WEIGHT MANAGEMENT: WHAT IS THE STORM TRIAL?

The STORM study (Sibutramine Trial of Obesity Reduction and Maintenance) is a 2-year, double-blind, randomized, placebo-controlled multinational trial of sibutramine over 24 months. It showed significantly improved weight maintenance in those patients treated with sibutramine compared with those offered dietetic and lifestyle change support alone. A total of 605 obese patients (BMI 30-45) from eight European centres were included. All patients were treated for the initial 6 months with sibutramine 10 mg/day together with a low-fat, low-energy, individualized diet (600 kcal/day deficit) and exercise regimen. Of the 499 patients who completed the 6-month run-in period, 93% achieved >5% weight loss after 6 months and were randomized to either sibutramine 10 mg/day plus diet and exercise or placebo plus the same diet and exercise over a further 18 months. Those patients randomized to sibutramine were able to maintain their weight loss for up to 2 years: 43% of sibutramine patients who completed the trial maintained 80% or more of their original weight loss, compared with 16% of the placebo subjects (odds ratio 4.6, P<0.001). In addition, sibutramine-treated patients achieved beneficial improvements in a range of cardiovascular and metabolic parameters, such as HDL-cholesterol, VLDL-cholesterol, triglycerides, insulin and uric acid concentrations.
*51/312/5*

 

(Русский) Течение болезни

(Русский) Психофизиология заболевания

(Русский) Факторы риска

(Русский) Что это такое

(Русский) Симптомы

(Русский) Причины возникновения

(Русский) Профилактика.

(Русский) Полезные статьи

(Русский) Питание

(Русский) Лечение гипертиреоза

(Русский) Диагностика гипертиреоза.

MULTI-INFARCT DEMENTIA: SWALLOWING AND PHYSICAL AND INTELLECTUAL IMPAIRMENT

Swallowing
Following a stroke there may be a period of time when swallowing is difficult. This usually recovers, sometimes with the aid of speech therapists, dieticians, physiotherapists and dentists. With multiple strokes (especially if they occur on both sides of the brain) the problem may develop with the other complications (incontinence, emotional lability, poor mental state etc.) The person may begin to get frequent chest infections or be seen to choke with every mouthful of food. The chestiness shows that some food particles are missing the gullet and going into the lungs because the act of swallowing has been damaged by the strokes. This often recovers as the person gets over the latest stroke, but in the later stages it can become permanent. The problem can be tackled in various ways. Following assessment it may be the case that certain types of food ‘go down the right way’; these often include purees and ice-cream type consistencies. Liquids and solids tend to be swallowed only with difficulty. Solids should be mashed to a puree consistency while liquids should be thickened with agents such as Carobel. The position of the head and neck is also important. The best position is sitting upright with the head looking straight ahead (not tipped back). Liquids should fill the cup/glass near to the brim so that on drinking the head does not have to be tipped back. The speech therapist is the best person to give advice on the swallowing difficulties of stroke patients. Some people, however, are unable to swallow anything and then the decision has to be made about passing a tube into the stomach (a nasogastric tube) and feeding the person that way. This may only be a temporary measure as recovery of the swallowing reflex occurs. In some cases the impairment is permanent and most doctors advise that the nasogastric tube be replaced by a more permanent feeding tube direct into the stomach, a gastrostomy. This is a fairly minor procedure and allows the nourishing liquid food to be pumped via the tube direct into the stomach. Once the feed is finished the tube can be disconnected and all that remains until the next feed is a small button-like attachment on the skin of the abdomen.
Physical and intellectual impairment
In any individual the symptoms and signs of their multiple strokes will vary and their degree of disability both mental and physical will differ. Some will have profound physical handicaps in the form of limb weakness and this will dominate their lives, their slight intellectual impairment being fairly irrelevant. For others the degree of physical handicap will be minimal, if present at all, if that part of the stroke has fully recovered. They may however be severely intellectually impaired with very poor memory, no concentrating power and limited learning ability. Speech may be affected (both in the ability to speak and in the ability to understand speech). Writing and reading powers can be damaged as well as the complicated processes of reasoning and decision making. This step-wise decline of both mental and physical powers can be devastating for both sufferer and carer.
*43/128/5*

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EYE CARE: CASE STORIES ON PERMANENT CORRECTION OF NEARSIGHTEDNESS

Robert McQueen of Danbury, Connecticut, age 32, works in one of the highly technical industries situated in that suburban city. He is the victim of moderately severe myopia with -5.00 diopters in each eye. For McQueen, contact lenses and eyeglasses are uncomfortable to wear. He’s tried all kinds of corrective lenses and spent a lot of money doing it.
One day in May, 1984, while visiting his eye doctor, McQueen noticed the doctor owned a piece of sophisticated high tech equipment. It was a computer, invented by Philadelphia ophthalmologist Frederic B. Kremer, M.D., which delivers a surgical plan for radial keratotomy using multiple regression analysis. The computer interested the patient and he asked lots of questions about RK.
The doctor explained that “each eye and each patient presents a different series of problems. Cookbook surgery cannot be used with this RK technique.” Then the eye surgeon showed McQueen the corneal thickness measuring device, the pachymeter, which meters the exact size of the cornea using sound waves. “Could you do the RK procedure to correct my nearsightedness?” Bob McQueen asked.
The following week he returned for a preoperative workup to determine if he was a candidate for RK. Intraocular pressures were taken. Corneal curvature was measured. Refraction was measured. Endothelial cell counts were done. All other necessary preoperative tests were carried out. Bob definitely was an RK candidate.
Without any requirement for the patient to spend 700 dollars for use of a hospital surgical room, the surgeon carried out the procedure in his exurban office the next week. The right eye was operated on first, and three weeks later the left eye was also corrected. The man’s vision is now 20/20 in the right eye and 20/25 in the left. He is nearsighted no more and doesn’t have to wear eyeglasses or contacts ever again.
Twenty-eight-year-old Janet Icons of Long Island, New York, is engaged to a man who had undergone RK for both eyes about four years ago. There was a time when his myopia was severe, but a Baltimore eye surgeon operated on him and obtained excellent results. He no longer wears any corrective lenses.
Ms. Icons’ fiancee virtually insisted that the young woman experience RK surgery also. He believed that it was silly to remain myopic because the condition can be made right in such a simple matter. Consequently, she visited   the eye   surgeon early   in   July   1984   to   have   the operation performed.
The ophthalmologist, seeing that Janet was only moderately nearsighted, warned her that she should not undergo radial keratotomy just to please her boyfriend. She decided to have the preoperative measurements completed anyway, and was amazed at the number of tests carried forward prior to accomplishing the correction. The Kremer computer read-out told the eye surgeon just what should be the depth of the cornea cuts for the patient. Janet requested the doctor to do the permanent surgical technique for her myopia if she was a candidate. She was, and he did.
In a few days the RK achieved an excellent correction of Janet Icons’ left eye. “The procedure is so simple and without discomfort,” she remarked immediately afterward. There was pleasure and surprise in her voice. Six weeks later when the right eye was fixed, as well, her vision had been improved to 20/20 in each of the operated eyes. Janet declared, “My fiancee was absolutely right in recommending radial keratotomy. He really loves me.”
*43/127/5*

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COMING OFF DRUGS: FOR SOCIAL WORKERS, TEACHERS, EMPLOYERS AND MEMBERS OF THE HELPING PROFESSIONS-OUR SUCCESS RATE

Those who specialise in the treatment of alcoholism or drug dependence know that it is not easy to treat alcoholics and addicts together. We do.
The most important British study of the decade, at an eminent London hospital, followed up one hundred alcoholics from stable family and work backgrounds at six, twelve, eighteen and twenty-four months after hospital in-patient treatment. It showed that by the two-year mark there was a 100-per-cent relapse rate: all the patients so treated had gone back to drinking over this period. A recent important ten-year follow-up at a number of London drug clinics showed that 53 per cent of addicts had either died or continued to be maintained on drugs. Only 38 per cent were abstinent from illegal drugs.
Our treatment results are much better. Our follow-up studies over five years include all patients, even those who did not fully complete treatment with us. Patients in the study ranged from very disturbed young addicts to alcoholics in their sixties. All patients were followed up at six-month intervals for five years after treatment.
Conservatively, fifty out of every hundred patients were totally abstinent. A further
twenty-five had had a relapse, usually of short length after leaving the clinic, but had gone back to abstinence, successfully continued in recovery and improved the quality of their lives.
These short-term relapsers were often the young and impulsive addicts or alcoholics. Though persuaded that they had a drink and/or drug problem, nevertheless they made one final effort to prove the treatment wrong. Their relapse instead acted as a final convincer that abstinence from all mood-altering chemicals was the only answer.
A final twenty-five addicts and alcoholics relapsed after treatment and had to be
re-hospitalised or “required further long-term treatment. Among these were many who had left treatment early.
These results show that treating alcoholics and addicts is not a waste of time or money, and that, with the right treatment, a high degree of success can be expected. Some patients, indeed, have an even better prognosis. Referrals from employers or unions with a policy of treatment and support for alcoholism and drug dependence, instead of dismissal or covering up the problem, can expect a 75-80-per-cent recovery rate without any relapse.
Treating alcoholics and addicts has great rewards. We see them arrive for treatment as sick, miserable people, leading destructive lives; but as their recovery progresses they become happy, stable, achieving people, full of life.
Change is the key that turns misery into a walking miracle.

*139\116\2*

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COMING OFF DRUGS: FOR SOCIAL WORKERS, TEACHERS, EMPLOYERS AND MEMBERS OF THE HELPING PROFESSIONS-OUR TREATMENT PROGRAMME

What we have done is successfully to integrate the caring philosophy of Alcoholics Anonymous into the professional treatment programme. This is a team concept, including counselling, nursing, medical, psychological and psychiatric staff who have had special training and experience with addictive diseases.
In doing this, something profound seems to have occurred – a humanising of a complex treatment programme with the close sharing found in both AA and NA.
Perhaps the most important factor in the programme is the opportunity the patient has to learn and grow in small structured peer groups. There is an immediate effectiveness in the sharing of a common experience. This common identity appears to be based on the admission and acceptance of human limitation. Non-addictive people seem to have no problem in accepting their own limitations. Most addictive people find this reality unacceptable.
In the commonality of accepting limitation, patients draw strength and help from other patients, and in turn help other alcoholic and chemically dependent people to recover. In simple terms, people who have made a career of abusing alcohol or drugs, and who have been dishonest, manipulative and intolerant towards their family and friends, learn to change when confronted with each other and their common, chronic addiction.
From this human ‘peak’ or spiritual experience, for the alcoholic or addict comes the courage to face up to the illness of chemical dependence and to recover.
The primary function of any chemical-dependence programme is to evaluate and initiate the proper treatment for people who are suffering from alcohol or drug dependence. We see this illness as dependence on or abuse of alcohol and/or drugs. These drugs can be prescribed or illegal; most patients substitute one for another during their career of dependence.
A wide range of services is provided by the treatment team. We think very few, if any, professionals can work successfully outside a team. It is just too draining and too emotionally stressful.
Based on the patient’s history, current physical and emotional condition, employment and family situation, a referral may be made to the out-patients’ department at our London centre or at Farm Place, our treatment centre in Ockley, Surrey, or to inpatient treatment at Farm Place. We insist on involvement in the appropriate self-help group of AA or NA.
Out-patient treatment begins with a medical assessment and detoxification, followed by necessary therapy by counselling, group therapy and family counselling – as indicated by the
individual treatment plan which is developed by the treatment team.
The patient requiring in-patient treatment receives a full medical examination and is placed on a detoxification regimen if necessary. In order to assist the newly admitted patient to understand the programme, there is an introductory and orientation session explaining the structure of the programme and the patient’s responsibilities and rights while in treatment.
Soon after admission, each patient is assessed several times so that an individual treatment plan can be developed. Treatment-plan designs are based on a series of interviews supplemented by co-operation from the family, GP and other referrants – employers and other significant people in the patient’s life.
This plan is designed to enable each individual to progress according to his or her capabilities. All patients have frequent sessions of individual counselling to enable them to recognise their dependence on alcohol or drugs and to resolve problems relating to the special needs of each individual and the family members.
Structured group therapy takes place twice daily. By sharing their experiences, patients come to terms with their dependence and the damage this has caused to themselves and to others. With the support of their peers, patients face their mutual problems with chemicals and begin to change.
Families are encouraged to involve themselves in the treatment programme. They participate in multiple family groups and in individual family-counselling sessions. This is to ensure that the family members, or significant others, understand the nature of chemical dependence. This understanding benefits both the patient and the family. Individual treatment plans are developed by the team for families, or significant others, to maximise their involvement. This is sometimes described as a ‘family-systems’ approach to addiction.
In recent years it has been recognised how much the families of chemically dependent people have become emotionally involved and damaged by association with the illness. The patient has often blamed his need for alcohol and drugs on other people or problems. Usually most families have initially believed this to be the case. They have taken the blame on themselves and have sometimes become immobilised and/or complicit in the illness.
Family programmes must therefore be geared to teach the family to modify their reactive behaviour and to detach from the patient while still caring. Another object is to help the family to know what to expect when the patient comes home. They must learn to live for themselves and not to be a weathervane for the chemically dependent person: to accept that their own personal growth is good for them, and that what is good for them is good for the chemically dependent person.
Of further assistance to the patient are the self-help groups of AA and NA, in which they participate while in treatment and which are their on-going support system in recovery. This applies equally to family members in Al-anon, Alateen and FA.
Early in treatment, each patient is given a psychological assessment, which is communicated directly to them in an understandable way. This is to help the patient to develop increased insight and understanding into the psychological problems that usually develop as addiction progresses and how these problems usually recede as recovery stabilises.
Patients are also assessed to ensure that no serious psychiatric problems, related to chemical dependence or independent of it, are present. This assessment is integrated into the individual treatment plan and updated as appropriate.
Further information is given to patients during treatment in the form of lectures giving guidelines for recovery, ways of coping and the way roles in the family change in recovery.
Exercise and relaxation sessions are provided to enhance the patient’s physical and emotional well-being, and also to promote social interaction. Having fun without chemicals is often a new experience which must be learned or relearned after years during which alcohol or drugs have been the main social lubricant.
Some patients need a longer period of treatment than four to six weeks of primary care. Extended care is provided within the residential centre of Farm Place. The aim is to help patients make changes in lifestyle and attitudes, and to develop self-worth without the risk of returning to alcohol and drugs.
Some patients need to spend between six months and a year in a halfway house – usually those who need to be able to spend a long period in a structured environment in which they can take time to consolidate recovery. This is necessary for some young people with a long drug history and little structure in their life, and for alcoholics with a previous extensive history of relapse. The halfway house provides counselling and on-going group therapy, as well as opportunities to work, continue education and progress to normal living while involvement in AA or NA is developing.
Plans are made to ensure, as far as possible, that the patient has the best chance for recovery. After-care services include introduction to the appropriate self-help group, out-patient follow-up and group therapy. The main goal of after-care is to continue progress made in treatment and to work towards happiness and normal living. All patients are followed for at least five years.
Recovery really begins when the patient returns home to use the tools that have been given and the skills acquired with the ongoing assistance of the self-help groups of AA and NA.

*138\116\2*

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BIOLOGICAL REASONS WHY YOU BINGE: SEROTONIN

Binge eating may be driven by a need to increase serotonin, a brain chemical that produces a feeling of relaxed calmness. Serotonin levels increase when we eat carbohydrate foods. That is why, compared to protein or fatty foods, carbohydrates such as pasta, bread, and chocolate have a soothing, mood-altering effect on us.


Some experts feel that we binge on certain foods to increase serotonin to soothe us. That is why you want to eat when you’re stressed out. Food becomes your antidepressant or antianxiety medication. It may be that your brain does not produce enough serotonin and you are driven to eat in order to get more. It may also be that you enjoy the mood changes resulting from serotonin more than others.


Jackie, a 46-year-old woman from Atlanta, described her reaction to chocolate in this way:


When I eat candy I feel like a totally different person. It calms me. I feel tranquilized. It’s a drowsy, relaxed sensation. My body feels warm and heavy. I hate to admit this, but chocolate gives me a mental and physical pleasure that I don’t get from anything else. I feel like a drug addict.


*49\358\8*


Weight loss

GENERAL BEHAVIOURAL PROBLEMS: SIBLING RIVALRY

Sibling rivalry is a common concern for parents. Children spend as much time, if not more, with siblings as with parents, and it is inevitable that some conflict will arise from time to time.

Sibling rivalry may be worsened by family stresses and tension , or by changes in the family such as separation or moving house. Sometimes conflict between siblings may be worse when one sibling has a chronic medical condition or a disability or learning problem, which necessitates additional parental attention.

The best way for parents to manage sibling rivalry and conflict is generally to keep out of it. Some rivalry is inevitable, and not necessarily a bad thing. The situation is often made worse by parents buying into the argument. Most of the time it is best left to the children to sort things out themselves. Parents should rather establish clear guidelines and set limits on what is acceptable behaviour, and handle it in the way they would handle any aggressive or inappropriate behaviour.

Parents can minimise sibling rivalry by addressing the following issues:

• inform other children of the imminent arrival of a new baby;

• involve other children in helping to care for the new arrival, strongly praising appropriate behaviour, and attempting to ignore behaviour that is inappropriate;

• try to set aside time for each child each day (‘special time’);

• demonstrate to each child the very special individual attributes they alone have; encourage individual activities and interests; allow them to have different activities, appropriate to their ages, such as different bedtimes.

*179\90\8*

ANXIETY DISORDERS/WORKING THROUGH THE RECOVERY: COGNITIVE BEHAVIOURAL EXPOSURE PROGRAM

A cognitive behavioural therapist will normally work with various types of exposure methods pertaining to our particular anxiety disorder. When wc begin to work with our avoidance behaviour we will probably feel anxious and the ‘what ifs’ may return. In only a few seconds the ‘what ifs’ can create a mountain of fear and anxiety which seems insurmountable. We may forget any management strategies we have learnt, and become caught up in the automatic cycle of thinking.

It is most important to realise that we will feel anxious and frightened when working with a CBT program. By accepting this we can work with it, not against it.

Making allowances

As an example, part of our CBT program may include doing the shopping alone. This can be broken down into easy steps. To begin with, we can go to the shop early in the morning. We will feel more comfortable in letting the anxiety and attack happen if the shop is not too crowded. As we become more confident in letting it happen, we can begin to shop at different times of the day.

If part of our program means going to dinner or the theatre, we can ask to be seated by an aisle or an exit, or both-not so much for a quick getaway, but to help break down the feeling of being trapped. The aisle or exit is there if we do need to leave quickly. If we work with our thinking and let the anxiety and attack happen, we will find we won’t have to leave.

*93\94\8*

CHILDREN’S SLEEP PROBLEMS/BUILDING THE BASICS: KNOW WHAT YOU WANT

It is much easier to prevent a problem than to solve it. And it is easier to solve a problem if you know what you want.

Values. As you plan for the ideal sleep situation, take into account the specific values you hold, and set expectations that fit your lifestyle. Values are as unique as each family.

We are frequently out evenings, so we value Maureen’s ability to get to sleep smoothly—and on her own.

Because my wife works late and enjoys spending time with the kids when she gets home, we appreciate their late bedtimes.

Goals. Your values will clarify the goals toward which to aim. For example, if you value everyone sleeping together, then your goal is to arrange a family bed where everyone is comfortable and teaching independent sleep will not be an issue. If you value independent sleep, you will not take your child into your bed under normal circumstances.

As you carry on, check to be sure your action supports your goal—watch that “just for tonight” doesn’t slip into an unwanted pattern.

*22\67\8*

PRESSURE SORES (BED SORES) – IMPORTANT SECTION

It is very important for you to read this section carefully if you can’t move around freely and easily, whether or not you are confined to bed. You don’t have to be in bed to get bed sores, which is why I prefer the name of pressure sores.

Pressure sores are nearly always preventable—you are not likely to get any if you, and the people caring for you, understand what causes them and how to prevent them. You are in danger of developing pressure sores whenever you stay in the same position for many hours at a time, especially if you have lost a lot of weight. This is because when weight is taken by any part of you where there is very little tissue between the skin and the bone, the circulation to that part may be cut off. It’s not only your backside that is in danger. Pressure sores can develop on hips, knees, ankles, elbows, and even the back of the head—anywhere where there is bone very close to the skin.

*218/40/1*

HEART ATTACK – DANGEROUS FACTORS

As well, plaques of atheroma collect and may ulcerate through the lining, leaving a raw surface. Platelets from the blood may be deposited on these raw surfaces to form a clot.

There are many factors which can lead to the formation of atheroma. These are:

Heredity — a history of heart attacks at an early age in parents or grandparents

High levels of blood fats (lipids) — cholesterol and triglycerides

High blood pressure

Obesity

Cigarette smoking — this increases the risk four to six times

Nervous tension

Lack of physical exercise

Most of these factors are reversible and there is no doubt that high fat levels are a cause. What is debated is whether you can do anything about changing the level of fat in the blood.

A diet high in animal fat tends to increase the amount of cholesterol and a high intake of refined carbohydrate increases the level of triglyceride. Changing the diet may reduce this factor and so reduce the risk.

*406/71/1*

MISCARRIAGE – THREATENED MISCARRIAGE

A threatened miscarriage is where there is bleeding from the vagina during the course of pregnancy. This may settle down and the pregnancy proceed to term. But if the cervix dilates and the membranes rupture, then the term used is inevitable abortion.

Incomplete abortion means that some placental tissue has been retained within the uterus or womb.

This miscarriage is usually associated with bleeding which may be heavy, and pain, backache or lower abdominal cramp, just like a mini-labor.

Very few miscarriages are complete — that is, all the products of conception completely discharged.

Most doctors would consider that all cases of miscarriage require the operation of D and Ñ — dilatation and curettage — to remove the products of conception.

If the womb is not completely emptied, then the retained placental tissue may cause infection or, later on, heavy or irregular periods.

A missed abortion is where death of the foetus has occurred. The symptoms of pregnancy disappear, but there may be no bleeding.

*152/71/1*

WHAT IS THE SKIN? (PART 2)

The dermis in turn is supported by the subcutaneous tissue, which in reality is a specialized layer of the dermis. It is more loosely arranged and has specialized in the formation of fat. The thickness of the subcutaneous tissue varies greatly in different parts of the body and even between the sexes. Its main function is heat insulation and being a support for the various blood vessels and lymphatic vessels which supply the skin with nourishment and drain away the waste products. Through it also run the bundles of nerve fibres which form a complex interlacing network throughout the dermis.

There are a number of both essential and non-essential skin appendages. The essential ones include the various glands, and the non-essential ones, the hair and nails. The sebaceous glands are a group of specialized cells in the basal layer of the epidermis which produces sebum. This is an important fatty secretion which is discharged onto the skin surface through a small duct leading into the hair follicle opening. Sebum has a number of functions, one of which is to lightly coat the epidermis with oil and so help retain moisture in the skin. Another is to improve the pliability of the skin. It also has a mild anti-bacterial and antifungal action. Sebaceous glands occur over the whole skin surface, except on the palms of the hands and soles of the feet. They are most numerous on the face and scalp. The activity of these glands varies greatly between individuals and at various ages. During adolescence there is usually an over-production of sebum, resulting in acne, whereas in the elderly there is an under-production, resulting in dry. non-pliable skin.

Apocrine glands are modified sebaceous glands, found mainly in the armpits, genital area, and around the nipples. They are specialized glands which do not function until after puberty. They are stimulated by certain hormonal factors (such as the hormonal changes which occur during menstruation and pregnancy) and emotional factors (such as stress and sexual arousal). Their secretions are responsible for an individual’s characteristic odour and may also have some minor lubricating function.

*2\44\4*

LOW-FAT AND LOW G.I. SNACK FOODS

Raisin toast (Burgen™ bread);

Low-fat milkshake or smoothie;

An apple;

Low-fat fruit yoghurt;

Dried apricots;

Peaches and plums;

Baked beans;

An orange;

Popcorn;

A glass of low-fat milk;

Leanne was seven and a half months pregnant when she developed gestational diabetes. Her doctor advised her to keep her blood sugar level after meals less than 7 millimoles/litre. To check this, Leanne performed finger-prick blood tests on herself every day. The only time she found her blood sugar tended to be higher than 7 was after her main meal in the evening. By looking back over the results of her home blood sugar monitoring, she found that her blood sugar was high if she ate potato but fine when she had pasta. The secret to good blood sugars for Leanne? Pasta more often, and inclusion of low G.I. carbohydrate whenever she had potato.

Many people with diabetes have to resort to tablets to control blood sugar levels. The following story shows you how an increased intake of low G.I. carbohydrate foods can sometimes make tablets unnecessary.

*132\42\4*

ACCURACY OF MEASURES OF FATNESS

The advantage of weight is that it is a simple, accurate and reliable measurement. The accuracy of any measure of body fatness, as with other physical and psychological tests, can be gauged in at least three ways; by its validity, reliability and sensitivity. Each of these are scored on a scale from 0 to 1.0, where 0 implies a low degree of accuracy and 1.0 a perfect measure.

Validity refers to the degree to which a measurement actually measures what it purports to. Without validity, any technique is useless.

Reliability refers to the degree to which the measurement used measures the same on different occasions.

Sensitivity refers to the degree to which the measurement instrument can detect subtle changes, and derive different scores as small changes occur.

Given these three factors, measures of fatness can then be rated for their usefulness in the practical situation. We have divided these into (a) manual measures, (b) machine measures of fatness, and 1 measures of body fat distribution.

*57\186\4*

BABY AND CHILDHOOD URINARY TRACT DISORDERS: HOW THE URINARY SYSTEM WORKS

The kidneys and bladder and its intricate system of tubes (many of them microscopic) form a very valuable filtering system for the body.

During its journey around the body, all blood regularly pays a visit to the kidneys. There it is filtered in a rapid and wondrous manner through the renal network. Impurities the body wishes to eliminate are rapidly shed. If the blood is overloaded with certain products it has no use for, these are also tossed out by the kidneys. The balance of chemicals, hormones and minerals needed by the body is kept normal by the balancing-out capacity of the kidneys.

Chemicals are filtered out in a fluid form, and collected in the central part of the kidneys. From there they are channelled by tubes, called ureters, which lead to the bladder. There the fluid is stored until a convenient time, when it is voided by another single tube called the urethra.

There is an important outlet valve at the lower end of the bladder. It takes babies many months before they have complete control over this valve. But eventually each one succeeds and is then capable of passing urine at a suitable time and place.

Some children do not gain this control for some years, and continue to pass their urine at night. Bed-wetting is an embarrassing problem, but in most cases it overcomes itself and it is uncommon after the age of 12 years. But it sometimes persists into the late teens or twenties, when it may become a social embarrassment. Treatment today is usually successful.

The kidney is probably the most common organ of the body to suffer from congenital malformations, though these are fortunately not frequent. Sometimes cysts, occasionally many in number, may damage the kidney structure. In other cases structural abnormalities may occur. Some of these are apparent from an early age and will be automatically cared for by doctors soon after birth.

Infections of the bladder and lower tracts of the urinary system are common. These usually respond well to prompt treatment.

More seriously, the kidneys may be affected by an infection that takes place in some other part of the body. This is believed to be an allergic type of reaction and it may produce serious symptoms.

*81\87\2*

BABY AND CHILDHOOD ILLNESSES: TEMPER TANTRUMS

Considering the complexities of the life of a child, it is often amazing they do not lose their tempers more often! They are not born with self-control. They have to learn it. Temper is due to anger, plus a sense of insecurity, plus helplessness. Many children can cope extremely well, but others seem involved in ongoing outbursts most of their lives.

Often the child’s tantrums are a direct reflection of upbringing. In families with a high level of emotional disturbance, where fighting and personality clashes are the rule, the child is more likely to reflect this by being involved in rages far more often. A child who normally lives in a calm, relatively serene atmosphere will lend to reflect this and be much less likely to be involved in temper tantrums, breath-holding bouts, sulky periods and similar emotional states.

Treatment

Children are usually the product of their environment and upbringing. A serene home life will invariably produce a child with a calm mental outlook and a tendency to fly into rages far less often than one who lives in a family ridden with mental stress and turmoil.

Children live by example. If parents only realized this, it would greatly ease the burden of treatment. Yelling, screaming and shouting, hurling abuse and chastizing verbally or physically will seldom do much good for frayed tempers. Indeed, it will tend to worsen the situation. Bribery will be equally disastrous, for the child may soon learn the pecuniary value of temper tantrums, and lack of self-control will be inevitable.

Self-control by parents is the best example. Adults are able to do this, and in so doing they will inevitably benefit their children and their children’s attitudes. Being neither overindulgent nor over-strict is also good admonition.

*32\87\2*

PLEURISY

The pleura are two delicate membranes which surround the lungs. The condition in which they become inflamed, as the result of either a bacterial or a viral infection, is known as pleurisy. It is characterised by sharp or stabbing pains in the chest or shoulder when a breath is taken.

Normally the pleura move smoothly against one another as the lungs expand and contract during breathing. A thin film of fluid lubricates the membranes. When an infection is present, the pleural fluid becomes sticky and the pleura rub against one another. This ‘pleural rub’ can be heard clearly through a stethoscope. Sometimes an excess of pleural fluid is produced, protecting the inflamed membranes from friction. This pleural effusion can be detected when a dull note is produced by tapping the chest wall. A raised temperature and general feeling of unwellness is a further symptom.

Pleurisy is generally a minor illness. However in some cases it may be a sign of a more serious disease such as pneumonia, a blood clot in the lung, lung cancer or tuberculosis. It is therefore imperative that a doctor be consulted before undertaking any form of complementary treatment.

Homeopathic remedies can be used to treat pleurisy. Chest and back compresses can help reduce internal inflammation. Large doses of Vitamin C and Vitamin A may be recommended by a naturopath.

*31\69\2*

ST JOHN’S WORT AT WORK: MERCEDES’ STORY

Mercedes is a social worker in her early fifties who makes a distinction between the two different kinds of emotional suffering that she has experienced in the course of her life. The first type, ‘the remains of a difficult childhood’, took her some time to sort out. But even after being satisfied that she had taken care of the residue of her childhood, she found herself left with ‘a light film of dysthymia, which lasted for years and was probably inherited from my parents, both of whom suffered from depression’. Dysthymia is a condition of chronic, persistent low-grade depression.

As a result of her low mood, Mercedes would procrastinate, putting off unpleasant tasks such as housekeeping or paperwork in favour of activities she greatly preferred, such as knitting, crocheting or playing with her birds and her dogs. Naturally introverted, she would withdraw in social situations, where she always felt as though she was holding back.

Mercedes decided to try St John’s Wort because it was natural and she understood it to cause few side-effects, starting with 300 mg three times a day. It took at least five weeks to notice an effect, and even then it was subtle though palpable. She stopped procrastinating as much and was more outgoing in social situations. Her husband noted the change, remarking that her dark moodiness had lifted and that she now seemed ‘lighter’. She experienced no side-effects whatsoever, plans to continue to take the herbal anti-depressant and is interested in recommending it to several of her clients.

The stories of Matthew and Mercedes illustrate how versatile an anti-depressant St John’s Wort is, capable of bringing someone out of the dark depths of despair, as in Matthew’s case, or of alleviating the milder and more subtle dysthymia which affected Mercedes. The dosages needed by these two individuals were quite different, with Matthew responding to 300 mg per day while Mercedes used the more conventional 900 mg per day dosing schedule. Optimal dosages of other types of anti-depressant medications vary widely and there is no reason to suppose that this will prove to be different for St John’s Wort. The size of the patient is not always a good guide to the best dosage, as these two cases illustrate: Matthew is 6-foot tall and weighs 13 stone, yet required only one-third the dosage used by Mercedes, who is a small woman. Another difference between Matthew and Mercedes is the time scale of the effects of the herbal anti-depressant, from the almost immediate beneficial effects experienced by Matthew to the five-week lag before the treatment kicked in for Mercedes. Such observations indicate why it can be useful to experiment with different dosages for different people and why it is important to persevere for several weeks before declaring a trial of St John’s Wort to be a failure.

*7\75\2*

CASE STUDY: BEHAVIOR PROBLEMS, HEARING LOSS, AND HYPERACTIVITY

David Hart was eight years old when he was brought to me. His problems were obvious: his face was never at peace, but was wracked by spasms; he was continually sniffing, blinking, and squinting. His eyes were red and rimmed by dark circles. Although his grades were average, he had frequent temper tantrums at school and at home.

In addition, David had a hearing problem, which seemed to increase as he grew older. He complained of a ringing in his ears, a condition called tinnitus. This had been unsuccessfully treated with decongestants and antihistamines. Sometimes he complained of having a “bug in his ear.” The slightest noise in class distracted him, since then he could no longer hear the teacher distinctly.

The routine five-day water fast in the Ecology Unit worked wonders: the mouth tic, eye-blinking, and hyperactivity disappeared. So, too, did the bags under the eyes, which are called “allergic shiners,” a frequent sign of food or chemical susceptibility.

When single foods, known not to have been significantly contaminated with chemicals, were returned to David’s diet, some of them brought on attacks of spasms and facial contortions. The worst offenders in his case were wheat, beef, corn, and blueberries, followed by haddock, cherries, peanuts, and potatoes.

Many foods, however, could be eaten without causing any symptoms, such as crab, chicken, pork, lamb, and onion. When some of these acceptable foods were given to David in their commercial, supermarket form, however, they caused grimaces, hyperactivity, eye circles, and gassiness. The boy became progressively more grouchy and twitchy after the second feeding of “normal” food, and this increased with each subsequent feeding. The avoidance of such foods paved the way for David’s recovery, and the last time I spoke to his family, he was greatly improved and doing well in school.

Like Paul Rossi, David was one of those hyperactive children whose problem was actually caused by a highly individualized reaction to the food and chemical environment, and greatly helped by avoiding those items to which he was allergic.

*60\110\2*

THE BASIC CONCEPTS OF ALLERGIES: INDOOR AIR POLLUTION

It may have occurred to the reader that air pollution plays a role in the problem of chemical susceptibility. This is true, but not in the way most people suspect. For while it is true that outdoor, or ambient, air pollution is a significant source of exposure, a far greater threat is posed by the presence of indoor, or domiciliary, air pollution.

Indoor air pollution? The term itself is unfamiliar and strange to most people, who tend to think of air pollution solely in terms of smog. Yet the home itself generates combustion products or is directly exposed to them, and many household products give off noxious fumes.

Indoor air pollution is particularly dangerous because exposure to it is so constant. Outdoor air pollution comes and goes; indoor pollution is ever-present, and thus its effects generally remain well hidden. In this it obviously resembles food allergy: as has been explained, allergy to uncommonly eaten foods is readily detected; the real danger comes from allergy to the ordinary foods which we take for granted.

My involvement with the problem of indoor air pollution dates from my earliest chemical-susceptibility cases. In the case of Nora Barnes, for instance, pine paneling and other pine products were implicated as a source of chronic illness. In Ellen Sanders’ case, natural gas and pesticide spray resulted in asthma, arthritis, and a host of other complaints. Removal of these pollutants has resulted in her enjoying reasonably good health over a twenty-five-year period.

I first discussed the topic of indoor air pollution in a series of articles published in 1961 and then in my book, Human Ecology and Susceptibility to the Chemical Environment (1962). Shortly afterward, the topic became a matter of public debate. In 1962, the government called a conference on air pollution, the first of its kind, in Washington, D.C. As often happens with such conferences, the program and speakers’ list were announced first, and then the public was invited to attend. Out of a three-day program, only one-and-a-half hours were allocated for open discussion. During the discussion, I rose to say how astounded I was that no reference had been made, in three days of speeches, to indoor air pollution as a separate topic. In my clinical experience, I added, indoor air pollution was eight to ten times more important as a source of chronic illness in susceptible people than ambient air pollution. Outdoor air pollution, I told the gathering, tended to be intermittent and variable, while indoor air pollution was constant. This very constancy made it a source of chronic disease. And of the various materials found in the home, the gas kitchen range, I said, was easily the worst offender. This left some of the experts without words, but on the far side of the room a gentleman rose and confirmed what I had said, adding some telling details of his own. He introduced himself as Francis Silver. He was an engineer from West Virginia, and later became a member of the Society for Clinical Ecology. We had never met before, but he and I had come to almost identical conclusions about the danger of indoor air pollution, as the result of very different experience—he as an engineer of buildings and I as a clinician studying the effects of such buildings on individual health.

In the following years, there were two conferences devoted solely to the topic of indoor air pollution. In general, these were productive, and I spoke at both.

Since the early 1950s, the extent of the problem of indoor air pollution has continued to grow larger. At the present time, it represents a major source of chronic illness among susceptible individuals in the United States. This can be best understood by considering the kinds of exposures which most frequently result in such chronic health problems.

*30\110\2*

CHILDREN’S HEALTH: DRAINING EAR

A draining ear occurs when any abnormal discharge or fluid comes out of the ear canal. The only material that normally comes from the ear canal is wax (cerumen). Earwax is ordinarily brown, though it may be beige or even yellowish if mixed with water when bathing, showering, or swimming. Normally, earwax has only a mild odor, contains no blood, and never flows out in large amounts.

Any other material discharging from the ear canal signals a potentially serious condition. It may be a symptom of a middle ear infection; a boil in the ear canal; swimmer’s ear (infection of the ear canal); rupture (break or tear) of the eardrum by injury or infection; a foreign object in the ear canal; tumour of the middle ear (cholesteatoma); or fracture of the base of the skull.

Signs and symptoms

Abnormal discharge from the ear may be thin and watery, bloody, odorous, cheesy, green, yellow, or white.

Home care

Any drainage from the ear canal (except typical earwax) should be considered abnormal. Do not try to treat a draining ear at home. It should be promptly seen by a physician.

While waiting to see the doctor, pain accompanying a draining ear may be temporarily treated with aspirin or paracetamol pain relievers.

Precautions

• A draining ear should be examined by a doctor within 12 to 24 hours.

• Do not pack cotton into a draining ear. Packing the canal may force the discharge back into the middle ear.

• Do not use a cotton swab or any other instrument to remove material still in the canal.

• Do not attempt to wash out a draining ear since the eardrum may be broken or torn.

Medical treatment

Your doctor will gently clean your child’s ear, inspect it, and diagnose the cause. Depending on what is found in the ear canal, treatment may require oral antibiotics, medicated ear drops, removing a foreign body, an X ray of the child’s skull or mastoid bone, or surgery for cholesteatoma (tumour of the middle ear). In the case of a ruptured eardrum, antibiotics may be required for a long time, until the eardrum is healed and hearing returns to normal.

*55/84/5*

MEDICAL TESTING: TAKING INVENTORY OF YOUR HEALTH

Your Forties

Age 40 is when it’s time to step up your tests, generally getting them every other year instead of every three. It’s also time to start tending to your lower half. Your risk for colon cancer rises sharply when you hit your mid-forties, and your risk for prostate cancer increases as well. In addition to the other aforementioned tests, get this test now, suggests Dr. Goldberg. He also notes that race and personal or family history of illness can change the timing and frequency of medical tests.

Rectal exam: Nobody wants one. Every 40-plus man needs one every year, says

Dr. Goldberg. A digital rectal exam (DRE) – in which your doctor inserts a gloved, lubricated finger into your rectum to feel your prostate-is your best line of defense against prostate cancer.

Your Fifties and beyond

Not much changes between 40 and 50, so long as you’re continuing your regular tests about every two years. At age 50, start getting physicals annually and continue getting the DREs you started getting in your forties. Just add a couple more tests, and you’re set for life, says Dr. Goldberg.

Stool sample: During a DRE, the doctor will also take a tiny sample of stool to test for any traces of blood-a sign of cancer growth or development. Like DREs, this should be done every year, says Dr. Coulehan.

Sigmoidoscopy: Your 50th birthday is a good time to start having this test and then get it done every five years thereafter, says Dr. Goldberg. A sigmoidoscope is a thin, flexible, lighted instrument that actually lets the doctor look into your rectum and large intestine for polyps, or growths that might signal cancer. The test takes just a few minutes. And don’t worry. The sigmoidoscope is so thin and flexible, doctors say that although the test is uncomfortable, it is not painful. If you are at higher risk because of family or personal history, your doctor may recommend more inclusive tests such as colonoscopy or a barium enema at an earlier age.

PSA screening: PSA (prostate-specific antigen) screening is a blood test that checks for a compound that is produced exclusively by the prostate gland. Significant increases in this compound can indicate a problem, such as prostate cancer. You should have this test done every year starting at age 50, says Dr. Goldberg, unless you are at high risk because of your family history or if you are an African-American.

*62/36/5*

BREAST SURGERY: STAYING IN HOSPITAL AFTER OPERATION

An operation to remove a lump from the breast will probably last about 20 to 30 minutes; mastectomies may take up to an hour. Therefore you are likely to be away from the ward for no more than 3 to 4 hours. You may feel drowsy and slightly sick as the effects of the general anesthetic wear off. If your mouth is dry, you can take sips of water, but drinking too much immediately after your operation can make any nausea worse. As your digestive system will not be affected by the operation, you will be able to eat as soon as you want to.

Following a mastectomy, you may be returned to the ward with a drip inserted into your arm. This contains a saline solution to replace the fluids that have been lost from your body during the operation, and will be removed after about 24 hours or when you are able to drink freely.

Drainage tubes

One or more small tubes will extend out of the side of the dressing covering your wound, each draining into a plastic bag or bottle, which will probably be placed beside you in the bed. Although the drainage system is cumbersome, you will be able to get up and move around the ward while it is still attached, but do remember to make sure the collecting bag(s) is supported before you do so. It may be taped to the.-side of your body or pinned to your nightdress. The weight of an unsupported bag will pull on the wound, causing discomfort.

During the first day following your operation, fresh blood and fluid will drain into the collecting bag. On the second day, the amount of fluid will probably have reduced substantially, and may be mostly clear, with a small amount of blood. Following a wide lump excision, the single drainage tube may be removed after about 24 hours. Each of the two tubes required after a mastectomy will be taken out when the drainage into them has reduced, which may be anything from 1 to 7 days after your operation.

The wound

Your wound will probably be covered by a clear dressing with an overlying pressure dressing to reduce bruising. The pressure dressing consists of a wad of gauze covered with Elastoplast strapping which is quite tightly applied after wide lump excisions and mastectomies. This will probably be removed after about 24 hours, once a doctor has visited you on the ward to check your wound.

If you do not want to be able to see the wound through the remaining clear adhesive dressing, do ask a nurse to cover it with gauze. You may find the sight of the blood-encrusted wound, the stitches and possibly some bruising upsetting. However, it will improve each day, and it should have healed and begun to look a lot better after a couple of weeks.

The wound may have been stitched with an absorbable material that will dissolve of its own accord in time, and only its ends may be visible. Alternatively, the stitches may be of a nonabsorbable material, possibly with a small white bead attached at each end. Stitches of this type will have to be removed 7 to 14 days after your operation. Many wounds are now stitched with a single continuous stitch, and appear as a single straight line.

The pull of the stitches may cause a feeling of tightness which will improve after a few days.

*41/39/5*

PHYSICAL EXAMINATION FOR ENDOMETRIOSIS

A physical examination usually involves:

• testing a specimen of your urine

• taking your blood pressure

• examining your breasts

• examining your abdomen

• a pelvic examination (sometimes also known as an internal or a vaginal examination).

The purpose of the pelvic examination is to try to determine whether there are any indications that you may have some endometrial implants or cysts present. Sometimes, the pelvic examination will suggest the presence of endometriosis but often nothing abnormal will be found, especially in the early stages of the disease.

Knowing what is involved in a pelvic examination will help to relieve any anxiety that you may have and help you to relax and therefore make the examination more comfortable for you and easier for the doctor. Ask your doctor to explain the procedure to you before she or he begins.

It is best if you empty your bladder just before the examination as a mil bladder will make it difficult for the doctor to perform the examination satisfactorily.

During the pelvic examination you will usually be asked to lay on your back with your legs spread apart, knees bent and feet together.

While the doctor is examining you it will help if you tell him or her when you can feel any pain or discomfort. A pelvic examination may cause a little discomfort but it should not be painful. If the examination does cause pain ask your doctor to stop for a moment to allow the pain to subside while you relax again. After the examination has been completed ask the doctor to describe what he or she felt.

The doctor will begin by examining the external genitalia, which includes the vulva, clitoris and labia, for any signs of inflammation, irritation or infection.

The doctor will then insert an instrument, known as a speculum that holds the sides of the vagina apart to examine the vagina and the cervix. The doctor may also take a Pap smear or a sample of any unusual discharge using a cotton swab or a wooden spatula. Once a thorough examination has been made the doctor will remove the speculum and perform a bimanual pelvic examination.

In the bimanual examination the doctor inserts two gloved fingers into your vagina and places the fingers of the other hand on your lower abdomen in order to feel the outline, shape, size and location of the pelvic organs between his or her hands. The doctor will also feel for any nodules, lumps, growths, enlargements or areas of tenderness.

During the examination the doctor may be able to feel nodules of endometriosis in the Pouch of Douglas, on the utero-sacral ligaments or in the recto-vaginal septum. It may also be possible to feel if the ovaries are enlarged, which may indicate cysts on the ovaries. The doctor will also be able to feel if the uterus is lying in the normal position or if it is stuck in a retroverted position.

Occasionally, the doctor may feel that it is necessary to perform a recto-vaginal examination if you are complaining of symptoms involving the bowel. This examination is similar to a bimanual pelvic examination but the index finger is inserted into the vagina and the middle finger into the rectum. The fingers of the doctor’s other hand are placed over the lower abdomen to help outline the organs and feel for any enlargements or growths.

If a pelvic examination does not indicate anything abnormal and if it was not performed near the time of your period it may be worthwhile having another examination just before, or during, your period when the endometriosis is most active thus making the implants more tender, larger and easier to feel.

*19/41/5*

PREVENTIVE MEDECINE: DISEASE AND THE WESTERN LIFESTYLE

To many, if not most, of us living in the West, the notion that some of the diseases we all take for granted as the major killers are preventable is indeed hard to accept. Strokes, heart disease and cancers between them kill most westerners yet they are relatively uncommon in the non-westernized world. Why should this be, and is it possible that by altering the way we live we could reduce or even abolish these conditions?

At first, the suggestion that it is our western lifestyle that causes many of our major diseases seems quite ridiculous, but the pioneering work of a group of doctors who spent decades in non-westernized parts of the world must make us think again. They noticed that certain non-infective diseases were very much less common in traditional societies than they were in the West. They wondered at first what to call these diseases. ‘Diseases of civilization’ (meaning modern, western civilization) is not quite right because evidence suggests that some of them were around but uncommon in the ancient civilizations of Egypt, Greece, Rome, India and China. Given that the conditions they found to be so common were now mainly seen in communities that had adopted our western, technological way of life, they decided to call them ‘western diseases’.

The first two criticisms that are immediately thrown at such a suggestion are, first, that people in the Third World tend not to live to be old enough to get ‘our’ diseases, and second that their medical systems are so poor that they simply do not diagnose the conditions even when they are present. Neither of these criticisms stands up when examined in depth, and studies which show that migrant populations (originally without western diseases) adopt the diseases of their westernized brothers in their new country, prove without doubt that it is not simply that whole populations in the non-industrialized world are somehow immune to westernized diseases. It is also impressive (if depressing) to watch peoples with traditional lifestyles take on our disease pattern as they adopt our way of life.

So what could possibly be causing these western diseases? Obviously motor-car accidents can only occur where there are motor cars, and pollution from industrial effluent or cigarette smoke is only found where these two abound, but these are not the diseases I mean when I refer to western diseases. The conditions in question are such disorders as: high blood pressure, obesity, diabetes, heart disease, appendicitis, piles, varicose veins, gall-stones, kidney stones and cancer.

Of course, any of many changes in western lifestyle in recent years could account for the frequency of all these conditions today and their virtual absence until the last century in the West and in most of the world today, but because many of them seem to affect the digestive system it makes sense to start looking for clues in the food we eat. Modern technology has radically altered the production and preparation of food and it now seems that food changes are at the heart of many of these ‘new’ western diseases.

*56/72/5*

FEEED YOUR BODY RIGHT: SHE NEVER LEAVES HOME WITHOUT HER BUTTER SPRAY

How can you lose 100 pounds on a 1,200-calorie-a-day diet and still enjoy going out to restaurants?

Carry butter spray and fat-free salad dressing in your purse.

That’s what Alayne Gunto of Moundsville, West Virginia, did when she became determined to whittle her 242-pound figure.

Alayne comes from a family with a history of weight problems. While she tried on and off to slim down, she was never really successful. Then her mother, father, and grandmother all had heart surgery within months of each other. That was the wake-up call Alayne needed. She decided to lose weight because, as she says, “I didn’t want to put my husband and children through that experience.”

Alayne put herself on a strict 1,200-calorie-a-day eating plan. She paid attention to what and how much she ate, something she had never done before. She kept close tabs on her portion sizes by reading food labels and using measuring cups. She started eating breakfast every day but quit her habit of munching on high-fat

snacks. To bolster her resolve, she joined TOPS (Take Off Pounds Sensibly), where she participated in regular weigh-ins.

All of these strategies helped Alayne hold course on her self-styled weight-loss program. But there is one trick in particular that she says has kept her from blowing her calorie and fat budget. “I like to eat out, but I want to know exactly what’s going into my mouth,” she explains. “I don’t want to leave it up to the restaurant to tell me I’m eating low-fat. I don’t necessarily believe their advertising. So I order my salads and baked potatoes plain. I just open my purse and dress them myself.”

Alayne’s strategy worked. Within 15 months of starting her weight-loss program, which included daily walks, she reached her goal weight of 145 pounds. She has maintained this weight for 2 years.

These days, just looking in the mirror is incentive enough for Alayne, a 34-year-old homemaker, to keep her eating and exercise habits on track. And although she admits to occasionally going over her fat and calorie budget, she never goes to a restaurant without her condiments.

WINNING ACTION

Stick with your own low-fat or no-fat condiments. Salad dressing and butter pack a lot of calories for the little room that they take up. Take a tip from Alayne and pack your own when going to restaurants. These travel particularly well: Marzetti’s fat-free salad dressing, available in packets at the supermarket salad counter, and I Can’t Believe It’s Not Butter spray.

*49\89\8*

MYOFASCIAL SYNDROMES

These occur when there is an inflammation of the body’s muscular system. Myofascial pain is a term that refers to the muscles and to the cellophane-like membrane that covers the muscles.

Such conditions are difficult to diagnose as there are no effective examinations or techniques to indicate their presence. The diagnosis is sometimes made only in the absence of neurological or orthopaedic factors.

Myofascial syndromes often mimic conditions such as disc disease and arthritis of the spine. The causes of such syndromes include whiplash, injuries to the neck, excessive exercise, and muscle tension such as typists feel in their shoulders after sitting through a long day.

In these cases, muscles which usually slide freely against one another are pinned down by adhesions caused by a muscular injury. Muscles pulling on the tight areas cause muscle spasm.

Australia has just experienced an epidemic of myofascial-type syndromes in otherwise healthy young individuals who usually complain that the condition is caused by sitting at computer keyboards

for long periods.

In Australia, such conditions are often labelled RSI (repetitive

strain injury).

One of the only ways to diagnose myofascial syndrome is to induce pain as an identifiable trigger point in the back or other muscles. Trigger points are parts of the muscles or ligaments that when pressed with a finger cause severe pain to radiate away from the pressure point.

Although the precise cause of such trigger points is not yet fully understood, it is thought that perhaps restrictive muscle movement causes initial pain. In turn, this restriction is believed to produce muscle spasm that pulls the sensitive covering over a bone to which the muscle is attached.

Treatments Myofascial syndromes are often treated well by physicians using the techniques of TENS therapy and acupuncture. Non-steroidal anti-inflammatory drugs may help relieve inflammation initially and relaxation techniques are often used as a back-up treatment to the physical treatments and appropriate medications.

Temporomandibular joint or TMJ syndrome

*73\37\8*

THE ‘REWARDS’ OF PAIN

Patterns of pain behaviour are very self-destructive.Yet sometimes people discover that there are coincidental, secondary rewards for suffering, such as increased attention, decreased family responsibility and avoidance of sexual activity. Alternatively, the pain can be used to provide a convenient tool which can be used to manipulate others.The attraction of such games may be strong enough to keep pain patients from recovering. They thus find it worth their while to adopt a certain posture and particular movements which may have been prevented, or alleviated, by taking the appropriate prescribed drugs at the recommended level.

Consequently, they may continue the posture, or the limp,or the drugs — even if such habits no longer have credibility. It is all part of the convincing pain games that a small, but important, minority of patients play.

Some pain sufferers may have found that their pain habits elicit sympathy, feelings of concern, or even approval — rewards they are willing to buy at the expense of being in pain. A particular facial expression, a moan, or a particular ‘pained’ look may offer a pleasant pay-off because others usually respond with kind words or efforts to help.

More common is the patient who is extremely hostile to doctors or members of their families who refuse to act sympathetically to gestures of pain. And there’s the type of patient who wants to ‘even the score’ with a spouse not considered sympathetic enough.

*50\37\8*

BRUCE’S MOTORCYCLE ACCIDENT AND GUNSHOT WOUNDS

Bruce was riding his motor bike along the heavily treed banks of a river and failed to see a large tree branch which caught his shoulder. The immediate result was of a tearing pain at the base of his neck followed almost instantaneously by total paralysis of the affected arm. A moment later the motorcycle hit another tree, head-on, causing an immediate loss of consciousness. His paralysed arm was removed and he had been given a number of neurosurgical procedures aimed at controlling his constant almost unbearable pain. Ten years after when he came to the pain clinic he was still suffering constant pain. Fortunately he had an almost miraculous response to TENS therapy and a small dose of Rivotril.

Gunshot wounds

Gunshot wounds, too, fall into the violent trauma category. Damage to peripheral nerves in the arms or legs by such wounds is accompanied by excruciating pain, persisting long after the tissues have healed. These pains may also occur spontaneously for no apparent reason, as in the neuralgia following shingles. The pain has been described by victims as ‘burning’, ‘cramping’ or ‘shooting’. Sometimes the pain is triggered by such an unlikely event as a gentle touch or even a puff of wind! Spontaneous attacks of pain may take minutes or hours to subside. Many occur daily for years after the injury.

*28\37\8*

MYTHS ABOUT PAIN

Many of the problems arising between doctors and patients appear from the perceived and common myths regarding chronic pain: It’s all in your head

To some extent all pain is in your head. Because pain is a purely subjective experience — pain is what you say hurts!

Just ignore that pain and it will go away

Many forms of chronic pain simply cannot be ignored. The person experiencing severe unending pain may be able to use distraction but the pain may well still be an intrusion into every waking moment.

Nobody ever felt as bad as you

Although it is true that no-one else ever felt what you feel, it is likely that there are-others who share similar experiences to yours.

God is punishing you for a past mistake .

It is highly unlikely that the Creator has taken the time to specifically torment you for some past misdemeanour.

You’ve been abusing your body so take the consequences

Unfortunately pain occurs in those who abuse their bodies and also

in those who were previously fit. Chronic pain plays no favourites.

All pain is the same

As mentioned earlier all pain is subjective and is thus different for each one who experiences pain.

You just look too healthy to have chronic pain

Since no-one has yet invented a pain meter what is observed by an outsider can be totally misinterpreted. Until the day an external pain measurement device is invented some patients will appear to casual observers as though they are pain-free.

*6\37\8*

CLASSICAL ALLERGIC DISEASES: HELEN’S STORY

Helen had eczema as a baby and began to have asthma attacks when she was about six. These got a great deal worse when she was eight years old, and on close questioning the doctor discovered that her parents had recently built an aviary inside the conservatory that was attached to their house. Skin-prick tests showed that Helen had a strong reaction to feathers, and when the birds were removed from the house her asthma settled down to its previous level. In the hope of getting rid of it completely, her parents replaced all feather pillows and cushions with foam-filled ones. Although this seemed to help a little, Helen still had asthma attacks once or twice a month. These frequently came on after parties or outings, and the doctor suggested that it might just be excitement

triggering off the attacks. Then her asthma started to become more frequent again, and as the attacks often took place at school, it was interfering with her studies. Helen’s mother began to wonder if foods that Helen only had at parties or at school, during breaks, were responsible. Crisps, squash and other food containing additives were obvious suspects as Helen was not given this sort of food at home. She agreed to go without these foods for a month to see if this had any effect. Within a few days her attacks virtually disappeared and tests with different types of additives showed that artificial colourings and sulphites could bring on an attack within a few hours. As long as she avoids ‘junk food’ Helen is now free from asthma.

*51\180\8*

SYMPHOSAN’S SEVEN INGREDIENTS – 2

Arnica, which may be found anywhere in Switzerland up to a height of about 2800 m (8,500 feet), has been recognised as an aid to healing wounds for thousands of years and is acclaimed as such in the oldest herbal records. Contusions with extravasation of the blood into the adjoining tissues are also cured by means of an extract from the root. Arnica will encourage proper capillary circulation, which makes it an important ingredient that enhances the effectiveness of the other plant remedies.

Besides these six ingredients making up Symphosan, there is yet one more. It is houseleek (Sempervivum tectorum), a plant that used to be found growing on the roofs of old houses in Switzerland, especially on thatched ones. It may not have been a good thing for the roofs, but the householders certainly knew how to take advantage of the fresh plant to treat inflamed eyes, burns, scalds, ulcers or sores and wounds, for which it is a cooling and healing medicine.

All these outstanding herbs are combined to make Symphosan a truly remarkable remedy that should be kept in every medicine chest and rucksack.

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HOW A GOOD HERBAL REMEDY IS DEVELOPED – ESTABLISHING THE THERAPEUTIC EFFECTS

To establish the effects of a natural plant medicine one must first of all be capable of observing accurately and interpreting correctly. In every age there have been people endowed with intuitive insight which enabled them, by personal experience and observation of others, to determine what plants are most suitable for curing a given condition or illness.

The effect of various substances on the human organism can be observed with greater accuracy after two or three days of fasting. Needless to say, one would only experiment with plants and substances known to be nonpoisonous. After taking one plant or another, it is possible to judge the relative merits – how it affects the bowels, the kidney, the stomach or the appetite, or whether it stimulates the functions of the body in some other way. If the body is in good condition, certain important effects can be easily perceived. In homoeopathy this is the so-called ‘proving’ of remedies on healthy people.

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THE SKIN – THE EFFECTS OF SUNLIGHT (PHYSICAL APPEARANCE)

With regular exposure to sunlight, the way we look and feel will both improve, giving us a better physical appearance than we had before. It has been found that exposing the skin to sunlight increases, in a manner of speaking, the voltage of the nerve system so that the whole body will experience greater vitality. The skin is like an antenna that absorbs and emits rays. For this reason some people appear to refresh us and others sap our strength; when in the presence of the latter if feels as if all our energy were being drained, tiring us very quickly.

It is interesting to note that sunlight on the skin also heightens the efficiency of our sensory organs. We are able to hear and see better when we let the sun recharge us.

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VIRUSES; LACTIC ACID PREPARATIONS; COMFREY (WALLWOSAN)

The syndrome observed in the patient matched the symptoms attributed to the cytomegalovirus. However, as I wanted to be absolutely certain I sent the lady to a hospital where the laboratory was headed by a virologist I knew personally. I explained to him that I suspected the cause of her problem to be the cytomegalovirus. He did not think so, however, especially as the symptoms were not so obvious to him that he could confirm my opinion there and then. Nevertheless, he agreed to do a blood test. To his great astonishment what I had suspected proved to be true.

I then asked him what he would recommend to help the patient, and he suggested building up and improving her general condition of health since there was no specific remedy to combat the virus.

Comfrey {Symphytum officinale) is a fine pain-reliever in cases of cancer of the stomach and intestines. For this reason it is usually prescribed for diseases of these organs.

In more recent times research has shown that lactic acid is also beneficial in caring for cancer patients and should be considered for this purpose. Molkosan, sauerkraut juice and vegetable juices taken alternately will improve the patient’s condition and quench his thirst, however great it may be.

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ARTHRITIS AND GOUT – CELL METABOLISM

The cell’s metabolism is yet another miracle at work, one whose workings scientists rack their brains to puzzle out. Although we do have some knowledge of the internal processes, this represents only a fraction of what actually goes on in the cell. We know, for example, that the cell takes in proteins, sugar and salt solutions together with various minerals and that it releases some substances, in a sense, waste material. But why is it that one kind of cell selects this or that substance for itself, while another kind attracts different substances? In other words, what enables the cells to make this selection? No one has yet been able to discover the answer to this question.

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SCIENTIFIC EXPLANATIONS: POOR POSTURE

Pain is a significant stress to the body. The adrenal glands are forced to work hard for as long as we are in pain. Back pain, neck pain and headaches are perpetuators of the stressed state. Poor posture places undue strain on the muscles of the back, shoulders and neck making them tight and eventually stiff and sore. The sensory nerves convey this state of agitation from the muscles to the brain creating, or adding to, any agitation that may already exist there. Brain agitation manifests as that stressed-out feeling of being ‘uptight’. Being ‘uptight’ usually means tight neck muscles that are causing the shoulders to hunch up.

The muscles of the neck are attached to the vertebrae of the neck and when they tighten they pull the vertebrae together. In time the vertebrae press tightly enough against each other for the nerves that run between them to become pinched. Pinched nerves that emanate from the neck can cause a host of symptoms in the tissues they serve as well as pain in the neck muscles. Those that run from the neck to head can give rise to headaches and those that serve the face can give rise to involuntary twitches in the facial muscles and puffy bags under the eyes.

Those nerves that run from the neck to the nose can give rise to sinus pains, stuffy nose, runny nose and post-nasal drip. Pinched nerves can mimic the symptoms of allergy. Pinched nerves are one of the reasons allergy type symptoms remain in stressed people who are sticking strictly to their Anti-Candida/Anti-Allergy Program. The other reasons are long-term high levels of stress hormones in the blood which lower the body’s resistance, and neurokinin.

Hard-chargers are prone to bad posture. Being always on the go they tend to sit on the edge of chairs and hunch forward over desks, typewriters and computers. This in time strains the neck, shoulder and back muscles. The head weighs 7-9 kg (15-20 lb) and this perpendicular posture with a forward-bending of the head places great strain on the neck muscles, which keep the head from falling forward, back or sideways.

To get some appreciation of what this does to the neck muscles, imagine what expanding a Bullworker to 9 kg (20 lb) of pressure and holding it for eight hours would do to your arm and chest muscles. If the perpendicular, forward-bending, while perched on the end of the chair, posture is combined with a lot of rushing around and speeding in cars the muscles tighten even more. Working under pressure and taking on too much work gives rise to rushing and speeding.

Poor fluid intake and poor oxygen intake also tighten muscles. The muscles are about 70 per cent water and if these levels drop below 70 per cent the muscle tends to shrink. A shrunken muscle is a tight muscle that does not respond well to any method that is used to relax it, whether it is deep breathing exercises, massage, meditation, heat or Valium. Fully hydrated muscles expand to their normal size and are much easier to relax.

Adequate oxygen is needed to facilitate the metabolic processes of muscular expansion and contraction. Oxygen-deficient muscles (hypoxia) are more prone to fatigue, tightening and pain as any out-of-condition person knows when they suddenly take up a vigorous exercise regime. A lack of vitamins and minerals, especially the B vitamins, calcium, iron, zinc and magnesium, interfere with muscle cell metabolism and predispose muscles to spasm (tight, sustained contraction).

In addition to correct diet, deep breathing exercises, adequate fluid intake and the mental relaxation exercises, close attention must be paid to posture if tight muscles, pain and the allergy-mimicking symptoms they produce are to be overcome. Sit back in chairs. By using the support of the chair back you reduce the strain on the back and neck muscles which no longer have to work hard to keep you upright.

If having to bend forward to do paperwork take the weight of your head on your hand with the elbow supported by a pile of books. If your shoulder and neck muscles are already sore sit with a warm hot water bottle on them for ten minutes at night while relaxing in front of the TV. To thoroughly negate the stresses and strains imposed by the perpendicular forward-bending posture we need to regularly practise the opposite posture, that is, horizontal bending back.

The best way to exercise this posture is by swimming backstroke two to three times per week in warm water. Follow this with a warm shower, never a cold one (heat expands, cold contracts and tight, sore muscles are contracted muscles), with the jets of warm water being trained directly on the tightest, most painful spots. Make sure while swimming that you look at the roof, not the end of the pool. Looking at the end of the pool cranes the neck forward and strains the muscles. Don’t rush, this is a time to relax. Do a length and take a rest. Breathe deeply and slowly during this time then do another length. Do not be competitive about this swimming exercise. This is a time for therapy not a time for goal setting. If you’re not a swimmer then Tai Chi, yogic walking and yoga are just as effective for releasing tight neck, back and shoulder muscles. No head, neck or shoulder stands though if you do yoga.

In addition to straining neck and back muscles the posture of perpendicular forward-bending tends to round the shoulders forward so that chest expansion is restricted. This same posture forces the lower ribs down into the abdomen restricting the action of the diaphragm. Shallow breathing results, giving rise to oxygen deficiency, which tightens muscles, which in turn reduces chest expansion and perpetuates shallow breathing. A vicious circle is born which gets the sufferer more uptight and tired, which aggravates the collapsed state of the perpendicular forward-bending posture. Is it any wonder those who rush get less done, make more mistakes and have to repeat more of their work. The distraction of the pain and the lack of oxygen in their brain greatly affect concentration, comprehension and memory. In the initial stages of your muscle relaxation regimen it pays to consult your osteopath or chiropractor for heat, massage and manipulation of the muscles and vertebrae. This will accelerate your recovery.

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SCIENTIFIC EXPLANATIONS: THE METABOLISM

The metabolism can be broadly described as the sum total of all the chemical reactions which take place inside all the cells of the body. Perhaps the most important metabolic processes are those which turn the food we eat into energy or into body chemicals such as hormones, enzymes and antibodies. These chemicals are made from protein, fat, carbohydrate, vitamins, minerals and trace elements. If a deficiency exists in any one of these nutrients certain chemicals cannot be made and this will adversely affect the function of the other chemicals, thus producing an imbalance in the metabolism.

Most metabolic imbalances are associated with over-weight which in turn is frequently the result of eating the wrong type of food. Take white bread for example. It is both fattening and capable of causing serious disturbances in the metabolism. It is fattening for two reasons:

1. Because white bread is refined it is quickly digested and therefore rapidly absorbed into the blood as molecules of glucose which arrive in the bloodstream in such large quantities that the blood sugar levels immediately shoot up. To normalise the blood sugar levels the pancreas releases the hormone insulin which removes the glucose from the blood by converting it to fat. Years of eating white flour and sugar can so sensitise the pancreas that it over-reacts and releases too much insulin. This causes the glucose levels to drop too low, causing the metabolic imbalance known as functional hypoglycaemia. This usually happens to those who are vitamin and mineral deficient and/or under stress.

2. Because white bread is refined it lacks the vitamins and minerals required for normal carbohydrate metabolism and, because it cannot be metabolised properly and used by the body as a carbohydrate energy source, most of it must be converted to and stored in the body as fat. Thus, the body has increased in weight but its carbohydrate needs have not been fully satisfied. This usually manifests a desire to eat more carbohydrate and all too often white bread is again the choice.

To be correctly metabolised, any carbohydrate food needs to contain vitamins B3 (niacin), B1 (thiamine), B2 (riboflavin), B6 (pyridoxine), B5 (pantothenic acid) and the minerals phosphorus and magnesium. During the milling process of whole grain flour to its white refined state the magnesium, phosphorus, pyridoxine and pantothenic acid are removed and not replaced. If this white flour (refined carbohydrate) is to be metabolised at all the body must steal these four nutrients from other glands and tissues, thus creating imbalances in the metabolism. It steals phosphorus from bone, thereby impairing its growth and ability to repair and magnesium from heart muscle, predisposing it to spasm and, in time, arrest. Pantothenic acid (B5) is stolen from the nerves and brain, rendering us liable to lowered energy levels and increased irritability, and pyridoxine (B6) is stolen from the white blood cells, particularly the T-lymphocytes (which attack viruses, yeasts, bacteria and cancer cells) causing them to become very weak and lethargic.

Sugar, be it white, brown or raw, requires the same vitamins and minerals to be metabolised and is thus responsible for creating the same metabolic havoc. How much of our processed foods contain white flour and white sugar? Most of it. Even frozen turkeys contain added sugar! Any manufactured food with a word in the list of ingredients on the label ending in -ol, -ole, -one, -os or -ose has sugar in it. You’ll be amazed how many do.

It is the complex interaction between all the vitamins and minerals which maintains a balanced metabolism and a healthy body. Foods picked fresh from the garden have a far greater chance of containing all the necessary nutrients. The foods on the Metabolism-Balancing Program, especially when supplemented by a complete vitamin and mineral formula, ensure that our bodies receive the required nutrients. No vitamin or mineral can work on its own and must be aided and complimented by all the others. For a single vitamin or mineral to be effective it must arrive in the system with all the other vitamins and minerals and at the same time. That’s why you take your vitamin and mineral formula just before the main meal of the day. Unrefined foods ensure a balanced metabolism and are also the foods which arc least (if at all) fattening.

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