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Лечение аллергии-Allergy treatment

Что такое Аллергия ?

Аллергические заболевания в действительности являются гиперреакциями организма в ответ на воздействие на него некоторых факторов внешней среды, принимаемых им за потенциально опасные, даже если на самом деле они таковыми не являются.

Иммунная система при первом контакте с чужеродным веществом становится способной запоминать и распознавать его. Затем она вырабатывает специфические антитела для того, чтобы иметь возможность нейтрализовать антигены. В случае попадания в организм того же антигена, идентифицируя его, иммунная система сможет атаковать его уже имеющимися специфическими антителами. Поэтому у человека, который страдает сенной лихорадкой на пыльцу растений, каждый раз при контакте с той пыльцой, которую его иммунная система воспринимает как чужеродный антиген, болезнь будет обостряться.

По проявлениям и тяжести лечения аллергические реакции многообразны и способны развиваться в различных направлениях, вовлекая различные ткани организма и органы.

Самыми частыми симптомами аллергии являются – заложенный нос и насморк, чихание, зуд в глазах и коже.

Естественным способом избавления от раздражающих веществ – пыли, песка и др. для организма является чихание, при котором вместе с небольшим количеством секреторной жидкости удаляются раздражители. Эта реакция становится преувеличенной при аллергии, когда при отсутствии насморка как такового, приступы чихания продолжаются целым днями без явной на то причины. Выделения из носа при аллергии отличаются от тех, которые наблюдаются при простуде. При аллергии они обычно водянистые и прозрачные, а при простуде – более густые и желтоватые. Попытки высморкаться ни к чему не приведут, а только усугубят заложенность носа.

Сыпь (крапивница) – множество маленьких точек на коже, замечаемых на разных участках тела и на лице – длится обычно несколько дней. Всем когда-нибудь приходилось протирать свои глаза, удаляя соринку, песчинку или ресницу. И сразу, как только причина раздражения устранена, нет необходимости тереть глаза. Но если у человека аллергия, ситуация совсем другая: зуд в глазах появляется без видимой причины и уменьшить его невозможно, он может длиться неделями. Веки при этом краснеют и опухают.

Проблема аллергии превратилась уже в глобальную медико-социальную проблему из-за широкой распространенности аллергических заболеваний, которыми страдает более 20% населения планеты. Как показывают исследования в этой области за последние 30 лет, повсеместно каждые 10 лет распространенность аллергических заболеваний удваивается.

Если мы обратимся к традиционной восточной медицине, то в первую очередь наше внимание обратят на то, что иммунная система очень тесно связана в своем функционировании с нервной. Те, люди, которые склонны больше волноваться и не владеют способами релаксации, больше подвержены заболеваниям вообще, и аллергиям в частности.

Современный психосоматический подход к лечению аллергии действует в согласии с этим утверждением древней восточной медицины, которая имеет в запасе мудрость нескольких тысяч лет и успешную практику. Именно так подходят к лечению аллергии в Центре лечения психосоматических заболеваний ApertaVia.

Умение вовремя понять, что помощь требуется и обратиться за ней – это первый шаг к тому, чтобы стать по-настоящему здоровым человеком.

Аллерген, как символ

Аллерген, как символ

Если человек под наркозом или без сознания, очутится в пыльной комнате или в окружении благоухающих цветов, аллергической реакции не будет. Значит можно сделать вывод – для возникновения аллергии нужно увидеть, пощупать, понюхать, т.е. необходимо сознательное участие.

Когда человеку дарят цветы, вызывающие у него аллергию, у него возникает приступ бронхиальной астмы, даже при том, что цветы окажутся искусственными. Спровоцировать аллергическую реакцию может даже фотография шерсти.Следовательно, реакция возникает не на сам аллерген, а на символ, вызывающий страх и конечно же защитную реакцию. А всем известно, что «Лучшая защита – это нападение». Вот в этом и вся причина!

Символизм

Проблемы в этих областях, могут быть тонкими причинами заболевания.

Шерсть кошки – лесть, ласка, сексуальность.

Шерсть собаки – преданность, агрессия.

Лошадь –сексуальное влечение в грубой форме.

Пыльца – размножение, оплодотворение.

Домашняя пыль –проблемы в быту. Пыль символизирует грязь, грязные шутки, копание в чужом «грязном белье». Чтобы убежать от проблемы не надо использовать свою болезнь, в качестве оправдания. От быта нельзя убежать. Не нужно все делить на то, что нравится и что не нравиться, тем самым лишая мир целостности. Для развития нужно выбирать не между приятным и не приятным, а между полезным и вредным.

Лечение аллергии.

Как работают психологические методы

Специалист ассоциирует пациента с аллергеном или с ситуацией, вызывающей взаимодействие с ним. В результате чего  если пациенты получают доступ к аллергической реакции, то специалист прослеживает симптомы ее проявления, но в большинстве случаев реакция не наступает.

Аллергическая реакция проявляется, если в процессе представления пациент ассоциируется со специфическим эмоциональным состоянием. Но как только его выводят из этого состояния аллергическая реакция быстро прекращается. Эти специфические эмоциональные состояния, переживание которых порождает  аллергическую реакцию иммунной системы организма, получили  название эмоаллергены. А повышенная чувствительность иммунной системы к эмоаллергенам называется эмоаллергией.

Независимо от того, благодаря какому стимулу человек вошел в это эмоциональное состояние, эмоаллергены порождают аллергическую реакцию. Стимулы существуют во всех репрезентативных и сенсорных системах в виде звуков, запахов, образов, вкуса и прочих ощущений.

Примером визуального стимула является случай, когда пациентка, имеющая аллергическую реакцию на розы, увидев искусственную розу, отреагировала полной аллергической реакцией.

К кинестетическим стимулам относятся такие виды аллергии, как на металлические украшения, запахи, холод и тепло, продукты питания, вкусовые ощущения и т.д.

Чаще всего наблюдаются полимодальные стимулы – комбинация визуальных, аудиальных и кинестетических стимулов.

Специфическая гипосенсибилизация.

Уже в самом зарождении учения об аллергии наблюдались принципиальные моменты и условия появления измененной реактивности, интерпретируемые как стадии истинной аллергической реакции. Это – первичный контакт системы иммунитета организма с аллергеном; определенный промежуток времени для возникновения сенсибилизации; повторный контакт с тем же аллергеном; развитие характерных проявлений, когда собственно развивается аллергическая реакция.

Определены 3 стадии истинной аллергической реакции. 1-ая стадия (имунная) начинается с момента первичного контакта иммунной системы организма с аллергеном и продолжается до развития сенсибилизации. 2-ая (патохимическая) – начинается при повторном контакте со специфическим аллергеном, этой стадии характерно высвобождение большого числа биологически активных веществ. Для 3-ей (патофизиологической) стадии характерны нарушения функционирования, вплоть до повреждения, клеток и тканей организма под воздействием веществ, выделенных во время второй стадии.

Но всё это ничего не говорит о причинах сенсибилизации и десенсибилизации антигенов, ведь сами по себе антигены не являются причиной появления сенсибилизации. К тому же здесь не отражены все основные принципы развития аллергических реакций.

Есть еще такое понятие, как «ложная аллергия» или «псевдоаллергия».  Практика лечения аллергии показывает, что истинные аллергические реакции практически всегда проявляются вместе с псевдоаллергическими, поэтому  процент псевдоаллергических реакций  приближается к 100%. Поэтому использование термина «ложной» аллергической реакции является некорректным.  Так как сама аллергическая реакция натуральная, вот только ее механизм развития не вписывается в рамки иммунологической модели.

В 2004 году были введены такие понятия как эмоциональная аллергия (эмоаллергия) и эмоциональные аллергены (эмоаллергены).

То, что аллергические реакции могут происходить по психологическим причинам, было выявлено еще более 120 лет назад при первых исследованиях аллергии. И только в 1985 – 1987 годах, на основе предположения, что аллергия очень похожа на фобию иммунной системы, были сформированы первые психологические методы, позволяющие  вылечить аллергию.

Выявлено, что существуют определенные эмоциональные состояния, переживание которых порождают аллергическую реакцию у человека.

Сенсибилизация антигенов.

Антигены (пыльца растений, домашняя пыль, продукты питания, животные и др.) имеются в окружающей среде постоянно и окружают нас с рождения, а система иммунитета реагирует и утилизирует их обычным способом до того времени пока не появляется ситуация, которую центральная нервная система воспринимаемает, как чрезвычайно опасную, моментально реагирует и приводит организм в стрессовое состояние. Такая разновидность стресса, при которой присутствует состояние безысходности или замешательства, является эмоаллергической и запускает процесс сенсибилизации. При наличии только такого стресса система иммунитета находит антиген, с которым уже имеется контакт, и маркирует его «чужим».  Затем, при мельчайшем контакте с антигеном, аллергическая реакция, предупреждая о надвигающейся опасности, заставляет ее избегать.  Собственно, поэтому самой эффективной является рекомендация избегать антигены, что и предлагают врачи всего мира.

При выборе антигена система иммунитета применяет несколько критериев – концентрация антигенов в окружающей среде, их токсичность и генетическая память – здесь имеется в виду память об аллергенах, сенсибилизированых у предков, благодаря которым те смогли избежать опасных для жизни ситуаций и выжить.

Психосоматические причины аллергических заболеваний.

Психологические причины возникновения аллергии
Во время исследования эмоаллергенов оказалось, что в большинстве случаев эмоаллерген присутствует в сильной стрессовой ситуации, произошедшей до появления аллергии.   Очень наглядно это проявляется при сезонных аллергиях на пыльцу растений – здесь легко отслеживается, что стрессовые ситуации происходили ровно за год или  несколько лет до первого проявления аллергии.
Например, у женщины, никогда ранее не страдавшей аллергией, весной появилась аллергия на березовую пыльцу.  А ровно за год до этого, она перенесла  хирургическую операцию, при которой испытала сильный эмоциональный стресс. По ее воспоминаниям, тогда за открытыми окнами больницы, стояли весенние березы, т.е. в момент эмоционального стресса в воздухе присутствовала березовая пыльца.  Именно тогда был сформирован  эмоаллерген и запущен механизм сенсибилизации на березовую пыльцу, а ровно через год на нее началась аллергия.
К  событиям, вызывающим эмоаллергию относятся тяжелые заболевания, хирургические операции, конфликт с родными и близкими, смерть близких людей, а также любимых животных, переезд на другое место жительства, потеря или смена работы, ситуации,  объективно или субъективно представляющие угрозу для жизни. А также ситуации, когда люди испытывали продолжительный стресс средней интенсивности, депрессию, сильное переутомление.
На основании имеющихся данных уже сейчас можно утверждать, что одной из психологических причин появления аллергии  является психологическая травма или специфический эмоциональный стресс, в результате которого возникает эмоаллерген и иммунная система запускает процесс сенсибилизации, такой стресс получил название -эмоаллергический стресс.
Два вопроса!
Чтобы понять, в чем конкретно ваша причина заболевания, задайте себе два вопроса:
«Чего  и почему я боюсь? В чем состоит для меня выгода, от этой болезни. Кем я манипулирую с ее помощью?».
Ведь у аллергии всегда есть какая-то выгода. Она определяет, что человеку кушать, с кем общаться и куда ездить отдыхать. Аллергия помогает избегать определенных ситуаций. Бывает, ею пользуются, для управления другими людьми или для привлечения внимания к себе. Например,  аллергия на сигаретный дым может оказаться верным способом вынудить кого-нибудь бросить курить, без применения чрезмерной настойчивости. Страдающий от аллергии, устраивает свою жизнь, следуя распорядку лечения. А когда болезнь будет вылечена, придется вносить изменения в порядок своей жизни, принимать другие решения. Необходимо будет  внести изменения в диету и обращать внимание на ранее  незамеченные вещи. До того времени, пока не будут решены эти вопросы, аллергия, вероятнее всего, будет продолжать действовать против вас.
При удовлетворительном разрешении всех этих вопросов, связанных с диетами, ситуациями…  ваша жизнь стала бы более наполненной, вы  бы захотели расстаться с аллергией?

СИМПТОМЫ ПОЛЛИНОЗА

Обычно, в первый год симптомы поллиноза (повышенной чувствительности к пыльце растений) незначительны, ограничиваются умеренным ринитом, затем на протяжении трех-четырех лет интенсивность симптомов со стороны носа нарастает, могут присоединяться и различные другие проявления поллиноза. В дальнейшем интенсивность заболевания годами удерживается на одном уровне.

В случаях тяжелого клинического течения и при давности заболевания более 3-5 лет развивается патологический процесс в придаточных пазухах носа, в частности гайморит.

Так как пыльцевая аллергия – это системное заболевание, порой возникают симптомы другого характера. В период обострения поллиноза больные могут жаловаться на периодические боли в области сердца, повышение артериального давления.

Нередко приступу заболевания предшествует фаза предвестников болезни- продрома, во время которой больной отмечает недомогание, головную боль, отсутствие аппетита. В тяжелых случаях может быть лихорадочное состояние, светобоязнь, чихание.

Полезные статьи.

КАК ПРОЯВЛЯЕТСЯ ПЫЛЬЦЕВАЯ АЛЛЕРГИЯ (ПОЛЛИНОЗ)

Наиболее типичным проявлением поллиноза (повышенной чувствительности к пыльце растений) является риноконъюнктивальный синдром – одновременное поражение внутреннего угла глаз, ощущение инородного тела в глазу, затем появляется слезотечение, светобоязнь, которые сопровождаются выраженной гиперемией конъюнктивальных оболочек, расширением цилинарных сосудов, отеком век. Конъюнктивальное отделяемое вначале прозрачное, а затем вследствие инфицирования может быть гнойным, густым, появляются жалобы больных на резкие колющие и давящие боли в глазах. Чаще поражаются оба глаза, но степень поражения может быть различной. Острота зрения при заболевании не меняется. Одновременно наблюдаются сильный зуд в области носа и носоглотки, приступы мучительного чихания с жидким носовым секретом. Приступы чихания чередуются с приступами почти полной заложенности носа. В процесс постепенно вовлекаются слизистые оболочки носоглотки, евстахиевых труб, появляются боль в ушах, хриплый голос, повышается чувствительность к неспецифическим раздражителям.

КРАПИВНИЦА – ОСТРАЯ АЛЛЕРГИЧЕСКАЯ РЕАКЦИЯ

Крапивница относится к острым аллергическим реакциям немедленного типа. Волдыри, возникающие на коже, подобны тем, какие бывают при ожоге крапивой. Наиболее часто высыпаниям предшествует сильный кожный зуд, иногда высыпания и зуд возникают одновременно. Крапивница может вызываться пищевыми аллергенами (наиболее часто), бытовыми, лекарственными и т. д. Описаны случаи крапивницы как реакции на пыльцу растений (при контакте – лежании на сене и т. д.), на холод, солнечное облучение, т. е. на физические факторы.

Крапивница бывает острой и хронической.

Острая крапивница продолжается от нескольких часов до недели, хроническая сохраняется долго, иногда около месяца, когда одни элементы исчезают, а другие появляются вновь. Размеры крапивницы – от мельчайших до гигантских сыпей в виде сливающихся элементов, которые занимают всю спину, живот, ягодицы и т. д. Чаще высыпания локализуются в местах, которые больше подвержены механическим воздействиям, поясница, плечи, ноги, запястья и т. д. Волдырь обычно возвышается над поверхностью кожи, плотной консистенции с четкими границами от бледно-розового до ярко-красного цвета (в центре обычно окраска бледнее).

Больной ощущает чувство жжения и зуд в пораженных участках кожи. Общее состояние страдает мало, хотя в ряде случаев крапивница сопровождается высокой (до 39 °С) лихорадкой, недомоганием, слабостью, головными болями, тошнотой, ознобом и т. д.

Хроническая крапивница чаще связана с состоянием желудочно-кишечного тракта (холециститы, гастриты, энтериты), с наличием глистной и других инвазий.

Причины возникновения аллергии.

ПРИЧИНЫ ВОЗНИКНОВЕНИЯ ПОЛЛИНОЗОВ, СЕННОЙ ЛИХОРАДКИ

Поллиноз или сенная лихорадка – распространенное аллергическое заболевание, возникающее вследствие аллергии к пыльце некоторых видов растений и проявляющееся острым воспалением слизистых оболочек дыхательных путей, конъюнктивы, пищеварительного тракта, кожи, нервной системы.

Чаще поллинозом заболевают люди в возрасте 20-40 лет. Среди детей в возрасте до 10 лет чаще заболевают лица мужского пола, в период полового созревания и климактерический – женского.

Поллинозы вызывает пыльца ветроопыляемых растений, широко распространенных в данной местности. При повторном попадании в дыхательные пути особенно чувствительных лиц пыльца обусловливает у них образование специфических повреждающих аллергических антител (реагинов), ответственных за возникновение болезни. В странах с различными климатическими условиями причиной поллинозов является пыльца различных растений.

Заболевание клинически проявляется различными вариантами сочетания аллергического пыльцевого ринита, конъюнктивита, пыльцевой бронхиальной астмы, аллергического дерматита, крапивницы, отека Квинке, мигрени. Характерной чертой является четкая сезонность заболевания, совпадающая с периодом цветения определенных растений.

Течение болезни.

ПЫЛЬЦЕВАЯ АЛЛЕРГИЯ: ПЕРИОДЫ ТЕЧЕНИЯ БОЛЕЗНИ

В течении обострения пыльцевой аллергии клиницисты и ученые-аллергологи выделяют следующие периоды: начальный, период катаральных явлений, астматический, период выздоровления.

Начальный период (кратковременный по продолжительности) характеризуется общими расстройствами: недомоганием, утомляемостью, слабостью, потливостью, субфебрильной лихорадкой (лихорадка, при которой температура тела не поднимается выше 38оС). Иногда этот период может отсутствовать, и тогда заболевание начинается сразу со второго или третьего периода.

Период катаральных явлений по длительности редко превышает неделю и характеризуется прогрессирующим развитием симптомов первого периода, к которым присоединяются катаральные явления со стороны верхних дыхательных путей и глаз (трахеобронхит, ринит и конъюнктивит).

Астматический период является наиболее тяжелым этапом болезни. Продолжительность его в основном зависит от длительности цветения растения, виновного в возникновении болезни; она колеблется от 2-3 дней весной и до 3-5 недель осенью. Астматические явления в этом периоде протекают в виде чистой астмы или в виде астматического бронхита, или в виде полной картины бронхиальной астмы. Приступы пыльцевой астмы развиваются остро и протекают крайне тяжело, особенно у больных, сенсибилизированных к пыльце амброзии.

ВИДЫ АЛЛЕРГЕНОВ

Аллергены – это вещества, которые в организме человека и животных вызывают образование антител. Все аллергены подразделяют на эндо- и экзогенные. Экзоаллергены попадают в организм извне и могут быть инфекционного (вирусы, грибы, бактерии и продукты их жизнедеятельности) и неинфекционного происхождения.

К неинфекционным аллергенам относится, например, бытовая пыль (домашняя, библиотечная), пыльца растений, шерсть, волосы, перхоть, а также некоторые пищевые, лекарственные и химические вещества.

Эндоаллергены образуются в самом организме и могут быть естественными, или первичными (нормальная нервная ткань, хрусталик и др.), и приобретенными. Среди последних различают неинфекционные (ожоговые, лучевые, холодовые) и инфекционные (продукты повреждения тканей вирусами и микробами; комплексные аллергены типа ткань+ микроб, ткань+токсин).

АЛЛЕРГЕНЫ РАСТИТЕЛЬНОГО ПРОИСХОЖДЕНИЯ

Существует группа заболеваний, причиной которых являются разнообразные аллергены растительного происхождения.

Важнейшим аллергеном растительного происхождения является пыльца, которую можно обнаружить, прикоснувшись к тычинкам цветущего растения.

Причиной происхождения аллергии могут быть листья. Например, при контакте с листьями плюща развиваются аллергические дерматиты.

Контактную чувствительность у человека и животных могут вызвать листья сумаха укореняющегося и сумаха лакового. В листьях этих растений содержится урсол.

Аллергический контактный дерматит может развиваться от свежего сока одуванчика лекарственного.

Аллергенными свойствами обладают волокна плодов тополей (тополевый пух), одуванчика и многих других деревьев и трав, плоды и семена которых разносятся ветром. В качестве примера можно указать также на хлопчатник, волоски семян которого – хлопок – хорошо известны как аллерген, вызывающий иногда бронхиальную астму и другие проявления аллергии. К аллергенам растительного происхождения относится и обширная группа плодов, употребляемых человеком в пищу (земляника, апельсины, лимоны, сливы, черешня, вишня, клубника и др.).

СИМПТОМЫ

СИМПТОМЫ ПОЛЛИНОЗА

Обычно, в первый год симптомы поллиноза (повышенной чувствительности к пыльце растений) незначительны, ограничиваются умеренным ринитом, затем на протяжении трех-четырех лет интенсивность симптомов со стороны носа нарастает, могут присоединяться и различные другие проявления поллиноза. В дальнейшем интенсивность заболевания годами удерживается на одном уровне.

В случаях тяжелого клинического течения и при давности заболевания более 3-5 лет развивается патологический процесс в придаточных пазухах носа, в частности гайморит.

Так как пыльцевая аллергия – это системное заболевание, порой возникают симптомы другого характера. В период обострения поллиноза больные могут жаловаться на периодические боли в области сердца, повышение артериального давления.

Нередко приступу заболевания предшествует фаза предвестников болезни- продрома, во время которой больной отмечает недомогание, головную боль, отсутствие аппетита. В тяжелых случаях может быть лихорадочное состояние, светобоязнь, чихание.

Профилактика аллергии.

МЕРЫ ПРОФИЛАКТИКИ ПОЛЛИНОЗА: УСТРАНЕНИЕ ПРИЧИН НАРУШЕНИЯ НОСОВОГО ДЫХАНИЯ, ЛЕЧЕНИЕ ИНФЕКЦИЙ

Больным поллинозами (пыльцевая аллергия) необходимо особое внимание уделять общему состоянию здоровья, а также состоянию верхних дыхательных путей, предохраняться от острых респираторных заболеваний, так как при измененной реактивности аллергия легче присоединяется к микробным антигенам. С большой осторожностью надо принимать лекарственные препараты. Ни в коем случае нельзя самостоятельно лечиться, чтобы не вызвать повышенной чувствительности к лекарственным веществам.

Появление со стороны носа патологических изменений (искривление носовой перегородки, полипов, аденоидов) приводит к нарушению носового дыхания и снижает устойчивость слизистой оболочки к инфекции. В результате нарушается проницаемость слизистой, что может способствовать дальнейшей сенсибилизации к пыльце, пыли, грибкам. Поэтому важным профилактическим мероприятием является своевременное устранение причин нарушения носового дыхания, лечение очагов инфекции.

Советы аллергикам.

ПЫЛЬ – ИСТОЧНИК АЛЛЕРГЕНОВ

Различные аллергены могут содержаться в пыли жилого помещения. Поэтому необходимо создавать условия, которые исключили бы возможность образования и скопления пыли, во всяком случае, добиваться того, чтобы ее концентрация в воздухе была минимальной. Необходимо избавиться от мягкой мебели, ковров, тяжелых гардин. Книги следует хранить только в закрытых шкафах. То же относится к различным конспектам, рукописям, тетрадям, пачкам писем и т.д. Пыль может накапливаться и на одежде, поэтому одежда должна храниться в шкафах.

Обработка вещей пылесосом, регулярная влажная уборка помещений, выколачивание на улице ковров, матрацев, одежды из плотных тканей, постоянное проветривание – вот основные меры, направленные на предупреждение скопления пыли в помещениях.

ПИЩЕВЫЕ АЛЛЕРГЕНЫ ПРИ ПОЛЛИНОЗЕ

В результате действия пищевых аллергенов может усугубиться поллиноз (аллергия на пыльцу растений).

Пищевые аллергены могут вызывать или провоцировать возникновение обострения, если:

- проявление заболевания было связано с употреблением в пищу определенного продукта;

- сенная лихорадка обострялась после употребления спиртных напитков с последующим приемом пищи. В такой ситуации алкоголь играет роль проявителя пищевой аллергии, увеличивая степень и скорость всасывания пищевых продуктов. Возможна, правда, аллергия и к самим спиртным напиткам (больной, например, не переносит виноградного вина). В случаях же пищевой аллергии, особенно к постоянно употребляемым продуктам (хлеб, мясо), аллергологическое проявление вызывают любые спиртные напитки;

- обострение сенной лихорадки сочеталось с явлениями гастрита;

- кожные реакци

OLD PEOPLE AND SOCIETY: PROBLEMS AND SOLUTIONS

Old age is, and must be seen to be by society, a success story. The fact that the elderly are more prone to lots of different illnesses should not detract from this. Most elderly people live completely fit and independent lives. For those that do fall ill much can be done, and for most the condition can be cured or substantially alleviated.
Chronic conditions by their very nature will always be with the elderly in one form or another. To accept this fact as inevitably leading to dependence is wrong. Active rehabilitation can postpone dependence indefinitely, remembering that dependence in old age is not due to old age but to ill health. The aim must be to envisage old age as a time of enjoyment, with health problems tackled as vigorously as in the young. There will always be some for whom early and accurate diagnosis, full treatment and rehabilitation will be insufficient and in whom the underlying disease process will continue. This is certainly true of Alzheimer’s dementia. However there is some evidence that a caring environment accompanied by techniques such as reality orientation can postpone further rapid deterioration so that the disease only progresses gradually, leaving most sufferers a good quality of life for many years.
It is to be hoped that, with continuing public and professional education, ‘ageism’ in all areas diminishes. It is morally wrong and financially absurd to spend vast sums of money on a large group of people at the end of their disease process, placing them in institutions instead of ensuring prevention and early detection of disease. The old have as valid and worthy a stake in preventive medicine as any other age group. The pendulum has a long way to swing before the elderly receive the same kind of publicity associated with, say, child immunization projects, child abuse, AIDS, smoking, etc. All are important. Why are the elderly less important than others?
Parts of this awareness and consciousness-raising of health issues in the elderly will inevitably lead to more preventive work and early recognition of diseases by the primary health care team – GPs, nurses, health visitors, etc. This means that all health care professionals will have to keep abreast of current developments in all fields of health care in the elderly. The GP is a vital and powerful gatekeeper when it comes to the early detection and treatment of ill health in old age; this is especially the case in confusional states, where delay in diagnosis can be disastrous.
Education concerning health matters is needed not only at all professional levels but also in the lay press. If glossy magazines were to publish as many articles on the early recognition of conditions that may cause confusional states or other medical conditions common in the elderly as they do articles on how to detect breast lumps, they may well increase their circulation. They would also provide insight and knowledge to at least three generations of women instead of the one or two generations they aim at now – the children and grandchildren of our current elderly.
For many the present and future dilemma is how to cope with a relative with dementia. To cope adequately a carer must understand the condition and how it may progress. It means knowing what to do in certain circumstances and where to go for practical help, advice and support. It means having a network of both professional and informal help, of not coping with the burden alone. Coping means knowing the law, getting the entitlements and most importantly it means understanding the system to get the information, the help and the support.
The caring continues as it always has done – there appears to be no decline in these acts of self-sacrifice. And it will continue as long as the carers are met at least halfway by the state. The provision of fundamental information and practical help with the caring role, and support during emotional strain, family upheavals, etc., can come from both statutory and voluntary concerns. The statutory sector, however, cannot shirk its responsibilities and expect the voluntary sector to pick up all the pieces. The role of the carer and all its implications have to be publicly recognized by the state and due credit given. Financial help must be widened and increased, because the caring performed by individuals is not only beyond price; it is beyond the capabilities of any health service to match, no matter how that service is funded.
For too long the care of the elderly in all aspects has been known as a Cinderella specialty. It is time for Cinders to go to the ball and for the clock to remain perpetually at one minute to midnight. Fairy godmothers may be a bit hard to come by, but dedication, commitment and a pride in the work is available in abundance.
The medical and social difficulties associated with old age will not go away; indeed they will increase. We know the problems and we have the solutions. All that is needed is the social and political commitment and then perhaps most of us will have a happier old age.
*97/128/5*

Pharmacy Online

MEDICARE REBATE AND MEDICARE SCHEDULE FEE

Medicare Rebate
The Medicare rebate is 85 per cent of the Medicare Schedule Fee. When doctors bulk bill this is the percentage of the Schedule Fee that they receive. Patients also receive this proportion of the Schedule Fee when they pay their medical bills prior to the receipt of a Medicare Rebate. The fee the doctor charges for a patient may be much higher than the Schedule Fee and therefore much higher again than the Medicare Rebate. Why the government chooses to say a doctor’s service is worth the Schedule Fee; and then proceed to rebate 15 per cent less has never been adequately explained to either doctors or their patients.
Medicare Schedule Fee
The Medicare Schedule Fee is a value derived by public servants in Canberra. It is a unilateral determination calculated without consultation with either the public; or the medical profession. Because it is a determination made by government looking over its shoulder at fiscal policy the Schedule does not necessarily represent the real value of medical services it purports to reimburse.
Irrespective of the extent to which the Schedule Fee represents the market value of a doctor’s services, it has been used in conjunction with bulk billing to gain control of general practitioners incomes. In so far as he who pays the piper calls the tune the Federal Government now has defacto control of most general practitioner’s and some procedural specialist’s incomes; whilst the market place still controls their expenditure.
Institutionalized in this way there can be no end to conflict between the Federal Government and the medical profession. This state of affairs serves poorly the best interests of Australia’s sick and suffering. It is the thin edge of increased waiting times, rationing of services and arbitrary inroads into the nations health expenditure at the whim of party political purposes.
*96/131/5*

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CURE OF CANCER BY COMBINATIONS OF TREATMENT WHICH INCLUDE RADIATION – SAMPLES

Where are cancer cells most likely to escape being killed by chemotherapy drugs? Firstly, they may escape wherever there are big deposits. One of the biggest deposits is often, but not always, the primary cancer. There may be a choice between surgery and radiation to tackle these large deposits. Secondly, there are parts of the body where there seems to be some sort of barrier to the penetration of chemotherapy drugs. Radiotherapy can be used to treat these areas. They are the central nervous system (brain and spinal cord), the testis and the ovary. For example, in acute lymphoblastic leukaemia of children, the chance of leukaemia cells getting into the central nervous system, testis or ovary is so high that preventive treatment of these areas by radiation is recommended. This addition to the usual chemotherapy treatment has been shown to improve the cure rate.
Bone marrow transplantation is a special instance where radiation is combined with other treatments to produce some cures. The preparation includes radiation of the whole body. Although bone marrow transplantation has been tried for many types of cancer, the only ones it can cure are certain types of leukaemia. The entire treatment package is very arduous, dangerous and lengthy and the chance of cure is usually not high. Try very hard to get all the facts before agreeing to this type of treatment.
*278/40/1*
Cancer

CURE OF CANCER BY COMBINATIONS OF TREATMENT WHICH INCLUDE RADIATION – CONCLUSION

Obviously, the more different types of treatment you have, the more your treatment is likely to ‘cost’. The situation with combination treatments is so complex that you could be very tempted just to tell your doctor to go ahead with whatever is most likely to cure you. The problem is that doctors have a tendency to overtreat, as we have seen. They are likely to want to add to your treatment anything that could be active against your cancer. They will probably make little or no attempt to weigh the likely additional cost against the likely additional benefit. In any case, you can do that much better than they can. It is therefore very important that you ask exactly what difference each part of your treatment is likely to make. What could happen if you only had one type of treatment? Does the addition of radiation improve the cure rate or only the local recurrence rate? How difficult is it to treat a recurrence? Would you still have a chance of cure if the disease recurred or is the ‘first bite at the cherry’ really your only chance? You will have to try to weigh up the possible costs against the possible benefits to come up with the decision that is best for you.
*277/40/1*
Cancer

CHILD’S DISORDERS: SWALLOWING DIFFICULTY (DYSPHAGIA)

Cause

If your child has trouble swallowing food or liquids it is most likely to be due to a sore throat, mouth infection or ulcer. Avoid giving him spicy or sour foods, and offer purees and soups instead of solid food which requires a lot of chewing. Ice blocks are often well tolerated, as are jellies. Swallowing difficulty may be associated with a serious underlying condition such as a weakness of the sphincter between the oesophagus and the stomach.

When to see your doctor immediately

• if your child is having difficulty breathing;

• if you suspect that he has swallowed or breathed in a foreign object;

• if your child is unable to swallow anything at all;

• if you suspect that your child has drunk some household chemical;

• if you suspect that your child has been stung or bitten by some insect.

You should also see your doctor if your child has a fever and is generally unwell for no apparent reason.

*241\90\8*

SEXUALITY, ILLNESS AND HEALTH/SEX AND CELL DISEASE (CANCER): TESTICULAR ANCER

Here some ideas regarding testicular cancer and sexuality. Most apply to cancer of the prostate as well.

1. Some, but not all, surgery may directly affect ejaculatory capacity. Remember, this surgery does not mean loss of psychasm or even loss of orgasmic contractions. There may be a loss of the ejaculatory fluid, but this loss has no impact on sexual capacity.

2. The type of rumor will determine actual physiological outcome. If their particular type of surgery affects fertility, some patients decide to freeze some of their sperm prior to surgery so they may decide to have children after. Many types of surgery do not affect fertility.

3. There is no loss of erection that accompanies testicular cancer treatment. Sometimes, prostatic cancer surgery affects erective reflex to varying degrees. Of course, anxiety, depression, and other emotions will affect your body, and that can affect blood flow to the penis.

4. Some patients report a diminished interest, arousal, or desire and other impact on their sexual-response system. If such states persist, ask your doctor about a serum-testosterone test to be sure your hormone levels an, within the appropriate range.

5. Short-term therapy, education, and reassurance can go a long way in pn>. venting or correcting the emotional setback that may come with this type of cell disease. Again, hire somebody who will work with you on this specific problem.

6. Even though we talk about cancer as a curse and call persons with over-growing cells «cancer victims,» sexual activity does not cause cancer, it does not directly cause any form of disease, even though intimacy can transmit some diseases. Guilt will only slow the healing process. Self, blame will only get in the way of a return to intimacy.

7. Loss of ejaculate or reduction of fertility due to the drugs or radiation used in treatment does not decrease virility or manhood. Remember our fourth perspective in all of this. Sex is not a measure of anything, it is a response growing from within a system of interaction between two people. Cutting anything on the body does not have to cut off sex.

*277\97\8*

YOUR MARITAL HEALTH/SEXUALITY FROM ANOTHER PERSPECTIVE: THE ASSUMPTIONS REGARDING HUMAN SEXUALITY

Here are fourteen of the assumptions regarding human sexuality. In each case, I have altered the assumption from the fourth perspective to illustrate this orientation to sexuality.

1.    Intercourse is the ultimate sexual act between a man and woman,

and intercourse means insertion of the penis into the vagina.

Anything less than penetration is not really intercourse.

FOURTH PERSPECTIVE: Intercourse with the penis inside the vagina is not the ultimate intimate sexual act, but one option among many intimate choices. When it becomes the ultimate act, we miss opportunities for forms of intimacy that involve equally intense pleasure and sharing and we become goal-directed and one-dimensional in our sexuality.

2.    Men are the «inserters» and women are «receivers» in sexual

intercourse.

FOURTH PERSPECTIVE: A more productive orientation to sexual intercourse and all sexual interaction is one of «merging» rather than «penetration,» of doing with and together rather than to or for.

3.    Genital contractions are orgasm.

FOURTH PERSPECTIVE: Genital contractions following sexual stimulation are pleasurable reflexes. The total experience of physical, emotional, and cognitive merging with someone we love is called a’ ‘psychasm,» and may or may not be accompanied by genital or pelvic contractions.

4.    Orgasm is the measure of sexual fulfillment.

FOURTH PERSPECTIVE: The number of orgasms is related to the number of neuromuscular responses to genital stimulation. Sexual fulfillment is a more complex interpersonal process involving all levels of human responsiveness.

5.    Women have more trouble having orgasm than men.

FOURTH PERSPECTIVE: There is no evidence that pelvic reflex is related to gender, but expectations can influence physiological responsiveness.

6.    Women respond sexually more slowly than do men.

FOURTH PERSPECTIVE: «Speed» and «time» are not the key variables in sexual response, and mental, emotional, and cognitive factors are person-, not gender-, related.

7.    Men have a refractory period and a period during which they

must rest before continuing. Women can go on forever.

FOURTH PERSPECTIVE: All neurological responses are followed by some period of refraction or rest. Gender is not predictive of the length of this rest period.

*104\97\8*

THE JOY OF PERFECT HEALTH: BACTERIA

Most of us, (including most doctors and medical scientists) are kept unaware that the «bacteria» theory of disease is simply NOT true, and there is evidence, that Pasteur himself has falsified his own records to advance his own career. Among the most important things Pasteur did not report are:

• All bacteria can very quickly change according to their environment, not only from generation to generation, but in a single lifetime. This means that a simple change of conditions (bacteria food supply) can create a new type of bacteria in a few minutes! Friendly acidophilus in our intestines could quickly become any other bacteria – if its environment changes. Any particular bacterium can become any other bacterium and revert back again, if the conditions (food supply) change.

• Bacteria need food to survive and multiply. No food -no bacteria. Bacteria can only feed on dead organic matter. (There is no bacteria known to eat any living cells). If the organism does not provide the necessary conditions for bacteria to multiply (there is no dead organic matter and toxins) such an organism is not susceptible to bacteria invasion and it does not get sick at all. Therefore, if you inject bacteria to induce a disease – only 40-60 % of the weakest organisms will develop a disease and among those who do, there will be several types of different symptoms {different diseases), depending on the particular combination of pre-existing conditions for each individual organism.

• Given time, bacteria can learn and adapt themselves to extreme conditions, by entering into a hidden state, undetectable by conventional types of microscopes. When you restore favourable conditions (food supply) once more, bacteria appears and starts multiplying again. In modern medicine such bacteria are known as «drug resistant».

*3\96\8*

KIDNEY STONES – EFFECT OF DIFFERENT STONES

In the same way, infection, producing clumps of bacteria and pus, may allow stones to form as the salts are precipitated out of solution.

Obstruction to the free flow of urine always leads to infection and may cause stones. Changes in the pH of urine, making it more acid or alkaline, can also lead to the precipitation of salts.

Prolonged immobilisation, such as can occur with a person laid up in traction for a broken bone or in paraplegics and quadriplegics, can lead to the demineralisation of bone.

Calcium comes out of the bone and is excreted through the kidneys. This excess calcium can form stones.

Calculi may be made of different chemicals, sometimes from a combination of two or more substances.

Calcium oxalate stones are usually rough with sharp projections and, because these irritate the lining of the kidney and cause pain and bleeding, are usually detected while still small.

Calcium phosphate stones, on the other hand, are smooth and may grow to a large size without detection. They may fill the pelvis or collecting chamber of the kidney and project into pockets of the kidney substance.

*470/71/1*

BACKACHE – DESCRIPTION

A lateral process projects from either side.

Between two vertebrae is the intervertebral disc and it is this structure which is believed to cause most back problems.

The disc consists of an inner core of thick fluid, surrounded by tough fibroelastic cartilage arranged with interwoven strands.

From the late teens, the disc starts to degenerate — the inner core loses its fluid and becomes smaller and firmer, and the elastic tissue is subject to strain and may develop splits.

Whether the backache is due to normal degeneration or to injury is important not only to the sufferer and his doctor, but also to industry, insurance companies and the law, as most severe back conditions result in workers’ compensation claims.

It is this lack of agreement and lack of full knowledge of the pathology underlying the condition which leads to disagreements about treatment.

Backache may be the result of muscle strain or tearing or may come from injury or strain to ligaments or joints but it is now believed most back problems stem from a disorder of the disc.

*215/71/1*

ENDOMETRIOSIS: WOMEN TELL THEIR STORY

Christina’s Story: After working for an insurance company for five years, twenty-five-year-old Christina decided to do what she’d always felt suited her best—she became a police officer. Christina leads a high-stress life, and although she experiences pelvic pain, she has been told that she does not have endometriosis. Christina tells it this way: «I’ve had cramping my whole life, and days of heavy bleeding, and I can’t afford to be fuzzy-headed when it’s a matter of life and death. My doctor says I don’t have endometriosis, just cramps. My mother had a hysterectomy when she was fifty-two (two years ago) and the gynecologist told her that her abdominal organs were almost literally cemented together by endometriosis. He was amazed that her intestines weren’t completely obstructed. I want to keep this disease in control and wonder if there’s some way to ‘track’ it. If I can predict a bad day, I can be better prepared.»

There are many ways to follow the symptoms of endometriosis as they seesaw through the month, but first we need to differentiate between normal cyclical functions—that is, menstruarion—and abnormal conditions. Normal function includes an approximate twenty-eight-day cycle with some premenstrual pelvic pressure and bloating. Any menstrual cramps can easily be controlled with Midol or aspirin. Discomforting premenstrual symptoms will vary from person to person, sometimes including mid month low-range pain (mittelschmerz), indicating ovulation.

Christina can increase her awareness of the disease by using a calendar. Ideally, entries should begin with the first day of menstrual bleeding, which is an absolute marker. Each day, symptoms should be listed from good to bad. Over a two-month period, it will become clear when the side effects of high levels of prostaglandins are the most virulent. Those effects may include severe cramps, fainting, diarrhea, and pounding headache. There are also cases in which endometriotic tissue growing on the fallopian tubes causes a special dysfunction: during ovulation, the fallopian tube «misfires» and cannot draw in all the fluid surrounding the egg. Some of this fluid drops into the abdomen, causing tremendous pain. Furthermore, some women will experience psychological symptoms of premenstrual syndrome (PMS) along with die more physically debilitating problems associated with endometriosis.

Keeping a chart of her symptoms is vital for helping a woman and her doctor assess the severity of the disease and select an appropriate treatment.

*39\43\4*

SKIN CARE: TREATMENT OF PSORIASIS

The overall aim of treatment is to inhibit or reduce the mitotic activity of the cells, so that they slow down their rate of reproduction or ‘turnover’. Along with this, the associated inflammation must be suppressed. Topical or surface treatment is the most logical form of treatment. The most useful substances for this are tar preparations and a closely related substance known as dithranol These preparations may come in various forms, and one of the most important considerations when using these substances is the choice of vehicle. That is to say, some bases, whether cream or ointment, are better absorbed than others, hence enabling the tar or dithranol to adequately penetrate the skin. The vehicle is particularly important when the preparation is intended for use on the scalp. If, for example, an ointment were to be used here, it may be difficult to wash out in the morning, and therefore cosmetically unsuitable; ointment, therefore, would not be used. The precise purpose of tars and dithranol is to reduce or inhibit mitoses, and therefore slow down reproduction of cells. Frequently, these preparations may be used in conjunction with salicylic or retinoic acids which are very useful in reducing the surface scaliness and allowing the preparations to adequately penetrate the tissues.

Topical steroids, ‘cortisone’ creams, are very commonly used in the treatment of psoriasis. The advantage of these preparations is, firstly, that they are cosmetically the most acceptable. Furthermore they are excellent for decreasing mitoses, decreasing surface scaliness, and reducing inflammation. However the weaker creams do not work effectively and the stronger ones, if used over large surfaces for prolonged periods, may occasionally result in side-effects. The other perhaps more important disadvantage is that the condition frequently recurs, or relapses, when their use is ceased. Ultraviolet light (UVB) is very useful as an adjunct to the treatment of psoriasis with these topical preparations: the UVB tends to decrease mitoses and reduce excessive cell reproduction. The sun is a better source of ultraviolet light than the artificial lamps available. Occasionally, however, sufferers with psoriasis are sensitive to sunlight, and then of course it should not be used. Systemic or oral treatment of psoriasis is also available for the more severe cases. This type of treatment should only be carried out by dermatologists who are prepared to carefully monitor the patient’s general health and carefully control the dosage of the drugs used. Oral cortisone has no place in the routine management of psoriasis because of its possible side-effects with continued use. Furthermore, with acute pustular psoriasis it may aggravate the condition. Various cytotoxic agents (like methotrexate), which in large doses are used for the treatment of certain cancers, may be most useful when used in low dosage. They act by inhibiting mitoses and slowing down cell reproduction. Methotrexate is used in very small doses which are given once a week. It is a very useful drug if there are no blood or liver abnormalities, which must be regularly checked for. Obviously it affects not only the skin but also the liver, bone marrow, bowel, and reproductive organs. It must therefore never be used during reproductive years unless appropriate contraceptive precautions are taken. However, if used with care and appropriate supervision, methotrexate is a most useful treatment for severe psoriasis. There are other similar drugs, such as hydroxyurea, which may be used if methotrexate proves unsatisfactory.

*67\44\4*

NUTRITIONAL ASPECTS OF APPETITE CONTROL: FAT SUBSTITUTES

Dietary fat substitutes have been designed to mimic the sensory properties of fat and enable the production of low-fat foods that can satisfy consumers. There are a number of ways to make a tat

Substitute. Some are made from carbohydrates and protein, whilst others are derived from other food components (e.g. Cellulose), or are completely synthetic compounds. Fat substitutes must be safe to use, must not affect the organoleptic properties of the food and provide some of the attributes of fat.

The biggest question is whether they provide dietary assistance for body fat management’ The answer appears to be yes when all high-fat foods are substituted for reduced-fat varieties or fat substitutes. If only a portion of high-fat foods (e.g. Only ice cream and biscuits) are modified, there is likely to be compensation in the form of extra fat or energy intake at other times in the day.

Based on current evidence it seems that a complete dietary overhaul to include low-fat options will be most effective for fat loss.

On a practical level, the use of the recently approved (though only in the US) fat substitute Olestra has been found to reduce feelings of deprivation associated with low-fat diets, as well as reducing the number of high-fat foods that were considered tempting’. Even so, Olestra has serious nutritional implications, as it has also been found to decrease the absorption of antioxidant carotenoids, vitamin E and other fat-soluble compounds. Oelstra is not yet available outside the US and its potential introduction to other countries will receive fervent opposition from dietitians.

It will be important to monitor a client’s use of fat substitutes, artificial sweeteners and reduced-fat foods to see if these dietary modifications are effective.

*120\186\4*

FEELINGS AND EMOTIONS IN CASE OF ENDOMETRIOSIS

Coping

The most important thing to realise is that you are not alone in trying to cope with this disease. There are many people ready to support you by listening, making suggestions and helping you to make choices about treatment.

Talk to your doctor. Tell her or him you feel alone. There are also self-help groups. The Endometriosis Association (Victoria) is a non-profit group set up to help all fellow sufferers. Do not be frightened to ask for help or advice.

For those entering a new relationship there is the problem of when to discuss endometriosis. You may think that a discussion ‘too soon’ in a new relationship will frighten off a potential partner. For those who suffer from painful intercourse there is the constant worry that a new partner may think that you are frigid or that you just do not find him sexually attractive.

Acceptance

For many of us it is necessary to talk through all of these emotions before we can come to terms with the fact that we do have a chronic disease and that this disease will probably cause disruption to our lives.

There is a light at the end of the tunnel. Once you have come to terms with your illness and accepted that you have a health problem you will feel better — both physically and emotionally.

You are going to face many hurdles and be forced to make choices or come to terms with decisions that will be difficult.

You may have to accept that you may never have children, that you may require further treatment at some stage, that your life may be disrupted at times, and that you will be faced with changes.

Decisions

With acceptance of your condition comes the need to make decisions. These decisions will undoubtedly affect your whole future and you really need to weigh up all your options very carefully. These decisions are going to affect your childbearing, your capabilities and your quality of life. Career and relationships will also be affected.

Understand that these decisions will not always be easy to make or to come to terms with.

As a guide, make sure that you are well informed and consider all your options carefully. Look at the side effects, the advantages and disadvantages, the possible outcomes, and your future.

Take time

Do not be rushed into making a decision. Do not be pushed into a decision that someone else has made for you. You are the one who must decide what you really want and what is best for you. You must list your priorities to include your options, treatment and personal needs. Think ahead.

Ask questions

Help yourself become well-informed by talking to your doctor, attending sessions run by self-help groups and using the resources offered by women’s health services.

Read as much as possible about endometriosis and talk to other sufferers. This will not only keep you well-informed but remind you that you are not alone.

Take control

It is your body and you have to live with your decisions. Carefully consider your doctor’s advice and take into account the information you have read. But remember the final decision should be yours.

Communicate

Talk to women who have been through similar experiences. Talk with your family and your partner, if you have one. Talk to your doctor. Get the best possible care. Do not be frightened to seek a second, third or fourth opinion before you make any final decision.

Be assertive

Remind yourself that you have the right to the best possible care and that you have the right to voice your concerns and opinions. Do not be pushed into any decisions that you feel uncomfortable with.

Set realistic goals. Take it step-by-step, day-by-day. Do not rush yourself or allow others to rush you into decisions.

Do not be afraid to ask for help. Seek help if you are finding it difficult to make decisions on your own.

You may come across many conflicting ideas about the best way to approach decision making. Remember to investigate all avenues, ideas and suggestions before you make choices.

Once you are well informed you should make a decision that you are happy with.

Decisions should not be put entirely on your shoulders. Encourage and involve others, including doctors, family, partners, friends, other women with endometriosis, self-help groups and women’s health centres, to help you make the right choice. Remember — you are not alone.

Infertility

This can cause heartache, disappointment and loneliness — but couples do cope. If you have been on the infertility merry-go-round at some stage you will need to ask yourself, ‘Have I had enough?’. When are you prepared to stop infertility treatment? Ask yourself how much is too much. How long can you continue to be disappointed when yet another treatment has failed? How long can you put up with the disruption to your life? If you agree to continue with infertility treatments, will these be at the expense of other plans you have for your life?

Realise that you may never have a child; try and accept this — getting help if you need it — and then re-evaluate your goals.

Accepting that you will be childless may actually signal success and show that you have come to terms with your limitations. You have recognised the need to go on with other aspects of your life.

But do not be pushed into making a decision one way or another. It is your choice so make your own decision, in your own time, for the right reasons for you.

Calling it quits

You have the right to decide when you have had enough so that you can come to terms with the impact of your endometriosis. It may mean that you will never have children if you decide to have no further treatment or investigations. If you have had enough of the pain, the treatments and the disruption that endometriosis can cause, then the final decision may be to have a hysterectomy.

It is important to remember that if you are not coping at any stage, do not feel ashamed or embarrassed to seek professional help.

*109\83\2*

TREATMENT OF ENDOMETRIOSIS: DANAZOL

Danazol is the drug which is most commonly used for the treatment of endometriosis. First developed in the early 1960s, it has been used for the treatment of endometriosis in Australia since the late 1970s; it is also used for the treatment of menorrhagia (heavy bleeding).

Danazol is a weakened form of the male hormone testosterone. Testosterone is one of a group of male hormones known as androgens which are produced by the male testes. They are responsible for the functioning of the male reproductive system and the development of the male characteristics such as facial hair and a deep voice. Women also produce very small amounts of androgens in their ovaries.

Danazol is distributed by Winthrop in the form of 100 and 200 milligram white gelatin capsules. In Australia, Danazol is also known by its trade name of Danocrine. In the United States, the United Kingdom and Canada it is marketed under the trade names of Danocrine, Danol and Cyclomen respectively.

In Australia, Danazol can only be supplied under the Pharmaceutical Benefits Scheme for the treatment of endometriosis if your endometriosis has been definitely diagnosed during a laparoscopy or a laparotomy and if your doctor fills in a special prescription form known as an ‘Authority’. If this is done a script of Danazol will only cost you the maximum cost of a prescription under the Pharmaceutical Benefits Scheme ($15 in March 1991) as opposed to its full cost (approximately $ 150 per script in March 1991).

*51\83\2*

PROBLEMS AT WORK AND SCIATICA

While it’s up to you to make sure that you take sensible precautions at home to protect your health, it’s a different matter when you’re at work where the demands of the job or the facilities provided for doing it can force you into a situation where damage to your back can result.

Sciatica and back pain are. of course, part of a much wider range of, at times, work-related ailments of all kinds that fall under the broad label of ‘musculoskeletal disorders’, a term that encompasses those conditions that affect the bones and muscles of the body and the tissues that hold them together.

Musculoskeletal problems often arise from tasks performed while employed, and each year more than half a million cases are reported as being caused by work. Says the Health and Safety Executive (HSE): «The potential to cause these conditions exists in most workplaces – although certain types of work are more often associated with musculoskeletal disorders than others, such as poultry processing, clothing manufacture, keyboard operation, nursing and assembly line work.»

According to the HSE, the causes fall into three main categories:

Manual handling and lifting – poorly designed tasks and incorrect lifting techniques and posture all increase the risk to workers. More than 55,000 injuries due to handling, lifting or carrying accidents are reported yearly.

Repetitive work – where work is done too quickly, such as in piecework, or where the work rate is controlled by a machine. This can be a particular problem when combined with the need for force; where the operator is positioned badly; or where the job is not varied enough.

Unsuitable posture – often caused by poor seating arrangements or by reaching and stretching awkwardly.

While a specific injury to the affected part can be detected in many instances of work-related disorders, in others, pain and discomfort may be the only evidence of problems, as in the case of chronic back pain or sciatica.

The HSE firmly believes that most of these problems can be avoided, often through relatively simple corrective action, such as perhaps modifying how a job is performed, or through re-siting parts of machinery or adapting seating positions.

The responsibility for preventing health problems caused by working conditions is one that is shared to a large extent by both the employee and the employer, and these can be summed up as follows:

The employer has a legal duty to safeguard the employee’s health and safety, and should identify tasks which could cause problems and take steps to improve the situation.

The employee must, however, exercise care and follow good work practices, particularly where lifting and carrying are involved. It is also up to the employee to ensure that any workstation is correctly adjusted when adequate adjustment is possible. Spelling this out more fully, current relevant legislation includes:

- Section 2 of the Health and Safety at Work etc Act 1974 (HSW Act) which places a duty on employers to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all their employees.

Section 6 of this Act also places a duty on manufacturers, designers, suppliers and importers of articles for use at work to ensure, so far as is reasonably practicable, that the article is so designed and constructed as to be safe and without risks to health.

Under section 7 of the Act, employees have to take reasonable care for their own health and safety and that of others who may be affected by what they do (or fail to do); they also have to cooperate with their employer, so far as is necessary, to enable

the employer to comply with legal duties.

It must be noted that the HSW Act deals with general duties and does not provide specific requirements on the prevention of particular ailments. However, various Regulations are more to the point as far as reducing the risk of back pain or injury are concerned, as shown below.

The Management of Health and Safety at Work Regulations 1992 (the Management Regulations) include requirements for employers to:

Assess risks to health or safety.

Arrange for the effective planning, organisation, control, monitoring and review of preventive and protective measures.

Appoint competent people to assist the employer in complying with health and safety law.

Cooperate and coordinate health and safety actions where the activities of different employers interact.

Provide appropriate health surveillance, information and training.

The Provision and Use of Work Equipment Regulations 1992 place duties on employers concerning the safe and proper use of work equipment. The risk assessment carried out under the Management Regulations, as mentioned above, is intended to help employers select work equipment and assess its suitability.

The Health and Safety (Display Screen Equipment) Regulations 1992 are directed mainly to protect employees who habitually use display screen equipment as a significant part of their normal work. Employers have duties to:

Assess and reduce risks.

Make sure new workstations meet minimum requirements covering equipment, furniture, the working environment, task design and software. There was a transition period until 31 December 1996 for existing workstations

Provide breaks or changes of activity, information and training.

While the health risks most commonly associated with operating computers and other VDUs are upper limb disorders (including repetitive strain injury) and sight problems, back troubles can easily arise from inadequate seating and a lack of breaks in the day’s work.

The Manual Handling Operations Regulations 1992 require the avoidance or reduction of risk where the manual handling of loads involves a risk of injury.

The Workplace (Health, Safety and Welfare) Regulations 1992 include requirements for lighting, workspace, workstation arrangements, seating and facilities for rest.

The Supply of Machinery (Safety) Regulations 1992 apply to the supply of new machinery which will need to meet relevant essential health and safety requirements.

Taken together, the HSW Act and the various Regulations put a strong onus upon any employer to ensure that everything reasonable be done to prevent employees from contracting work-related ailments. Despite that, it remains a fact that many sufferers from back problems certainly attribute their difficulties to conditions at work. Should you think that your health problems are due to unsatisfactory work practices, this is what the HSE says you should do:

In the first instance, consult your doctor, giving as much information as is possible to enable him to decide whether or not your condition is likely to be due to your work. In some cases individuals suffering from specified conditions can get state compensation under the Industrial Injuries Prescribed Diseases Regulations. Ask your doctor about this or get leaflet N12 from your nearest Social Security office.

If you suffer from symptoms which may be attributable to work, particularly if they recur, then it is important to tell your doctor and employer. If you have a works nurse or doctor, then you should also tell them about your problem. You may also want your union representative to know that -you think your job is affecting you. If you are off sick for more than seven days your doctor will inform your employer of the cause via a sick note.

You can also contact a doctor or nurse from your local Employment Medical Advisory Service. You’ll find them at your local office of the Health and Safety Executive.

If you need more information, contact the HSE’s Information Centre on 0541 545500.

Additionally, should you develop a musculoskeletal disorder that makes it difficult for you to continue with your current job or you are out of work, you can get advice from your local Job Centre on assessment and rehabilitation schemes, registration as a disabled person, job retention, work aids for people with disabilities and help with job applications.

*56\124\2*

ANTI-DEPRESSANT LIFESTYLE: SUPPORT AND RECOVERY GROUPS

Support groups now exist for many serious and debilitating illnesses, and depression is no exception in this regard. Such organizations provide up-to-date information and meetings to help members and their families cope with depression. A listing of available support groups that deal with depression and related disorders is provided in the Resources chapter at the end of this book.

Recovery or 12-step groups are modelled on the principles set down by Alcoholics Anonymous, which was the first such group to be developed. There are currently recovery groups for drug addicts, sex and love addicts, compulsive gamblers, overeaters and the adult children of alcoholics. There are also separate groups for the spouses, partners or family members of those who participate in these various groups. Recovery groups combine a programme consisting of working through a series of specific steps with fellowship, support and simple wisdom. In meetings people learn that they are not alone in their unhappiness. They are encouraged to talk freely and are listened to in a non-judgemental way without being challenged or confronted. There is a spirit of respect for what people have to say and the problems they are grappling with.

I have encouraged many of my patients with depressions and addictions to go to an appropriate recovery group, often with good results. At times I have managed to locate another group member who is willing to pick the newcomer up and take him or her to a meeting of the group. I have encountered considerable reluctance in my patients to go along with this suggestion and they have frequently cited concerns about confidentiality and their professional reputations. Nevertheless, all those who have followed my suggestion have found such groups to be quite valuable. It is very important in choosing a group to pick one where you feel you can identify with the other group members. Token contributions are requested of members. I often appeal to the ordinary human instinct (possibly genetically programmed) for finding a bargain, by pointing out to my patients that at 50 pence a meeting, recovery groups are the best deal in town.

Even if one is not an addict, these groups might still be helpful and, given the large number of groups available, it is usually not difficult to find one where you feel at home. One of my patients, a woman in her mid-sixties, has suffered from severe intermittent depressions for decades despite my best efforts at medicating her with multiple anti-depressants including St John’s Wort. She would qualify as an adult child of an alcoholic as her mother was drunk through much of her childhood and died of cirrhosis of the liver when the patient was a young girl. She was reluctant, however, to go to a recovery group, so I shared with her some of the slogans that members of recovery groups often repeat to themselves and to others by way of encouragement.

To my surprise, this extremely sophisticated woman, a veteran of many years of all sorts of psychotherapy, repeated the slogans to herself several times and wrote them down carefully every day. The slogans I shared were:

One day at a time.

Just get your body there; the rest will follow.

Fake it till you make it.

These are all useful slogans for the depressed person, who amplifies his or her troubles and projects them into the distant future. Take one day at a time, the slogan urges. If you consider all possible future problems at once they will seem overwhelming and you can drown in a sea of sorrows. In the case of an addict, this can drive a person to drink, drugs or acting out in some addictive way.

In a depressive person, it can drive one to despair. In contemplating some professional or social commitment, a depressed person frequently asks, ‘How can I possibly handle it?’ Just get there, urges the slogan. Often your automatic pilot will take over and see you through. In a song written to encourage those in despair, the singer Billy Joel counsels the listener not to forget his second wind but rather to wait for the momentum to kick in. My patient used this way of thinking to help her get to a wedding which she had no wish to attend. Once there, however, she surprised herself by having quite a good time and afterwards felt very pleased that she had been able to come through for her friends and family. The slogan ‘fake it till you make it’ suggests that if you pretend you are managing, you might be surprised to discover that you really are managing after all. Things may turn out this way for all sorts of reasons. First, the anticipation of the task or event may be worse than the thing itself. In certain types of depression it is impossible to anticipate pleasure, but once placed in a pleasurable situation you may actually be capable of enjoying it. Another reason why you might make it after you fake it is related to daily or circadian rhythms of mood, whereby it is common for a person’s depression to be at its worst in the morning and to improve as the day wears on.

Some people balk at recovery groups because many of the steps are geared round the concept of a Higher Power and, as such, may offend a person’s religious sentiments or lack thereof. Nevertheless, the whole matter is generally handled with a light touch and in a non-coercive way that many people find acceptable.

In summary, support groups offer invaluable information and encouragement around specific illnesses including depression, while recovery groups provide fellowship, wisdom and tangible assistance for people with all manner of sorrows and problems.

*71\75\2*

THE DIFFERENT TYPES OF EPILEPTIC SEIZURE: TYPICAL ABSENCES

(PETIT MAL SEIZURES)

Although a translation of petit mal is the ‘little illness’, petit mal does not mean the same as ‘minor epilepsy’ as there are all sorts of small attacks which are not attacks of petit mal. True petit mal seizures, or typical absences are, by definition, associated with a characteristic EEG discharge. Short-lived partial seizures arising from a focus of abnormal nerve cells in one temporal lobe of the brain may be somewhat similar on clinical grounds, but the distinction is worth making because of the difference in cause, treatment, and outcome between the two.

Absence epilepsy is virtually invariably a disorder of childhood. A typical attack is very brief, lasting only a few seconds. The onset and termination are abrupt. The child will suddenly cease what she is doing, stare, look a little pale, perhaps flutter her eyelids, and drop her head slightly forwards. Posture of the limbs and trunk is usually maintained so she does not fall. After the seizure, the child resumes what she has been doing. Because the interruption of the normal stream of consciousness is so brief, attacks may be unobserved by parents, and not remarked upon by the affected children. One of us has seen a typical attack in a supermarket. A girl aged about nine was helping her mother unload a wire basket at the checkout. She suddenly paused, with a pot of honey held in the air between basket and counter, fluttered her eyelids, and then continued transferring the purchase without further pause.

Whereas one would be unfortunate to have more then one grand mal seizure in a day, absence seizures may be very frequent—10 to 50 seizures a day being occasionally encountered. Fortunately most children have far fewer attacks.

Absence seizures are often associated with myoclonic jerks, which are particularly frequent soon after waking. These are brief shock-like contractions of the muscles, which are so

short-lived it is not really possible to tell whether consciousness is disturbed or not. We have heard this described by one family as ‘the flying saucer syndrome’ in reference to the broken crockery that may occur as a result of jerks at breakfast-time!

*10\188\2*

SYMPTOMS, HOME CARE AND TREATMENT OF CHILDREN’S HIVES

Signs and symptoms

Hives appear as itchy, red, raised welts that can range in size from 5 millimeters to several centimeters across. The most noticeable characteristic of hives is that they change appearance rapidly – they come and go and change in size from one hour to the next. No other type of rash has these same characteristics, so you can be pretty sure that any welts that itch and change appearance rapidly are hives.

Sometimes an insect bite looks like a hive at the point of a bite; however, it does not come and go as rapidly. Hives that are triggered by an allergic reaction to an insect bite appear at sites distant from the bite itself. Hives can also accompany allergic arthritis, which is signaled by stiff, swollen, red joints.

The form of hives known as erythema multiforme appears as welts that look like red targets of different sizes painted on the skin.

You can sometimes pinpoint the cause of your child’s hives by considering his or her activities in the minutes or hours before the hives appeared.

Home care

Unless the child has been given medication with instructions to take it when the hives recur, home treatment of hives should be confined to measures to relieve the itching. Cold water compresses, calamine lotion, and corn flour baths may help make the child more comfortable. Frequent or repeated cases of hives require medical attention. Also, if the child has been given medication but the medication fails to relieve the symptoms, you should call the doctor.

Precautions

• If hives appear on the tongue, make the child cough, or cause difficulty in breathing or swallowing, see your doctor immediately.

• If hives are accompanied by fever see your doctor to rule out a strep infection.

• If antihistamines don’t help relieve a case of hives, telephone your doctor for advice.

Medical treatment

When your child has hives the doctor may administer epinephrine to reduce the intensity of the outbreak and then prescribe antihistamines to be taken by mouth. If the hives recur and it’s not possible to pinpoint the cause, the doctor may order skin tests or refer the child to an allergy specialist. The doctor may also order a throat culture to check for strep infection. If the child shows symptoms of arthritis, tests are necessary to confirm or rule out that possibility. If the hives are caused by an allergy to the venom released in an insect bite, the doctor may suggest a long-term course of injections to decrease the child’s sensitivity to the venom; these shots may be given over a period of years. In the case of an allergy of this type, the child may also be given medication and instructed to take it if he or she gets bitten.

*117/84/5*

SELF-HELP PREVENTION: DENTURE PROBLEMS

What are they?

There are many problems connected with wearing dentures, many of which are related to the fact that they are not nearly as stable as natural teeth. Advertisements suggest that denture fixatives are the answer and they certainly do work, but even the best false teeth are clumsy and cannot match up to natural teeth. Surveys have found that between 15 and 45 per cent of denture wearers are unhappy with them, and that 20 million people wear dentures in the US alone. This amounts to a very large number of individuals worldwide. One study found that about 30 per cent of denture wearers thought they needed refitting, or that they needed new dentures.

What causes them?

Some problems with dentures are inevitable because they are not fixed structures like natural teeth. They are only as good as the bony ridge or foundation on which they sit. In a fair percentage of denture wearers the bony ridge shrinks away. As this happens the dentures fit less and less well. This bone loss can be prevented.

Prevention

• Take more calcium. One study of people with denture problems found that those with good underlying bone were consuming about 900 mg calcium a day and that those who had jawbone problems were getting only about 500 mg calcium. Another trial looked at dummy tablets versus vitamin D (which helps with calcium absorption and better bone formation) for jawbone loss. After a year those taking the supplemental calcium had lost 34 per cent less bone from their upper jaws and 39 per cent less from their lower jaws than had the un-supplemented group. This study also found that the ratio of calcium to phosphorus the person consumed was important too. As levels of phosphorus rose jawbone resorption speeded up. The ideal ratio of calcium to phosphorus is 1:1. In red meat, though, there is twenty times too much phosphorus and in refined cereal products six times too much. They found that meat, bread and potato eaters experienced more of this bone loss than did other people. Also, soft drinks contain lots of phosphorus. Even teenage girls have been found to have started losing bone abnormally as a result of their soft-drink intake. This study recommended taking Dolomite, a phosphorus-free calcium and magnesium supplement. It can be bought at health-food shops and chemists. All of this is interesting even to those of us who still have our teeth, because the breakdown of tooth support is seen in gum disease. A study of people with bleeding, inflamed gums found that taking l g of supplemental calcium for six months produced considerable improvement. X-rays of the jawbones showed that bone loss reversed in 70 per cent of the cases.

*134/72/5*

CONSTRUCTIVE CRITICISM OF ARTHRITIS TREATMENT

Trials and influential factors

In order to determine the safety and value of substances that are to be used to create a change in human or anima conditions, various trials are necessary. Even cosmetic preparations can come into this category because they can influence the physiology of the body by being absorbed through the skin and hair. Trials usually begin with animals and progress to studies using human patients, once safety and reasonable chances of efficacy have been established.

There is little to criticize in the actual trials themselves, provided that they are carried out with the true aim of the trial in mind. This means that these trials should not just be thought of as routine procedures: they must take account of any special application that the substance under trial may have. They must also take into account both the specific nature of the substance and the specific purpose for which it is being used. This all sounds so obvious, but unfortunately trials are not always carried out this way. This can, of course, mean that a potentially valuable substance can be missed or given a false evaluation because of incompetence in trial application.

The interpretation of results

Perhaps the main faults in trial work come in the interpretation of results. In most scientific trials or survey work, once the structure of the trial system has been suitably established, the trial procedures are fairly simple and can be conducted by non-specialist staff. Where expertise and specialist training come in is the interpretation of the results produced by the trial. Unfortunately, even in some of the highly-rated establishments, errors in judgment and mismanagement creep in.

It might be argued that this is, after all, the kind of human error that occurs in all spheres of life. Agreed; but in these cases such errors can result in something of great value in the treatment of disease being incorrectly assessed and perhaps lost, to the detriment of thousands of afflicted people. There are also problems of corruption and bias, particularly when governmental and commercial interests are involved. Having pointed out, perhaps rather dramatically, the way in which trial results are so dependent on the character and ability of those who organize and interpret them, it might be as well to suggest a possible remedy for this disorder in the testing system.

Basically, there is no guaranteed remedy because there will always be corruption. If we ignore this aspect and concentrate on the more practical one of ability, then there are possibilities. Normally, the rating of a person or an establishment is based on ability, though not always. It is suggested that future assessment of potential, new, therapeutic substances will need to be done by assessors who have ability as well as knowledge. This means that they are able to apply their knowledge beyond the narrow confines of books of regulations. This will be a necessity in the future as we progress into the greater utilization of the earth’s resources for survival. This sort of comment is not so dramatic as it may sound. Just think for a moment of the world-wide change in energy and fuel policy over the last few years! The same may happen in medicine and nutrition, though perhaps to a lesser degree.

*23/48/5*

BREAST LUMPS: COMMON COMPLICATIONS AFTER OPERATION, RECURRENCE

Complications of general anesthesia

As has already been mentioned, there is always a small risk associated with the use of a general anesthetic. However, you are far more likely to be run over while crossing the road than you are to suffer any serious complication caused by a general anesthetic.

Very rarely, the supply of oxygen to the brain can be interrupted during anesthesia, and brain damage, possibly with paralysis, or death can occur. Although this risk has to be borne in mind, it should be kept in perspective.

Other minor complications are a sore throat, coughs and chest infections. Muscle pain which may develop as a result of the muscle relaxants used usually lasts for no more than 48 hours.

If a complication arises

If you are at all concerned about anything that occurs after your operation, contact your doctor, the consultant or the hospital ward for advice. Although serious complications are not common, it is better to err on the safe side, and most doctors will be happy to discuss your worries with you.

Recurrence

One of the worst complications to follow surgery for cancer is to have a recurrence of the disease. The risk of cancer recurring in the scar of the operation or in the lymphatic in the armpit should be less than 5 per cent. The surgeon will take all possible steps to be sure that local control of the cancer is achieved. Recurrence outside the area of the breast and its immediate lymphatic drainage is less easy to predict and to treat.

*49/39/5*

HORMONAL TREATMENTS OF ENDOMETRIOSIS: DANAZOL

 

The hormonal treatments currently available in Australia for the treatment of endometriosis are Danazol, Duphaston, Provera, Depo-Provera, Primolut N and the oral contraceptive pill.

GnRH agonists and Gestrinone are two newly developed forms of hormonal treatment used in some overseas countries which are currently only available in Australia on a trial basis.

Danazol is the drug which is most commonly used for the treatment of endometriosis. First developed in the early 1960s, it has been used for the treatment of endometriosis in Australia since the late 1970s; it is also used for the treatment of menorrhagia (heavy bleeding).

Danazol is a weakened form of the male hormone testosterone. Testosterone is one of a group of male hormones known as androgens which are produced by the male testes. They are responsible for the functioning of the male reproductive system and the development of the male characteristics such as facial hair and a deep voice. Women also produce very small amounts of androgens in their ovaries.

Danazol is distributed by Winthrop in the form of 100 and 200 milligram white gelatin capsules. In Australia, Danazol is also known by its trade name of Danocrine. In die United States, the United Kingdom and Canada it is marketed under the trade names of Danocrine, Danol and Cyclomen respectively.

In Australia, Danazol can only be supplied under the Pharmaceutical Benefits Scheme for the treatment of endometriosis if your endometriosis has been definitely diagnosed during a laparoscopy or a laparotomy and if your doctor fills in a special prescription form known as an ‘Authority’. If this is done a script of Danazol will only cost you the maximum cost of a prescription under the Pharmaceutical Benefits Scheme as opposed to its full cost.

*33/41/5*

WEIGHT LOSS: THE GOALS OF TREATMENT FOR BULIMIA NERVOSA

Treatment of bulimia has a different focus. For one thing, anorexics need to do more of something – eating – while bulimics need to do less of something – bingeing and purging.

Rodney Dangerfield, the comedian, tells about the time he went to his doctor with a sore shoulder. Raising his arm, he said, «It hurts when I go like that.» The doctor replied, «Don’t go like that.»

Unfortunately, breaking the binge-purge cycle is rarely that easy. Instead of just telling the patient, «Don’t go like that,» one must reduce the forces behind the urge to binge and purge. These forces include the physical effects that are caused by an irregular pattern of eating or trying to maintain a weight that is too low.

Another goal of treatment is to change the patient’s characteristic cognitive distortions and disturbed emotional responses. For example, learning how to be more assertive can be a key element in recovery. A binge is frequently triggered by anger that the patient feels powerless to express. One woman told me her boss demanded that she work on a Saturday when she had made other plans. She suppressed her fury, telling herself that «I’m lucky to have this job, no one else would hire such a worthless person.» She worked that Saturday, then went home and pigged out for two hours. After assertiveness training, such patients find it easier to «just say no» without feeling guilt or self-hatred.

Finally, improving family relationships can be very helpful, especially for patients living at home. But because bulimic families can vary widely in their dynamics, therapy must address the particular family pattern involved.

*57/35/5*

WIN THE FAT WAR: HER «SMALL» SURPRISE WAS TOPS

In 1997, when David Zimmerman arrived home after a year of active duty overseas in the U.S. Marine Corps, he got the surprise of his life. His wife, Hope, was there to greet him—121 pounds lighter.

He didn’t recognize her. He’d never seen her so svelte.

«It was a big motivator for me, to try to shock him,» Hope says. And shock him she did. «He didn’t know who I was at first,» recalls the 31-year-old Leavittsburg, Ohio, resident. «After he hugged me, he stepped back to look at me and said, ‘Oh my gosh, how did you get smaller than me?’ That whole day, he kept touching me now and then, saying, ‘I just don’t understand where it all went!’

Hope had set out on her secret weight-loss mission after watching her obese grandmother struggle after breaking a rib. «She was so overweight that it took two people to move her out of bed,»

Hope recalls. «And she was so independent. I could see what it was § doing to her pride. I didn’t want that to be me one day.» So at 6 feet and 306 pounds, and with her husband far away, © s Hope joined TOPS—Take Off Pounds Sensibly Through the program’s sound diet-and-exercise program, she whittled her way to 185 pounds in just over 11 months.

Months later, still jazzed by her weight-loss success, Hope bought herself a sexy velvet dress. Her husband was on the phone with a relative when she walked downstairs to model it. He paused to lavish her with compliments, then described to the caller how fabulous his wife looked. «The reply was, ‘She’s not as thin as your brother’s girlfriend,’ Hope recalls. «I was devastated.»

Hurt and angry, she headed to the kitchen for some solace. But she stopped in her tracks, then went outside for a walk instead. Thirty minutes later, she returned home, calm and enlightened. «I let go of those hurtful words by focusing on the kindness that I received from others who supported me,» she says.

Eventually, Hope began strength training to shape and tone her body. Now a Zena-esque size 10 and 195 pounds, she no longer turns to food to heal those emotional blows. If she feels down, she bypasses the kitchen and heads out for a walk.

WINNING ACTION

Realize that you have weight-loss friends and foes.

When hurtful words hit you, consider the source. Understand that there will always be negative people in your life, but don’t accept their perception of you. Remember the title of the book written by Saturday Night Live character Stuart Smalley: I’m Good Enough, I’m Smart Enough, and Doggone It, People Like Me!

*111\89\8*

WHAT VITAMINS CAN DO FOR YOU? VITAMIN A AND VITAMIN B1 (THIAMINE)

VITAMIN A

Functions: the single most important vitamin with respect to the immune system • necessary for night vision and protein synthesis • promotes fertility • stimulates bone growth • assists in growth and repair of body cells • essential for healthy skin and respiratory tract, as well as the linings of esophagus, stomach, intestine, colon, rectum, gall bladder, kidneys and urinary tract • prompts secretion of digestive «juices» • necessary for growth in the young.

Deficiency signs and symptoms: increased susceptibility to infection • night blindness and other eye problems • dryness, thickness and eruptions of the skin • dry, brittle nails • softness of bones and teeth.

Vitamin A’s enemies: mineral oil • alcohol • light • high temperature • air.

VITAMIN B1 (thiamine)

Functions: vital for a healthy immune system • necessary for the conversion of carbohydrates into energy in the nervous system and in muscles.

Deficiency signs and symptoms: mental problems such as loss of mental alertness, irritability, memory loss, confusion and depression • fatigue • loss of appetite • heart irregularities • numbness, tingling and weakness in the extremities and other parts of body (polyneuritis) • constipation • tenderness in the calves • burning sensations in the feet • the classic Bj deficiency disease is beriberi • extreme deficiency leads to heart failure, degeneration of nerve endings, and death. Vitamin B{s enemies: heat • air • excessive cooking of food • caffeine • alcohol • excessive dietary sugar.

*159\80\8*

TESTING FOR RELAXATION: TOTAL = TRUNK

Fill your lungs with as much air as you can. Holding the air in your lungs, bear down as if you were going to have a bowel movement. While holding the air and bearing down, place your fists up by your chin. Squeeze your arms tightly against your chest. Feel the tension in your chest muscles as you slowly count: one thousand . .. two thousand .. . three thousand … four thousand … five thousand … six thousand … seven thousand . . . eight thousand . . . nine thousand . . . ten thousand.

Slowly relax, letting the air out of your lungs.

Now, take in a deep breath through your nose. Hold it for a moment. Let it slowly out through your mouth, very slowly, taking at least five seconds to let it all out.

Take another breath … hold it … let it out slowly.

Fill your lungs once again, bear down, hold your fists by your chin and squeeze your arms against your chest. Hold that position, chest muscles clenched tightly, as you count slowly: one thousand … two thousand … three thousand … four thousand … five thousand … six thousand … seven thousand . . . eight thousand . . . nine thousand . . . ten thousand.

Slowly relax and exhale.

Take in a deep breath through your nose … a nice, deep breath.

Hold the breath for a moment. Now let it out slowly, very slowly, through your mouth, taking at least five seconds to empty your lungs. ^

Take another big breath, filling up your lungs.

Hold it for a moment. Now let it out very slowly.

Your trunk now feels relaxed.

*117\80\8*

FOOD FOR IMMUNE: SUPER RECIPES WITH FISH

FLIPPER’S CHOICE

1 lb. low-fat fish fillets pepper garlic powder basil oregano onion powder

1 sweet red pepper

1 can tomato sauce (no salt added)

Wash and dry fish fillets, cut into 2-inch strips. Place in baking dish; sprinkle on all the spices. Wash and slice red pepper, and place slices on top of fish. Pour tomato sauce over fish. Bake 10 minutes at 375° without turning.

Serves 2.

MILK FISH

4 6-oz. snapper or perch fillets 1/2 cup nonfat milk tarragon dillweed onion powder paprika

Preheat broiler. Dip fillets in milk, place in shallow baking dish and sprinkle with tarragon, dillweed, onion powder and paprika to taste. Broil about 3 inches from the heat source for 3 to 4 minutes, basting once with drippings. Turn, baste and sprinkle with additional herbs if desired. Broil 3 to 4 minutes longer.

Serves 4.

PASSYUNK FISH

2 onions

2 lemons

3 garlic cloves, minced 1 cup celery

1 small eggplant 1 large tomato 1 small can tomato paste, with water to make 11/2 cups 1/2 tsp. cumin 1 1/2 lbs. low-fat fish

Preheat oven to 350°. Wash vegetables. Thinly slice onion and lemon, chop garlic buds and celery, dice eggplant and slice tomato. Use a heavy pan to saute onions and garlic in water. Add celery and eggplant, tomato paste, water and spices. Cook about 10 minutes. Spread half the resulting sauce in a baking dish, put in fish; top off with remaining sauce, lemon and tomato slices. Cover dish and bake about 20 minutes. Uncover; cook 5 minutes more. Serve with brown rice.

Serves 2 to 3.

*74\80\8*

SUPER FOODS FOR IMMUNE: «GOOD” AND “BAD» ITEMS

Cholesterol: Leave It to Nature

Cholesterol is a «good/bad» item: good because it’s essential for life, bad because it’s associated with clogged arteries and heart disease.

Here’s the general rule I explain to my patients: Your body is very good at making all the cholesterol it needs. You don’t have to help it out by eating a lot more. In fact, you really don’t have to eat any cholesterol at all.

But eat it we do, in large amounts. Working hand in hand with fat, cholesterol plugs up arteries, especially the tiny arteries that supply the heart muscle and brain. When those arteries close up, some or all of your heart or brain will die.

The Pick-Me-Up That Lets You Down

Caffeine is another food item you can do without. Many studies have linked caffeine to irregular heart rhythms, increased blood pressure, heart disease, anxiety, the heartburn of gastritis and esophogitis, peptic ulcers, digestive problems and cancer. Ironically, the caffeine we drink to give us a lift eventually does the opposite. Caffeine gets your heart beating faster and increases your blood sugar. That’s what gives you the lift. Your body then reacts to the sudden energy surge by gathering up all the blood sugar it can and stuffing it into your cells. Too much sugar, however, is often gathered up. Now your blood sugar is low; you feel fatigued and want another cup of coffee. For many of my patients, every day is a cruel cycle of fatigue, coffee, brief lift, fatigue, coffee, brief lift, fatigue.

That’s why I call caffeine the pick-me-up that really lets us down, overstimulating our heart and muscles at the same time. It just makes trouble for our «doctor within.»

*30\80\8*

DUBIOUS TESTS FOR FOOD ALLERGY AND INTOLERANCE

An elimination diet is not an easy method of diagnosis, and unless the patient fully understands the procedure it may not work at all. Doctors have been searching for a simpler method of diagnosing food intolerance for many years, but so far without success.

As alternative practitioners have moved into this field, they have found the elimination diet too difficult and time-consuming, and have sought easier diagnostic tests. Some, such as the pulse test and the cytotoxic test, are based on methods that were originally devised by conventional doctors but found to be too inaccurate. Others are frankly unscientific. All have helped their practitioners to earn a very comfortable living, without necessarily doing the patients a great deal of good. We will only consider the most common tests.

*118\180\8*

TELEVISION AND HEALTH – SHORTER WORKING HOURS – NO SOLUTION (PART 2)

Nothing exciting happened to disturb the peace and pleasure hours of leisure. No noise and no radio programmes subjected the body to further tension and no television shows demanded the undivided attention of the viewer. In the place of these canned programmes there was often heard rising from the valley a beautiful song that refreshed the singer and the listeners alike. These aspects of life led to wholesome relaxation which we search for today but seldom find in spite of all the money spent. Often, sound sleep escapes those who did not retire early enough, not wanting to miss out on some nocturnal pleasure. For them the hours of the night become more arduous than even their work during the day, but sleep is an indispensable and natural requirement.

While some people are never able to relax, there are others who cannot do enough to make money. Some workers, for example in the catering industry, do not enjoy their days off as a time of rest and relaxation, but to make more money they accept casual work as well. Such demands on the body may be possible for a little while but they will sap the person’s energy reserves in the long run. We must recognise that the rhythm of life consists of periods of tension and relaxation, the latter being necessary to recharge life’s batteries. Another modern tendency is to seek the necessary relaxation in sport, but unfortunately this often degenerates into competition and the body is overtaxed once again.

*1194/28/1*

MISCELLANEOUS TOPICS – AN EXAMPLE OF POISONING THROUGH CHEMICAL SPRAYS (POISON CLOUD)

Sure enough, what she remembered confirmed my suspicions because she told me that her husband had been spraying the trees round about that time; in fact, the girl had walked straight into the poison cloud. From that moment onward, her mother said, the trouble started. I was in no doubt at all that the circumstances and symptoms proved what the cause really was.

Now all I wanted to know was whether the doctors had been told of the incident, and she said that they had. Yet only one doctor at the hospital considered pesticide poisoning to be the cause of the girl’s condition, whereas his colleagues flatly rejected this opinion. It was perfectly clear to me, however, why penicillin could not even relieve the symptoms, because it would have given at least temporary improvement if bacteria, instead of chemical poisons, had been the cause of the illness. Having made the correct diagnosis, I had no problem in choosing the appropriate treatment and remedies, and I suspect, no, I am convinced, that the natural treatment and necessary natural remedies helped the little girl to recover.

*1125/28/1*

OILS AND FATS – REFINING AND SOLIDIFYING

Oils and fats have not escaped being tampered with either. By being refined and solidified, and by having emulsifiers added, they have received a bad name, and rightly so. Not only polyunsaturated fatty acids, but the whole structure of natural products with all their known and still undiscovered qualities, has been thrown off balance. Every oil or fat, left as nature made it, would provide us with what we need to meet our nutritional requirements. It is only when we interfere by introducing chemical and technical methods in the manufacturing process that damage is done and loss of value ensues. More often than not these interferences cause health problems. Of course, oils have been refined, and their taste improved, for many years, but simpler methods were used in the past. Oil was refined by means of wood ashes, because their alkaline substances removed some of the excess acid in the oil, thereby improving its taste. A further advantage of the old methods was that large quantities of oil were not stored, but a fresh supply was pressed from time to time. Oil-bearing fruits keep longer than the oil once extracted.

It is especially harmful when fats are hardened by electrolysis, as metal salts are used in the process. Although this method destroys much of the goodness in the natural product, this is not the only bad result. The traces of metal salts remaining in the oil can cause further damage to health by acting like poisons in homoeopathic potencies. Scientific research, as well as information disseminated by groups promoting a more natural way of life, have accomplished a great deal of good by encouraging greater awareness of these problems in recent years.

*1055/28/1*

RAW JUICES, MEDICINAL JUICES – WHICH JUICES ARE COMPATIBLE?

Some people assume that it is permissible to combine fruit and vegetable juices, such as orange with carrot juice. This, of course, is no better than eating fruit and vegetables at the same time, which, as already discussed, is apt to cause fermentation and flatulence, especially in sensitive people. Generally speaking, one juice can be mixed with another of the same kind, so that the best way is to take, for example, carrot and beetroot juices at one time, and orange and another fruit juice some other time. This way your digestion will not suffer. As a rule, it is better to drink only one juice, not a mixture. What is more, sipping is much better than gulping it down, because little sips, properly insalivated, will avoid flatulence or any other digestive disturbance. The curative effect will be greater too. Insalivating well helps to warm ice-cold juice in the mouth and so avoid chilling the stomach. A bite of crispbread or rusk with each sip of fruit juice will help to neutralise the acidity somewhat and protect the stomach lining.

*985/28/1*

QUESTIONS OF NUTRITION – VEGETABLES AND HERBS (INTRODUCTION)

If you want healthy vegetables they must be grown organically. They depend upon the soil in which they are grown and for the soil to be healthy it must be worked and looked after properly. If you live in the country, take advantage of the various edible plants growing wild in the woods and fields. You will find wild spinach and many other wild vegetables, all tasty and nutritious. Do not neglect to gather and eat them. Bear’s garlic (ramsons), for example, is a prized vegetable, one of the best blood-purifying plants there is, and it should be gathered and eaten in the spring. It regenerates the blood vessels, and lowers and normalises blood pressure. The blood pressure problems that often accompany old age, brought on by the loss of elasticity of the arteries, can be effectively counteracted with brown rice, bear’s garlic and mistletoe tea, if taken on a regular basis. Young nettles, finely chopped and mixed in with salads or steamed like spinach, are also very good for the blood.

*915/28/1*

CONTRACEPTION AFTER CHILDBIRTH – CONCLUSION

After childbirth a contraceptive choice must be made as few women will want to risk another pregnancy immediately. As always, that choice will rest on the balance between what is medically appropriate and the emotional factors involved.

The experience of childbirth exerts profound changes, both physically and mentally. The doctor providing contraceptive care is in a unique position to observe these changes, which in most cases will be part of a healthy maturational process but which may have an important effect on the choice of contraceptive method and its efficient use.

*187/197/1*

THE STEREOTYPES – ‘MEN NEED TO BE IN CONTROL’ (WITHDRAWAL)

Can withdrawal be considered the ultimate test of control for the man? It involves fully potent sex up to a point that only he can recognize. Most men have tried it at some time, and talked excitedly about the experience until it came to describing the difficult bit. In addition to recognizing the importance of his own control, several said it was impossible if, at the last moment, the woman grabbed hold with her arms or legs and held him in. These men were describing risky sex, and the group must contain a number whose enjoyment is particularly connected with the risk of conception.

*150/197/1*