Статьи Апрель, 2009
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MOTION SICKNESS
Car, plane and sea sickness result from the overstimulation of the canals of the inner ear which regulate the body’s system of balance. Waves of nausea are the principal symptom, usually resulting in vomiting. These are sometimes accompanied by cold sweats and giddiness. People vary in their susceptibility and, with regular travel, can learn to overcome the problem in most cases. Children, for example, are more prone to car sickness than adults. Motion sickness is much more likely to occur in an enclosed space with insufficient ventilation, such as in a cabin of a ship. At sea, get up on deck when possible; in a car or bus, open the windows; and when travelling by plane, keep the ventilator on full.
Avoid alcohol, rich, aromatic food and excessive tobacco and do not attempt to read until your body has adapted to the motion. Do not try to focus your eyes on objects moving around you.
To prevent and treat motion sickness, administer strong ginger tea before travelling and carry a supply for the journey. This simple anti-nausea medicine is highly effective and can safely be given to young children.
Some motion sickness has emotional causes such as fear of flying. In this case, counselling may help.
*11\69\2*
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ANXIETY IN THE MIND: PHOBIAS AND PHOBIC TENSION
In a phobia anxiety is manifested in a different way. The patient remains reasonably at ease until confronted with the phobic situation. He then experiences discomfort which may vary from mild apprehension to uncontrollable panic. The patient develops a fear of the particular situation which causes him his distress, and for this reason the condition is known as a phobia. Common phobias are heights, being away from home, being in crowds, or being in enclosed spaces such as lifts, toilets, or railway coaches. Knives, swords, and firearms often become the objects of phobias. In a similar way people may develop an irrational fear of certain animals such as mice, cats, moths, or snakes. The sufferer is always aware that his phobia is irrational. He knows quite well that there is nothing to be afraid of in going across the street, but this does nothing at all to relieve his sense of panic as he goes out the door. More and more he tends to stay indoors so that he soon becomes housebound, not venturing forth from one month to the next.
*14\57\2*
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RELAXING YOUR FEET AND LEGS
To tense your feet, you can either turn your toes downwards, as though you are trying to point them into the bed, or stretch them upwards and backwards as though you are trying to point them at your head. I prefer the second method, pointing upwards, because the first tends to give people cramp in the calves of their legs. But once again, find which suits you best. When your toes are pointed, you will feel a stretching sensation along the soles of your feet and you will ache round your heels and up the back of your legs, along your calves almost to your knees. Deep breath, blow out your three candles and let your feet drop back into an easy position.
Now tense your knees by pushing the back of your kneecap down towards the bed, or the bolster. Breathe in, blow and release the tension. If you are doing well your feet will already be feeling heavy and you will not want to move them. And by now your hands and arms will be so heavy they’ll hardly seem to belong to you.
Inner thighs next. It helps to imagine that somebody has placed a penny between your legs, above your knees, and has told you to keep it in position by pressing your thighs together. You’ll feel tightness and tension at the tops of your legs and in the lower part of your abdomen as you do this. Once again breathe in, blow out your breath and let the penny fall. Don’t be a bit surprised if your legs fall open of their own accord as you relax, so that your toes point east and west. If your legs and thighs are really relaxed that’s exactly what should happen, which is why it’s sensible to wear jeans or trousers if you’re learning relaxation in a group. You need privacy and time if you’re to get this bit right, because whether you’re aware of it or not, you’ve probably been taught from a very early age not to lie or sit in that particular position, which in many cultures, including our own, is taboo.
*9\177\2*
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ALLERGIES: CHEMICAL SUSCEPTIBILITY
Nora Barnes came to me as a patient in 1947. Mrs. Barnes had been repeatedly diagnosed as a hypochondriac. No physician had been able to find the cause of her multiple symptoms and complaints.
In childhood she had been the victim of widespread allergies and had frequent problems with runny nose, cold sores, and outbreaks of hives. These went away as she grew to adulthood but were soon replaced by fierce headaches— blinding pain which sent her running to her bed. She suffered from persistent fatigue, irritability, nervousness, and tension. She also had a cough, which eventually turned into bronchial asthma.
At one time she had been employed as a cosmetics saleswoman. She noticed after a while that when she applied nail polish, her eyes would itch furiously. She soon had bags under her eyes, and the skin around them became red and inflamed. She applied make-up to hide this problem.
By the time she came to see me, she was in a wretched condition. She had had to drive through the industrial belt of northern Indiana to reach my office, and as she approached the city limits of Chicago, she felt sicker than ever. In the city, she practically caused an accident when she swung out of traffic to escape from the exhaust fumes of a bus.
Arriving at a hotel in Chicago’s downtown Loop district, she was practically incoherent when she called me on the telephone. By chance, the desk clerk gave her a room on the twenty-third floor. Soon she felt somewhat better and attempted to go downstairs and do some shopping. But she found that when she went into the lobby or onto any floor below the twentieth, her nausea, dizziness, and feelings of suffocation returned.
She had had three experiences in which she had collapsed in a «drunken» stupor while driving her car. Only the fact that someone was in the passenger seat beside her prevented a serious accident. She often became ill while riding in the back seats of cars, but rarely in the front. Some cars, especially those with noisy mufflers, seemed worse than others.
All of this was confusing, but the single most intriguing fact in her case was that her symptoms became progressively worse after July Fourth and did not get any better until after Christmas. Between New Year’s and Independence Day, she remained tolerably well, only to get miserably sick and «neurotic» again after the Fourth of July.
One possible explanation of this could be hay fever, but there were no pollens in her state which were troublesome during that particular period. In the course of our conversation, however, Nora mentioned that she always went to a cabin in the woods for the summer—on July Fourth. Something in that cabin, I felt, might be responsible for these various symptoms. By testing samples from her home, it turned out the main culprit was the pine paneling of the cabin. Pine was also burned in the fireplace, and various pine scented materials were used in the house, including disinfectants. When all pine products were removed from the cabin her symptoms improved.
Some time later, however, she and her husband went to a hunting lodge which had been heated by a fuel-oil stove. She began to cough and wheeze within a few minutes after entering the building, and became unconscious.
She reported that the odor of her gas kitchen range made her feel sick, as did those of her gas-burning home utilities, sponge rubber padding, plastic upholstered furniture, rubber mattress and pillow, and beds whose mattresses were encased in plastic coverings. She was able to effect real improvement by simply removing all these items from her home and replacing them with less offensive substitutes. Her Christmas-time malaise was traced to the pine Christmas tree.
The overall picture of Nora Barnes’ illness did not strike home until one blustery day, when a fierce storm threatened the Chicago area. All other patients had cancelled their appointments, but Mrs. Barnes came in, and together we reviewed over fifty typewritten pages of her record. Finally, a pattern emerged. Almost all her problems could be traced back to petrochemicals, combustion products, or man-made chemicals manufactured from petroleum. Nora Barnes was allergic or susceptible to a wide range of supposedly safe environmental agents. Her susceptibility to pine and pine products fit into this picture, too, since our current supply of hydrocarbon fuels is believed to be derived, ultimately, from a huge prehistoric pine forest, crushed beneath the earth.
This theory led to new revelations in Mrs. Barnes’ case. By eliminating all plastics and chemicals from her life, she discovered that she could dramatically improve her health. Food stored in glass, for instance, could be eaten, but the same food stored in plastic containers made her sick.
A drink of creme de menthe invariably made her sick—in fact, she passed out on several occasions when trying to drink it. She now found out why: she was incredibly sensitive to all artificial food colorings and so she avoided not only this green liqueur, but also maraschino cherries, mint sauce, frankfurters, and similar products (see list, Chapter 4).
She noticed that canned tomatoes made her sick, but that she was able to eat tomatoes from her own garden. The problem was traced to the lining of the tin cans in which the commercial food was packed. Also, foods sprayed with insecticide would bring on headaches, whereas unsprayed food would not. She found that she could eat beef raised on a neighbor’s farm but not commercially raised beef, which had been fed pesticide-treated feeds and sprayed for fly control.
The case of Nora Barnes provided a new perspective on medical practice. It soon became apparent that she was not alone, that many of the patients seen by physicians with similarly peculiar and multiple symptoms were actually suffering from allergies to synthetic chemicals. These people were not born this way. They acquired a high susceptibility because of constant, day-in and day-out exposure to chemicals, especially in the period since World War Two.
Almost inevitably, their susceptibility to chemicals intermingled with food allergies, to form an overall picture of environmental illness. These patients were reacting to foreign substances which are known to be toxic (poisonous). But it had always been assumed that reactions of toxicity occurred at much higher levels of exposure. These «chemical patients» reacted to minute amounts of contamination, which doctors until then had not considered problematic.
The full clinical implications of the chemical susceptibility problem developed over a number of years. As this environmentally oriented medical problem emerged, each new patient revealed some aspect or feature of this condition not previously appreciated. Full realization of the two most important sources of chemical pollution of the environment, namely, the contribution of gas utilities to indoor air pollution and the crucial roles of pesticide exposures in both indoor and outdoor (ambient) air pollution, did not become clear until Ellen Sanders came to me as a patient in early 1953.
*10\110\2*
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CHILDREN’S HEALTH: COMMON COLD
A cold is an infection of the upper respiratory tract that is caused by a virus. The infection causes discomfort of the throat, nose, and sinuses. A cold sometimes also affects the eyes (connected to the nose by the tear ducts); the ears (connected to the nose by the Eustachian tubes); and the lymph nodes of the neck (connected to the nose by lymph channels). A cold is transmitted from person to person through the air or by droplets on the hands or on objects (toys, drinking glasses, handkerchiefs). Symptoms may develop within two to seven days after being exposed to a cold virus. People of all ages are subject to catching colds, but younger children and infants are particularly at risk from colds.
Many fruitless years were spent trying to develop a vaccine against the cold germ. Then it was discovered that there is not just one cold germ. Colds are actually caused by many different viruses, and all respiratory viruses can cause common colds. An attack by any of the more than 185 viruses makes a person immune to only that virus and none of the others. Often this immunity lasts only for a short time.
Many cold viruses can cause complications such as croup, laryngitis, bronchitis, viral pneumonia, and encephalitis. All cold viruses can make a child more susceptible to additional bacterial infections – ear infections, sinus infections, lymph infections, or bacterial pneumonia. No child’s cold should be taken lightly.
Signs and symptoms
The symptoms of a cold are nasal congestion, sneezing, clear nasal discharge, scratchy sore throat, and fever up to 39.4°C. In general, the younger the child, the higher the fever. Symptoms may also include reddened, watery eyes; dry cough; mild swelling and tenderness of the lymph nodes in the neck; and mild pain in the ears.
It is often difficult to tell a cold from other illnesses that have similar symptoms. Usually it is assumed to be a cold if the familiar cold symptoms occur but symptoms of other illnesses do not. Another clue is that a cold lasts only three to ten days.
Home care
Increase room humidity with a vaporizer or humidifier. Have your child drink a lot of liquids. Isolate the child from others, particularly from infants and the elderly. Bed rest is not required, but the child should avoid strenuous physical activities while fever is present. Give aspirin or paracetamol for fever or pain. Use nose drops or oral decongestants and a nasal aspirator to relieve nasal stuffiness and discharge. Use cough medicines for easing a severe cough. Remember, however, that overuse of any of these medications can cause more harm than good. Chest rubs and vitamin Ñ treatments have not proven to be helpful. Your child should eat only what he or she is able to eat.
Precautions
• The following symptoms do not usually occur with a common cold and may be signs of another illness: fever lasting more than two to three days; pus-like discharge from the eyes, nose, or ears; large, red, tender neck glands; breathing difficulties; chest pain; severe headache; stiff neck; vomiting; shaking chills; prostration (collapse). If any of these symptoms occur, call your doctor.
• Some viruses that cause common colds stay in the body for one to two weeks, so the child remains contagious for the entire time of the cold.
• Infants should not be exposed to anyone with a cold, even a mild cold. Infants are not protected against the common cold by the mother’s antibodies; young infants can become seriously ill from these viruses.
Medical treatment
Your doctor will perform a physical examination to check for signs of other illnesses and for signs of complications. The doctor sometimes will order a blood count and throat culture. Otherwise, the doctor’s treatment is the same as home care.
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PREVENTIVE MEASURES AGAINST PROSTATE PROBLEMS
• Magnesium deficiency has been studied in France in this connection-as long ago as 1930 a French specialist found that it was a valuable food supplement in men with prostatic problems. In one study twelve men with prostatic problems were given magnesium tablets. Ten of them were cured. Another French doctor found that magnesium reduced the swelling of benign enlarged prostates. Often, the reduction in size was small but the improvement in the man great. The specialist concluded that magnesium contributed to the battle against senility. Food sources of magnesium are Dolomite tablets, wheat-germ, honey, nuts, brown rice, seeds of various kinds and kohlrabi.
• Zinc is now the most researched of all the trace elements, with more than a thousand learned papers a year appearing on the subject in the western world alone. Zinc is especially plentiful in the prostate gland for reasons that are as yet unknown. There is a well-established link between a lack of zinc and prostate problems. A prostate gland that is abnormal due to infection contains less zinc than a healthy one. In benign enlargement zinc levels are the same as normal but in cancer of the gland zinc levels are low. Semen too is very rich in zinc but it is still not known why all this zinc is necessary in the male reproductive tract. Zinc appears to be related to spermatic physiology so perhaps prostatic fluid (which contributes substantially to the amount of fluid a man ejaculates) is rich in zinc to sustain sperms and to help them mature.
In a Canadian study, a 35 per cent fall in prostatic zinc levels resulted in mild enlargement of the gland. When the drop in zinc approached 40 per cent the men suffered from chronic infection of the gland. When it dropped by 66 per cent the men developed cancer. Foods rich in zinc are seafood, brewer’s yeast, onions, bran, eggs, nuts, rabbit, peas, beans, lentils, wheat-germ, gelatin and beef liver.
• Coffee and sugar have provable effects on the prostate gland. Every year thousands of men in the UK and US die from prostatic cancer or from the more severe effects of benign enlargement. In Japan cancer of the prostate is almost unknown and even benign enlargement is uncommon. Japanese researchers examined the differences between the diet of men with prostatic troubles in Japan and in the West. There were, of course, many differences but the most compelling was that the Japanese male drinks almost no coffee. The Japanese researchers then went to World Health Organization statistics and found that in Sweden, where the death rate for prostatic cancer is the highest in the world, coffee consumption is also the highest in the world (8 kg per person per year). They then went through a list of twenty countries and found that for nearly all of them the correlation applied.
They next checked for research into cancer-causing agents in coffee. A US study had indeed found that benzo-pyrene and other cancer-producing hydrocarbons are present in lightly roasted coffees such as are drunk in the US and Europe. Very long roasting does not produce a coffee rich in these substances-such coffee is drunk in Italy where cancer of the prostate is half that of Sweden. So could it be that over thirty years of coffee drinking these tiny amounts of carcinogens can produce prostatic cancer? Sugar consumption is also statistically linked to prostatic cancer and whilst no correlation can be found between coffee consumption and other types of cancer in the body, this is not so with sugar. There is a higher incidence of cancer of the breast, ovary, intestine and rectum the more sugar a person consumes. This raises the question as to whether it could be the sugar in the coffee that could be causing the prostatic cancer and not the coffee itself. More research is needed.
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BREATHWORK FOR YOUR HEALTH: CATCH YOUR BREATH
We take about 20,000 breaths each day. For a healthy man that should translate into 12 to 14 breaths per minute, says breath researcher and psychologist Dr. Gay Hendricks. Catch yourself breathing normally and calculate your per-minute rate. If it is higher than that, your health is in jeopardy and you should make deep, comfortable, slower breathing a priority, Dr. Hendricks says.
Much of the «breathwork» taught by experts today is drawn from ancient Oriental spiritual teachings. Many of the health claims for ancient Taoist, Hindu, and Yogic breathing exercises have been substantiated in the laboratory. One such exercise, alternate nostril breathing, is a proven tension-tamer and mental energizer, Dr. Hendricks says. Here’s how he teaches it.
Close off one nostril with the index finger of your dominant hand and breathe out and then in through the open nostril, slowly, gently, fully. Then close off the other nostril, still using your dominant index finger, and breathe out and then in through the open nostril. Keep your belly muscles relaxed and breathe comfortably, slowly in and out of your abdomen. Put your attention on the sensations of the breath leaving your nose and the breath returning. Alternate like this for two minutes, and then switch to the index finger of your non-dominant hand and continue for two minutes. Switch back to your dominant hand for one more minute, and then rest for a minute with your hands in your lap. Just don’t try it while you have a runny nose.
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LEARNING MORE ABOUT BREAST CANCER
How breast cancer spreads
Cells from the primary tumour can spread to other parts of the body to produce secondary tumours. This spread is known as metastasis and can occur via the blood or lymph vessels. The secondary tumours are called metastases. Spread may also be local, to areas around the breast, or even across the abdominal or pleural cavities.
Breast cancer most commonly metastasises to bone, lung, liver, ovaries and brain. Lymph node metastases are the first to occur and are the most commonly seen. The malignant cells become lodged in these areas and multiply to form further tumours.
Although both breasts can be affected simultaneously, it is more usual for the second breast to become involved after a period of years, if at all. Rarely, spread to the second breast occurs via the lymph vessels.
Differentiation of tumours
Tumours can be well differentiated, containing easily identifiable cells which clearly resemble the tissue from which they were derived; poorly differentiated, with a mixture of cells which it is difficult to identify; or moderately differentiated, an intermediate form. The prognosis for a well-differentiated tumour is always better than for a poorly differentiated one.
Staging
There are various methods of classifying the development of breast cancer, known as staging. The TMN method, used until quite recently, is now generally considered unhelpful as it relies on subjective observation and has a high inter-observer variation.
Staging of cancers of the breast is now based on factors such as the following.
* Has the tumour infiltrated into a large area (i.e. what size is it) or is there evidence of lymphatic or blood vessel invasion?
* Is it well differentiated, i.e. does it look like normal breast tissue that has gone out of control?
* Are the auxiliary lymph nodes involved?
* Is the tumour confined to the ducts of the breast (intraductal cancer)?
This last factor is important because tumours which are completely contained within a duct can usually be cured by surgical removal of tissue containing the duct and the growth within it. Intraductal tumours, once removed, do not tend to recur.
A commonly used system stages cancers on a scale of I to IV, tumours at stage I (confined to the breast) having the best prognosis; stage IV denotes metastatic cancer at distant sites within the body.
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ASSESSING THE PREVENTIVE HEALTH PROGRAMMES VALUE
Evidence over many years shows that whatever financial and other resources are put at the disposal of western medicine will be swallowed up. In fact one researcher has calculated that by doubling the current expenditure longevity would not be altered significantly. Half of the increased expenditure since the 1950s has gone in higher prices. The other half has gone largely on more hospital beds, more technology, more hospital admissions, more health employees and more in-patient days in hospital. But in spite of all of this the major killers-heart disease, strokes and cancer-have declined little. The exception to this is the decline in heart disease deaths in the US that has occurred over the last fifteen years. This has almost certainly come about as the result of lifestyle changes and not increased expenditure on curative medicine. Although it is difficult to make
accurate estimates it is generally agreed that about 2 per cent of healthcare expenditure goes on preventive medicine in most western countries, yet we are told from the cradle that prevention pays and that a stitch in time saves nine. Just how true are these claims?
Trying to assess the value of a preventive programme is a complex task. It is not too difficult to work out the cost-effectiveness of a simple curative procedure because the end-point is often fairly clear and you know what the starting point (an ill person) is. But when it comes to spending money on prevention there are many problems, some of which arise because the person involved is healthy and the benefit conferred on him or her, or on society, may not be easily quantifiable in terms of money and may occur many years after the original expenditure on the preventive measure.
When trying to work out how financially worth while a preventive health programme is we have to consider four main points: (1) The positive and negative effects of the programme; (2) how many of these effects can be clearly related to a preventive programme; (3) what value can be put on the results and (4) the balance of the advantages and disadvantages of the programme.
As an example let’s look at screening for breast cancer. The effects of the programme will include: the cost of convincing women they should be screened; the cost of their time off work or other duties to go to be screened; the cost of actually getting there; the cost of the screening itself (both in people and equipment); the cost of following up the abnormal findings; the cost of treating those who have abnormalities but who would have otherwise gone untreated; the cost of any doctor-induced problems (i.e. other problems which the screening programme itself brings into being) and their follow-up treatment; and the savings resulting from the reduced use of medical and other facilities by the women who have a cancer detected early and so do not need more expensive treatment.
The next step involves putting values on the programme. There are several questions that need to be answered. Obviously the cost of convincing women to be screened has to be related to the numbers who actually come forward. If it costs 100 pounds per woman simply to persuade her to be screened this alters the whole balance of worth of such a screening to the community. What about the increase in doctor-induced diseases? Is it possible that by having too many false negatives we give women false confidence, causing them to ignore lumps in the future? Or that by giving too many false positives we worry people so that they end up having unnecessary and worrying operations?
The last thing we really have to be sure about is what good the screening actually does and which part of it is most worth while. Obviously doing a total physical examination and an X-ray every six months would be a way of detecting breast cancer early but the side-effects of the X-rays, and the costs, would be enormous.
Lastly, a price has to be put on the whole thing and this can be difficult. The actual cost of delivering the medical side of such a programme is, of course, easily worked out but the benefits (peace of mind, improvement in life expectancy and so on) are much more difficult to evaluate financially.
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FEED YOUR BODY RIGHT: LENTEN PROMISE LED TO 20-POUND REWARD
If you’re having a hard time pinpointing the hidden calories in your diet, take a tip from Jim Gorman. The 33-year-old public relations supervisor from Hoboken, New Jersey, will tell you to look in the bottom of your empty glass. He knows from experience.
In 1995, Jim gave up all sugary beverages and alcohol for Lent, resolving to drink only water and club soda. By the time Easter rolled around, he was 20 pounds lighter. «I wasn’t really looking to lose weight,» he says. «But I have to admit that I was a bit bulkier than I wanted to be.»
Since then, Jim has kept his weight between 158 and 163 pounds, appropriate for his 5-foot-11-inch frame. He attributes his trim physique to his continued ban on sugary beverages. «Staying away from soda, lemonade, sweetened iced tea, and other flavored drinks has made all the difference on the scale,» he says.
WINNING ACTION
Be wary of liquid calories. Alcohol and sugary beverages can contribute to weight gain—and they don’t do a thing to fill you up. A 12-ounce glass of beer supplies 146 calories; 12 ounces of soda, 150 calories; and 8 ounces of fruit juice, about 100 calories. If you’re having a tough time losing weight, take account of your liquid calories. Substitute water for your sugary beverages. You’ll be a lot happier eating a 300-calorie meal than quaffing a few colas. As for alcohol, save it for special occasions (like losing 10 more pounds), and stick to light beer or wine.
And remember to sip, not gulp.
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APPENDIX VIII\BRONCHODILATORS: ? 2-ADRENOCEPTOR AGONISTS
These are drugs which make the bronchial muscles relax, and are therefore useful in asthma. There are three types of bronchodilators: |32-adrenoceptor agonists, xanthines and anticholinergics.
? 2-adrenoceptor agonists
Antagonists are drugs such as antihistamines which bind to receptors and block the effect of the natural messenger (eg histamine) that normally binds to the receptor. Agonists have the opposite effect. They bind to receptors and stimulate the cell, in the same way that the natural messenger would – in other words, they mimic the effects of that natural messenger.
The (32-adrenoceptor agonists mimic the effects of adrenaline on the bronchial muscles, by binding to receptors for adrenaline. These are called (52 adrenoceptors, hence the name of the drugs. They include salbutamol (Ventolin,
Ventodisks, Volmax, Cobutolin, Salbulin, Salbuvent, Asmaven, Aerolin-Auto), terbutaline (Bricanyl, Monovent), fenoterol (Berotec), pirbuterol (Exirel), reproterol (Bronchodil), rimiterol (Pulmadil). Sometimes such drugs are combined with corticosteroids (see below), as in Ventide, which contains salbutamol.
Of all the bronchodilators, these drugs have the most specific effects on the bronchi. They are now preferred to isoprenaline (Iso-Autohaler and Medihaler-Iso) which has a less specific effect, and tends to combine with adrenaline receptors in the heart muscles as well as those in the bronchi, sometimes causing irregular heartbeat, flushing and headaches. Isoprenaline is combined with a sympathomimetic, phenylephrine in Duo-Autohaler and Medihaler-Duo. ,
Isdetharine (Numotac) is another nonspecific 6-agonist. It is combined with phenylephrine in Bronchilator.Orciprenaline (Alupent) is a drug of the same type that is partially selective for bronchial muscles, and has similar side-effects.
Side-effects can also occur with the specific p2-adrenoceptor agonists, such as salbutamol, although they are generally less of a problem. They include tremor, nervous tension, headache, flushing and dry mouth. Taking the drugs from an inhaler reduces the side-effects by targeting the drug on the bronchi – this allows a much lower dose to be used than if the drugs were taken by mouth.
The effects of these drugs lasts for up to six hours, and the timing of doses should be geared to the patient’s needs. Learning how to operate the inhaler properly is very important, as the drug can be ineffective if the inhaler is misused.
Even if they are used at quite high doses over long periods of time there seem to be no serious ill-effects with these drugs. On the other hand, they do not reduce the sensitivity of the bronchi, as sodium cromoglycate does, so once they are discontinued their beneficial effects cease. A combination of the two drugs is sometimes used.
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THE ELIMINATION DIET: JANET’S STORY
Janet was 40 years old and had been ill in various ways since she was twelve, with rhinitis, severe migraine, urinary problems and pain in the region of her kidneys. During her thirties she had also developed depression which had led to two suicide attempts and resulted in electroconvulsive therapy. Over the past six years she had made over 100 visits to her family doctor, spent 63 days in hospital, visited outpatients 49 times and taken 34 courses of drugs.
Janet was then tried on an elimination diet which excluded all commonly eaten foods. This provoked the
worst migraine she had ever experienced at first, but then left her feeling a great deal better. On testing, a glass of milk produced sneezing, rhinitis and headache, whereas wheat left her depressed with a severe migraine. Eggs produced a headache, nausea and pain around the kidneys. Eating maize resulted in nausea and fatigue. By avoiding these four foods, Janet has remained very well. In the six years since her treatment she has visited her doctor five times, spent only two days in hospital and not required any drugs – a striking contrast to her previous six years.
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THE FINAL STEP OF ELIMINATION DIET
The final step takes us to the least rigorous form of elimination diet, in which most fruits, vegetables, fish and meats are allowed, but wheat and other cereals, milk, eggs and other common offenders are excluded. This diet is quite good enough for many people, but those with multiple sensitivities tend to slip through the net because they are still eating some foods which cause symptoms.
One other form of elimination diet should be mentioned here. This uses elemental diets during the exclusion phase, rather than any foods. Elemental diets are made from various ordinary foods, but these are treated to break down the food molecules into smaller pieces. They are similar to the hydrolysate formulas used for babies who are sensitive to cow’s milk but they are designed to be eaten – or rather drunk – by adults. In theory, the molecules that remain in the elemental diet are too small to cause any allergic reactions or other problems. In practice, some people with established food sensitivity do react to them, because the fragments of molecules they contain are too reminiscent of the original molecules. For many people, however, they are very effective.
Various drawbacks are associated with elemental diets. Firstly they taste dreadful. Secondly they are very expensive – the cost of living on them and nothing else is about £20 per day. Although they are available on the National Health, they are classified as ‘borderline substances’ which means that they can only be prescribed for certain named illnesses – suspected food sensitivity is not one of these. The elemental diet that most doctors prefer to use is Vivo-nex, and this is only available on prescription. Another form of elemental diet, Elemental 028, is available without prescription, but this contains sugar (sucrose) to which some people are sensitive. Nevertheless, it might be useful as a last resort for someone who is intolerant of a great many foods and has therefore not succeeded with an elimination diet. You should not try out an elemental diet without the help and advice of your doctor.
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HOW TO TREAT HYPERKINETIC SYNDROME: THE TIMING OF RESPONSES IN THE DIET VARIES
The timing of responses in the diet varies. Most children recover within a week or two on the initial stages of the diet, but others take up to three weeks. Foods should only be tested once there is a noticeable and sustained improvement. If this does not occur, then revert to the normal diet and consider other options. It may be that your child has chemical sensitivities – reading Chapter Nine should help you to assess this possibility. Be prepared to reconsider the likelihood of emotional stresses and strains.
The procedure for testing foods is slightly different for hyperkinetic syndrome. Although a few may take up to a week of daily feeding with the culprit food before they respond, this is probably fairly unusual. The response time for most is between 15 minutes and four hours. Reintroduced foods should be fed in the morning, and again in the afternoon, if there was no reaction, or only a slight reaction, to the first feeding. A normal-sized portion should be eaten, except in children who have asthma or urticaria, where a very small amount should be tried first, in case there is a severe reaction. If, by the morning after, there is no reaction to the food, then it can be incorporated into the diet, and testing begun on a new food. As always, in an elimination diet, it is important not to eat too much of any one food.
Assuming the diet is effective, and you discover what foods or additives cause the problems, then you have to decide on a plan of action. Again, you should discuss this with your doctor. Avoiding the foods in question may be quite difficult, especially at school or with friends, and you may wish to reconsider other options, especially if your child is not affected all that severely or if he reacts to a great many foods. Drugs are one option, and you should discuss the pros and cons of these with your doctor. Another, more controversial form of treatment, is neutralization therapy. Although this is not accepted widely among the medical profession, there are many reports of it being used successfully for the treatment of hyperactive children. If you decide on avoidance of the food, bear in mind that the child’s sensitivity may disappear in time. The culprit foods should be retested at one- or two-yearly intervals, to see if they still produce the same symptoms.
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IGE AND MAST CELLS
IgE molecules are just as specific for their antigen as other antibody isotypes but they operate in a rather different way. Their main function is to defend the body against parasites such as ringworms and flukes – these are much larger than bacteria and viruses so the body has different strategies for killing them. In the tropics, where parasites are common, quite high levels of IgE may be found even in non-allergic people. Cooler conditions are not as favourable to parasites and they are far less of a health problem – in non-allergic people living in temperate climates, the level of IgE is usually very low.
Like other antibodies, IgE molecules are produced by B cells. But once they have been produced, the IgE molecules behave difference from most other antibodies in that they attach themselves to mast cells and basophils. These two types of cell look slightly different under the microscope, and whereas basophils are found floating in the blood, mast cells are embedded in the solid tissues of the body. Mast cells are better known and understood, so we will conveniently ignore the basophils from here onwards: the two types of cell probably work in much the same way.
Although the stem of the IgE molecule is attached to the mast cell, the antigen-binding sites are still free. So when the right, antigen comes along, it will bind to the IgE molecules. This is the signal the mast cell has been waiting for. Packets of chemicals inside the cell are suddenly released to the outside, where they act as messengers, causing major changes in the cells and tissues around them.
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BUTTERBUR (PETASITES OFFICINALIS [HYBRIDUSJ) – INTRODUCTION
During the past few years butterbur, or Petasites, has proved itself as a valuable remedy, one that has achieved quite astonishing results. Since it is a strong remedy, the mother tincture is not usually tolerated by the average patient and it has to be potentised to lx or 2x, or even higher. If the patient, for example one suffering from a tumour or cancerous growth, notices a very strong reaction, he will have to take the remedy in a weaker potency. Let me add that this reaction is a sign of having made the right choice, that the remedy is appropriate. All that is left to do is to ascertain the potency that is tolerated by the patient. To find the individual tolerance, it will be necessary to ignore the usual directions; instead, add one drop of Petasites to a glass of water (200 ml/7 fl. oz) and take frequent sips during the day. After 8-10 days the body will have become used to that particular strength and the dose can be increased, using one drop to 100 ml (3.5 fl. oz) of water. Continue taking this dilution for eight days, then add one drop to 50 ml. In time, the body will tolerate Petasites in even stronger doses.
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CARE OF THE FEET – INTRODUCTION
What long and faithful service is rendered by our feet! We take it for granted that they will support the whole weight of our body and take us wherever we want to go every day of our life. Nevertheless, as a rule we neglect the daily foot bath that they so urgently need and deserve. For the feet perform not only a mechanical but also an eliminative function, although this may generally be ignored. Everyone knows about perspiration of the feet and although it can become offensive and unpleasant when excessive, so that we would like to get rid of it, it does have a purpose. Suppressing this perspiration can have extremely serious consequences. Granted, it is most disconcerting when others become aware of the strong odour, and cases have even been known where smelly feet led to a divorce. Excessive sweating of the feet should really be looked upon as being the action of a safety valve of the body; when it reaches the point where it becomes embarrassing the sufferer should do something about stimulating the kidneys and the skin by natural means. For if you try to suppress foot sweat, the toxins will remain in the system and cause havoc, leading to various ailments. The types of problem that might arise from such action, together with some suggested alternatives for dealing with excessive foot sweat.
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OUR TEETH -BASIC RULES FOR CARE OF THE TEETH (GENERAL INFORMATION)
Arthritis may develop, possibly leading to rheumatoid arthritis and other serious ailments, all stemming from granulomas or abscesses. Some of the other problems attributed to them include cardiac pains and troubles, palpitations when walking upstairs or uphill, kidney and liver dysfunctions, as well as other organic upsets – all without our knowing what the cause might be.
American doctors are generally credited with the discovery of these problems emanating from germ-ridden dead teeth. The sad thing was that in the case of articular rheumatism, rheumatic fever, some dentists short-sightedly extracted not only the dead teeth with their abscesses, but also all the good ones. This, of course, was wrong, although many doctors worldwide followed this method. The error was later recognised, but not before a lot of damage had been done.
An acquaintance of mine, a railway employee, was forced to have all his excellent teeth extracted because a doctor had decided that they were the cause of his heart trouble. He was unwilling to have this done, but gave in because he was afraid the insurance company would refuse to continue his policy. Unfortunately, the removal of his teeth did not cure his heart problem. A nature cure did eventually succeed in doing so, but, alas, nature treatments, however effective, could not bring back his extracted teeth.
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NATURE DOCTOR – HEALTHY HABITS
It is certainly unwise to expose oneself to the danger of cancer because of some so-called pleasure. Think of the terrible suffering cancer of the larynx or lungs can mean. If you have ever had to watch a victim of this tragic condition slowly dying in agony, no doubt you will muster the courage and consider it your urgent duty to warn others of the dangers. Honest records and statistics show that by far the greater percentage of the above-mentioned kinds of cancer occur in smokers and those who work with tar.
It is not difficult to admit that smoking does not quite agree with a young person to begin with. This is a fact. Still, the tiniest bit of inherent cowardice may cause the young person to overcome the natural aversion to smoking because he does not want to be different from his peers – he does not want to be an outsider. Nor does he fancy being teased; above all, he wants to appear grown up and so imitates the adults.
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ARTHRITIS AND GOUT – SUFFER
Sufferers from arthritis or gout are often frightened by the same argument, that tomatoes encourage their development. This view has been propagated by researchers whose experiments have been confined to laboratories, without the necessary field work. It is true, however, that green or unripe tomatoes are not good for the health, since they contain toxic substances that are only rendered harmless by the process of ripening. But is it not also true that unripe apples, or any other unripe fruit for that matter, are detrimental to the health for exactly the same reason? Of course it is. However, it is wrong to argue that such toxins are contained in ripe fruit merely because they are found in the unripe ones. In reality, tomatoes that have fully ripened on the plant are wholesome and contain at least five different vitamins which are essential for the human body.
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SEXUAL DISORDERS: DESCRIPTION OF KAPLAN’S METHOD TREATMENT PROCESS
The therapy process consists of erotic tasks performed at home, plus weekly or semiweekly meetings with the therapist. At each therapy session, the therapist and patients explore together the feelings and emotions experienced during the erotic exercises, which often are deep and profound. The therapist must be sensitive to the verbal and nonverbal cues that reveal the anxiety beneath the overt and covert responses of the patients and takes great pains to uncover their real reactions to the therapy, if progress is impeded. In this way not only does the therapist help the couple to obtain a clearer picture of their individual functioning and dyadic transactions, but also the partners learn to be frank and open about their emotions in general and their erotic preferences in particular.
Typically, the patients are instructed to perform the exercises more than once during the week. It is common for couples to experience difficulties during the first attempt, and to resolve these difficulties by the last attempt. With these patients, it is necessary only to present the next set of tasks. It is also common for patients to experience initial difficulties that are only partially resolved during the week; with these patients, some exploration of the resistances encountered, with insights and/or interpretations offered by the therapist, is often enough for a complete resolution. These couples also would probably be instructed to go on to the next set of erotic tasks.
These outcomes used to be the most common. However, the population seeking help for their sexual problems seems to be changing. More and more couples are coming with more profound problems that have remote causes. This results in increased difficulties in performing the sexual prescriptions. These resistances and obstacles can occur even before the exercises take place, for example, in deciding which partner «should» initiate the exercises and whether the other partner «must» agree. Other couples can «misconstrue» the instructions or interfere with his or her partner by «sabotaging» the process. Such maneuvers will compound the difficulties normally encountered in performing the actual tasks. Some couples can perform exercises properly and ruin the results – by having intercourse, for example, when intercourse has been proscribed. When these patterns persist or appear deeply entrenched, more intense psychotherapeutic confrontations and explorations are required.
Such psychotherapeutic, as opposed to behavioral interventions are performed strictly in the service of the experiential aspects – the sexual therapy prescriptions. Resolution is attempted only to the depth necessary to allow the tasks to continue; the resolution of intrapsychic or interpersonal conflicts for their own sake is avoided. Similarly, the therapist will tend to avoid offering insights to the couple that may apply to other realms but not to the psychosexual, if they pose a resistance to treatment.
If the resistance seems slight or manageable, it is bypassed, and the couple is instructed to proceed to the next exercises. Bypassing may also be indicated in certain unusual cases, for example, a man with erectile problems may have difficulty assuming the passive role in non-genital sensate focus, but may be much less resistant to genital stimulation. (The former is «womanly,» the latter is «manly.») Although the inability to accept affectionate «pleasuring» may imply a severe disturbance, it should not be explored in this case. Instead, the man’s resistance to non-genital pleasuring would probably be bypassed, and the couple would be instructed to perform the next exercise, genital stimulation.
If the problems experienced during the sexual exercises appear too severe to be bypassed and are obstructing the sex therapy process, they must be explored jointly by the therapist and the patients. The probable prescription will be a repetition of the same exercise for the next week, which is often enough to solve the problem. When bypassing and repetition techniques are both ineffective or when the resistances seem formidable, they must be confronted directly.
The erotic exercises themselves include those described by Masters and Johnson, in addition to many others which have been developed in the last five years, such as in the treatment of premature ejaculation. In the Masters’ and Johnson’s technique, the female is instructed in the «squeeze» technique, applying pressure to the coronal ridge area of the penis to inhibit the ejaculatory reflex. Kaplan uses a modification of the Semans technique (Semans), in which the female aids the male in what is essentially a desensitizing procedure. It is felt that the Semans’ technique gives the responsibility for ejaculatory control to the male, to whom it is most appropriate.
The Kaplan method prescribes a unique series of exercises for each couple. Other methods prescribe the same exercises to all patients, with specific exercises for the particular complaint. In Kaplan’s technique, the dysfunction, as well as the motivation and assets of each couple, determines the course of the treatment. Using this approach, relief of the symptom will usually take place between six and sixteen sessions, although some patients have reported cures in as few as three sessions.
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PSYCHOANALYSIS AND SEXUAL DISORDERS: THE ORAL STAGE
The earliest of the psychosexual stages Freud described was the oral stage. At this earliest phase of infantile development, the infant’s needs, perceptions and behaviors are centered primarily on the mouth, lips, tongue, and other organs related to the oral zone. Pleasurable excitations and affects arise from stimulation of the mucosal surface of these organs. The primary model of oral stimulation and satisfaction is breast feeding, in which hunger pangs give rise to oral sucking movements which are then satisfied by active sucking on the mother’s nipple and the consequent feeding.
The oral zone maintains its dominance in the libidinal organization for approximately the first eighteen months of life. Oral sensations would include thirst, hunger, sensations related to swallowing, satiation of hunger, and the pleasurable tactile stimulation evoked by sucking on the nipple or nipple substitute. Libidinal satisfaction at this stage of development, how-
ever, may not be restricted solely to the oral zone but may also arise in connection with the multiple forms of tactile stimulation that are connected with mother-child contact, not only in the feeding situation but in the multiple contexts of infant mothering. There is some evidence, particularly from animal studies, that such maternal contact and tactile stimulation has an important influence on the infant’s affective development.
The oral drives are generally regarded as consisting of separate components, the libidinal oral drives and the aggressive oral drives. States of oral deprivation or tension tend to stimulate a seeking for oral gratification which is typified by the state of satiation the infant reaches at the end of a nursing period. Lewin has suggested that there is an oral triad which consists of the wish to eat, the wish to sleep, and the wish to attain that quiescence and relaxation which occurs at the end of sucking just before the onset of sleep. It is generally thought that the libidinal needs of oral erotism predominate in the early phases of the oral stage, but that they become compounded with more aggressive components later on in the stage of oral sadism. The development of oral sadism can express itself in biting, chewing, spitting, or crying. For many analysts, particularly those of the Kleinian persuasion, such oral aggression is associated with primitive wishes and fantasies of biting, devouring, and destroying. Such fantasies, for example, may be directed against the mother’s breast as an expression of primitive incorporative wishes. Although such fantasies can often be recovered in primitive regressive states (in psychotic or border line patients) and may even be elicited in the more regressive associations of even healthier patients, there is no good evidence to substantiate the operation of such fantasies at early infantile stages of development.
In developmental terms, the objectives to be attained in the oral period are among the most important for establishing a well functioning personality and for establishing the rudiments of a significant capacity for an accepted relationship with objects. If the oral period can be carried through successfully, the child should be able to establish a trusting dependence on the nursing and sustaining object and to establish a comfortable expression of oral libidinal needs and to find their gratification without significant conflict or ambivalence from the oral-sadistic wishes to attack, devour, or destroy the object.
The failure to achieve these objectives in one degree or another can lay the foundation for the development of pathological traits. Excessive oral gratification or deprivation can result in significant libidinal fixations. The traits deriving from such infantile fixations can include excessive optimism, narcissism, pessimism, and demandingness. Oral characters are often excessively dependent and require others to give to them and to look after them. Such persons want to be fed and supported and nurtured, and may be selfishly demanding in their attempts to have these wishes gratified; but they may be also exceptionally giving to others as a way of eliciting a return of being given to in kind. Oral characters are thus often extremely dependent on their objects and on a return of support and narcissistic supplies in order to maintain a fragile and often faltering self-esteem. Characteristics of envy and jealousy may often be associated as pathological manifestations of such basically oral traits. Such oral traits are often associated with fairly primitive degrees of narcissism, but these dimensions should be considered separately.
Nonetheless, the oral phase may find a successful resolution and thus provide the basis for character traits positively contributing to personality functioning. Such individuals may develop capacities for giving, for giving to and supporting others, and for receiving from others without a sense of excessive dependence or envy. They may develop a capacity to rely on and trust others and to be capable of relying on themselves and of trusting themselves in their complex dealings with others and in facing the difficulties and challenges of life. The continuing capacity for trust and reliance, either as an enduring possession of one’s own inner life or in one’s relationship with the significant others in his environment, rests ultimately on the development of the basic sense of trust during this earliest oral phase of psychosexual development.
Erikson has characterized these complex aspects of character development deriving from pregenital phases of psychosexual development as phases of psychosocial development. He envisions the phases of psychosocial development arising out of the psychosexual phases as being characterized by certain definitive crises in the development of the individual personality, leading finally to a phase of identity formation. The specific psychosocial crisis associated with the oral phase is the resolution of basic trust versus basic mistrust. The capacity for enduring trust in oneself or in others represents a successful resolution of the early object related crisis in the oral phase, while the failure to resolve that crisis results in a basic and perduring mistrust which provides the basis for a lasting impairment in the capacity to relate to others and to rely on one’s own inner resources.
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SEX AND SOCIETY: SEX DIFFERENCES
There is a commonly held notion that women are tougher on other women than men are. The evidence supporting this assertion is only fragmentary. In general, women and men have been shown to share the identical sex stereotypes, to have the same differential standards for men and women, and to be equally sex-biased in their behavior. However, there is a style among professional women that gives rise to and perpetuates such ideas.
The «queen bee» syndrome (Staines, Tavris, Jayarante) is that in which successful women who could assist the careers of other women prefer not to do so. Queen bees choose not to be mentors and to teach new women «the ropes» and, despite the power to help women advance, they do not support them. There are a number of reasons for this behavior.
First, being a member of a minority often causes people to identify with those in power and to dissociate themselves from those in their own social category. In this way, there is the possibility of being hailed as an exception and being accepted into the ranks of those with power. Second, these women may enjoy their uniqueness. They may relish their positions in male-dominated fields and be unwilling to open the door to additional women who not only will lessen their unique status but also might make them compete for it. Third, these women often have made their ways up the career ladder with great hardship and sacrifice, and they may resent what they perceive to be the «special treatment» and «premature advancement» of younger women who are seen as capitalizing not only on their own talents but on the pressures of the women’s movement.
There might well be resistance by established women to the advancement of new young women. But there is no evidence that similar prejudices are harbored by the younger or less established women who usually are the participants in research studies. On the contrary, the overall degree of sex bias evidenced by men and women, whether in the experimental laboratory or in the field, has not been shown to differ dramatically or consistently.
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STUDIES OF EXTRAMARITAL SEXUALITY
Because of anthropology’s emphasis on marriage and social control, there has been a general de-emphasis on the study of extramarital sexuality. Also lost in the shuffle is the view of sexuality as a component of culture, since it has been assumed to be a component of marriage. Despite this obvious and continuing orientation to sexuality only as it prevails in marriage, some anthropologists have recently begun to report on extramarital relations, mostly in Africa, native South America, Polynesia, and New Guinea.
Wagley, for one, had no choice but to recognize sexual activity outside of marriage, for Tapirap? Indian men take six- or seven-year-old girls as wives, a custom they refer to as «raising your own wife». These men have to find sexual satisfaction surreptitiously; their marriages are, at least initially, asexual. After doing field work among the Fulani, a pastoral people of Upper Volta, Riesman offered this important critique of the standard anthropological understanding of marriage and sexual control:
It is a commonplace in anthropology to say that marriage, as an institution, channels man’s sexual impulses so that they contribute to the maintenance of social structures rather than their subversion. But in reality, in the case of the Fulani at least, the effect of marriage is much more complicated than that. On the one hand, instead of channeling sexual impulses, so that they flower within limits defined as legitimate, marriage, in its beginnings, makes this flowering very difficult. Instead of being a honeymoon, in which the young people can satisfy their passion and begin to become a unit which will present a common front to others, this period in Fulani marriage prevents the couple from being together and, especially, prevents them from becoming a unit. On the other hand, the ease of divorce and the possibility of polygamy are a positive encouragement to men to be interested in other women. In the same way, this interest on the part of men is an encouragement to women to remain in a way available, whatever their matrimonial situation at the present.
Riesman criticizes the «sexual channeling» function of marriage identified and emphasized by Malinowski. Malinowski assumed a universal function in marriage, based on his Trobriand data, which in effect focuses emotional and sexual feelings and behavior in one direction, on one person (in monogamous unions). Riesman also cites a statement made by Bohannan, that «marriage and the resultant family is, everywhere, one of the main modes by which sexual activity within the society is controlled». Bohannan is aware, however, of periods of relative sexual freedom in various societies and of the non-familial institutionalization of sex, prostitution being the obvious example in our own society.
Work such as Riesman’s indicates the mistake of studying sexuality exclusively within the context of marriage and the family for the Fulani case and it warns against similar assumptions and oversights in work on other societies. Riesman may be aware, however, that Malinowski’s focusing effect in marriage may still operate for Fulani women, if not the men. «Being available» and being free to have additional and various sexual partners are different.
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SEXUALITY AND AGING: SEXUAL CAPACITY IN MEN AND WOMEN
In summarizing age-related changes in sexual capacity, Masters and Johnson state that «there is no question of the fact that the human male’s sexual responsiveness wanes as he ages.» The variables affecting this change are both physiological and psychosocial. This is also true for females, who Masters and Johnson contend, have no time limit with regard to sexuality. With the obvious exception of reproduction per se, age-related changes in sexual capacity are not as severe for females as for males. The components of female sexual behavior are not as «obvious,» and female sexuality has traditionally not been as «performance-oriented» as has male sexuality. For example, the inability of a male to achieve a rapid erection is an obvious sign of waning sexual function; the female analogue of this, the inability to lubricate readily, is not as obvious and can be alleviated more easily, either endogenously or exogenously. The male’s signal of sexual responsiveness is external and evident. The female’s is much less overt. Sexual capability is a principle part of most males’ roles and self-concepts; capability per se is not the stereotyped badge of femininity. Previous experience and availability of appropriate sexual partners are important influences on sexuality for both men and women. Within the constraints set by physical changes, experience and attitudes towards self and sexuality are probably the most important determinants of sexual functioning and satisfaction in later years—but this is probably as true in young and middle adulthood.
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WHEN YOU KNOW YOU HAVE BRITTLE BONES: MANAGEMENT OF THE PROBLEM
Careful management under your doctor’s supervision can probably reduce the rate of further bone loss, possibly stop loss of bone and even gradually strengthen your skeletal mass.
If you have secondary osteoporosis due to another disease or condition, treatment of this other ailment early enough to save your bone mass can be beneficial. If, for instance, you can reduce your need for drugs to combat inflammatory arthritis, or hyperthyroidism, you may be able to prevent the loss to your skeleton that these can cause, apart from age-related bone loss. Here are further useful ideas for your fight against osteoporosis:
1. Have regular bone-density tests performed by your personal physician or at your local clinic, every three to six months depending on severity, so your skeletal mass can be monitored.
Eliminate as many ‘negative factors’ as you can (e.g., stop or cut down smoking and drinking) and ‘accentuate the positive’ (e.g., eat well, drink plenty of lowfat milk, get as much exercise as you can manage, and be out in the sunshine!).
Keep a daily log of dietary calcium and vitamins and other supplements (perhaps utilizing your home computer). Calcium should be at least 1200 to 1500mg each day.
Check that your bed is comfortable with firm support; a sheet of % in (2cm) plywood beneath the mattress is an instant and inexpensive solution, or try a water bed.
Immediately after back injury, or when you have strained muscles, ice packs will help reduce swelling and inflammation. Rest as much as you can.
If your back problem is stiffness on waking, try warmth to soothe and relax: a warm bath, the warm sun, warm heating pads.
Massage can increase the flow of blood to your back and relax muscles.
Gentle stretching exercises can flex your back muscles; swimming can give you gentle exercise while supporting your body.
Prolonged sitting can place more stress on your back than standing, since your pelvis is not supporting you in that position. Change positions often, whether in bed, at home, or at work, and be sure your chair has a back-rest, preferably adjustable.
Women should look critically at the heel height of their shoes and discard any pair with heels of more than 1.5 in.
Use painkillers sparingly – they can be addictive, and if pain is masked, you could further injure your back unknowingly.
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OSTEOPOROSIS: HAVE YOUR OVARIES BEEN REMOVED?
In some surgical cases, it is essential to remove ovaries because they are either diseased or damaged, but unfortunately some physicians routinely recommend healthy ovaries be taken out at the time of hysterectomy if a woman is approaching natural menopause anyway. They reason that such surgery would prevent possible ovarian cancer at a later date – a cancer which is often fatal because it is difficult to diagnose early. But removal of ovaries before natural menopause involves abrupt loss of oestrogens and a 50 per cent risk of the rapid onset of osteoporosis if hormone replacement therapy is not prescribed.
Christopher E. Cann, Ph.D. of the University of California at San Francisco, recently conducted a three-year study of forty-seven women (white-, yellow-, and brown-skinned), aged between twenty-four and forty-eight who had undergone oophorectomies (removal of ovaries). His report revealed that they lost spinal mineral content at an alarming average rate of 9 per cent the first year after the operation. Two women had lost more than 20 per cent!
There are several kinds of hysterectomies and it is important to know the differences:
Partial hysterectomy means the removal of the uterus and cervix. Subtotal hysterectomy is the removal of the uterus but not the cervix.
Hysterectomy and unilateral salpingo oophorectomy is the removal of one tube and one ovary.
Radical hysterectomy is the removal of tubes, ovaries, uterus, cervix and pelvic lymph nodes.
When a woman undergoes a partial hysterectomy or has only one ovary removed, her levels of hormones are usually unchanged. But a total or radical hysterectomy involving the extraction of both ovaries can cause a sudden cessation of hormone production with consequent severe menopausal symptoms, especially if the operation is performed when the woman is young or several years before natural menopause would have occurred.
In 1981, 63,620 women in England and Wales underwent hysterectomy, and over 650,000 women in the United States had the surgery in the same year. Various surveys in the US have revealed that between 20 to 40 per cent are performed unnecessarily or for doubtful reasons. In some cases, it is used as a method of birth control, or as a way to correct menstrual irregularity, but this is a major operation, and simpler alternatives are often available. It is important to get a second opinion if your physician suggests a hysterectomy, to ensure that the surgery is essential; and it is crucial to know if both ovaries will be removed, as this will effect a surgical menopause, change your hormone level, and may trigger a rapid loss of bone mass. If ovaries are healthy, there are compelling reasons for leaving them intact – know your condition as thoroughly as possible before the operation.
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MINERALIZATION IN CASE OF OSTEOPOROSIS: VITAMIN D
Vitamin D is vital for the absorption of calcium into your body for proper bone mineralization. The D.H.S.S. has no recommendation for adult intake of vitamin D, but children, adolescents, pregnant/ lactating women and the housebound need 10 micrograms daily.
You get most of your vitamin D from the sun, with the ultraviolet (UV) light in sunshine converting a substance in your skin to a pre-vitamin D. This pre-vitamin is then changed in the liver and kidneys to its active form, the hormone calcitriol, necessary to maintain constant blood calcium levels for the normal functioning of nerves and muscles. Your body is not actually synthesizing vitamin D while you are in the sunshine, as it takes three or four days for your system to complete the process and ‘recharge your batteries’. How much sunshine are you getting every day?
Invisible UV light cannot penetrate ordinary window glass, so in order to soak up those rays you have to be outdoors. The Earth’s surface is protected by the upper layers of the atmosphere with ozone molecules in the stratosphere absorbing most of the near ultraviolet. Pollution at ground level may increase the ozone layer still further and interfere with the overall strength of the radiated light, so it is difficult to measure how much UV you are getting.
According to a research team at Harvard Medical School, you need about fifteen minutes to one hour of sun exposure each day, to fill your vitamin D needs, if you are a lightly pigmented person. Transmission of light depends on the thickness of your skin’s outer layers. After you reach the age of forty or fifty, there is a steady decline in the ability of your skin to produce that pre-vitamin D, as your skin thins with age (coupled perhaps with a lesser performance from your liver). So the skin of a woman in her seventies makes about half the vitamin D produced by her twenty-year-old granddaughter under the same conditions.
There are many variables: How intense is the sun? Is it winter or summer? Do you live in a northern latitude or the ‘Sun Belt’? The incidence of hip fracture is highest in the north of Scotland and lowest in the south of England, in studies related to the hours of sunshine and its effect on body stores of vitamin D.
Are you at a high altitude? At high altitudes and near the equator, the UV level is greater than at sea level or in northern latitudes. How clear is the air? Do you have smog and pollution? The low angle of a winter sun blocks much of that UV light, as the rays have to pass through more of our planet’s ozone layer, and smog, smoke and fog can block out still more UV.
Do you have a light or a dark skin? If your skin is naturally dark with the pigment melanin, it can screen off as much as 95 per cent of the UV light from the skin layers making pre-vitamin D. It is estimated that a black person needs five times as much exposure to the sun as a fair-skinned person to produce the same amount of vitamin D. When darker pigmented people move from the south to the lower intensity of a northern sun, they can become vitamin D-deficient. For instance, Arab and Indian women, accustomed to living in seclusion or heavily veiled, have been found deficient in the vitamin when going to live under the cloudy skies of Britain. So let the sun get to your bones!
As the sun is at its strongest and most harmful between 10 a. m. and 2 p.m., sunning in the early morning or late afternoon is less damaging to your skin than the middle of the day.
, If you use one of the sunblockers or sunscreens, wait about fifteen minutes when out in the sun before applying. These preparations may prevent the sun-related production of vitamin D in your skin.
Beware of excessive sunbathing which is both unnecessary and unhealthy. Most people think it fashionable and fun to be tanned. Millions of fair-skinned people now live in the ‘Sun Belt’ though their skin may be sun-sensitive and burn rapidly.
Sunlamps and sunbeds using UV light have been popular for providing a tan in winter and more recently tanning salons have been established in some cities. Dermatologists agree that concentrated doses of UV can cause skin damage, so the potential for short- or long-term injury is there, whether the UV radiation is from sun or lamp, with the result being premature wrinkles and, more seriously, a risk of malignant melanoma. This once-rare cancer has been doubling about every twelve years since World War II with a death rate in women faster than from any other malignancy other than lung cancer. Queensland, Australia, had an influx of fair-skinned people after World War II, and seven to ten years later they saw a large increase in melanoma there. If you notice any changes in colour or size of moles or scar tissue, see your doctor immediately.
The elderly need to take special precautions against overexposure to the sun and high temperatures, particularly if you are obese or have diabetes or heart disease. Certain types of drugs can create a vitamin D deficiency, but others when combined with excessive sunshine, can bring on photosensitive or phototoxic effects. Drugs that can create problems when taken along with heavy doses of sunshine are: some tranquillizers, anti-hypertensives, diuretics, tetracycline antibiotics, sulpha drugs, oral diabetic drugs and quinidine. If you are taking any prescription or non-prescription medicines, check first with your doctor or pharmacist for possible reactions in strong sunlight.
And make sure your eyes are protected during sunning -research suggests that prolonged exposure to UV over many years can contribute to the premature development of cataracts and tumours.
Getting a healthy exposure to sunshine every day is the best way for your body to acquire vitamin D, but there are dietary sources if you can’t get outdoors or if skies are smoggy.
Because medical authorities were concerned several years ago about possible deficiencies in vitamin D, with few natural sources in food, it was decided to fortify certain items. Margarines and lowfat spreads are required by law to be fortified with 2.25 micrograms of vitamin D per ounce. Some dairies and food firms also fortify skimmed or semi-skimmed milk, evaporated milks, yogurts, dried milk powders and breakfast cereals.
Other foods with naturally present vitamin D are some saltwater fish (herrings, salmon and sardines, for instance), cod-liver oil and halibut-liver oil, egg yolks, liver and cheese.
Vitamin D is stable in cooking and not lost by heating or processing, but it is affected by rancidity in oils. Hence if oils, butter and margarine become rancid, the active vitamin is destroyed.
For better absorption, it’s more desirable to get this vitamin from sunshine, but you may need supplementary amounts of vitamin D, especially in winter, if you are:
breast-feeding, or
elderly, living in a town or housebound,
a shift-worker (nurse, for example) working mainly at night,
heavily wrapped in clothes, and
rarely eat dairy products.
use heavy make-up.
The NACNE report (from the National Advisory Committee on Nutrition Education) also recommends that Asian schoolchildren be given vitamin D supplements.
By springtime you may have depleted your store of vitamin D. Records indicate that bones fracture most frequently in winter and early spring, when daylight is short, sunshine scarce and when vitamin D and calcium reserves are low. Multi-vitamin preparations usually contain vitamin D, and calcium supplements are often augmented by the vitamin.
However, you can have too much of a good thing: because vitamin D is fat-soluble and stored in the liver, large quantities from over-supplementation can be toxic, cause kidney damage, or trigger the creation of kidney stones. The toxic dose varies among individuals, but toxicity has occured at levels as low as 50 to 125 micrograms daily. When large amounts of vitamin D supplements (over 25 micrograms) are taken without sufficient calcium, bone depletion may occur. (In contrast, your skin has a built-in system that shuts down synthesis of vitamin D after a certain amount of UV exposure, eliminating the danger of toxic effects from sunning.)
Discuss your needs with your doctor before embarking on any tablet supplementation.
*46\114\2*
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CAUSES OF OSTEOPOROSIS: CARE OF YOUR TEETH
Periodontal disease can be either an indication of poor oral hygiene or a warning that underlying bone is becoming porous. It is often called gingivitis in its earlier stages, then periodontal disease as the condition advances, when tooth and bone loss may occur. The 1978 Adult Dental Health Survey reported that 91 per cent of adults with their own teeth suffer in varying degrees with this disease of the gums and tooth-supporting tissues – conditions that can result in the loss of underlying alveolar bone containing the tooth sockets.
Mature teeth in an adult do not significantly change their structure or calcification with altered intakes of calcium or a change in calcium metabolism. Periodontal tissues, on the other hand, do have an active interchange of available nutrients similar to bone and soft tissues in other parts of the body. Dental researchers have concluded that insufficient calcium may contribute to the loss of alveolar bone and tooth-supporting tissues; there is also a strong connection between periodontal disease and the accumulation of plaque, the sticky semi-transparent material containing food debris, bacteria and toxins that irritate and destroy gum tissue and surrounding bone. Diseased or infected gums are often the cause of bad breath.
So there are two key points: (1) make sure you have adequate daily calcium in your food and (2) maintain good dental hygiene.
If plaque is not brushed off your teeth every day, it hardens into calculus (tartar) which can only be removed by your dentist or dental hygienist. Build-up of plaque and calculus can lead to gum disease, which if untreated can create pockets of infection. Eventually the structures that support the teeth are destroyed, the bony sockets around the roots of teeth begin to demineralize or resorb, and as the bone is lost, the teeth become loose and fall out. Good dental hygiene is the key to prevention of gum disease, with a programme of regular visits to your dentist.
Adults and teenagers should use fluoridated toothpastes and mouthwashes to help ward off dental decay and prevent gum disease. Some British toothpastes also have calcium in their formula to aid dental repair. It’s vital to brush your teeth and gums with a soft toothbrush and floss daily to remove plaque the brush cannot reach. Fluoride in toothpaste works on the surface of teeth in two ways:
It stops the reproduction of Streptococcus mutans, the most powerful of many acid-making bacteria in your mouth. This bacterium feeds on the sugars and starches in your mouth and turns them into enamel-burning acid. Streptococcus mutans also is responsible for creating plaque, the gummy stuff that sticks to teeth to make a breeding spot for more bacteria; and
Fluoride allows the acid-scarred surface of teeth to heal. When fluoride is present in your mouth, calcium and phosphorus from saliva fill in the microscopic pits made by acid. Without fluoride, the pits get wider and deeper, and bacteria can penetrate further into the tooth enamel.
Cut down on sugar (all types: table sugar, fructose, maltose, glucose), sticky foods (like caramels, raisins, dates and soft drinks sweetened with sugar) and smoking. If you have mild periodontal disease, talk with your dentist about increasing your daily intake of calcium and vitamin C.
To maintain firm gums, healthy underlying bone and strong jaw muscles, give them sufficient exercise every day: let them go to work on crisp, crunchy fresh fruits and vegetables that need plenty of biting and chewing.
If you are already wearing dentures, make sure they are fitted properly and firmly – uniformly against the gums without uneven pressure on underlying bone. Brush your gums, ridges and palate with a soft brush to stimulate circulation, remove debris, and harden the tissue surface so that your dentures are most comfortable to wear.
*33\114\2*
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OSTEOPOROSIS: HOW SOON TO HAVE CHILDREN, AND HOW MANY?
During pregnancy there is usually a natural high level of oestrogen to promote the production of active vitamin D, encouraging calcium absorption. There are also much higher levels of progesterone during pregnancy, to conserve the bone mass. Therefore pregnancy can be beneficial to your bone mass if your daily consumption of calcium is adequate for your body and for the formation of your unborn baby. The conclusion among many doctors is that if you have not had children, your risk of osteoporosis may be higher.
If, on the other hand, a teenager becomes pregnant before her bone mass has reached skeletal maturity (in 1982,90,000 teenagers in England and Wales were pregnant), and if an expectant or nursing mother does not maintain an adequate daily intake of calcium, or embarks on unwise dieting before lactation is finished, her body will steal from its own skeletal reserves to nourish the foetus and provide lactation. This explains the origin of the old saying ‘for every child, a tooth’.
Similarly, in poor countries where the level of nutrition is low, pregnancy and a lengthy period of breast-feeding can have a debilitating effect on a mother’s skeleton. Whatever calcium is available goes straight to the foetus to start bone building. With an insufficient intake, the mother’s calcium reserves in her skeleton will be drawn upon.
A new type of woman is becoming pregnant today – the older career woman who decides to have a family at a later date in her life. She may already be at an age when she is starting to lose trabecular bone tissue from her vertebrae, making good nutrition of vital importance, and sufficient intake of calcium essential.
If you have many pregnancies at frequent intervals, with no due regard to proper nutrition, each child will represent a drain on your calcium reserves and bone strength.
Many experts consider it prudent to build up calcium levels before pregnancy.
*22\114\2*
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- Характеристики действия различных форм инсулина (1)
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- БЕРЕМЕННОСТЬ И ДИАБЕТ (2)
- Взаимосвязь между болезнью и психологическим состоянием. (1)
- ДИЕТА ПРИ ДИАБЕТЕ (1)
- Кормление ребёнка. (11)
- Методы снятия эмоционального напряжения. (4)
- ОСЛОЖНЕНИЯ САХАРНОГО ДИАБЕТА (12)
- Отношения в семье. (1)
- ПОЛЕЗНЫЕ СОВЕТЫ (4)
- ПСИХОЛОГИЧЕСКИЕ ТРУДНОСТИ ПРИ ДИАБЕТЕ (22)
- ПСИХОЛОГИЧЕСКИЕ ФАКТОРЫ. (1)
- Психологические этапы формирования отношения к болезни (1)
- САМОРЕГУЛЯЦИЯ (1)
- СУЩНОСТЬ ДИАБЕТА (1)
- Течение диабета во время беременности и роды. (6)
- ТРАДИЦИОННЫЕ МЕТОДЫ ЛЕЧЕНИЯ ДИАБЕТА (4)
- Характеристики действия различных форм инсулина (1)
- Что такое психосоматические заболевания. (18)
- Эмоциональные реакции. (2)