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The biggest change in people’s attitudes is an increase in apathy. People with dementia gradually become less responsive, harder to talk to, emotionally flat. They lose interest in their jobs, their family and friends, their homes, even themselves. Perhaps some of the problems of memory loss and difficulty concentrating are caused by apathy. Lisa said her husband, Glen, lost his “sparkle” and became less affectionate, gave short answers to questions, and couldn’t get interested in a conversation. She described a typical conversation: “I’d say, ‘What are you thinking about?’ He’d say, ‘Nothing.’ I’d say, ‘What did you do today?’ He’d say, ‘Rested, watched TV, read the newspaper, that’s about it.’ I’d say, ‘Anything interesting on the TV or in the paper?’ He’d say, ‘I can’t say so.’ I’d say, ‘Are you hungry?’ ‘No.’ ‘Are you thirsty?’ ‘Hard to say.’”     Lisa’s daughter agreed: “Dad was always happy to see me, but he’d lose interest. He was real dull, not enthusiastic about anything. He just seemed to go through the motions. When I’d call him on the phone, we’d talk a minute and he’d just hang up. We used to talk for a while. If I didn’t call him, we wouldn’t talk for a week.” Caregivers routinely report that people with dementia seem content just to sit and stare.     When people are in the later stages of dementia, their apathy becomes even more distressing for the caregiver. People with dementia gradually become disconnected from the world, stop laughing or empathizing or showing affection, and finally become so disconnected that they will not speak.     Even though apathetic people seem depressed and unhappy, they say they are not. They are satisfied with their quietness. They are not sad, not frightened, not lonely, only disconnected.In the early stages of AIDS dementia complex, people who are apathetic can often be drawn out. Mental health professionals say they do not know whether being drawn out decreases apathy or just makes the situation less distressing for the caregiver. In any case, they say, it can’t hurt. Lisa found that trying to draw her husband out often helped: “I’d try to talk to Glen about recent events, or someone I saw that day, or what happened around the neighbourhood. That often got him talking. When he became less affectionate with the grandchildren, I’d remind him of the good times we’d had with them, and then bring them over, one at a time, and that seemed to work. When he got less affectionate with me, I began sitting on the arm of his chair and snuggling against him, and he seemed to like that. Or I’d talk about our memories, like when we were dating or got married, and that got him talking too. But sometimes I just let him be disengaged. I think he needed some of it.” Dean says he doesn’t socialize well any more and that other people do more of the talking, though he enjoys listening to the talk. “But I can’t handle strange social situations,” he says, “no company picnics, no big parties.”     Because people with dementia are both apathetic and have difficulty concentrating, they need help making decisions. They can’t pay attention for long, they become confused, and they don’t care much about the outcomes; as a result, they make decisions slowly or not at all. Lisa’s husband needed several days to make a decision. “If a friend called and asked us to eat dinner that night,” she said, “he couldn’t answer because he couldn’t make a decision that fast. In those cases, I made the decisions. When the decision was important or when we had two or three days to make it, then he could make up his mind.”     When the decision is important—like deciding when to apply for disability insurance or how to provide for children—the person with dementia has difficulty both making the decision and acting on it. Caregivers need to present the options one by one, slowly, discussing each one, the way Lisa did with the decision to lend the lawnmower. They should repeat the options until the person with dementia understands, even if that takes days or weeks: “Should the child live with your mother? Your sister? Should the child be adopted?” Once the person has made the decision, caregivers need to write down the list of things to do, the steps to take, one simple step at a time. If the person seems to have trouble carrying out the decision, the caregiver should remind him: “We talked about this and I know you want it done. Shall I call the lawyer for you? Shall we do it together tomorrow? Shall I come over at ten?” Decisions may need to be repeated, gently and sympathetically, for days.*147\191\2*

One of my patients started on estrogen and progestin as she neared her fiftieth birthday and her periods became few and far between. After Elise went through menopause, a bone density scan showed her Z-score (comparing her to other women her age) was actually positive, and her T-score (comparing her to peak bone density) was just —.3. In the midst of what would otherwise have been the most rapid bone loss of her life, Elise was sitting pretty thanks to HRT.In this case, I know HRT was largely responsible for Elise’s relatively dense bones because although she took calcium supplements fairly regularly, her diet and exercise habits were otherwise far from ideal. Her job, in addition to being extremely stressful in general, required constant travel. Because of her schedule, she had long ago given up on the idea of a regular workout. Elise felt she couldn’t really eat right, since so many of her meals came from vending machines or room service or while dashing through the airport; For all these reasons, Elise had room for improvement. She began taking a range of other supplements along with her calcium, and starting paying attention to what she ate. She couldn’t always get all the calcium and other nutrients she would like (which is where the supplements come in), but found it was just as easy to grab a yogurt as anything else to eat, and began carrying healthier snacks along with her in her travels. She also committed to a walking program she could do wherever she was, and began making inquiries about gym facilities at the hotels she was destined for.If she sticks to those things, I’ve no doubt that her next bone scan will show her density to be right up there with the densest of 30-year-olds.*134\228\2*

When brain damage affects areas of the brain that control the coordination of movements, the child may be athetoid; movements are performed slowly and in a writhing fashion. Damage to other areas of the brain may cause more rigid movements, that is, dystonia. Since these control areas lie deep within the brain in regions less likely to cause seizures, epilepsy is uncommon among such children. They are also less likely to be retarded.Children with damage to multiple areas of the brain may have both spasticity and either athetosis or dystonia. Such children are said to have mixed cerebral palsy.”How can I help my child who has cerebral palsy?”Helping your child to cope with cerebral palsy depends on whether or not there is mental retardation. Many children with cerebral palsy are of normal intelligence, and for these children the motor dysfunction can be enormously frustrating. To be unable to dress, to go to the bathroom alone, to feed yourself can create such a sense of helplessness and dependence that depression is not uncommon. And yet children with cerebral palsy are increasingly able to find areas in which they can become competent and ultimately develop self-esteem. Appropriate use of computers allows both learning and communication. Motorized wheelchairs and special adaptations may permit mobility and independence. It is amazing what can be done to help unlock the real person who is within.For the child with cerebral palsy as for the child with mental retardation the most important ingredients in successfully coping are development of motivation and self-esteem. Motivation can be stimulated by activities and hard work such as those involved in preparing for the Special Olympics. The joy of successfully participating in such sports promotes self-esteem. Special Olympics is a model of what can be achieved in other areas of life, with patience and persistence. Such children need role models of successful handicapped adults. Their ability to become an achieving adult begins with small successes in the family and in the school.Helping your handicapped child to cope with the accompanying psychological problems is still an art, not a science. How to do this is unclear, but he, and you also, need help in articulating your frustrations, concerns, your anger, and your hopes.There has been amazing progress in recent years in enabling both the retarded and those with cerebral palsy to participate more fully in the community. The old stereotypes of institutionalization and handicap persist. But these children, while disabled, are not able.*201\208\8*

Tuberculosis is spread from infected individuals through the air by tiny droplets that contain Mycobacterium tuberculosis. These droplets are aerosolized when an infected patient coughs, sneezes, or speaks. Particles larger than this size are deposited in the upper air-way and tend not to cause infection. After inhalation, droplets are deposited in the respiratory bronchioles or the alveoli, where the organisms can multiply. They can then spread via the lymphatics to the hilar lymph nodes and through the bloodstream to more distant sites. Multiplication continues until the replicating mycobacteria are of a sufficient size to elicit a host immune response. In normal individuals, the growth of M. tuberculosis is halted once cell-mediated immunity develops. This usually requires 2 to 12 weeks and corresponds temporally with the development of reaction to the tuberculin skin test. Once cell-mediated immunity develops, granulomas consisting of macrophages and activated T lymphocytes can form and arrest the growth of the organisms. A small number of viable mycobacteria may persist inside the granulomas, typically in the necrotic center. Often, this primary infection is clinically silent, but it may manifest as a mild pneumonic illness. Primary infection can occasionally overcome the host defenses, resulting in primary progressive disease. In most patients, however, the mycobacteria remain arrested inside the granulomas, with the potential for reactivate in the future. Reactivation occurs to create active disease.About 10% of infected persons will develop active tuberculosis, with the highest risk of developing active disease in the first 2 years after infection. Certain host factors are associated with an increased risk of developing active disease. Patients with the man immunodeficiency virus (HIV) have a greatly increased risk of developing active tuberculosis and may progress from latent disease to active disease at a rate of 10% per year.*59/348/5*

Some people with BDD exercise excessively. They may run or do aerobics to decrease cellulite or the perceived flabbiness of their thighs, or to make their arms or legs slimmer or larger. Others do sit-ups to flatten their stomach. These behaviors are carried to an extreme. As a 30-year-old woman said, “My whole day is planned around exercise.” A man I treated was so worried about not exercising during his hour-long drive to see me, thinking his muscles would “shrivel up,” that he joined 5 gyms between his house and my office, which he worked out at along the way.Exercise often doesn’t have the desired effect, and some people think it makes them look even worse. One woman did what she called “extreme exercises” to decrease supposed facial bloating. “But the exercise didn’t have the desired effect,” she said. “In fact, it made my legs look bigger and worse. I became obsessed with my legs while I was waiting for them to decrease in size.”Nick, a 32-year-old former car mechanic, carried weight lifting to an extreme, severely damaging his body. He believed his body was too small, which he related to feelings that women didn’t find him attractive or “enough of a man.” To increase his size, he ate massive quantities of food, weight-gain powders, and special vitamins. He also wore extra shirts and padded his clothes. “But the main thing I did,” he said, was lift weights. I lifted for hours a day. In retrospect, I realize I looked fine before I started to lift, and I’m sure everyone else thought I looked fine, too. I looked normal. I was 195 pounds; I wasn’t fat, but I wasn’t overdeveloped. Now I realize I probably looked even better that way. But at the time, I thought I looked too small. I was obsessed with looking bigger. I wanted to be stronger and more masculine. I wanted to be the biggest person on the planet!”I became obsessed with working out. I spent a lot pf the day lifting. I had to exercise before I left the house. I had to get the feeling and the look of bigness before I went out. I was trying to keep up with my friends who were using steroids. And I did get big—I got a lot of reinforcement for it. People would compliment me. Sometimes I even felt high while I was lifting. But I still felt I wasn’t big enough. I had to get even bigger.”Lifting became the focus of Nick’s life. “It’s embarrassing to talk about this,” he said. “I’m ashamed of how it interfered with my life—I stopped working because of it, I dropped out of life…. I couldn’t concentrate on my work because all I was thinking about was lifting. I actually stopped working because I couldn’t get out of the house without exercising. I didn’t see my friends—I just stayed in my basement lifting. I lost a lot of them because of it. Once, I got so upset thinking I wasn’t big enough that I stayed in my basement for a month, lifting and lifting. I was desperate to be bigger—I couldn’t get out of the basement! I was so depressed, thinking I’d never be big enough, that I thought I’d rather be dead. I couldn’t let anyone see my body.”Nick injured himself so severely that he had to stop playing sports, and he wasn’t able to work. He was often in pain, and even had difficulty walking. When I saw him, he was in physical therapy and had to use crutches to walk. “I totally ruined my body by lifting,” he said. “I tore my muscles apart. The irony is that now I can’t work out at all—not even a normal amount.”*110\204\8*

Acute bacterial and viral infections of the brain (meningitis and encephalitis), as we know, may cause acute seizures and may occasionally damage the brain and result in epilepsy. Other infections that occur before birth or, rarely, after birth may also damage the brain and lead to epilepsy. The most common infection of the brain world-wide is cysticercosis; in some countries this may be the most common cause of epilepsy, but in the United States it is a rare cause of seizures. A doctor will suspect this diagnosis when single or multiple areas of typicalcalcification, the result of cysts within the brain, are spotted on the CT. Surgical removal of these cysts may cure the child’s epilepsy.Another brain infection is toxoplasmosis, an infection spread by cats. If a pregnant woman acquires this infection it may be transmitted to her baby and cause scarring in the brain. Infection, often undetectable in the newborn, is first manifested, possibly, as mental retardation or as seizures. A CT scan can detect scars within the brain and aid diagnosis. Also, small scars on the retina in back of the eye may be noted by your physician and suggest a diagnosis. In addition, blood tests can confirm what the observations suggest. Suspected toxoplasmosis is often treated in an attempt to prevent further damage. The treatment of seizures in affected children is similar to those used in the treatment of other forms of epilepsy.*101\208\8*

Chicory people may even simulate sickness to keep friends and relatives waiting on them. They may even weep incessantly just for wanting attention all the time. Chicory characters like to have a kind of possessive pride in the feelings and lives of their dear ones. The grandma is very helpful to all the members of her family, loves them and wants to control their lives – organizes, guides, criticizes and directs and quite often forces her attention on the family. She feels hurt if her attentions are not accepted with gratitude. In her own words ” I am telling you because I mean you well.” The Chicory mother feels happy in the company of her children. She feels elated if her grown up children make distant calls “How do you do”? on week days, and travel long distances on Sundays and holidays to see her personally. She is aptly described as “the needy mother”. When a child feigns sickness – headache, stomach ache or nausea, when the school bus comes to pick him up and feels alright when the school bus has left him, then it can safely be presumed that there is nothing physically wrong with the child. He only wants attention all the time for which the proper remedy is CHICORY.Similarly there are many professional beggars in India who mangle some body-part to invoke sympathy or attention of the public. They need CHICORY Remedy.*86\308\8*

Acne is the bane of many teenagers’ existence. Although it is considered a ‘normal’ part of growing up, it seems unfair that just as interest in the opposite sex is beginning and confidence is all-important, a teenager may develop acne. Indeed, the psychological effects of acne can be devastating. Despite all this, it often goes untreated even though there are effective remedies available. It must also be said, however, that many ineffective remedies are promoted, so it is important to be discerning when it comes to choosing a treatment. Neither should acne be dismissed as ‘just a stage’ a person is going through, as many people continue to have acne into their twenties, thirties, and even forties.The exact causes of acne are not known, but much research over the last twenty years suggests that genetic and hormonal factors are major contributors. If there is a family history of moderately severe acne it is very likely that children will develop acne at puberty. The natural history of acne is that it will eventually disappear in the late twenties. About ten per cent of people, however, continue to suffer from acne in their thirties and forties and this can often be predicted by their family history.That hormonal factors are important is evidenced by the fact that acne often begins at puberty. In women, it may also vary with the menstrual cycle. Male hormones are more potent in producing acne than female hormones, so men tend to have more severe acne than women. Women with high levels of male hormones also usually have more severe acne.Acne develops from the increased production of sebum (oily secretion) by the sebaceous glands. These glands are under hormonal control and are deep below the surface of the skin. Under hormonal influence they produce and secrete sebum, and the more sebum that is secreted, the more severe the acne tends to be. Sebum secretion is markedly increased at puberty and has several effects on the skin:- Sebum is a very sticky substance, similar to mozzarella cheese in texture, which blocks the oily glands. This leads to blackheads and whiteheads.- Sebum is an irritant to the skin and therefore produces inflammation which leads to red lumps.- Sebum is a good growth environment for certain bacteria, called propionibacterium acnes, which live in the sebaceous glands. They are attracted to sebum and they release various inflammatory products which in turn lead to pus, inflammation and cysts.
*15/150/5*

“Record-keeping” is particularly poisonous when a person constantly compares himself with himself. Usually, he has a mental progress chart that is part of his poisonous onward-and-upward demand for continual improvement. The greater his need to prove himself in this way, the more toxic he becomes. The poisoning effect of performeritis is increased by the person’s uncertainty of how good he really is. The standards he sets for himself, measured against what he imagines to be the capabilities of others, are merely the product of his own fantasies. He is trapped on a self-improvement treadmill.A woman became upset whenever she felt she was not the most attractive female in the room. She rejected the friendship of women whom she saw as rivals. Typically, her women friends were older, overweight, or in some other way clearly less attractive than she. She subjected herself to a lifelong beauty contest at the expense of enjoying her over-all growth as a person. The process became even more deadly when combined with her morbid fear of growing older. She fantasized diminishing attention and admiration from men as an over helming catastrophe.A similar toxic pattern occurs in aging men who become anxious about their virility. Toxic performeritis often begins to affect their sexual behavior, in that they feel compelled to prove their sexual prowess at the expense of the experience itself. Any relationship is poisoned to the degree to which it is contaminated by preoccupation with performance. In T people of both sexes, anxiety about aging tends to take on an obsessive quality. To the extent that the obsession demands the time, energy, and resources of the person, the remainder of his total identity is deprived and disregarded.
While we all may be interested in developing some talent or ability, focusing on these aspirations at the expense of appreciating present functioning is toxic. Performeritis postpones gratification to some future time. Most self-nourishment comes from functioning in the now.*56\350\8*

Guilt does not necessarily have a cause. Guilt, like fear, is a feeling that may or may not have anything to do with the facts. Some people feel honestly that they did something they should not have done. Perhaps they knew they ran a risk when they became infected. Others are accepting blame for something over which they had no control. Perhaps they knew nothing about the virus or they thought they were taking appropriate steps to avoid infection or they unknowingly received infected blood. Guilt, like all other reactions to this infection, is a natural human feeling. Sooner or later in their lives, most people feel guilty about something, sometimes justifiably, sometimes not. Alan, for instance, remembers stealing a plastic toy from a dime store when he was seven years old, and though he does not feel like a criminal, he does feel a vague sense of shame and is not able to forget the incident.     Perhaps guilt comes from a sense that good behavior deserves reward and bad behavior deserves punishment. Perhaps people feel that since the virus feels like a punishment, they must have behaved badly. Perhaps social disapproval operates the same way: people feel isolated and punished, so they feel they must have done something wrong to deserve it. Both of these possibilities are built on bad logic and are just plain wrong.
*77\191\2*

Fasting is not advisable for diabetic patients, specially non-obsese
Avoid over cooking of food, reheating and deep freezing etc.
Certain food like ‘papad/bhujia’ (fried things) are taken in large amount by certain communities. These should be taken in right amount or should be avoided.
Food to avoid: Sweets like rasagulla, sandesh, lalmohan, barfees, halwas, katli, petha, laddoo etc.
Sugar, glucose, jaggery, honey, syrup, jams, jellies, preserved fruits, dried fruits, nuts, aerated drinks, cake, pastries, candy, fried food, chocolate drink, chocolates, alcohol etc.
Free foods: Clear soups, unsweetened lime juice, tomato juice, lemon soda water, raw vegetable salad, plain tea and coffee, skimmed butter milk, seasoning like onion, mint, pepper, curry leaves, corriander, vinegar, mustard and spices.
Recommendations
Calories – should be prescribed to achieve and maintain desirable body weight
Carbohydrate – 60-65% of calories
Protein – 0.85 g/kg body weight (15-20% of calories)
Fat – 15-25% of total calories
Cholesterol – Less than 300 mg/day
Salt – Restricted l000mg/1000 kcal and should not exceed 3000 mg/day
Alcohol – In moderation, restricted entirely in Diabetes with insulin induced hypoglycaemia, neuropathy, hyperlipidemia
Smoking and tobacco – Avoid
Vitamins – Supplements unnecessary
*33\329\8*

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These are congenital defects (defects present at birth). During development of the foetus, there is incomplete closure of the lip or the roof of the mouth, forming an open cleft. Each can occur separately, but they often occur together, sometimes in association with other malformations. Usually only soft tissues are affected, but occasionally bone can be involved, causing deformity of the nose as well. Cleft lip alone is more common, occurring in about 1 out of every 1000 births; cleft palate occurs in about 1 out of every 2500 births.

Cause

The exact cause is unknown. Genetic influences are believed to be largely responsible.

Clinical features

The defect varies in severity, from a small notch in the upper lip, to a gaping defect of the lip and palate, and sometimes the nose. Aside from the obvious appearance of the lips and mouth, a baby with cleft lip and/or cleft palate will have significant difficulty with feeding. This is because they find it difficult or impossible to suck, even though they have no problems with swallowing. They are usually otherwise very normal children.

Treatment

Initially the baby is fed with a special spout or elongated teat that delivers milk to the back of the throat. Surgery is always necessary, and the type and extent depends on the degree of deformity. The lip is usually repaired at 2-3 months of age, and the palate at around 1 year, before the baby starts to speak. Occasionally minor corrections are made before the child starts school. The cosmetic results with cleft lip alone are usually excellent. Speech therapy can help enormously in correcting nasal-sounding speech in the case of a cleft palate. Regular follow-up with your doctor is essential, as these children are more prone to develop ear infections and subsequent problems. Specialised dental care may also be necessary.

Prevention

Cleft lip and palate cannot be prevented.

*227\90\8*

Most premature babies require specialised care, usually within a newborn intensive care nursery, for up to several weeks after birth. The baby is nursed in a humidicrib and, depending on his condition, may require oxygen, intravenous infusion, tube feeding and careful monitoring. If your baby does need intensive care, your doctor will explain exactly what is going on.

Most premature babies have an excellent outcome. The smaller the baby and the more premature or ill he is around the time of birth, the higher the risks of him developing problems later. Careful follow-up is necessary until the child starts school. All neonatal intensive care units have follow-up programs for premature babies.

Having a premature baby can be very stressful for parents. Mixed with the joy of having a new child comes the fear of whether or not he will be all right. Seeing your newborn in a humidicrib, hooked up to tubes, can be a distressing experience.

Mothers who have had a Caesarian section may find it especially difficult to move around and visit their baby initially. It is important for parents to spend as much time as possible with their newborn, in order not to feel too distant from him. Talk to staff, who are experienced in these matters. They are generally sympathetic and encourage you to be involved in what is going on, and to touch your child as much as is practicable. Make sure that the staff do not overlook the central role you as parents play in the care of your child.

Treatment of premature babies is often a highly complex and specialised field, and you may at times feel overwhelmed by all the technology surrounding you and your baby. This is understandable, but remember also that there are human beings behind all this sophisticated gadgetry, and they are there to talk to you if you reach out to them also.

Apnoea is the term used when a newborn baby stops breathing for a short period of time, usually for more than 20 seconds. The baby may turn blue (cyanosis), and go limp, but usually starts breathing again as soon as he is stimulated by touch.

Apnoea occurs usually within the first 10 days and more often in premature babies. It is due to immaturity of the centre in the brain that controls breathing. Babies born at less than 34 weeks gestation are at risk of having at least one apnoeic spell within the first two weeks of life, and therefore require careful monitoring in a special care nursery.

Apnoeic attacks can also occur in babies who have a heart or lung problem, or who have an infection. Once the underlying condition is treated, the apnoeic attacks usually stop.

*60\90\8*

“I am deathly afraid that he is having an affair. He just doesn’t want that much sex anymore. Is he?”

ANSWER: Frequency of and interest in sex is not a symptom. It does not “mean” anything if medical problems are ruled out. It is a means of sharing and expression that stands in and of itself. Looking for outside affairs only avoids the real issue of strengthening the marriage. Even if an affair were taking place, the issue would still be to strengthen the intimacy of the marital relationship. To enhance the intimacy of your relationship, particularly at times of outside stress on the relationship, devote for a period of time almost all of your mental and emotional energy to this, relationship and suspend other relationships, even friendships and family ties. This doesn’t mean give them up; it means announcing that for a few weeks you are giving your full attention to your marriage. After that, you will be back in all relationships you value, even more ready to be close to others because of your new trust in the closeness of your marriage. I have found that there is little interest in returning to relationships that are only approximations of what super marital sex can be. If after these few weeks there is still a trust problem or other difficulties, look inside, at the marriage, for the cause, not outside at other factors.

*251\97\8*

Even if you do not plan to change anything else in your diet, for social, business or other reasons, improve the quality of the water you drink. Drink at least 2 or 3 litres of it every day.

The latest research indicates, that it is not only the purity of water that is important, but also its molecular structure. To be particular, a 20 molecule liquid crystal water structure, first predicted by a Nobel Prize laureate Linus Pauling in his famous book The Hydrogen Bond seems to be very important. Such structures are formed by a phenomenon known as “hydrophobic hydration” and cause changes in the surface tension, heat capacity and other properties of the water. Water liquid crystals occur naturally in some spring water high in the mountains, and are also formed in the water inside living cells. Water impurities practically eliminate any trace of water liquid crystals.

Note, that nearly every civilisation in the past had tales, related to “living water”, which was to be found only in inaccessible locations high in the mountains. In view of the current scientific research (Flanagans) it is quite possible, that such tales were based on real experiences.

Seek fresh air as much as possible. Even if you live in the city, and you are forced to breathe polluted air, make an effort to go to the country, forest or at least to a park as often as possible. Trees and other plants purify the air for us there. Use an ozone generating lamp to purify the air in your home, if the air outside is worse than inside. You can leave the lamp on when you are away.

With regard to other ingredients of the diet, again there is remarkable agreement found in wisdom of many civilisations. They all agree, that we should eat PURE FRESH FOOD. Note for example, that “kosher” means “pure” in Hebrew. (Be careful here: the modern definition of “kosher” food should be carefully examined, because it most likely has lost its exact meaning over the centuries, similarly to fasting in other cultures)

Again, the emphasis should be on purity. The best foods from such a point of view are fresh fruits and vegetables. Even if grown in quite polluted environment, fruits accumulate very little pollutants- They are created from simple inorganic compounds with the aid of photosynthesis. Their content is mostly water.

*41\96\8*

In the condition known as hiatus hernia, there is reflux of the acid contents of the stomach up into the lower part of the gullet and this may produce indigestion.

If this symptom of indigestion is of recent onset then it may be safely treated without further investigation. If it is severe or persistent or recurrent, then it is necessary to investigate the person further to determine if a condition such as an ulcer is present.

Usually an X-ray is necessary and the stomach can be outlined in the procedure known as barium meal X-ray where a radio opaque salt of barium outlines the hollow organ of the stomach and can reveal abnormalities in its structure.

Sometimes, to differentiate the symptoms from the stomach or gallbladder, it is necessary to carry out an X-ray procedure on the gallbladder. Here a radio opaque dye containing an iodine salt is taken. This substance passes through the liver into the bile and so outlines the gallbladder.

There are available many proprietary preparations which patients can obtain directly from the chemist without a doctor’s prescription … all designed to relieve indigestion. These usually work well.

As well, attention to the diet is helpful. The taking of small meals frequently rather than large meals infrequently so that there is always some food in the stomach to neutralise the acid is most helpful.

Antacid mixtures, tablets or powders all can give relief.

Prevention, of course, is usually better than cure and if one is certain of the cause of indigestion, such as over-indulgence, then a little more prudence next time may prevent the development of this disorder.

*456/71/1*

Penicillin was first isolated from a mould by Fleming in 1929 but it was Chaim and the Australian, Florey, who first brought it into clinical use in 1940.

Originally, penicillin had to be given by injection but now derivatives are available which can be taken by mouth. This drug is bacteriocidal and has such a low toxicity that massive doses can be given without risk to the person.

However, allergy to penicillin is probably the commonest of the drug allergies. Some may show an allergy when first they take this drug, having previously been sensitised by minute quantities in milk. This gets in the milk because the antibiotic may be given to cows to prevent or treat mastitis.

Others can develop an allergy after having taken penicillin for years without trouble.

Some of the newer derivatives of penicillin, such as ampicillin, are more effective against a wider range of organisms than penicillin itself.

Ampicillin may cause a fine rash which is not due to allergy, although anyone allergic to penicillin will also be allergic to its derivatives.

Amoxycillin, a derivative of ampicillin, has now supplanted it. It has all the benefits of ampicillin but is absorbed in the presence of food and gives higher blood levels.

*200/71/1*

Psychologists and psychiatrists have been examining the effects of Stress on the immune system. How do we cope with stress? Do we fed reasonably able to deal effectively with the world and maintain a positive sense of self, or do we feel helpless, as if no effort can make a difference? What if endometriosis is the outcome of the immune system’s collapse of effort?

In a study measuring the correlation between the psychological symptoms of stress to natural killer cell activity. Dr. Steven E. Locke at Beth Israel hospital in Boston reported in Psychoiomatxc Medicine that “symptoms such as anxiety and depression may negatively affect immunity.” Those who were good at coping with life’s vicissitudes tended to have “significantly higher natural killer cell activity” than those who felt a greater lack of control over the environment.

Transcendental meditation, hypnosis, biofeedback (wherein one literally learns to control the calming alpha waves produced by the brain), guided imaging, and other mind-control techniques have been studied extensively in laboratories and hospitals. Cancer patients have used many of these techniques to reduce pain and, in some cases, to fire immune system regeneration—in effect, curing themselves, or Creating an environment where cure is more possible. Stress, as such, is not a fixed quantity: what is negatively stressful for one person may be of little consequence to another. For now, much of the data indicates that stress cm contribute to the onset of disease.

Women with endometriosis tend to lead stressful lives – this tact cannot be denied. A persuasive enough argument has been made, in my estimation, for sufferers of this disease to consider making changes in their lives as a means of controlling the disease.

*25\43\4*

This is a superficial, contagious infection of the skin sometimes known as ‘school sores’. As this name suggests, it is more common amongst school-age children. It usually affects more than one person in the family or group, and seems to be more common in the summer months. Most commonly it occurs on the face, particularly about the nose and mouth. The common infective organisms is either the Staphylococcus or the streptococcus. If untreated, new lesions may continue to erupt for months.

Adequate treatment requires the administration of appropriate antibiotics by mouth. It is not sufficient to treat impetigo with applications of antiseptics or antibiotics alone. The only local treatment necessary is the washing of the skin with an antiseptic soap, and the gentle lifting off of crusts. Penicillin or Erythromycin are usually the most appropriate antibiotics, and will also help prevent possible complications of impetigo, such as infection of the kidneys.

*52\44\4*

There is considerable scientific backing for the health benefits of a diet with a high proportion of starches. National health targets suggest that carbohydrates should provide about 55-60 per cent of daily energy. Unfortunately, carbohydrate intake in most Western countries has declined this century with the increased consumption of fat. Fibre intake in most Western countries averages only about half the national target of an achievable 30g per day.

The first idea that fibre could protect against certain diseases appeared in I960, when researchers observed that the degenerative illnesses common in affluent societies were rare in rural Africa where diets were high in unrefined plant foods. Subsequent studies confirmed the health properties of fibre and it is now considered to have a role in protection against chronic diseases such as cardiovascular disease, colorectal cancer, and the management of constipation and diabetes. The specific benefits depend on the type of fibre. Foods high in insoluble fibre reduce transit time (i.e. shorten the time for food to pass through the GIT), soften stools by holding water and increase stool volume. In contrast, foods high in soluble fibre have little effect on bowel transit but appear to slow the rate of carbohydrate absorption due to their gel-forming ability. This helps to reduce rapid fluctuations in blood glucose and insulin among people with diabetes.

The combination of the effects of different fibres (including resistant starch), the SCFAs produced and a diet low in fat are all thought to protect health, so it has been difficult to credit any one factor. Nutritionists therefore recommend a diet low in fat with a variety of foods containing all types of starch and fibre.

A low intake of carbohydrate in any form appears to be linked to obesity on a population level because, by default, it is a high-fat diet. The claim that carbohydrates, whether as sugars or starches, are fattening’ is a myth. However, it is prudent for some individuals who are obese and who consume large quantities of sugars, to moderate their intake as a second level of priority after decreasing fat.

*105\186\4*

Just because you have endometriosis does not necessarily mean that it is the only cause of your inability to conceive.

Most doctors will want to do a number of tests to check that everything else is as it should be.

First, you will be asked to have your hormone levels assessed. This is usually done as a blood test where the levels of progesterone will be measured. If these are abnormal, oestrogen, prolactin, testosterone, follicle stimulating hormone (FSH) and luteinising hormone (LH) levels will be measured as well.

The results of the test can take up to four weeks. Your doctor will tell you at what stage in your cycle the test should be done. Usually, it will be collected one week after your expected ovulation (for example, if you usually ovulate on day 14 then your blood test will be done on day 21).

The next test most women have to undergo is the tedious process to establish a basal body temperature chart. Once told to do this test your morning cannot possibly start without sticking the thermometer under your tongue — do not drink, go to the toilet, get out of bed or even talk before doing this!

Once the temperature has been noted it is then marked on the chart at the appropriate day in your cycle and the pattern is observed.

Like playing dots and dashes, you then draw a line joining the dots and this should indicate when ovulation is due. Intercourse is then timed to coincide with ovulation.

If ovulation has occurred your temperature will normally rise by about one degree. If your temperature remains high after the due date of your period this may be the first indication that you are pregnant.

If your basal body temperature chart shows that you are ovulating but still have not conceived your doctor may want to perform other tests. These may include:

Hysterosalpinogram

An hysterosalpinogram is an X-ray where dye is injected through the cervix to check that both tubes are functioning and that the internal structure of the uterus is normal. The procedure lasts approximately ten minutes.

Your doctor may say that this test will be a little uncomfortable. It is, but thankfully most hospitals will inject you with a sedative before the test is carried out and you should experience little more than some ‘cramping’ pains.

This test is becoming less frequent as most doctors feel that a laparoscopy provides a more accurate picture.

Post-coital test

A post-coital test allows your doctor to observe sperm within the cervical mucus after intercourse. You will be asked to have intercourse (at home) four to twelve hours before the test and this is usually done mid-cycle as the mucus is then clear.

It is similar to a smear test and carried out to make sure that the live sperm are penetrating the mucus and that the mucus is not ‘hostile’. Do not panic if your doctor says your mucus is ‘hostile’. IVF-related procedures mean that the sperm and egg can be fertilised outside the womb and transferred back into the fallopian tube, by-passing the cervix.

The Kremer test

The Kremer test is similar to the post-coital test except that you are not asked to have intercourse. Instead, specimens of mucus and sperm are collected and tested together at regular intervals over six hours. This test will help pinpoint if the problem lies with the sperm or the mucus.

*95\83\2*

Many of the symptoms of endometriosis are also the symptoms of other conditions — particularly other gynaecological conditions — and therefore endometriosis is easily confused with them. These include pelvic inflammatory disease (PID), irritable bowel syndrome, ovarian cysts, appendicitis, ectopic pregnancy and occasionally cancer.

Pelvic inflammatory disease

Pelvic inflammatory disease, often known as PID, refers to any infection of the pelvic organs including the ovaries, fallopian tubes, uterus and cervix. Symptoms may include painful menstrual cramps, pain during or after intercourse, bleeding between periods, painful bowel movements or urination, generalised pelvic pain, lower back pain, nausea, fatigue, slight temperature and infertility.

PID is the condition which is most commonly confused with endometriosis when the diagnosis is made without the use of a laparoscopy because the symptoms of the two conditions are so similar. However, PID is caused by bacteria and it can be successfully treated with antibiotics. If antibiotic treatment fails to relieve the symptoms, further investigations should be carried out.

Irritable bowel syndrome

The term irritable bowel syndrome is sometimes used to describe a range of bowel symptoms when no other diagnosis can be found. The symptoms may include chronic lower abdominal pain which may be relieved by a bowel action, bouts of diarrhoea and constipation, flatulence (wind), straining to have bowels opened, bloated abdomen, chronic backache, lethargy, nausea and heartburn.

Many women are diagnosed as having irritable bowel syndrome before endometriosis is finally diagnosed.

Simple ovarian cysts

A cyst is a growth that contains fluid and is enclosed by a membrane. There are many types of ovarian cysts, the most common are follicular and luteal cysts. A follicular cyst is a fluid-filled cyst which has developed from an ovarian follicle that has continued to grow and enlarge. A luteal cyst is one which has developed from a corpus luteum which has enlarged and become filled with fluid or, occasionally, blood.

The symptoms of ovarian cysts include abdominal pain on the affected side, pain with intercourse, abdominal swelling, fullness or discomfort and irregularities in the menstrual cycle. If the cyst is large it may put pressure on the adjacent organs, such as the bowel or bladder, which in turn may cause some discomfort with bowel movements or when passing urine.

Many follicular and luteal cysts disappear within a few weeks as they are reabsorbed by the body. If the symptoms persist, a laparoscopy is the only way to distinguish between an ovarian cyst and an endometrioma.

Acute appendicitis

Acute appendicitis is an inflammation of the appendix and the symptoms include sudden and severe right-sided abdominal pain, nausea and vomiting, malaise and a raised temperature.

The symptoms of acute appendicitis are sometimes confused with those experienced by a woman with endometriosis where a large cyst, usually an endometrioma, has burst.

Ectopic pregnancy

An ectopic pregnancy occurs when a fertilised ovum implants itself in an abnormal location outside the uterus, usually within a fallopian tube, and continues to develop. Because the fallopian tube cannot expand to accommodate the developing foetus the tube eventually ruptures. The symptoms experienced when an ectopic pregnancy ruptures a fallopian tube include severe left or right-sided abdominal pain, nausea and/or vomiting, vaginal bleeding and internal bleeding which can lead to shock.

The symptoms of a ruptured ectopic pregnancy may sometimes be confused with those experienced by a woman with endometriosis who has a ruptured large endometrial cyst. A diagnostic laparoscopy is necessary to determine the correct diagnosis.

Cancer

The two main forms of cancer that may possibly be confused with endometriosis are ovarian cancer and rectal cancer. The symptoms of ovarian cancer include pelvic pain, weight loss, weakness and anaemia, while the symptoms of rectal cancer include constipation, bleeding from the rectum and backache.

However, ovarian and bowel cancer are very rarely confused with endometriosis. If there is any possibility that you may have cancer, diagnostic tests will be carried out quickly and thoroughly.

*36\83\2*

Live yoghurt contains ‘friendly’ bacteria which form lactic acid in milk, suppressing the growth of harmful bacteria. Some of the bacteria which are used to make yoghurt are Lactobacillus acidophilus, Lactobacillus bulgaricus and Streptococcus thermophilus. The bacteria in many yoghurts are still alive, but are kept dormant by refrigeration. However yoghurts which have been pasteurised or otherwise treated by heat, no longer contain live organisms.

Yoghurt is often recommended for its nutritional properties: it is a good source of protein, calcium and other minerals and A and B vitamins. Because yoghurt also contains lactose, the calcium is readily absorbed by the body. Yoghurt stimulates the synthesis of lactase, so that some people with a lactose intolerance are able to eat it without ill effect.

The inclusion of yoghurt in the diet is useful in preventing the proliferation of toxic intestinal bacteria which are often introduced into the body by contaminated foods. There are substances in yoghurt which have an antibiotic effect in the gut, reducing the concentrations of pathogenic bacteria such as E. coli so that a balanced concentration of friendly bacteria is encouraged. As a result, yoghurt may be beneficial in treating diarrhoea and other digestive disorders.

In the treatment of thrush or Candida, live acidophilus and bifidus bacteria can help to recolonise gut flora which have become unbalanced by the fungus. The lactobacilli in live yoghurt are the same which normally inhabit the vagina, so when these have been killed by some cause, such as a course of antibiotics, yoghurt inserted into the vagina for a few days, either with a spoon or a plunger, is often of benefit.

Orotic acid, a substance found in some yoghurts, interferes with the synthesis of cholesterol in the liver. Inclusion of acidophilus and bifidus yoghurts in the diet is therefore recommended in the prevention of heart disease.

*84\69\2*

Just as depression tends to cast a grey pall over everything in your world and in yourself, so there is an irresistible tendency to project that gloomy view into the future. The depressed person will always find something to be pessimistic about. And as with one’s view of the present, these gloomy predictions are often without any reasonable basis in reality. And even when there are problems in a person’s life, there are many different ways to look at one’s future. A person with cancer, for example, may have a very optimistic and upbeat view of the future, whereas a depressed person in perfectly good physical condition may be full of gloomy predictions about his health. In fact, in one research study patients who had suffered from both cancer and depression were asked to rate which of their two conditions involved greater suffering. They rated depression as the more painful of the two conditions. In summary, there is not generally a very close correlation between the realistic prospects for a person’s future and how a depressed person is likely to view it. Pessimism is a cardinal symptom of depression.

If the future seems bleak and gloomy to you and this has been going on for more than a few weeks, consider the possibility that you may be depressed.

*57\75\2*

Plastic has become increasingly common, one might say all-pervasive, since the end of World War Two. The chemically susceptible person, however, should try to avoid unnecessary exposure to plastics wherever possible. The sources of plastics are explored in Chapter 6. As a simple preventive measure, one should go through one’s house and make all obvious and necessary changes.

For example, many lamps now have plastic shades. As the light bulb heats up, the plastic begins to give off odors and fumes which can have a marked effect on mental and physical well-being. It is necessary, in such cases, to replace the plastic shades with shades made from glass, metal, or natural fabric. In the kitchen, plastic bowls and dishes should be replaced by ceramic, glass, or wooden ones. Wrap foods in aluminum foil instead of plastic wrap and use glass or metal containers instead of plastic refrigerator ware.

The degree to which one must make such changes obviously depends on the severity of the problem. Some people are able to tolerate the harder plastics, while others find they must make a clean sweep through the house in order to feel reasonably well. It is beyond the scope of this book to discuss every aspect of this large problem, although books listed in the “Suggested Reading” should be of help with the practical details.

*108\110\2*

While petting frogs is a harmless childhood activity, handling toads can be dangerous, the New England Journal of Medicine (314:1517) reports, since the skin of some types of toad secretes a poison which, when conveyed to the mouth, causes drooling, convulsive seizures, and serious disturbances of the heart rhythm. The Colorado River toad is the most toxic toad in North America and well-known as the cause of neurological problems and even death in animals that pick it up by mouth.

Now, according to the Journal, a young boy who played with a toad of this type required intensive care in a hospital for over seven days before he began to recover from paralysis, seizures, and difficulty in breathing, and probably would have died without such treatment.

Accordingly, while it is quite safe for children to play with frogs, don’t let them ever even touch a toad. Telling frogs and toads apart, however, may not always be so easy.

*186\143\2*

Emergency symptoms: Apply emergency treatment immediately.

Important: A child with heatstroke who does not revive within minutes after treatment is in danger and requires immediate emergency care.

Symptoms: feeling that lungs and muscles are “on fire”, dry mouth, breathing difficulty, dizziness, nausea blurred vision, hot, dry skin, high fever, absence of sweating.

Emergency treatment

1.     Call for emergency help and begin first aid.

2.     Remove the child’s clothing and lay the child down, feet higher than head, in a shady area.

3.     Pour cold water over the child’s body; rub the body with ice, then fan the child to promote evaporation.

4.     When the child is conscious and his or her body temperature is normal, give plenty of fruit juices to replace fluids and minerals lost during dehydration.

5.     Watch the child closely and repeat treatment if the symptoms recur.

Precautions

-    Heatstroke can be fatal if not treated immediately.

-    Heatstroke occurs most often when both temperature and humidity are high.

-    Strenuous exercise within one week of an attack of heatstroke increases the possibility of another attack.

-    Susceptibility to heatstroke is increased by: lack of water; excessive sweating; vomiting or diarrhea.

-    Salt tablets are not helpful in preventing heatstroke.

*103/84/5*

For the past 50 years or so, we’ve been killing ourselves with a silent bang. It’s a little-known fact that suicide is the ninth leading cause of death in this country and the fifth leading cause among men ages 25 to 44.

There is no simple answer for why men commit suicide, says John L. McIntosh, Ph.D., professor of psychology at Indiana University in South Bend, who works with the American Association of Suicidology in Washington, D.C.

Nearly 95 percent of people who kill themselves are suffering from a psychiatric illness-most often depression – in the months before they commit suicide. Yet, it often goes undiagnosed, says Matthew Nock, research coordinator for the American Foundation for Suicide Prevention (AFSP) in New York City.

To be fair, detection is difficult because men often don’t let on that they’re in trouble, at least not in obvious ways, Dr. McIntosh says. Men also may have underlying biological tendencies for self-destruction that we just don’t understand yet, say suicide researchers. For one, men have lower levels of the brain neurotransmitter serotonin than women. And not only are people with low levels of this mood-governing chemical prone to depression but also research suggests that their suicide risk is 10 times that of people with higher levels.

And that’s not the only chemical connection. Very low cholesterol levels-less than 160 milligrams per deciliter-have also have been linked to elevated suicide risk in men. Researchers in Paris found that of more than 6,000 men they studied, those with low cholesterol levels were more than three times more likely to commit suicide during the four-year study than those with normal cholesterol levels.

Drinking and drug use seem to add mental anguish all their own, says Dr. McIntosh. Alcoholism is a factor in 30 percent of all completed suicides. And cocaine ranks right up there with depression and alcohol abuse as a primary risk factor.

Personal loss, particularly of a wife or a job, is another leading factor. For every rise in the divorce rate (measured as one extra divorce per 1,000 couples), there is a 35 percent increase in male suicide rates. And men without jobs commit suicide twice as often as men who have them.

*113/36/5*

Non-steroidal drugs

Non-steroidal drugs, other than the salicylates, are used as anti-inflammatory, analgesic or anti-pyretic agents. Some have a combination of more than one of these properties. In general, the way in which these drugs work is not known, although it is possible to demonstrate the relative efficacy of one versus another by special trial procedures.

These drugs are usually marketed under trade names which derive from either their generic or chemical name. Considering them in general, it is fair to comment that most of the non-steroidal anti-inflammatory drugs take effect fairly quickly, usually within a few hours of consumption. It would also be fair to say that the effects are not long lasting, unless the drug is being taken regularly.

Side-effects of such preparations range from the usual gastric irritation and indigestion, with or without severe ulceration, to impaired vision, depression, skin rashes, loss of hair, impaired liver function, impaired kidney function, respiratory distress and changes in mental attitudes such as depersonalization. In rare cases bone marrow depression can also occur. One further aspect of many of these preparations is that they are not suitable for use with children.

Steroidal drugs

Another type of therapy is that using steroidal drugs. Usually steroidal drugs would be one of the last forms of therapy to Û tried on any patient. The dangerous effects of treatment with, and withdrawal from, these particular drugs are well known. It is also important that the clinician treating any patient with corticosteroid therapy is familiar with the various facto relating to that particular patient’s general condition before commencing. Use of corticosteroids in arthritic treatment usually produces a rapid and dramatic response. The person begins to feel much better in general and their arthritic condition shows a significant improvement. The mechanism of the anti-inflammatory and anti-rheumatic activity of the corticosteroids is not yet understood, but their effect is known to be palliative and not curative.

It would be reasonable to assume that, as a result of what has just been said about the beneficial effects of these preparations that they would be in widespread use. Unfortunately they possess some very unpleasant side-effects and therefore are only used as a last resort.

Probably the most hazardous effect of the steroids is that the anti-inflammatory effect is non-discriminating. This means that it can and does have an anti-inflammatory effect on the inflammation which is the body’s natural defense mechanism against some infectious agents. In addition to this, other side effects include a protein-wasting effect; a linear-growth impairing effect in children; a quite significant impairing o: wound healing capacity; a generalized osteoporosis effect (increasing porousness of the bones); ulcer development; development of syndromes such as rounding of the face; fattening around the waist; disorders of the eyes; menstrual disorders; depression and insomnia.

This is not a complete list, and of course, not all people who are treated with steroidal drugs will develop or experience these effects.

When these factors are considered together with the tact that, generally speaking, steroid therapy does not remain effective for long, and withdrawal from this therapy has unpleasant effects, it is easy to see why use of it is, generally made with great reluctance.

Before leaving the subject of drug therapy in the treatment 0f rheumatoid arthritis, gold therapy should receive at least brief mention.

*9/48/5*

For a number of years researchers have sought ways to diagnose and monitor endometriosis that would avoid the need for a laparoscopy. Various methods have been tried, including examining the blood and endometrium for the presence of antibodies and testing for a substance known as the CA-125 antigen. Other methods are still being investigated. So far, most of the tests tried have been unsuccessful because they have not produced consistent and accurate results, especially in the early stages of the disease. Work is continuing and it is likely that a reliable test will be developed in the future. In particular, work on the CA-125 antigen looks promising but it is likely to be several years – at the earliest – before this or any other tests are fully developed and available for general use.

CA-125

CA-125 is a substance known as cancer antigen 125 which is produced by the endometrium and is found in the blood. It was discovered while researchers were trying to find a test for ovarian cancer.

Researchers found although it was present in extremely high levels in some women with ovarian cancer, raised levels were also found in some women with a range of gynecological conditions, including endometriosis, adenomyosis, pelvic inflammatory disease, unexplained infertility and during pregnancy and menstruation. In an attempt to find a reliable blood test for endometriosis researchers have been investigating the levels of CA-125 in women with endometriosis. They have found that the levels in women with minimal and mild endometriosis are no different to those found in women in general but the levels in women with moderate and severe endometriosis are generally significantly higher.

Unfortunately, the CA-125 test is not yet sufficiently accurate to replace laparoscopy as a general test for the diagnosis of endometriosis because the levels are not raised in all women with endometriosis and because the levels are raised in a range of conditions other than endometriosis.

It may soon be useful as an aid for the diagnosis of endometriosis and could be used to help decide who needs a laparoscopy. For example, if the gynecologist only vaguely suspects that a woman has endometriosis he may decide to perform a laparoscopy if the CA-125 levels are raised, but not if the levels are normal.

For now, the most useful role of the CA-125 test appears to be in monitoring the progress of the disease after a definite diagnosis has been made. The levels of CA-125 appear to rise as the disease worsens and fall as the disease improves. Therefore, it may be possible to use repeated CA-125 tests to help determine the real effectiveness of drug treatment or to determine whether or not the underlying disease has worsened, improved or recurred, thereby avoiding the need for repeat laparoscopics.

The CA-125 test offers the most promise as a diagnostic test for endometriosis but further work is necessary before it will be accurate and reliable enough to be used by gynecologists for the diagnosis and monitoring of endometriosis.

Kylie’s story

I started menstruating at the age of 13. For the first 12 months everything was fine, but I then started to develop acute pain in my right side. I went to my GP who referred me to a surgeon and I was then rushed to hospital to have my appendix removed. Strangely, my appendix was quite normal. I felt well for three months, but then the pain started up again. After having an ultrasound, I was admitted to hospital with a suspected ovarian cyst. A laparoscopy was performed, but everything appeared normal. I was sent home, having been told that it was quite normal to suffer some discomfort when having a period.

For the next year I tried to put up with the pain because I was sure the doctors would tell me it was ‘all in my head’. After another bout of severe pain my GP referred me to another specialist who ordered a barium enema. He said that I had an irritable bowel and to eat more fibre. Unfortunately, this made no difference to the pain. My GP then thought that perhaps I was suffering from pelvic inflammatory disease – a course of antibiotics made no difference. My mother wasn’t happy with the doctor’s explanations and so took me to another GP who immediately suspected I may have endometriosis even though I was only 17 years old. He sent me to a gynecologist who immediately performed a laparoscopy and diagnosed endometriosis.

During the laparoscopy the gynecologist ‘burnt off’ all the endometrial deposits that he could find. He explained to me that because there could still be microscopic endometrial deposits in the pelvis, I was to take Provera 30 milligrams a day for nine months. I am now pain free and have just finished the course of tablets. I am looking forward to starting university next year and enjoying life.

*28/41/5*

Brain chemicals do more than regulate behavior. They also determine our moods. An imbalancetoo much or too little of a given substance-can produce symptoms of mental disorder ranging from depression to the abnormal elation and hyperactivity known as mania.

As we have seen, the incidence of depression in relatives of eating-disordered people is higher than the rate found in the general population. Researchers have long been intrigued by this apparent connection between eating disorders and affective disorders (mood disorders, such as depression and mania). Is it possible that both types of illnesses arise from a common source?

We don’t yet have all the evidence we need to answer this question with confidence. However, there is no doubt that disruption along certain neurochemical pathways can lead to disturbed moods of varying severity.

Consider, for example, some of the fairly common syndromes in which feelings of depression play a part. The first, and most widely known, is PMS-the premenstrual syndrome. Symptoms of PMS include sudden mood swings, irritability, anxiety, feelings of hopelessness, difficulty concentrating, sleep disturbance, food cravings, and physical problems such as headaches or joint pain.

Another illness that has received considerable publicity in recent years is SAD, or seasonal affective disorder. With the onset of winter and its shorter days, people with SAD begin to feel depressed, hopeless, and lethargic. The illness is particularly troubling because during the summer these same people are lively, outgoing, and energetic. The contrast can be confusing, not just to the patient, but to family, friends, and co-workers as well.

Less familiar is the syndrome known as CCO, or carbohydrate-craving obesity. The name is self-explanatory: Patients with this condition overeat carbohydrates to the point of severe, health-threatening obesity. A variant of this illness is a form of bulimia in which patients, usually mildly obese women, engage in severe bingeing, often involving carbohydrate-laden foods, but with little or no vomiting.

These conditions share certain symptoms, including depression, lethargy, difficulty concentrating, and periodic bouts of overeating leading to weight gain. People with these disorders seem specifically to prefer carbohydrates above all other foods. One of my patients, who as it turned out had SAD, described herself as a “bread and pasta fiend” in the winter, while in the summer she ate more protein.

Bouts of depression in SAD, as its name suggests, appear in a cycle determined by the changing seasons. PMS strikes regularly every month (though it is worse for some people during the winter months). CCO, however, seems to trigger abnormal eating virtually every day, most often in the late afternoon or early evening. It’s this regular rhythm-seasonal, monthly, daily-that caught the attention of investigators concerned with the ways our bodies change over the course of time.

We now know that many of our bodily functions operate on what is known as a circadian cycle. Circadian means “about a day.” The word refers to the fact that many natural functions- sleep, hunger, sexual arousal-are not discrete events but rhythmical processes that continue over a period of approximately twenty-four hours, with peaks and valleys that occur at different times. As a rule, these processes are regulated by the hypothalamus.

*43/35/5*

John Bradley always loved being outdoors. As a youngster growing up in northern Maine, he spent many more summer nights sleeping outside than in. His days were filled with work on his family’s potato farm, fishing, swimming, canoeing, and hiking in the woods.

Now age 45, John still finds joy in the great outdoors. It not only relaxes him but it also helped him lose 30 pounds.

John, who ran his own farm for more than 20 years before becoming a student at the University of Maine, had a weight problem | for most of his life. He ate too much of the wrong kinds of foods, and despite his active lifestyle, it showed.

“My family always kept a lot of sweets around the house,” he says. “And I had a special fondness for french fries and Coke. I drank Coke all the time.”

Every now and then, John would diet and lose some weight, only to regain it. By age 40, he reached 220 pounds. “I realized that slimming down wouldn’t get any easier as I got older,” he says. “And I knew that I’d be a lot healthier without the extra pounds. So I made up my mind to get rid of them for good.”

John paid more attention to his food intake, eliminating fried foods, desserts, and high-calorie snacks. He kept an eye on his portion sizes, too. For exercise, he began doing situps, working up to 100, five times per week. But what really made a difference, he says, were his nightly nature walks.

Every evening after dinner, John, sometimes accompanied by his wife, would step out his backdoor and head for the old logging roads that cut through his 270-acre farm. He’d wander the roads for an hour, sometimes two, observing nature in all her glory. He’d spy bears and their cubs; coyotes; moose; and deer. “Even when I walked alone, it was never lonely,” he says. “I might see muskrats or beavers or trout in my stream. But I knew I’d almost always see something.”

John so enjoyed his nature walks that he never really thought of them as exercise. Yet in combination with his improved eating habits and his sit up regimen, they got him down to a healthy 190 pounds in about 6 months. He’s been holding steady since 1996.

“If I wasn’t active, I’d gain weight quickly,” John says. “But the exercise that I do is a pleasure. I’m always glad to get outdoors. It’s where I feel best. It’s the place where I most love to be.”

WINNING ACTION

Pursue your exercise through your passion. One of the best ways to stick with your exercise routine is to find an activity that you look forward to. If the traditional choices such as running, biking, and swimming don’t interest you, ask yourself what does. Bird watching? People watching? Karate Swing dancing? Anything that gets you moving can help you slim down and shape up.

*97\89\8*

Affirmation for Happiness

Many of the patients I see, regardless of their symptoms, are unhappy. I give them this happiness affirmation:

I really like myself. I am a worthwhile person. I am fantastically happy, and I have great happiness.

Affirmation for Serenity

We could all use serenity, especially the stress seekers who are always running at top speed. Say to yourself:

I am calm-, serene and have peace of mind. All my thoughts are loving and happy. My positive thoughts give me strength and confidence, happiness and peace. I have the energy, time, money and wisdom I need right now to make my world a happy place.

Affirmation for Success

Affirmations for success are especially helpful for stress phobics and others who feel frustrated at work, school or life in general:

I am now happily successful. I see myself continually achieving more success, step by step, overcoming all obstacles. I see and feel myself to be a successful person. I give myself the power and permission to be a success.

Affirmation for Self-Respect

Along with success affirmations, this affirmation for self-respect is important for stress phobics, who have so much self-doubt and so little love for themselves:

I truly like myself. I am an interesting, energetic man/woman who is respected and admired. I radiate positive, friendly feelings to everyone I meet or talk to.

The point is not to become an egomaniac but to recognize the good qualities you have. You can be proud of yourself without being egotistical.

*145\80\8*

Use your heart to determine whether you’re walking rapidly enough. Count your heartbeats by feeling your pulse at your wrist, your temples or on either side of your neck.

Count the number of times your heart beats in ten seconds. Multiply that number by six to get your heart rate per minute. The goal is to walk briskly enough to keep your heart beating at 70 to 80 percent of your maximal attainable heart rate. The 70 to 80 percent range will vary according to your age. Check your pulse a couple of times during your walk, and again when you finish, to make sure you’re pacing yourself just right.

If you think daily walking would be boring, who says you have to walk by yourself? Years ago I took brisk evening strolls with my young children. We’d start from our house and walk all the way down the hill, then over to the shopping center. It was about a two-mile walk. Then I’d call my wife to bring the car and drive us back up the hill. (I would tell her the kids were too young to walk up the long, steep hill. The truth was I was too lazy.)

The time I spent walking with my children was great. We talked about baseball, medicine, history or whatever else was on our minds. They would tell me the latest jokes from school. Our walks were always enormous fun.

I’ve exercised with my family, friends, patients and business colleagues. While exercising I’ve chatted, conducted business, given medical advice, caught up with old friends and talked through ideas for books and articles with my son and coauthor, Barry.

And when I’m walking alone I use the time for sightseeing and mental relaxation. Sometimes I’ll include streets such as Rodeo Drive in my exercise route. That gives me a chance to window-shop. Other times I’ll walk in the park or among the beautiful houses of Beverly Hills. Walking is an exercise that leaves you free to think, see, hear, talk and laugh all you like.

*103\80\8*

Nutritional deficiencies can attack your immune system directly, or they can launch a two-stage attack by way of the mind. Lack of nutrients, especially the B vitamins, can lead to such personality changes as depression, irritability, nervousness, anxiety and moodiness. As a group, the B vitamins are especially important for maintaining a positive outlook on life.

As we learned earlier, there are physical and chemical links between mind and body. What kind of thoughts will an anxious, depressed, irritable mind generate? The kind that harm the “doctor within” and the immune system. That’s why it’s important to take in plenty of the nutrients that will keep you happy.

Nutrition profoundly influences your immune system, both by direct action and by way of the mind.

*60\80\8*

Government and industry claim that there are “safe” levels for various toxins in the body. That idea is patently absurd. Five to 40 years may pass before chemicals and particles you were exposed to at work, home or school are expressed as a disease. To be safe, I say that any amount is too much. Any risk we take of harming our “doctor within” is too great.

This much we do know: worldwide chemical pollution of our air, food, water and environment is reflected in the chemical pollution of our bodies. For example, house and industrial painters, who have worked for long periods in confined spaces and inhaled paint fumes, may suffer from a chronic brain syndrome characterized by fatigue, headaches, dizziness, depression, irritability and memory impairment. Being on guard against the obvious toxins isn’t enough. Hobbies such as sculpting, welding and painting, for instance, expose us to various toxins. Common household cleaners are potentially toxic. You may be unwittingly exposed to asbestos in school, at your workplace, even in your own home.

I couldn’t figure out what was wrong with the attractive 45-year-old woman who came to me complaining of frequent colds, irritability, nervousness and forgetfulness. “And those are only the major problems,” she explained. “I also have dizziness, insomnia and sometimes pain in my stomach.”

The laboratory studies I ordered showed that her immune system was out of whack, but not in any of the usual ways. She didn’t have AIDS, EB virus, CMV or any other standard immune-system diseases.

As is my custom, I reviewed all her old medical records. There was nothing in the many documents that suggested an answer to her current problems. She worked in a defense plant, making parts for a new, top-secret bomber. Perhaps she had inhaled a chemical at the factory?

“No,” she said, “there aren’t any chemicals where I work. We have good ventilation, too, so even if there were chemicals, I wouldn’t breathe in a lot of them.”

“Well,” I continued, “what exactly do you do at work?”

“I run a big machine that stamps out metal,” she explained. “But it’s almost entirely run by computer. I don’t have to touch the machine itself, just the contol board. Except when I clean it.”

“How do you clean it?” I wanted to know. She told me that she poured fluid out of an unlabeled can onto the machine and, using her bare hands, rubbed the fluid in to get the grease off of the machine. That was the clue I needed. Suspecting there might be a toxic chemical in the cleaning fluid, I ordered a battery of toxicology tests to be run. The laboratory found large amounts of chloroform in her blood, plus trichloroacetic acid and trichloroethanol in her urine. It turned out that the cleaning fluid contained trichloroethylene, a very dangerous but widely used industrial solvent. Exposure to this chemical, along with other chemicals and their break-down products, can depress the immune system and cause mental depression and such abnormalities of the central nervous system as confusion and un-coordination. In animals, this chemical has even caused liver cancer.

Happily, when she adopted my Immune For Life program and transferred to a different part of the factory—and got away from the cleaning fluid—most of her symptoms disappeared, and her immune-system tests returned to normal. As a special precaution, I had her get rid of the cleaning fluids and other chemical concoctions in her home.

Toxic chemicals are everywhere. There’s asbestos in our buildings, mercury in the fish we eat, pesticides in our beef and potentially harmful and hormones in our chicken. The DDT that was banned long ago is still in our drinking water and meats. Processed foods are full of potentially toxic substances. The air we breathe can be toxic. Even wallpaper contains pesticides. In our society, it’s very hard to avoid toxic chemicals and environmental pollutants. That’s why we must do everything we can to protect and strengthen our “doctor within.”

*16\80\8*

A third factor that influences medical trials is the type of patients a particular doctor sees. To take one example, a consultant gastroenterologist working in a large hospital will see a wide range of patients with persistent diarrhoea, who have been referred by their family doctor. These patients will vary in all sorts of ways, including their own ideas about their illness. Some may think that particular foods cause their symptoms but most will have no clue at all why they are ill. An allergist, on the other hand, will not see many patients with diarrhoea, but those he does see will probably have been referred by their family doctor because they believe their symptoms are caused by ‘allergies’ to food. Experience shows that such patients have often tried some form of self-diagnosis, or alternative therapy, without success.

A proportion of the allergist’s patients may be people with psychosomatic problems, who have latched on to diet as an explanation for their symptoms because they find the label psychosomatic’ unacceptable. Despite their lack of success in identifying dietary triggers for their symptoms they are unwilling to give up. Of course, the first group of patients – those seen by the gastroenterologist – may well include some with psychosomatic problems, but they are probably fewer than in the group seen by the allergist.

When referring patients, family doctors take account of the consultant’s views, and, it must be said, their own personal preferences. A ‘difficult’ patient whose diarrhoea is accompanied by a patently neurotic personality is likely to be referred to a consultant whose main interest lies in psychosomatic causes. Another patient with much the same bowel symptoms, whom the family doctor believes to be mentally well-balanced, will probably be referred to a consultant who is more interested in physical causes. This again biases the ‘sample’ of patients that a particular consultant sees, and tends to reinforce medical prejudices.

Neither of these two groups of patients is a representative sample of everyone in the country with persistent diarrhoea. A survey which showed that a third of ‘apparently healthy’ people suffered some form of bowel disorder also discovered that the majority had not sought medical treatment. So the statistics produced by any medical study are not necessarily applicable to the population at large.

*104\180\8*

It’s common for doctors to receive a flat monthly fee for every patient under their care. Under this arrangement, known as capitation, the cost of lab tests, procedures and other care comes out of the doctor’s pocket. If the doctor orders an $80 X ray, $80 is deducted from his paycheck.

Frequently, HMOs give bonuses and assess monetary penalties according to how much the doctor spends. For example, many HMOs reward doctors who limit the number of patients they hospitalize or who minimize referrals to expensive specialists. Using a technique known as “economic credential-ing,” managed-care plans terminate doctors who spend too much on patients.

To further limit costs, HMOs set up barriers to care. Under most managed-care plans, you can’t see a specialist without being referred by your primary care doctor. Visits to the emergency room require pre-authorization. And it can take weeks—even months—to get an appointment.

Given these new realities, here’s how to protect your interests. If you’re thinking of joining an HMO or are already enrolled, learn as much as you can about the plan. Read the membership materials carefully. If possible, talk to current and former members about their experiences with the HMO in question.

*83/47/1*

what to look for: Whole wheat is typically the first ingredient, but it could be whole oats, whole rye or millet.

typical nutritional data per slice: 90 calories, 1 g fat, 3 g fiber, 180 mg sodium.

good brands: Arnold Natural 100% Whole Wheat… Oroweat 100% Whole Wheat…Stroehmann Dutch Country 100% Whole Wheat.

important: Some “wheat” breads are made with enriched wheat flour. Enriched means that after the grain was refined, only five nutrients that were removed in the refining process were added back in—thiamin, riboflavin, niacin, iron and folic acid. However, fiber, magnesium and other vitamins and minerals are not restored to the flour.

RYE…

what òî look for: Whole rye should be the first ingredient.

typical nutritional data per slice: 100 calories, 0.5 g fat, 3 g fiber, 200 mg sodium.

good brands: Rubschlager 100% Rye, Rye-Ola Black Rye… Genuine Bavarian Organic Whole Rye.

*74/47/1*

A “hand-sanding” technique lets doctors remove wrinkles without the high cost of the usual technique (laser resurfacing).

Called manual dermasanding, the technique involves injecting the wrinkled area with topical anesthetics. Wrinkles are then buffed away using a sandpaper-like material.

Saw palmetto berries are widely recognized for their potential to diminish an enlarged prostate gland, say studies at major medical institutions such as the University of Chicago. But saw palmetto may also help prevent baldness by blocking the body’s production of dihydrotestosterone (DHT), a substance that deadens hair follicles.

Adding licorice extract (which also reduces the body’s amount of DHT) to your shampoo helps do the same thing. For additional benefits, regular scalp massage can increase blood circulation to the head.

*64/47/1*

Eighty-seven percent of Americans have foot trouble—bunions, corns, calluses, foot odor, etc. Despite their prevalence, however, such problems are not inevitable, most can be prevented via a simple five-step foot-pamperinc regimen…

• Soak your feet at the end of each day. Use lukewarm water along with Dr. Scholl’s Soap ‘n Soak Instant Foot Bath or another product containing sodium bicarbonate. This compound lowers the skin’s acidity, rendering it less susceptible to fungus and calluses.

After soaking, dry your feet thoroughly—especially between your toes.

Massage moisturizer into your heels after each soak. Moisturizer will help prevent skin fissures and calluses. These problems are common in summer—especially if you wear open-heeled shoes.

Use foot powder twice a day. After soaking at night and then again in the morning, dust your feet with Quinsana Deodorant Foot Powder or another product containing the perspiration-fighting agent benzethonium chloride.

Foot powder is especially beneficial during summer months, when foot perspiration is a big problem.

• inspect your toenails once a week. If they need trimming, cut them straight across using a long-handled nail clipper. Each time you trim your nails, scrub your toes and the soles of your feet to remove calluses.

For dry skin, use Kerasal or another foot mask containing salicylic acid or another “keratolytic agent.” This rids the feet of excess keratin, a moisture-repelling protein found in skin.

• Do nightly foot exercises. Before going to bed, spend a few minutes picking up a pencil with your toes…pressing on an imaginary accelerator pedal with each foot…and using your toes to trace the outlines of letters of the alphabet on the floor.

Nightly foot exercises help minimize the foot swelling that inevitably occurs during the day.

*55/47/1*

Up to 12 million Americans are allergic to one or more foods—and most aren’t aware of it. Food allergies can stimulate activity of mast cells, immune cells that produce hay fever symptoms, such as nasal congestion, watery eyes, etc.

self-test: In the morning, take your pulse for one minute on an empty stomach. Then eat a food that you want to test, sit still for 20 minutes and check your pulse again. If it has increased by 15 to 20 beats per minute, you’re probably sensitive to that food.

Patients who identify a food allergen in the self-test or who suffer from severe seasonal allergies should eliminate the suspected food and other common food allergens (see below) for three weeks to see if symptoms subside.

most common food allergens: Dairy and wheat. Others include chocolate, corn, soy and tomatoes.

*45/47/1*

It is sad that few hospitals now support postnatal family planning clinics and the opportunity to return to the place where the baby was born is seldom available. At such a visit the woman could show off the baby, have her new status as mother recognized and discuss her delivery, even though it might be with a doctor whose only knowledge of the delivery was from the notes. Some women will delay or postpone their postnatal examination, thereby indicating perhaps an unconscious wish to postpone entry into normal, and in particular, sexual life. Or it may be that they fear that they might fail the test of official recognition as a fully fledged mother. On the other hand, the woman who fails to attend altogether may be indicating her wish to guard her privacy and assume total responsibility for herself again. She will happily resume intercourse, using her old cap or having started herself on as old supply of Pills.

*173/197/1*

Men are unlikely to admit that they consider contraception to be the woman’s business but again the shadow is there. ‘A lot of other men do,’ they say. Perhaps it is because many men are nervous about their sexuality. They stir quickly and not always when expected, and they are not used to the idea of saying ‘No’ and waiting for a more suitable time. On the assumption he wants sex, he may be carrying condoms. On the other hand, he hopes that any girl who lets him get carried away will have thought about it in advance and also have protection.

Mr. B.’s present lifestyle shows him comfortable with his feminine side. He does not have to be ‘macho’, to prove his masculinity, but now regrets he has taken so long to want children for himself. In his youth his fear of being trapped made him extremely nervous about leaving contraception to the other party, but also somewhat guilty about his behaviour, with a degree of insight into the problems of his victims.

*136/197/1*

Some women present late because they genuinely did not believe themselves to be pregnant, often at the extremes of the reproductive age range, or because they have irregular cycles. Some deny the problem until the bulge begins to appear, or hope that they will miscarry. Others sadly may be the victim of a laborious system and unnecessary delays in pregnancy testing and in hospital clinics. Other women are just too inadequate to sort themselves out quickly. A small proportion may delay because of true ambivalence about the pregnancy or perhaps they hope that if they leave it long enough, the doctor will turn down their request for abortion.

*99/197/1*

The COC is the most common form of contraception chosen by the younger patient. In view of this, it merits most attention in this chapter. The doctor looking after this age group has a unique opportunity to get it right at the first consultation as regards absolute and relative contraindications and risk factors. At the same time the first consultation should allow the equally important input from the patient. History-taking may be tedious but gives both patient and doctor time to get used to each other. The doctor certainly becomes aware of the patient’s attitudes and no doubt the patient forms an opinion about the doctor during this interchange. In the end it is the young person’s perception of the doctor which determines whether the consultation will be useful. The doctor may become aware that thoughts or feelings about the patient are unusual, and this can lead to a study of the doctor-patient relationship which may throw some light on the patient’s problems.

*62/197/1*