we found that during the internal generation of words beginning with a specified letter, there is activation of extensive regions in the left dorsolateral and medial frontal
cortex, posterior cingulate and thalamus, while there is a diminution of activity in the superior temporal gyrus. The extent of activation in these regions was substantially greater than would be accounted for by smoothing arising from sources such as the limited spatial resolution of the PET camera. In these studies, the pattern of cerebral activity associated with the internal generation of words was determined by subtracting the pattern of activity during the articulation of a list of words provided by the experimenter from the pattern of activity during the articulation of words generated by the subject.

Imaging neuroreceptors

2008-01-24T06:20:00.000-08:00

Positron emission tomography (PET) and single photon emission tomography (SPET) can be used to measure the distribution of radioactively labelled tracers in the brain. When the tracer is a ligand for a specific neuroreceptor, the distribution of the labelled tracer provides a quantitative measure of the spatial distribution of accessible receptors. However, not only are there many technical difficulties in preparing a labelled tracer that binds with high specificity to the receptor of interest, and in executing the imaging procedure, but there are intrinsic uncertainties regarding the behaviour of ligands in vivo that complicate the interpretation of the observed binding of the administered ligand. In particular, the administered ligand must compete with any endogenous ligand that is present. A decrease in the amount of tracer that binds to receptors in a particular condition may reflect either a decrease in receptor number or an increase in the concentration of endogenous ligand occupying the receptors, thus making fewer available.
The situation is made even more complex by the fact that competition between endogenous ligand and administered ligand does not appear to obey the laws of equilibrium binding that are observed in vitro. If the administered radio-ligand is present at trace concentrations that occupy only a minute proportion of the available receptors, the number of available receptors should be determined by the total number of receptors and the concentration of endogenous ligand. The relative affinities of the endogenous ligand and the administered ligand for the receptor should have a negligible effect on the observed density of available receptors. The number of available receptors should be the total density of receptors minus the proportion occupied by the endogenous ligand, irrespective of the presence of trace amounts of the radio-ligand. However, that is not what is observed. The binding of administered ligands that bind very strongly to the
receptor appears to be unaffected by the presence of endogenous ligand, whereas ligands that bind weakly are sensitive to the presence of endogenous ligand.
For example, the dopamine D2 ligand N-methylspiperone, which binds very tightly to the D2 receptor, is apparently insensitive to the presence of endogenous ligand, whereas raclopride, which binds relatively weakly, is affected by endogenous ligand, although less strongly than would be predicted. This has led to apparently contradictory findings regarding D2 receptor density in the basal ganglia in schizophrenia, measured by different investigators using different tracers. Wong et al (1986), using N-methylspiperone, found an apparent increase in D2 receptor
density in previously unmedicated schizophrenic patients relative to healthy subjects, while Farde et al (1988), who employed raclopride, found no generalised increase, although they did find an increase in the left putamen relative to the right.

link fatigue to other markers of disease activity.

2008-01-09T13:01:00.000-08:00

Several studies have attempted to link fatigue to other markers of disease activity. These include general measures of nutritional status such as weight and albumin, and tumour-specific markers of disease. In general these studies show disappointingly few clear associations:Mendoza et al. (1999) showed a relationship between albumin levels and fatigue for both solid and haematological malignancy, but Monga et al. (1999) found no association between fatigue and haematocrit or body weight in patients with carcinoma of the prostate. Monga’s study also did not find any association between prostate-specific antigen and fatigue in this group. Similarly Stone et al. (1999) found no association between subjective fatigue and malnutrition.
Should we be surprised by the somewhat unspectacular associations between disease activity and fatigue? In a review of the literature Wessely et al. (1998) assessed the association between many different physical diseases and fatigue and in general found a consistent lack of association between disease severity and fatigue. This held for renal failure (Brunier and Graydon 1993), heart failure (Wilson et al. 1995), Parkinson’s disease (Friedman and Friedman 1993), and rheumatoid arthritis (Belza et al. 1993; Belza 1995).Whilst all these diseases are in themselves powerful risk factors for the development of disabling fatigue, there is little association between disease severity and severity of fatigue, or indeed other important symptoms.
There are probably a number of reasons for this failure to find an association between disease severity and symptom severity. Firstly, it may be an artefact of study design. Many studies selected homogeneous populations of patients among whom the disease status may not vary sufficiently to demonstrate the importance of severity as a risk factor for the symptom. Secondly, most studies are cross-sectional, and a true relationship between disease severity and fatigue may get lost in the ‘noise’ of interindividual differences. If longitudinal studies were used to follow patients across the course of their illnesses these might demonstrate rather more convincing associations. Thirdly, it may simply be that any association is overwhelmed by the importance of psychological and behavioural factors—the presence of depression, interindividual differences in terms of self-efficacy, the effects of behavioural change and deconditioning, and so on.

Sociodemographic risk factors for fatigue in cancer

2008-01-09T12:57:00.000-08:00

The pattern of increased risk of fatigue among women which was so clearly demonstrated in population-based studies of healthy individuals is not so obvious in cancer-related fatigue. Of nine studies identified which assessed the relationship, five found no difference between men and women (Hickok et al. 1996; Smets et al. 1998a; Glaus 1998; Donnelly et al. 1995; Stone et al. 1999), whilst the remaining four (Vogelzang et al. 1997; Smets et al. 1998b; Loge et al. 1999; Akechi et al. 1999) showed that women had more fatigue than men. The key difference between papers which appear to show a difference and those which do not is the disease stage or time from treatment—those that found a difference in rates between men and women tended to have taken samples with earlier disease or ‘survivors’ in whom the disease had remitted. It may be that with less aggressive or remitted disease, the pattern of fatigue becomes closer to that of the general population.
The pattern of fatigue in cancer according to age is confusing. There might be an expectation that younger cancer patients suffer less fatigue, but Hickok et al. (1996) found a U-shaped distribution of fatigue in cancer patients according to age, with fatigue symptoms at their highest in relatively young adults (aged less than 50) and the over 70s. Glaus (1998) found a slightly more complex biphasic relationship, with younger patients having more affective symptoms of fatigue whilst the older group had more physical symptoms of fatigue. Two other studies reported a relationship between age and fatigue—Loge et al. (1999) found that older patients were more fatigued and Vogelzang et al. (1997) found younger patients were more fatigued. The remaining studies showed no relationship (Andrykowski et al. 1998; Smets et al. 1998a; Stone et al 1999; Cimprich 1999; Hann et al. 1999).
One other remaining sociodemographic characteristic was widely studied, namely educational status. Here there appears to be a consistent association, with most studies reporting greater fatigue in the less well educated (Irvine et al. 1994; Mast 1998; Loge et al. 1999) although, as ever, there are exceptions, with one study (Akechi et al. 1999) describing the opposite relationship.

Prevalence: how common is fatigue in cancer?

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The simple answer to this question is ‘very’. However, there are a number of important obstacles to determining the prevalence of fatigue in cancer patients. In part it is difficult to gain a reliable picture of the prevalence of fatigue in cancer because most studies which look at fatigue in cancer assess the symptom in special groups. It is likely that the prevalence of fatigue in cancer patients varies significantly accordingto site and type of cancer, stage of disease, presence of medical co-morbidity (anaemia,infection, metabolic disturbance), and psychiatric disorders (especially depression andanxiety).
it makes the results difficult to interpret except to those familiar with the questionnaires involved.
Some studies have assessed the prevalence of fatigue against other common symptoms:
Ng and von Gunten (1998) found that fatigue and weakness were the two commonest symptoms in hospice patients, with a prevalence of over 80%, whereas painwas only present in approximately half. Despite the almost universal presence of fatigue in this population, it was relatively infrequently rated as the ‘main symptom’— only being reported by 6%, as opposed to 11% for pain (the most common ‘main symptom’ was respiratory problems, present in 22%). Other studies which have assessed multiple symptoms also point to fatigue being the most common symptom of cancer irrespective of diagnosis or stage (Kurtz et al. 1994; Savage et al. 1997; Newell et al. 1998), except where the symptom was ascertained from case notes (Savage et al. 1997), implying that medical staff tend not to question patients about it, or ignore the symptom if it is spontaneously reported.
Relatively few studies have attempted to compare patients with cancer and other control populations: Mendoza et al. (1999) and Stone et al. (1999) (see Table 1.2) are exceptions and took healthy controls as comparison groups. Both studies found very significant differences in prevalence rates of severe fatigue between these groups. There can be little doubt that cancer is strongly associated with fatigue when healthy control populations are used. In contrast Andrykowski et al. (1998) compared levels of fatigue in 88 women with breast cancer and a similar number of women who had attended a breast clinic for benign breast disease.Whilst the women with breast cancer had more fatigue than those with benign disease the difference was slight and not statistically significant on several of the fatigue scales used. This may say more about their control group of symptomatic women consulting for a breast problem than about the cancer patients.
Two studies (Mendoza et al. 1999; Stone et al. 1999) looked at the distribution of fatigue among patients with cancer. In the general population the distribution is strongly skewed, with a long tail going to the right of the distribution. These studies indicate that the entire distribution is shifted to the right in cancer patients. Hence the increased prevalence of fatigue in cancer patients is not due to a relatively few sufferers who are very fatigued, but to a general shift in the population’s experience of the symptom.

Uncertainties regarding assessment, treatment,and future care

2008-01-09T12:46:00.000-08:00

The complexity of fatigue in cancer and the wide range of different mechanisms means that accurate assessment, with an understanding of the likely cause(s) and associated factors, is critical to considering treatment options. There has been a lack of information on this in the past, often leading doctors and nurses to feel hopeless in the face of fatigue.
But some possible methods of assessing fatigue and monitoring progress are now available. Measuring the severity and consequences of fatigue is complex; fatigue is difficult to measure, because of the different ways in which it is interpreted and understood. Yet this is vital if treatments and their outcomes are to be monitored over time. Treatment options are varied, depending on the likely cause. The evidence base for treatments is only now developing; studies are often lacking and are difficult to conduct.
However, correction of simple causes, such as sleep interruption or anaemia, if identified, is a common first step. There are also general non-pharmacological measures such as adapting activities of daily living and occupational therapy to help match clinical function and symptom status with the expectation of patients and families. There is a wide range of pharmacological and non-pharmacological interventions available. Corticosteroids have been proposed as a treatment, and are often used. It is argued that they may decrease fatigue, either by inhibiting the release of tumour-induced substances or by a central euphoria effect. Amphetamines have been favoured in some settings, in particular in North American countries. Many other pharmacological treatments are emerging for the treatment of fatigue and its related symptoms.
Because of the lack of concentration of research and clinical effort in cancer-related fatigue some aspects the findings are preliminary and in some areas they contradict. Here we have sought to present the best knowledge and to debate opposing evidence, in the hope that it will provide doctors, nurses, and all those involved in caring for patients and families with mechanisms for improving care, as well as identifying important future lines of enquiry through research. The appraisals may begin to break the past, sometimes nihilistic, attitude to the assessment, discussion, and treatment of fatigue and encourage future trials and investigation, so that ultimately the effects of this most common and neglected symptom may be reduced.

Fatigue: a complex symptom with wide-reaching effects

2008-01-09T12:30:00.000-08:00

Fatigue is associated with increased distress due to some other symptoms, including
pain. It often clusters with cachexia and anorexia, and is difficult to distinguish
between them . It has profound effects on everyday functioning and,
perhaps consequently, service use. It reduces quality of life and increases suffering.
Fatigue has been associated with hospital admission and increased stress to caregivers
(Hinton 1994; Robinson and Posner 1992). The needs of lay caregivers in this context
are often overlooked . A deeper comprehension of these factors is
important in assessing patients, planning care, and in designing and testing future
treatments for fatigue.
But do the effects of fatigue stretch even wider, reaching well beyond traditional
symptom boundaries? Having energy and vitality is an important part of self-image.
Fatigue is often seen as a sign of impending deterioration. So if doctors and nurses are
to discuss fatigue with patients, grasping their interpretation and understanding of
fatigue is essential . Fatigue can have a profound meaning for patients
living with fatigue, and for their carers or family, which also need to be considered and
assessed.

IS OBESITY PREVENTABLE?

2007-12-26T15:03:00.000-08:00

The pandemic of overweight and obesity is now so advanced and so widespread that few regions of the world (with the possible exception of parts of sub Saharan Africa) appear to have escaped the effects of this major public health problem. Previous chapters have highlighted the strong biological influences that contribute to the creation and maintenance of a positive energy balance in humans; current attempts to abate the rapid increase in body weight at both an individual and a community level have been less than inspiring. This has led some people to question whether it is possible to prevent continued increases in population body weight.
Despite these concerns about the effectiveness of current obesity prevention approaches, there is indirect evidence from a range of sources that supports the view that prevention is not only feasible, but offers the only solution to controlling the worldwide epidemic of obesity. Bouchard (4) indicates that the heritability of obesity and body fat stores is only moderate and that recent increases in obesity rates have occurred at a rate too fast to be explained by changes in the frequency of obesity genes or susceptibility alleles. He concludes that the increase in obesity prevalence can only be due to the fact that a greater number of children and adults are in positive energy balance and that it should be possible to attend to this through influencing diet and physical activity patterns. This view is supported by studies of monozygotic (MZ) twins discordant for body mass index (BMI) which have shown that mean body weight can vary between the overweight and lean sibling by up to 16 kg in men and 19 kg in women, even though they have exactly the same genotype.
While the obesity epidemic appears to be affecting all regions of the world, there are some countries that appear to less affected than others. In the Netherlands, the rates of obesity for both men and women are only half of that experienced in the United Kingdom or neighboring Germany and are increasing at a much slower rate. In Brazil the prevalence of obesity within
upper-income, urban women has actually decreased in recent times, although men continue to put on weight at a rapid rate . In addition, while rates of obesity continue to climb in Finland, men from higher education grades have shown only a marginal increase.
Attempts to reduce the rising rates of obesity and poor physical fitness in Singapore appear to have been successful, at least in the short term. Intensive programs of physical training and influence over dietary intake resulted in a significant reduction in the number of schoolchildren being classified as overweight between 1992 and 1995 . Studies of young men inducted into the Singapore army also showed improvements in mean BMI during their periods of service, which unfortunately are reversed when they are released from the military.

Cultural Differences as Influences on Approaches to Obesity Treatment

2007-12-26T14:56:00.000-08:00

Culture influences all human behavior and dialectically shapes social institutions and social interactions among populations groups and individuals. Culture has many definitions, but all embody the underlying concept of implicit and explicit guidelines that are inherited and shared by members of a particular society or societal subgroup . These guidelines define ‘‘how to view the world, how to experience it emotionally, and how to behave in it in relation to other people, to supernatural forces or gods, and to the natural environment’’ .
These cultural perspectives are identifiable and transmitted from one generation to the next through distinctive symbols, language, and rituals. Of particular relevance to cross-cultural treatment issues, cultural influences on behavior tend to be relatively invisible. Certain types of behavior seem universal, natural, and nonnegotiable to those influenced by a given culture .
In fact, the influence of culture often becomes evident only when cultural differences are encountered, e.g., in interactions between individuals or groups that have contrasting beliefs, expectations, or values related to a particular issue; that is, one might not perceive that one
is operating within a culture until one has to operate outside of it.
To be theoretically sound, cultural adaptation strategies should link culturally influenced variables to specific aspects of treatment process and outcomes. Examples of such possible links from the client and provider perspective . For example, body image and other attitudes may have an influence primarily through effects on the motivation to seek treatment initially or to continue with treatment. Outreach to increase enrollment in a program might then employ persuasive strategies to increase awareness of the possible health or functional status benefits of modest weight loss (e.g., on blood pressure, breathing difficulties, or knee problems) as separate from potentially less salient social or physical attractiveness issues. Cultural sensitivity in the way treatment is delivered would be helpful in ensuring that participants fully engage in the process (quality of participation). The distinction between factors affecting initial adoption versus long-term behavior changes is informed by Rothman’s proposition that different theoretical models are needed to explain initial adoption and maintenance. For example, whereas initial adoption is related primarily to a desire to achieve a favorable outcome and expectations that these outcomes will be achieved, once adopted, behaviors may be maintained by satisfaction with the outcomes that result.
Thus, offering behavior change content in ways that are relevant to the patient’s lifestyle issues and accessible from the perspective of language and learning style would be expected to facilitate short-term behavior changes. Contextual factors such as the world view, the general salience of health considerations in making lifestyle choices, and the structural constraints would be most relevant at the level of maintaining long-term change. Ultimately then, the rewards of having lost weight must be sufficiently reinforcing (positively) within the applicable context to motivate continued practice of the altered eating and activity patterns or, rather, according to Bouton, to drown out the inherently strong reinforcement for the prior, original, and culturally embedded behavior pattern. Clinical programs may be able to maintain changes by providing continued reinforcement through continued treatment.
On the other hand, given the nature of obesity and its determinants, a better alternative might be to reframe obesity treatment within health promotion paradigms. Health promotion paradigms are broader than clinical paradigms, are more inclusive of contextual issues, and are ahead of clinical paradigms in articulating specific frameworks for addressing cultural variables.

Obesity and the Primary Care Physician

2007-12-26T14:41:00.000-08:00

A significant portion of the time spent in the evaluation and treatment of the obese patient can be expedited by use of protocols and procedures. A self-administered medical history questionnaire can be either mailed to the patient prior to the initial visit or completed in the waiting room. In addition to standard questions, sections of the form should inquire about past obesity treatment programs, a body weight history, current diet and physical activity levels, social support, and goals
and expectations. The review-of-systems section can include medical prompts that are more commonly seen among the obese, such as snoring, morning headaches and daytime sleepiness (for obstructive sleep apnea), urinary incontinence, intertrigo, and sexual dysfunction, among others.
Identifying the body mass index (BMI) as a fifth vital sign may also increase physician wareness and prompt counseling. This method was successfully used in a recent study where a smoking status stamp was placed on the patient chart, alongside blood pressure, pulse, temperature, and respiratory rate . Use of prompts, alerts, or other reminders has been shown to significantly increase physician performance of other health maintenance activities as well. Once the patient is identified as overweight or obese, printed food and activity diaries and patient information sheets on a variety of topics such as the food guide pyramid, deciphering food labels, healthy snacking, dietary fiber, aerobic exercise and resistance training, and dealing with stress can be used to support behavior change and facilitate patient education. Ready-to-copy materials can be obtained from a variety of sources free of charge such as those found in the Practical Guide, or for a minimal fee from other public sites and commercial companies.
Based on the health promotion literature, use of written materials and counseling protocols should lead to more effective and efficient obesity care. In a study of community-based family medicine physicians, Kreuter et al. showed that patients were more likely to reduce smoking, increase physical activity, and limit dairy fat consumption when physician advice is supported by health education materials. In another randomized intervention study by Swinburn et al. a written goal-oriented exercise prescription, in addition to verbal advice, was more effective than verbal advice alone in increasing the physical activity level of sedentary individuals over a 6-week period. Several exercise assessment and counseling protocols have been developed that can be easily incorporated into obesity care.
These include Project PACE (Provider-based Assessment and Counseling for Exercise) , ACT (the Activity Counseling Trial), and STEP (the Step Test Exercise Prescription). Finally, protocols and procedures for various treatment pathways can be established for obtaining periodic laboratory monitoring and referral to allied health professionals, such as registered dietitians, exercise specialists, and clinical psychologists.

IN WHICH REGIONS OF THE WORLD IS HEALTH MOST AFFECTED BY ENVIRONMENTAL FACTORS, AND HOW?

2007-12-24T16:21:00.000-08:00

Developing regions carry a disproportionately heavy burden for communicable diseases and injuries.
The largest overall difference between WHO regions was in infectious diseases. The total number of healthy life years lost per capita as a result of environmental burden per capita was 15-times higher in developing countries than in developed countries. The environmental burden per capita of diarrhoeal diseases and lower respiratory infections was 120- to 150-times greater in certain WHO developing country subregions as compared to developed country subregions. These differences arise from variations in exposure to environmental risks and in access to health care.
No overall difference between developed and developing countries in the fraction of noncommunicable disease attributable to the environment was observed.
… However, in developed countries, the per capita impact of cardiovascular diseases and cancers is higher.
The number of healthy life years lost from cardiovascular disease, as a result of environmental factors, was 7-times higher, per capita, in certain developed regions than in developing regions, and cancer rates were 4-times higher. Physical inactivity is a risk factor for various noncommunicable diseases including ischaemic heart disease, cancers of the breast, colon and rectum, and diabetes mellitus. It has been estimated that in certain developed regions such as North America, physical inactivity levels could be reduced by 31% through environmental interventions, including pedestrian- and bicycle-friendly urban land use and transport, and leisure and workplace facilities and policies that support more active lifestyles.

… Developing countries, meanwhile, carry a heavier burden of disease from unintentional
injuries and road traffic injuries attributable to environmental factors.
In developing countries, the average number of healthy life years lost, per capita, as a result of injuries associated with environmental factors, was roughly double that of developed countries; the gap was even greater at the subregional level. For road traffic injuries, there was a 15-fold difference between the environmental burden of disease in the best performing and worstperforming subregions, and a 10-fold disparity for 'other' unintentional injuries.
The results suggest that an important transition in environmental risk factors will occur as countries develop. For some diseases, such as malaria, the environmental disease burden is expected to decrease with development, but the burden will increase from other noncommunicable diseases, such as chronic obstructive pulmonary disease (COPD), to levels approximate with those seen in more developed regions of the world.

WHICH POPULATIONS SUFFER THE MOST FROM ENVIRONMENTAL HAZARDS TO HEALTH?

2007-12-24T16:08:00.000-08:00

Children suffer a disproportionate share of the environmental health burden.

Globally, the per capita number of healthy life years lost to environmental risk factors was about 5-times greater in children under five years of age than in the total population. Diarrhoea, malaria and respiratory infections all have very large fractions of disease attributable to environment, and also are among the biggest killers of children under five years old. In developing countries, the environmental fraction of these three diseases accounted for an average of 26% of all deaths in children under five years old. Perinatal conditions (e.g. prematurity and low birth weight); protein-energy malnutrition and unintentional injuries – other major childhood killers – also have a significant environmental component, particularly in developing countries.
On average, children in developing countries lose 8-times more healthy life years, per capita, than their counterparts in developed countries from environmentally-caused diseases. In certain very poor regions of the world, however, the disparity is far greater; the number of healthy life years lost as a result of childhood lower respiratory infections is 800-times greater, per capita; 25-times greater for road traffic injuries; and 140-times greater for diarrhoeal diseases. Even these statistics fail to capture the longer term effects of exposures that occur at a young age, but do not manifest themselves as disease until years later.

HOW SIGNIFICANT IS THE IMPACT OF ENVIRONMENT ON HEALTH?

2007-12-24T15:59:00.000-08:00

An estimated 24% of the global disease burden and 23% of all deaths can be attributed to environmental factors.

Of the 102 major diseases, disease groupings and injuries covered by the World Health Report in
2004, environmental risk factors contributed to disease burden in 85 categories. The specific fraction of disease attributable to the environment varied widely across different disease conditions.
Globally, an estimated 24% of the disease burden (healthy life years lost) and an estimated 23% of all deaths (premature mortality) was attributable to environmental factors. Among children 0–14 years of age, the proportion of deaths attributed to the environment was as high as 36%. There were large regional differences in the environmental contribution to various disease conditions – due to differences in environmental exposures and access to health care across the regions. For example, although 25% of all deaths in developing regions were attributable to environmental causes, only 17% of deaths were attributed to such causes in developed regions. Although this represents a significant contribution to the overall disease burden, it is a conservative estimate because there is as yet no evidence for many diseases. Also, in many cases, the causal pathway between environmental hazard and disease outcome is complex. Where possible, attempts were made to capture such indirect health effects. For instance, malnutrition associated with waterborne diseases was quantified, as was disease burden related to aspects of physical inactivity attributable to environmental factors (e.g. urban design). But in other cases, disease burden was not quantifiable even though the health impacts are readily apparent. For instance, the disease burden associated with changed, damaged or depleted ecosystems in general was not quantified.
Diseases with the largest absolute burden attributable to modifiable environmental factors included: diarrhoea; lower respiratory infections; 'other' unintentional injuries; and malaria.

Differences Between the Sexes on Cholesterol?

2007-10-25T10:00:00.000-07:00

For a long time, medical studies didn’t include women because researchers were afraid that their menstrual cycle would skew results or that the subjects would become pregnant and have to stop taking a medication. Younger women were also less likely to have heart disease, which meant more participants would have to be included to be able to show a difference in outcomes if women were involved. More study subjects means more money to do the study, so leaving women out was a practical decision that wasn’t as sexist as it sometimes appears.
Fortunately, once the benefit of a particular therapy was shown in men, the economics made it favorable to study women as well, and later studies have shown that women benefit just as much as men do from cholesterol-lowering interventions, whenever the risk is equivalent. By the time women are in their midsixties, their risk of new coronary events is similar to that of similarly aged men, so there should be little difference in treatment at that point. In younger, premenopausal women, the risk for heart disease is less than that of men, so fewer women in this age group require treatment. However, when all risk factors are taken into account, men and women of equivalent risk for heart disease get treated to the same LDL target goals.

Why Won’t My Doctor Prescribe a Statin-Fibrate Combination?

2007-10-25T07:14:00.000-07:00

Some primary care doctors are hesitant to prescribe this combination of drugs after the deaths and other problems caused when the no-longer-available statin Baycol was mixed with fibrates. There is also a warning in the labeling of all statin medications that generally advises that they not be used in combination with fibrate therapy. Lipid specialists know that despite the risks, a statin-fibrate combination is an extremely effective way to lower lipids when combined disorders are present. As long as a patient is fully educated to watch for serious muscle side effects, I believe this combination can be safely used. If a person were unable to recognize or communicate the presence of muscle pains for any reason, however, this combination treatment should probably not be used. If you have a combined lipid disorder but your doctor is shying away from statin-fibrate therapy, you might want to ask for a referral to someone in your community who specializes in the
treatment of lipid disorders.

How to Save Money on Drugs (2)

2007-10-24T06:50:00.000-07:00

Shop Around for the Best Price
The same kind of comparison shopping you might do for a car or a coffeemaker can pay off for drugs.
• Buy by mail. If your prescription drugs are covered by insurance, see if the insurer has a mail-order pharmacy. Some offer lower co-payments.
• Call around. You’ll find that drug prices vary from store to store. Try independent pharmacies, national chains, and megastores such as Wal-Mart and Costco.
• Go online. You can find bargains or quickly compare drug prices on the Internet. (If you don’t have a computer, the ones at your public library are free to use, and many librarians will help you find information.) Many brick-andmortar pharmacies have websites that offer discounts on prescription drugs. So do “virtual” pharmacies, which do all their business online. For the most part, shopping for prescription drugs online is safe. One way to tell if the site is legitimate is the VIPPS (Verified Internet Pharmacy Practice Sites) seal of approval from the National Association of Boards of Pharmacy. You can also check with the board to see if an online pharmacy is licensed and in good standing.

Join a Group
Some organizations offer savings on prescription drugs as a perk. If you’re a member of AARP, for example, you can join its MembeRx Choice plan for $20 a year. It offers savings on topselling
drugs. If you served in the military, you may be eligible for the TRICARE Pharmacy or Senior Pharmacy programs. Buying groups such as the Peoples Prescription Plan and the United States
Pharmaceutical Group also offer savings and are open to everyone. (Find more information in the Resources.)

Look for Low-Income Options
Some money-saving options are aimed at low- to middle-income seniors without any drug insurance. The Together Rx Card, for example, provides savings on more than 150 widely prescribed medicines. Some states provide assistance with prescription drugs to low-income seniors or people with disabilities who do notqualify for Medicaid. To quickly find out if your state has such a benefit or if you qualify for other programs, try the National Council on the Aging’s BenefitsCheckUp Web site. (For more information, see the Resources.)

Reduce Your Need for Drugs
If you’re serious about cutting your drug bill, get serious about adopting a healthier lifestyle, which may cut the need for medication. Don’t stop taking your pills first and then try to make lifestyle changes. Make the changes first. When you start getting results, then talk with your doctor about medication changes.

How to Save Money on Drugs (1)

2007-10-23T07:34:00.000-07:00

You don’t need the newscasters to tell you that prescription drug prices are on the rise or that insurers are covering less of the cost. For some people, the out-of-pocket outlay for prescription drugs extracts little more than a quiet moan at the cash register. For others, it means skipping medicine or meals in order to pay. Here are some tips for cutting costs.
Get Your Doctor’s Help
Unless a doctor knows you’re trying to cut corners, he or she won’t take price into consideration when filling out the prescription pad. But most doctors are willing and able to help once you mention your concern. Here are a few things to ask about:
• Generic drugs. Buying generic drugs instead of the more expensive brand-name versions is one of the most effective ways to cut your monthly drug bill. For example, a month’s supply of the 20 mg dose of the brand-name statin Mevacor costs about $70, while the same amount of generic lovastatin costs about $35. There’s no need to worry that a cheaper price means less quality. The Food and Drug Administration (FDA) regulates the production of generics just as carefully as brand-name drugs. The only difference may be in the inactive ingredients—things like fillers, coatings, and flavorings. Some doctors worry that the inactive ingredients change how much of the active ingredients the body absorbs. The FDA doesn’t share this concern, though. Some classes of drugs are so new that generic forms aren’t yet available. If your doctor prescribes one of these, ask if there’s a slightly older type of drug that does much the same thing.
• Cheaper brand-name drugs. Sometimes you can trade off convenience for savings. For instance, if your doctor suggests a brand-name combination drug, ask if you can save money by taking the component drugs one by one. In other cases, you can save by taking an older drug two or three times a day instead of using a newer (and more expensive) once-a-day formulation.
• Starting small. When you start a new drug, ask your doctor to give you a prescription for just a week or two. This way you can see if the dosage is right and if the drug agrees with you. If everything goes well, then you can fill a longer-term prescription. If it doesn’t, you aren’t stuck
with a stockpile of pills you paid for but can’t use.
• Starting low. Ask about starting a drug at the lowest possible dose, especially for a drug that’s relatively new.
• Splitting the difference. You expect to pay about twice as much for a two-pound box of pasta as you do for a onepound box. But the same pricing concept doesn’t always apply to drugs. Often, you can save money by asking your doctor to prescribe pills in twice the dosage you need.
Then you can cut them in half to double the number of doses. This approach is not for everyone, and it can’t be done for all drugs. Capsules and timed-release formulas, in particular, should never be split.

The Metabolic Syndrome

2007-10-21T06:00:00.000-07:00

A person with metabolic syndrome has three or more of the following:
• A large waist (forty inches or more for men and thirty-four inches or more for women; to measure your waist size, don’t go by your belt measurement—instead, wrap a tape measure around the largest part of your midsection and make sure you keep the tape measure parallel to the floor)
• Borderline or high blood pressure (anything above 130/85 mm Hg)
• A high level of triglycerides (above 150 mg/dL)
• Low HDL (under 40 mg/dL for men or 50 mg/dL for women)
• High fasting blood sugar (above 100 mg/dL)
What does metabolic syndrome do to the body? Doctors and researchers think that metabolic syndrome’s impact on health is more than the sum of its parts. Basically, in people with this disorder, blood sugar levels stay high after a meal or snack instead of dropping to a base level as they do in most people. The pancreas, sensing still-elevated glucose levels, continues to pump out insulin. Constant high levels of insulin and blood sugar have been linked with many harmful changes, including damage to the lining of coronary and other arteries, increased triglyceride levels in the blood, changes in how the kidneys handle salt, and blood that clots more easily. Chronic overstimulation of the pancreas may exhaust it so that it stops supplying enough insulin.
This cascade of changes isn’t healthy. Damage to artery walls, high triglycerides, and increased chance of blood clots can lead to heart attacks and some strokes. Changes in the kidneys’ ability to remove salt contribute to high blood pressure, another path to heart disease and stroke. And dwindling insulin production by the pancreas signals the start of type 2 diabetes, which greatly increases the chances of having a heart attack or stroke, as well as nerve, eye, and kidney damage.
Even after heart disease appears, the metabolic syndrome continues to complicate things. Among almost sixty-five hundred men and women who had bypass surgery, for example, those with metabolic syndrome were four times more likely to have died within eight years of their surgery than those without it. This syndrome was especially hazardous for women, who were thirteen times more likely to have died.
Researchers from the Centers for Disease Control and Prevention applied the given definition of metabolic syndrome to almost nine thousand people who took part in the Third National Health and Nutrition Examination Survey. In this sample, about 23 percent had the metabolic syndrome. Applied to the entire United States, this would mean about forty-seven million Americans have this problem. The treatments outlined in the next chapters can decrease the chance that you’ll have the symptoms that characterize metabolic syndrom.

Things to Mention to Your Doctor if You Are About to Be Treated for an Abnormal Lipid Profile

2007-10-21T01:55:00.000-07:00

Going to the doctor can be overwhelming or scary. And it’s easy to forget to ask questions or mention recent events that might have skewed a blood test result. I suggest that you bring a written list of questions or topics you want to cover. Here are some issues you might want to bring up with your doctor when discussing your recent lipid profile:

Tell the doctor if you had a flu or other major or minor illness shortly before the blood test was performed. These events can dramatically alter the lipid profile, either reducing or elevating several of the lipoprotein fractions.
If your diet was dramatically different from your typical diet in the weeks leading up to the lipid test, this is worth noting, because high alcohol or carbohydrate intake can cause a dramatic elevation in serum triglycerides.
If you were expected to fast and didn’t, don’t be embarrassed to say so. You could end up on the wrong drug treatment if this error is not identified.
If there is an abnormality (i.e., high cholesterol levels when there hadn’t been in the past), ask if your cholesterol will be measured again to make sure it wasn’t a fluke.
Ask how you and your doctor will use the results to decide on a treatment plan.

Alternative Remedies For Heart Desease

2007-10-20T17:32:00.000-07:00

Several natural therapies are promoted as treatments for heart disease. Some have been put to the test in scientific studies and look promising, but others have not held up to scientific scrutiny. Many such herbal remedies and alternative treatments—available in drugstores and on the Internet—remain unproved and therefore should be taken with caution. And because herbs and other nutritional supplements are not reviewed for purity or effectiveness by the FDA, you can’t be sure that what you’re buying is effective or even that the bottle contains the substance on the label. If you take any herbal remedies, be sure to tell your doctor. These preparations may hinder or exaggerate the effects of prescription drugs used to manage cardiovascular disease. Indeed, heart patients are more vulnerable than most others to adverse drug interactions. Here is some information about two popular alternative remedies for heart disease. Of course, there are many others out there that I just don’t have the space to cover.
Coenzyme Q10
This vitamin-like substance is found in every cell in the body but is most prevalent in tissues with high energy demands, such as the muscles of the heart. Many advocates of alternative medicine believe that it can strengthen the heartbeat by increasing the cellular fuel available to the heart muscle. And some small studies have suggested that it might help patients with angina, heart failure, or other cardiovascular problems. But a few years ago, researchers in Australia conducted a rigorous trial that evaluated coenzyme Q10 in thirty patients with heart failure. All were taking conventional medicines, but for twelve weeks each subject also took either coenzyme Q10 or a placebo. At the end of the study, there was no change in the strength of the heartbeat as evaluated by echocardiography and cardiac catheterization. And the people who took coenzyme Q10 did not feel better or report improved ability to function.
Chelation Therapy
Chelation therapy uses infusions, or slow injections, of a chemical called ethylenediaminetetraacetic acid (EDTA). This process is sometimes used to remove toxic levels of lead, iron, or other metals from the body. (The metals exit the body via the urine.) Some experts think that the oxidation of LDL cholesterol requires interaction with such metals. The idea behind chelation for cardiovascular disease is that removing some of these metals from the bloodstream will also reduce oxidation—and this “antioxidant” effect might improve blood vessel function.

What a Heart Attack Feels Like

2007-10-20T10:21:00.000-07:00

I hope you’ll get diagnosed and treated long before heart disease leads to a heart attack, but you should know the warning signs just in case. Unlike in the movies, where a person having a heart attack gropes his chest (and in the movies, unlike reality, it’s almost always a man) and falls to the floor, the symptoms of a reallife heart attack are often more subtle. They differ between men and women and from person to person. Generally, men will report the following:
• Pain or discomfort in the chest that radiates to the shoulder or arms, to the upper back near the shoulder blades, or to the neck or jaw
• Uncomfortable pressure, tightness, fullness, or ache at the center of the chest
• Shortness of breath, sweating, nausea, or dizziness

Women, on the other hand, usually report the following:
• Pain in both arms or shoulders
• Chest cramping or dull pain between the breasts
• Shortness of breath
• Feeling of indigestion
• Lower abdominal pain
• Severe fatigue (the least specific symptom, usually not caused by a heart attack.