• выбирать подходящий препарат следует обдуманно, так как гипотензивное лекарственное средство должно хорошо восприниматься организмом и обеспечивать лекарственный эффект не менее одного дня;
• начинать лечение артериальной гипертензии начинать нужно с не больших доз любого гипотензивного средства и потихоньку эту дозу увеличивать до наступления стабильного терапевтического эффекта;
• наиболее правильным является применение медикаментов длительного действия, чтобы таким образом обеспечить стабильный суточный эффект за один прием. К тому же, с приемом данных лекарств, обеспечивается мягкий гипотензивный эффект со значительной защитой здоровых соседних органов;
• к  большому сожалению, разовое проведение медикаментозной терапии не избавляет от артериальной гипертензии. Это заболевание требует длительного приема медикаментов с целью поддерживания оптимального показателя артериального давления и, как следствие, предотвращения осложнений болезни;
• если эффективность лечения одним медпрепаратом низка, то рекомендуется использовать оптимально сочетающиеся лекарства — для того, чтобы достигнуть максимального терапевтического действия и минимального побочного эффекта для организма.

Психосоматические заболевания — это психологические расстройства, которые влияют на физическое и психическое здоровье человека.

Психическая деятельность человека ещё не достаточно изученная сфера. Но, ни у кого не возникает сомнения, что душевное состояние человека находит отражение на физиологическом уровне. Работу организма контролирует нервная и гуморальная система. Они тесно между собой взаимодействуют. К нервной системе относится головной и спинной мозг, нервные отростки и окончания. Гуморальная система функционирует при помощи гормонов, которые выделяются в кровь эндокринными железами.

За психическую деятельность человека отвечает головной мозг, который состоит из двух полушарий, правого и левого, покрытых корой. Каждый участок мозга и коры отвечает за выполнение определённых функций организма. При психосоматических заболеваниях головной мозг перестаёт адекватно анализировать информацию, полученную из окружающей среды и внутренних органов, и соответственно человек будет испытывать дискомфорт. Постепенно будет развиваться скрытая депрессия, сопровождаемая другими проявлениями заболевания, например астмой.

У каждого человека депрессия проявляется по разному, могут преобладать чувства печали, тоски, тяжести, раздражительности, часто заболевание даёт о себе знать только неприятными физиологическими ощущениями: болевым синдромом, сдавливанию в горле, груди, рвотой и т. д. При этом человек пребывает в благоприятном эмоциональном состоянии. Длительная депрессия, может привести к необратимым изменениям в организме, у человека на фоне симптомов начинает развиваться и прогрессировать мнимая болезнь. Без помощи специалистов практически невозможно самостоятельно избавиться от заболевания. Затяжные депрессивные состояния со сменой настроения могут привести к суициду.

На сегодняшний день психосоматические заболевания эффективно лечат в Чехии в психотерапевтическом центре санаторного типа ApertaVia

Существует множество причин развития психосоматических заболеваний, к ним относятся:

- генетическая предрасположенность;

- мутации хромосомного набора;

- расстройства в работе центральной нервной системы;

- индивидуальные особенности характера человека;

- социальные факторы;

- межличностные отношения с родителями, детьми.

Учёными доказано, что существует семь основных психосоматических заболеваний — бронхиальная астма, язвенный колит, пептическая язва, ревматоидный артрит, нейродермит, артериальная гипертония и гипертиреоз. С каждым годом перечень психосоматических заболеваний пересматривается и добавляется. Например, доказано, что если в семье укоренился конфликт между матерью и дочкой, со временем у девочки, вступившей во взрослую жизнь, начнутся проблемы со здоровьем половой системы органов.

Процесс лечения психосоматических заболеваний очень длительный и тяжёлый. В-первую очередь пациенты должны признать свою болезнь и согласиться прибегнуть к помощи специалистов. Сейчас существует масса различных эффективных методик лечения заболеваний, как на психологическом уровне, так и медикаментозно. Чтобы одержать победу над болезнью возле человека должен быть хороший специалист психотерапевт или психолог, который поможет правильно выявить причину развития болезни и подберёт индивидуальную программу лечения.

Чтобы добиться быстрых, стойких и эффективных результатов пациенты должны полностью доверять врачу и откровенно отвечать на все вопросы. По желанию человека можно приходить на индивидуальный приём к лечащему врачу или записаться на групповые занятия. Психосоматические заболевания возникают на подсознательном уровне и чтобы избавиться от них необходимо заново пережить ситуацию, из-за которой они возникли, и пересмотреть к ним своё отношение. Опытный специалист поможет двигаться в правильном русле и не нанесёт вред психике пациентов. Однако если пациент не настроен на конструктивную работу над собой врачи могут оказаться бессильными. Помните, что неквалифицированное вмешательство в психическую деятельность человека может привести к глубоким психическим расстройствам, поэтому следует внимательно отнестись к выбору лечащего врача.

панические атаки симптомы

А.Л. Мясников наблюдал больного 32 лет, летчика, давление у которого внезапно повысилось при аварии самолета в воздухе. Обстоятельства вынудили летчика покинуть самолет и выброситься на парашюте. По какой-то причине парашют долго не раскрывался и прыжок принял затяжной характер, после этого случая у летчика резко подскочило артериальное давление – до 210/120 мм ртутного столба и в течение длительного времени держалось на высоких показателях. До этого происшествия давление у него было всегда низким. Только упорное лечение в условиях больницы позволило снизить давление.

Гипертоническая болезнь имеет отчетливую связь с нервным напряжением профессионального характера. Так, у работников телеграфа и телефона, рабочих шумных цехов частота заболевания выше, чем у людей других специальностей того же возраста. Заболевание часто встречается у руководящих работников предприятий, инженерно-технического персонала, у врачей, артистов, писателей. Заболеваемость выше среди городского населения, особенно среди жителей крупных городов. Это объясняется быстрым ритмом городской жизни, наличием постоянного шума.

Не менее существенное значение имеют индивидуальные особенности нервной системы и организма в целом. Возникновение болезни у некоторых больных можно связать с перенесенной ранее контузией. Наследственное предрасположение к гипертонической болезни, также, несомненно, имеет значение. В «гипертонических семьях» повышенное артериальное давление среди здоровых, не предъявляющих никаких жалоб, выявляется почти в 2,5 раза чаще, чем в семьях, не отягощенных этим страданием. В этом отношении интерес представляет опубликованный в печати случай с двумя сестрами-близнецами, которые заболели гипертонической болезнью в один и тот же день у обеих (одна из них живет под Санкт-Петербургом, другая – под Брянском) возникло осложнение – расстройство мозгового кровообращения. Мы наблюдали гипертоническую болезнь, наследственный фактор, при которой, несомненно, имеет значение.

Следовательно, в тех случаях, когда имеется наследственная отягощенность к гипертонической болезни, при выборе специальности и трудоустройстве необходимо исключить или уменьшить воздействия факторов внешней среды, вызывающих повышение артериального явления.

Не следует стремиться довести артериальное давление до нормальных величин в том случае, если это сопровождается головокружением, слабостью, резким ухудшением самочувствия. Необходимо знать также, что все лекарственные препараты, применяемые при артериальной гипертонии, имеют побочные действия, которые обычно не опасны для здоровья, но могут быть неприятными (например, сухость во рту, заложенность носа). Эти побочные действия надо знать и не следует прекращать, сразу же, приём лекарств при их появлении, тем более, что эти неприятные ощущения в последующем обычно проходят или в значительной степени уменьшаются.

Как ни велики наши успехи в диагностике и лечении артериальной гипертонии, основной целью все-таки должна быть первичная профилактика этого заболевания.

Проще говоря, эссенциальной гипертензией называют заболевание, главный симптом которого – повышенное артериальное давление (далее в тексте используется сокращение АД). Диагностика болезни происходит методом исключения. У пациента с подозрением на эссенциальную гипертонию в течение длительного времени, неоднократно измеряют АД. Допустимое давление, 160мм – максимальное, систолическое АД, в момент наивысшего подъёма пульсовой волны, сердечной систолы, 95 мм – минимальное, диастолическое – АД, момент, когда сердечная мышца расслабленна. Если эти показатели превышены, тогда начинается диагностика всех других видов гипертонии (внутрибрюшная, почечная гипертензия, гипертензия в жёлчных путях и т.д.). И только после их исключения, ставится диагноз эссенциальная гипертензия. Повышенное АД это не показатель болезни, это временный сбой, который указывает вам на то, что вы в зоне риска. Если же повышенное давление хроническое, то это приводит к гипертонической болезни. Что может закончиться гипертензионным поражением сосудов (почек, мозга и сердца). Есть мнение, что у человека не имеющего предрасположенности к психосоматической форме эссенциальной гипертензии, данное заболевание может развиться из-за психофизических нагрузок (стресс, страх, внутреннее напряжение). В большинстве случаев (примерно 90 процентов), у больных первичным видом гипертонии, не выявляют никаких заболеваний лежащих в основе диагноза.

панические атаки симптомы

Лица с тенденцией к гипертонии нуждаются в систематическом врачебном наблюдении. Им необходимо организовать правильное чередование труда и отдыха. Продолжительность сна должна равняться примерно 8-9 часам. Таким лицам противопоказана работа в ночную смену, сверхурочная нагрузка. Установлена тенденция к снижению артериального давления под воздействием физических упражнений, однако не следует заниматься гимнастикой без рекомендации врача и медицинского контроля.

Важно, по возможности, устранение шумового и вибрационного факторов. Неблагоприятное влияние на кровеносные сосуды оказывает курение табака и употребление алкоголя.

Не менее важна правильная организация питания. Рекомендуется ограничить употребление животного белка, жира, включить достаточное количество растительной пищи. Необходимо избегать избыточного питания.

Установлено, что избыточное употребление соли также способствует возникновению гипертонической болезни.

Мы знаем много причин, ведущих к повышению кровяного давления. Например, некоторые железы внутренней секреции выделяют вещества, вызывающие сужение кровеносных сосудов, что ведет к повышению кровяного давления. Это можно сказать, например, о надпочечниках, выделяющих адреналин, о придатке головного мозга (гипофизе), выделяющем гипофизин (питуикрин). Некоторые заболевания этих желез сопровождаются высоким кровяным давлением, но в таких случаях говорят о гипертоническом состоянии, артериальной гипертензии как об одном из признаков заболевания желез внутренней секреции, а не о гипертонической болезни как самостоятельном заболевании.

Точно также при многих заболеваниях почек, в особенности при остром и хроническом их воспалении (нефрите), как правило, наблюдается высокое кровяное давление. Оно появляется вследствие того, что больные почки выделяют особое вещество, которое, соединяясь с другими веществами, всегда имеющимися в здоровом организме, вызывает спазм артерий, а, следовательно, повышение кровяного давления. Но и так называемую почечную гипертонию не причисляют к гипертонической болезни, хотя между этими двумя заболеваниями есть определенная связь: в далеко зашедшей стадии гипертонической болезни, когда появляется склероз мелких почечных артерий, состояние больного ухудшается и кровяное давление ещё больше увеличивается именно потому, что к основному заболеванию присоединяется почечная гипертония. Но почечную гипертонию и гипертонию, вызванную заболеванием желез внутренней секреции, находят не больше чем у 10% из всех, у кого повышено артериальное давление. А у остальных 90% имеется гипертоническая болезнь, возникающая по совершенно другим причинам.

Можно считать доказанным, что чаще всего этими причинами являются перенапряжение при умственной работе, а также перевозбуждение центральной нервной системы в связи с волнениями и неприятными переживаниями.

Кора больших полушарий головного мозга постепенно утрачивает способность управлять нижележащими участками головного мозга (подкоркой), где находятся сосудодвигательные центры. Здесь образуется очаг так называемого застойного возбуждения, т.е. возбуждения, не находящего «разрядки», не сменяющегося своевременно наступающим торможением. Таким образом, возникает невроз, нарушается нормальная деятельность сосудодвигательных центров, что и приводит к нарушению регуляции кровяного давления.

Возникновению и дальнейшему развитию гипертонической болезни и особенно осложнению её атеросклерозом способствует также слишком обильное питание и наличие в пище большого количества продуктов, богатых холестерином.

Несомненно, влияние на уровень артериального давления оказывают климат и состояние погоды. В условиях длительного жаркого сухого лета и короткой теплой зимы с наиболее благоприятным для организма барометрическим давлением, равным 715-730 миллиметрам ртутного столба, как это, например, имеет место в г. Ташкенте, гипертоническая болезнь, по данным 3.И. Умидовой, встречается лишь в 4,2% всех форм болезней. То же относится к болезням, связанным с коронарной недостаточностью (стенокардия и инфаркт миокарда). Наоборот, в г. Караганде (сравнительно недалеко от Ташкента), где климат континентальный, но где высока относительная влажность воздуха, часты сильные ветры, барометрическое давление нередко падает до 700 миллиметров ртутного столба и ниже, гипертоническая болезнь встречается в 22,8% случаев (более чем в 5 раз чаще, чем в г. Ташкенте).

Успех лечения, в большой степени, зависит от правильного режима труда и отдыха. Иногда этого одного достаточно, чтобы артериальное давление снизилось до нормальных цифр и чтобы состояние больного резко улучшилось.

Весьма полезна психотерапия в самом широком значении этого слова. Сюда входит, прежде всего, влияние успокаивающей обстановки, ободряющая беседа близких людей. Систематическое лечение внушением, а также гипнозом, проводимое опытным врачом, во многих случаях даёт хорошие результаты. Проводить такое лечение лучше в санатории. Существенную роль играет создание соответствующего «охранительного режима» – забота о душевном покое больного, устранение излишних поводов для волнения. В некоторых случаях больному надо временно предоставить полный физический покой, т.е. он должен лежать в постели. Но не следует настаивать на том, чтобы больной оставался на постельном режиме дольше, чем это необходимо. Надо помнить, что многие больные, привыкшие к труду и любящие свою работу и коллектив, нервничают из-за безделья и лучше себя чувствуют после возвращения на производство.

Бром, настой валерьяны и некоторые другие лекарства, принимаемые по назначению врача, улучшают общее состояние больного, обеспечивают удовлетворительный сон и способствуют снижению артериального давления.

Сон является охранительным торможением, т.е. тем торможением, которое предотвращает вредное перевозбуждение нервных клеток коры головного мозга. Поэтому особенно важно заботиться о том, чтобы обеспечить достаточно продолжительный и глубокий сон. В некоторых случаях в больницах применяют лечение длительным сном.

Диета должна быть выбрана лечащим врачом в зависимости от общего состояния больного, стадии болезни, состояния сердечно-сосудистой системы, склонности к ожирению и т.д.

Учитывая особую склонность больных гипертонической болезнью к более раннему и быстрому развитию атеросклероза, нужно обратить внимание на соблюдение ими правил питания, предупреждающих развитие ожирения и атеросклероза.

В некоторых случаях (чаще при ожирении) врач рекомендует проводить так называемые разгрузочные дни.

Физиотерапевтическое лечение, главным образом, водолечение, благоприятно действует, если ведет к успокоению нервной системы (теплые ванны, укутывание). Широко применяются и электротерапевтические процедуры.

Во многих случаях при гипертонической болезни очень полезна лечебная физкультура. Высокое кровяное давление в артериях при этой болезни обычно связано не только с напряженным умственным трудом и с обилием отрицательных эмоций (горе, волнение, страх), но и с недостаточностью мускульной работы. Поэтому физическая культура не только помогает предотвратить возникновение гипертонической болезни, но и является методом её лечения.

При физических упражнениях (не очень трудных) в крови появляются вещества, расширяющие сосуды. Кроме того, под влиянием физических упражнений улучшается слаженность тех нервных и биохимических процессов, от которых зависит напряжение мышц в стенках мелких артерий.

Массаж головы иногда устраняет головные боли и рефлекторно снижает артериальное давление.

В некоторых случаях полезно принимать лекарства, понижающие кровяное давление в артериях, но делать это можно только по совету врача.

Многие из тех, у кого имеются ясно выраженные признаки гипертонической болезни, могут продолжать свою работу, но им необходимо обратить внимание на правильный режим труда, обеспечить достаточный отдых после работы и соблюдать все советы врача, чтобы предупредить дальнейшее развитие болезни. Некоторым больным врачи рекомендуют перейти на другую работу или временно прекратить её.

Сохранение трудоспособности во многом зависит от правильного трудоустройства и от бодрости духа больного. Даже если гипертоническая болезнь уже значительно развилась, в большинстве случаев можно добиться выздоровления или, во всяком случае, такого значительного улучшения общего состояния больного, при котором трудоспособность полностью восстанавливается. Об этом особенно важно знать мнительным больным, склонным к преувеличению своих страданий и к необоснованным страхам. Внушить больному оптимизм должен не только врач, но и окружающие. Сам больной должен воспитать в себе спокойствие и сдержанность. Это содействует успеху лечения, Здоровый оптимизм – одно из лучших лекарств при гипертонической болезни.

В крови отклонения от нормы обычно вначале нет. Имеется лишь тенденция к увеличению количества эритроцитов и гемоглобина. Малокровие появляется только в тяжелых случаях болезни.

Ознакомившись с течением гипертонической болезни и почечными изменениями, возникающими при этом, и сопоставив указанные данные с признаками воспаления почек, можно найти между ними большое сходство. Это обусловлено тем, что изменения со стороны почек при гипертонической болезни встречаются тоже часто, как и вторичная гипертония при хроническом нефрите. Вместе с тем дифференциация указанных состояний имеет большое значение для проведения соответствующего лечения.

Первая стадия — обратимая, характеризуется выраженным повышением давления. Однако для нормализации его достаточно непродолжительное лечение и спокойная обстановка.

Во второй стадии артериальное давление стойко повышено. Но под влиянием соответствующего лечения, режима и трудоустройства болезнь и в данной стадии может подвергаться обратному развитию.

В третьей стадии давление стойко повышено, оно с трудом и незначительно снижается под воздействием комплексного лечения. У таких больных могут наступить серьезные изменения внутренних органов и частичная или полная утрата трудоспособности.

Общий спазм сосудов наблюдается реже, чем преимущественное сужение их в одном или нескольких органах. В связи с этим, различают несколько форм заболевания: сердечную, почечную, мозговую и др.

При исследовании больных врач обычно не обнаруживает таких изменений в сердце и сосудах, которые указывали бы на их поражение. В этой стадии болезни имеется только невроз с наклонность к кратковременному повышению артериального давления.

При дальнейшем развитии гипертонической болезни кровяное давление надолго устанавливается на высоких цифрах, а в последующих стадиях болезни может развиться атеросклероз в различных артериях, могут появиться изменения в сердце.

Однако даже тогда, когда имеется поражение сердца и кровеносных сосудов, организм благодаря, главным образом, регулирующей роли нервной системы может приспособиться к новым условиям, т.е. обеспечить кровообращение при повышенном артериальном давлении. Поэтому многие больные и в этой стадии болезни сохраняют полную работоспособность.

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Older children, in addition to the reactions described, may feel guilty that they are somehow responsible for the separation, believing that if they had behaved better or differently, it would not have occurred. Often there is yearning for the absent parent. Sadness and even overt depression are common.

Adolescents may feel intense anger at one or both parents, and may feel loyal and protective to one of the parents. Somatic complaints, such as stomach aches and headaches are common, and there may be problems with schoolwork and with peer relationships. Acting-out behaviour (such as talking back or open hostility) common to adolescents, may be accentuated. One of the developmental tasks of adolescence is to separate from the family, and this is made more difficult if there is separation and divorce during this period. They worry about their own ability to have successful relationships later in life.

*144\90\8*

Your doctor may say that twenty tablets per prescription is the maximum he or she can prescribe. This is not true. In Australia, your doctor can apply to the Department of Health for permission to give you enough painkillers per prescription to last one month. Permission is always given for people with cancer. Find out from a doctor or pharmacist what regulations apply in your country.

If you are in hospital, you have to rely on nurses as well as doctors to get the painkiller you need. First, ask your doctor to write up your painkiller to be taken regularly, (every three to six hours as is appropriate for the particular painkiller), not ‘as required’. If it is written up ‘as required’ you will have to ask for every dose. Even once you persuade the nurse you do need it, you will have to wait while senior nurses and keys are found, so cupboards can be unlocked to get your painkiller out. You shouldn’t have to go through this and you won’t have to if you can persuade your doctor to say you must have the painkiller regularly.

*181/40/1*

(2.) Assume command (someone has to). (3.) Assess the situation …

Any injuries?

How many?

How bad?

(4.) Delegate specific people to do specific things; particularly with road accidents. Block traffic or divert vehicles on one side of the accident (many a minor injury has been converted to a major one through a car ploughing into the injured person on the road). Send someone to phone police and someone else to phone for an ambulance.

(5.) Move the patient out of danger if it is not practicable to block the traffic. If you worsen the injuries by moving the victim, this is better than the injured — or yourself — being killed by another car.

(6.) Remember the A-B-C of saving lives …

A is for airway. Is he breathing? If not, start artificial respiration. If breathing, check whether it is easy or labored respiration. If he is unconscious and lying on his back, lift his lower jaw upwards and forwards. This lifts the tongue, stopping it from falling back and blocking the airway. Take out false teeth!

 is for bleeding. Look for bleeding, then stop it. Direct pressure will nearly always stop brisk haemorrhage. Put your THUMB on it, or your hands. Pads and bandages are great, but take time. Remember. NO TOURNIQUETS!

Ñ is for conscious state. If unconscious, check the airway as above, turn the head to one side, or, if there is no other apparent injury, place the patient on his side, so that in case of vomiting the vomitus cannot enter the lungs.

R … to that A-B-C let’s add an «R» — Re-assess! Keep going back over the A-B-C.

*624/71/1*

Food poisoning due to toxins usually develops within four to six hours but those cases due to infection with bacteria or viruses may take 12 to 24 hours to develop. Food may be contaminated with chemicals, especially the heavy metals and then symptoms come on quickly, usually within one to two hours.

If you want to avoid this unpleasant group of illnesses, some simple precautions may help. You would be wise to avoid food which appears «off», in any way. If the color, smell or taste gives an indication that all is not well, leave it alone. This applies to left-over foods at home as well as those you buy.

Foods which are kept warm for long periods are prone to contamination. Look at the standard of cleanliness in the shop. If it is generally good, the owners probably take care of the food as well as the premises. Sloppy people tend to be sloppy in all things.

*367/71/1*

The endometrium is the layer of cells which forms the lining of the uterus or womb. It is this layer which is under hormone control and builds up and becomes thick and spongy, ready to receive the fertilised egg should conception occur.

If it doesn’t this layer of tissue is shed, along with a certain amount of bleeding, and is the menstrual flow which constitutes a woman’s period.

In endometriosis, some of this endometrial tissue is found in other areas. It may be present deep in the muscle layers of the womb itself, in the ovary in the ligaments which hold the womb in place or on any of the abdominal organs. Why this tissue should be present in an unusual position is uncertain.

The problem with this condition is that the ectopic, or «out of place» cells react in the same way to the hormonal changes as the cells in their proper place. They build up, increase their blood supply and then shrivel up and bleeding occurs at the time of the period.

*117/71/1*

*148/40/1*

Food manufacturers are increasingly interested in having the G.I. of their products measured and the G.I. concept is already being discussed on the back of some commercial breakfast cereals. As more products are measured and consumer awareness of glycaemic index increases, we may see manufacturers highlighting the glycaemic index of foods. As consumers, people with diabetes should lobby Diabetes Australia if they believe the information should be on food labels.

Can I still lose weight eating as much carbohydrate as I want?

Possibly not. We recommend a high carbohydrate intake and a low fat intake. While carbohydrate is not usually stored as fat, if you are eating more energy in total than your body requires, then the carbohydrate will be used as a source of fuel in preference to fat. This would have the effect of limiting the breakdown of body fat stores. The idea is to eat enough energy in total to satisfy your appetite (using low G.I. types helps) and nutritional requirements but not more than you need. An increase in your activity level will help burn up body fat as it used as an additonal fuel.

Should I only eat foods with a low G.L?

No, that is unnecessary. You can lower the G.L of your diet effectively by substituting approximately half of your carbohydrate with low G.L types. When we eat a high G.L food with a low G.L food we end up with a meal of intermediate G.L so high G.I. foods needn’t be excluded. It is also generally healthier to eat as wide a variety of foods as possible, so don’t narrow your food choices unnecessarily.

Everybody can benefit from adopting the G.I. factor approach to eating. It is the way nature intended us to eat.

*97\42\4*

loss.

2. Patients with a genetic predisposition to obesity or with a long history of obesity should have their previous exercise history carefully considered before any prescription as to the type of planned physical activity is given.

3. More attention needs to be given to duration, frequency and intensity of physical activity with pre-menopausal women and particularly those with gynoid-form obesity.

4. Greater attention needs to be paid to the combination of diet and physical activity in the case of long term obesity.

5. More emphasis should be placed on energy input in the initial stages of severe obesity with activity limited to incidental activity or weight-supportive exercise.

6. Consideration needs to be given to the different fat loss responses to exercise in post-menopausal compared to premenopausal women, and in android compared to gynoid forms of overfatness.

7. There is a need for greater attention to spontaneous activity in older patients. This tends to decline naturally and may do so even further after the introduction of a planned, daily physical activity session.

8. Different levels of intensity of physical activity may be required for clients with different levels of cardiovascular fitness.

9. It should not be assumed that individuals of equal fatness have equivalent cardiovascular fitness. Prescription needs to be specific to each individual.

10. For programs that are gym or fitness centre based, provision needs to be made for organised physical activity on days when the gym is not used (i.e. making up a total of 6-7 days/week of organised physical activity).

11. It should be recognised that total energy use and substrate utilisation can vary between individuals depending on gender and age. These variables need to be recognised in developing any individualised prescription.

12. It should be recognised that many people over-estimate the amount of physical activity they carry out during the course of a day. Hence, activity diaries, or pedometers or other measurement tools are suggested to keep track of daily efforts.

*161\186\4*

2. When assessing the health importance of obesity for an individual, total fat, fat distribution and risk of disease all need to be considered.

3. It is more crucial for abdominally obese people to reduce fat for health reasons than for people with a more gynoid pattern.

4. The primary* location of fat storage in an individual (i.e. upper or lower body) influences not only the health risk but also the degree to which changes can be made in body fat content. Abdominal body fat stores tend to be more mobile than those in the lower body.

5. For this reason, body fat in android-shaped males is likely to be more easily mobilised than in most gynoid-shaped females.

6. Because of possible significant genetic, psychological and metabolic differences, long term cases of severe and morbid obesity should be regarded differently to short term cases of overfatness.

7. Because of hormonal changes, the fat loss response of postmenopausal women may be different to that of younger women and hence fat loss treatments may need to be different.

8. The genetic contribution to overfatness needs to be assessed to help determine the difficulty of the potential fat loss response.

9. Look for and consider less obvious health problems that may be related to excessive overfatness, e.g. bad back, bad knees, poor sleep, all of which may affect the fat loss response.

10. Be sensitive to psycho-social problems and sexual disorders in people who are excessively fat.

11. Accept that there are many factors influencing body fat and body shape that cannot be significantly modified, i.e. genetics, gender, age.

*22\186\4*

It could be truthfully said that:

you are as young as your glands;

you areas young as your cells;

you are as young as your collagen;

you are as young as your enzymes and your digestive system;

you are as young as your arteries and your heart.

But in order to keep your glands and organs young, your colon free from decay and putrifaction, your collagen elastic and your cells healthy and vital, you have to feed your body with the highest quality vital nutrition, which contains all the essential nutrients necessary for the normal function of all these organs and tissues.

Of course, the state of your mind has a determining influence on your health, too. But even the state of your mind, your attitudes, your mental capacities—yes, even the strength of your moral fiber – all depend to a great extent on the quality of your nutrition. «Mens sana in corpore sano» said the old Romans, and this is just as true today. A sound mind can only dwell in a sound body.

The more we search for the secrets of aging the more we convinced that you cannot discuss the problems of premature aging without discussing the problems of nutrition.

Dr. Henry C. Sherman of Columbia University, one of I lie-greatest authorities on nutrition, has stated that not only can human life be extended, but also youthfulness can be preserved and the extended life span made more useful, by the right selection of foods.

Recently, the Journal of the American Geriatrics Society reported on research by a Hungarian scientist, who has found that malnutrition is a prime cause of premature aging.

*136\58\2*

It is true that just about all your body is made up of protein. Of course it is true that your hair is also made up largely of protein. But this does not mean that you have to eat masses of protein each day. Your actual protein need for the normal, healthy functioning of all the vital organs and processes of your body is only about 30 grams a day, which can be supplied by one pint of milk and a cheese sandwich. Protein intake should not exceed 50-60 grains per day—which is less than half what is usually advocated in the United States. Proteins eaten in excess of the actual need, especially animal proteins, are definitely detrimental to your health, including the health of your hair. And don’t forget that practically all natural foods contain some protein, even fruits and vegetables.

Here is something to ponder: Are there many bald heads in Japan, China, India, or Mexico? In these countries a bald man is rare and the hair retains its blue-black color until very old age. Yet these people live, by American standards, on a very low protein diet. Certainly, hereditary factors have some part to play in this. But heredity is not the whole answer, as demonstrated by the fact that Chinese and Mexicans get gray hair and even become sleek-bald when they move to the United States and adopt western habits of eating. Studies of the nutritional habits of these people have shown that their diets are very high in vitamins, especially vitamins C and B; minerals; trace elements, especially iodine; and essential fatty acids—ail very important for healthy hair growth.

If you’d like to undertake a program of feeding your hair from within, please don’t stuff yourself with huge amounts of animal protein. Too much animal protein may cause metabolic disorders, self-intoxication and hardening of the arteries with resultant impaired blood circulation—in other words, it may create the very problems you are trying to remedy. Enough, but not too much, should be the rule in regard to protein.

*111\58\2*

10′-15′, right iris: 45′-50′—commencing directly at the iris-wreath.

With heart signs, as with the entire iris, a lightening of colour signifies over-activity

= inflammation, and darkening indicates underactivity = weakness.

With all cardiac conditions, more so than with other organ signs, one has to consider the entire iris, and in particular the blood zone, brain, liver, lung and kidney areas. In addition, the finger-nails, legs and lips should be examined, since these often give early indications.

Heart signs for individual conditions are:

1. Endocarditis (inflammation of the endocardium): shows small white flakes in the heart area, or short white lines, especially close to the iris-wreath in the blood zone.

2. Myocarditis (inflammation of the heart muscle): is recognised by the appearance of small white flakes or clouds in the muscle zone: in the middle of the heart area, or further outwards towards the skeletal zone. These signs are very often apparent during the course of, or following an infectious disease, and must then be regarded as very grave indications. These signs are also frequently to be found with so-called ‘rheumatic’ patients. With such people the whole iris is too white, and these patients complain of generalised rheumatic pains, e.g. in shoulder, neck, back muscles, etc.

With such patients one often observes merely a thick, white zigzag line in the heart area which shows a small white flake at its termination in the mucous membrane zone. In such cases it will be found that the patients suffer severely from changes in the weather, and complain of great uneasiness and anxiety from stormy weather.

3. Pericarditis (inflammation of the pericardium): the pericardium registers approximately at left iris: 15′-17′, showing clouds in the lower margin of the heart signs when there is pericarditis. Since pericardial disease very easily gives rise to adhesions, one should always give careful attention to the fine white adhesion-signs (transversals) in this area, as well as to the adjacent pleural area below.

4. Cardiac neuroses: are widely spread in these times of increased tensions, haste and anxiety. Since in many cases of neurotic disturbance no clinical evidence can be found, iris-diagnosis becomes an especially important help.

In the early stages, nervous disturbances of the heart are shown by a very fine white line which runs out over the heart area from the iris-wreath, roughly horizontally. The patients complain of disturbance and sudden palpitations (the heart beats ‘up into the throat’). If this white line takes on a more acutely zigzag form, then stronger disturbances are probable. Patients with such signs usually have enlarged ‘moons’ on the finger-nails.

If near these fine white lines contraction rings are observed (i.e. nerve rings), which interrupt at the heart area, then there is a risk of cardiac spasm, resulting in the appearance of praecordial anginal attacks.

If the nervous heart disturbances have existed for some time, then the fine white lines become darker, i.e. grey to black; usually there is only a dark line to be seen, known as ‘irritation line’. Patients with such signs have constant heart disturbance as a result of irritation, grief or fear. If the lines become somewhat wider apart and give rise to lacunae, then the patient will complain of an anxiety state. If these signs lie at about 10′-12′ (left iris) then according to Frau Flink there is a condition of heart oppression and dyspnoea; if they lie at 16′-17′ then agitation and excitement will give the patient the feeling as if the heart was being strangled. Patients with these signs have nail ‘moons’ which are too small, or are wholly or partly missing.

5. Cardiac myasthenia (heart muscle weakness): is shown by a darkening of the heart area, appearing as dark wisps, clouds, and closed or open weakness-signs. The iris fibres no longer run radially, but more or less in arc form. For so long as the dark signs are small (narrow) and the fibres only slightly separated, then the condition is one of simple debility of the heart muscle, but if not treated this becomes a heart muscle weakness. The weakness-sign itself is usually evidenced above or below (also above and below) by a light well-defined arc. Frau Flink interpreted a well-defined upper arc as a tendency to asthmatic symptoms, which arise on slight exertion. In the case of a lower arc, then according to Frau Flink the patient can eat only little.

When in addition to these signs the stomach and intestinal zones are coloured brown, then every excitement affects the stomach of such a patient.

The wider the separation of the fibres in the muscles zone of the heart area, the greater the tendency to cardiac dilatation. If the weakness-signs are closed, then according to Frau Flink, the condition should be regarded as one of cardiac dilatation and cardiac weakness. Such patients must always be treated as for a heart condition, especially with feverish infections—e.g. rheumatic and renal conditions. If the weakness sign is not closed, but is open as far as the iris margin, then the condition is one of hypertrophy (Frau Flink). If besides the weakness-sign in the heart area one finds an overgrowth of the nail-quick on the fingers, then the patient suffers cardiac anxiety and oppression. In children this is a sign of fearfulness.

As is well known, a heart muscle-weakness leads to stasis in the systemic and pulmonary circulation. With left cardiac insufficiency this gives rise to dyspnoea with cough and catarrh, whereas with right cardiac insufficiency there is liver and portal stasis, haemorrhoids and hydropericardium. Thus, with weakness-signs in the heart area, one always pays attention to the lung areas. Stasis here makes the lung fields appear dark, the patient complaining of cough and dyspnoea, especially at night. Cardiac asthma and pulmonary oedema are possible dangers.

In proportion to the extent of cardiac weakness, stasis signs may be found in the areas for liver and kidneys, together with a dark neurasthenic-ring, haemorrhoidal signs in the rectum area, and stasis signs in the extremity areas. These areas become dark and the iris fibres separate.

Small lacunae in the heart area are sometimes found even in small children, in which case the cause is attributable to the mother. If during pregnancy the mother suffered much irritation and worry then the child is liable to have a heart-area lacuna. Such children are very nervous, and remain affected throughout the whole of life.

6. Cardiac valve lesions: show in the iris as small black points in the heart area in the vicinity of the iris-wreath, lying in the upper part of this area. There may be one to three black points. The appearance of a fourth point is a presage of death. Struck wrote on this matter in

Iris-Korrespondenz as follows: a visible fourth heart point renders hopeless any measures to counter impending death. This iris indication is diagnostic of the last stages of struggling man.

Another sign in the heart area which is difficult to interpret is the black wedge-sign. It lies in the blood zone with its base to the iris-wreath and the apex pointing into the muscle zone. It indicates that the patient may suffer a sudden cardiac arrest.

If in the heart area one or more black points are observed in the blood zone (indicating valvular defects), or in the muscle zone (indicating callosities), then one must not neglect to make a thorough examination of the mouth-throat area. Dark points in this area will suggest that the heart damage is secondary to a focal infection arising in the teeth or tonsils (angina, diphtheria).

7. Coronary sclerosis: was earlier the privilege of elderly and aged persons. Today, however, it not infrequently affects persons between 30 and 50 years of age. In the iris it is recognised by the following signs: At 15′ the iris-wreath shows a thicker white margin, conjoined with the lower arc of a cardiac weakness sign, and extending with it to the muscle zone.

Sometimes a fine white line can be observed running obliquely from this white margin to the spleen area. This line is a sign of threatened cardiac infarct.

8. Roemheld syndrome: is shown in the iris as a strong dilatation of the colon (i.e. iris-wreath) in the direction of the heart area. This dilatation may lie above or below the heart area.

9. Coloured flecks in the heart area: Such colour or toxin flecks in the heart area are small light to brownish-red pigment flecks. These indicate that the patient suffers mentally, and such patients tend strongly to brooding (melancholy, true depression, religious delusions, etc.). These signs very often go together with abdominal disturbances —usually affecting persons of

Sepia-type (yellow glistening of the nose, dirty ring around the mouth, unable to get going in the mornings yet gay and lively in the evenings.)

*20\78\2*

*64\177\2*

A baby’s first visit to the doctor’s office is usually between two and four weeks after birth and this visit serves several purposes. For one thing, it gives the parent, the doctor, and the child an opportunity to meet together and begin a relationship. The parent can get to know the doctor and the customs of the practice, the doctor can get basic information about the family, and the child’s general health can be evaluated. At this first visit the doctor will take the baby’s physical measurements. This initial information is necessary so that the child’s development can be followed from the beginning of life. The doctor will also examine the baby for abnormalities. Some babies are born with physical problems and abnormalities that are obvious right away. Other inborn problems do not show up until a few weeks after birth.

At the first visit, the doctor will ask questions about the parents’ health and health history as well as examine the baby. Some medical problems can be inherited, and some can run in families. It is important for the new baby’s medical record to show such background information. If the child later shows signs of problems that have appeared before in the family, the doctor will be able to make a diagnosis more quickly.

The first visit will also include checking to see that the umbilical cord is healing as it should, that the circumcision (if it was done) is healing, and that the child has had no ill effects from labor and delivery. Feeding schedules, vitamins, and immunizations will be discussed as well. Usually a schedule of regular return visits is made up at the first visit. The number and spacing of the visits will depend on the baby’s health, the parents’ needs and wishes, and when the baby should have immunizations.

If the baby’s health and development seem to be normal, some or all of the later visits may be handled by a pediatric nurse practitioner, a physician’s assistant, or another health professional. These people are specially trained to be an extension of the doctor. They can work with you to clear up any questions you have about taking care of your baby. Of course, any question or problem that the nurse or assistant cannot handle is referred to the doctor.

Later visits

As the child grows past babyhood, questions will come up about how to handle toilet training, rivalries with brothers and sisters, obedience, temper tantrums, and the like. These are areas where your doctor and the staff can help. Go ahead and ask about them. A child’s doctor is not concerned only with the child’s physical body. Social and psychological development is also a part of every child’s growth and affects health in many ways.

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Five to 10 percent of children who bed-wet have a physical disease, such as an infection or abnormality of the urinary tract, diabetes, or a neurological (nervous system) disorder. If a trained child suddenly begins bedwetting, the cause may be physical. If bedwetting develops a year or more after night training has been established, or if a child wets himself both day and night, a physical disease is likely.

However, most cases of bedwetting are not caused by an identified physical disorder. Some cases seem to be hereditary, with brothers, sisters, and parents also having been bedwetters. Some are caused by overemphasis by the family on toilet training. Others are caused by taking children out of their night nappies too soon or by waking children to urinate in an effort to train at night. Some children have emotional problems that cause bedwetting. Still, the cause of many cases of bedwetting remains unknown.

Signs and symptoms

A child who frequently and consistently wets the bed after age five has a bedwetting problem.

Home care

Before beginning any home treatment of bedwetting, see your doctor. The doctor can perform tests to determine whether bedwetting is being caused by a physical disease, such as a urinary infection or diabetes.

If the doctor finds no physical cause, then the best home treatment is to ignore bedwetting as much as possible and to try to avoid it. Do not take a child out of night nappies until the child consistently remains dry. Do not make a big fuss about daytime training. Do not try to shame a child into remaining dry at night.

Consult your doctor before using devices which awaken the child as urination starts. Withholding liquids during late afternoon and evening hours is not usually successful and may seem like punishment to the child. Behavior modification techniques (rewarding success and reacting neutrally toward failure) rarely work. Rubber sheets and plastic pants are helpful until the child stops bedwetting. Until then, patience, calmness, and understanding may be the best treatment.

Precautions

• Do not let a minor problem like bedwetting become a major destructive factor in your relationship with your child. Anger and frustration between parent and child are more costly than extra laundry.

• Do not allow other children to taunt a bedwetter.

Medical treatment

Your doctor will insist first upon conducting a physical examination and urinalysis. The doctor may suggest X rays of the urinary tract or consultation with an urologist; imipramine (an antidepressant) by mouth at bedtime for a trial period; dextroamphetamine, phenytoin, or caffeine also on a temporary basis; or a program of behavior modification. Although many of these treatments are not always effective, they may be worth a try.

*20/84/5*

1. Foods containing both protein and fat

2. Foods containing fat only

You will be advised by your dietitian how many servings to use from the choices in these lists.

1. Protein and fat containing foods:

These foods are listed below and are separated into those with a high protein, low fat content and those with a high protein, high fat content. As much as possible choose foods with the lower fat content and remove any visible fat before cooking. The method of cooking is also important. Try to avoid cooking with oil or fat or keep to a minimum.

Each of the following amount provides approximately 315 kjoules (75 kcals).

High Protein – Low Fat Foods
Amount
White fish
60g
Canned tuna/Salmon in brine
45g
Chicken (no skin), Turkey, Rabbit
45g
Lean Red Meat

(beef, lamb, liver, kidney, brains)
30g
Oysters or Scallops (12)
110 g
Prawns, Crayfish or Crab Meat
100g
Egg
1 large (65g)
Non-fat Cottage Cheese
100g

High Protein – Fat Foods
Amount
Fried Fish                     30g

Fried Chicken or Turkey             30g

Fried Veal Cutlets                 30g

Scallops – Fried in Batter             30g

Sardines/Herrings in Oil             30g

Tuna/Salmon in Oil                 30g

Full Cream Cheese                 30g

Nuts                        15g

Peanut Butter                     15g

Bacon – cooked                  l0g

2. Fat containing foods

These foods are concentrated sources of energy. Each of the following amounts provides approximately 150 kjoules (35 kcals) and is therefore interchangeable.

Food                         Amount

Margarine (polyunsaturated)             1 level teaspoon (5g)

Butter                        1 level teaspoon (5g)

Oil (polyunsaturated)                1 level teaspoon (5g)

Cream                        2 level teaspoons (l0 g)

French dressing                 2 level teaspoons (l0g)

Mayonnaise                    1 level teaspoon (5g)

Coconut, shredded, flesh             2 tablespoons

Olives – Green                 5 medium (30g)

– Black                 3 medium (20g edible part)

Avocado                     1/8, 10cm diameter (25g)

*105/54/5*

Comedians have been getting cheap laughs at the expense of the old ball and chain for as long as there have been women and steel. The funny thing is that as much as we joke about women driving us to our graves, the fact is that they actually add years to our lives. Finding a mate and being happily married is about as good as, if not better for our health than, quitting smoking, maintaining healthy blood pressure, eating a low-fat diet, or exercising more than 60 minutes a day.

Marriage may also be the key to disease survival, say experts. When researchers at the Veterans Administration Medical Center in Miami checked the survival rates of 143,969 men with prostate cancer, they found that those who were married lived almost three years longer than those who either were never married or were separated or divorced. Marriage is even better for your health if you do it only once. Researchers found that the trauma of divorce can be bad enough to negate the benefits of being remarried.

«But the findings are pretty consistent that being married has plenty of health benefits for men,» says study author Joan Tucker, Ph.D., assistant professor of psychology at Brandeis University in Waltham, Massachusetts. «Women traditionally do things for men that have health benefits. Things like improving his diet, reducing his risky behavior, providing stress relief, and helping him remember to take medication are all strong health supports.»

You are what you eat

Remember the tired old «an apple a day» cliche? Well, a 20-some-year study of almost 10,000 people in Finland confirmed it. Those who ate the most flavonoids, which are natural antioxidants found in many fruits and vegetables, had lower risks for all cancers and half the risk for lung cancer than those who ate the least. The clear winner for lowering lung cancer rates? You guessed it: apples.

But apples aren’t the only fruit of paradise for your health. A study of more than 2,000 Welsh men demonstrated that those who ate the most of any kind of fruit had half the risk for all cancers compared to those who ate the least.

Hell, it’s becoming so hip to eat healthy that major-league ballpark stadiums are even hawking fruits and vegetables next to the weenies and fries these days. Busch Stadium, the Astrodome, Dodger Stadium, Jacobs Field, Oriole Park at Camden Yards, Riverfront Stadium, and Shea Stadium all offer vegetables, garden salads, or fruit and vegetable platters. Others, including Candlestick Park and Wrigley Field, offer garden burgers and other healthful stadium snacks.

Laughing in the Face of Death

Though Bobby McFerrin almost drove us all to an early grave in 1988, with his incessant and insipid «Don’t Worry, Be Happy,» his advice was scientifically sound. If you can laugh in the face of adversity, you can live better, longer.

A Japanese researcher studying 157 men and women ages 65 and older has found a strong connection between maintaining a general sense of well-being and having low levels of total cholesterol, low levels of artery-blocking low-density lipoprotein (LDL) cholesterol, and high levels of healthful high-density lipoprotein (HDL) cholesterol. Lifting your spirits, he concluded, is important in caring for your heart.

Any moves that men can make to relieve their stress and lighten their moods will probably decrease their risks for heart attack, says Dr. Ichiro Kawachi of the Harvard School of Public Health.

*14/36/5*

Coffee also has the ability to raise blood pressure and damage our blood vessels. An Australian study was conducted on 18 healthy middle aged men and women who consumed 250mg of caffeine per day; this is roughly the amount found in two or three cups of coffee. The study showed that caffeine caused raised blood pressure and made the aorta less elastic and more rigid. The aorta is the largest artery in the body. People who drink coffee have higher amounts of the stress hormones Cortisol and ACTH in their bloodstream than people who don’t. These stress hormones can act as free radicals in our body and promote abdominal obesity.

Drinking unfiltered, boiled coffee can raise total cholesterol, LDL «bad» cholesterol and triglycerides if six or more cups are consumed per day. This effect is not present in filtered coffee, as it is the coffee oils found only in unfiltered or boiled coffee that are the culprit. Unfiltered coffee is more common in Europe; ground coffee is placed in a device that goes on the stovetop. Greek coffee is a type of unfiltered, boiled coffee. A more worrying fact is that coffee can raise homocysteine levels; four or more cups per day are required to have this effect. High homocysteine levels are a major risk factor for heart disease because homocysteine causes damage to artery walls and makes platelets stickier. Caffeine also promotes insulin resistance, meaning it makes us more likely to gain weight and develop diabetes. It is okay to enjoy coffee in moderation, approximately two to four cups a day.

*18/53/5*

«It’s hard to answer the question of whether death itself hurts because nobody really knows,» Dr. Iserson says. There can be pain and discomfort at the initial onset of a fatal event, especially with trauma or where a heart attack or a terminal illness is involved. «But it’s not likely that the final moments are very painful since the brain is shutting down. In fact, some dying processes, like drowning, can actually be quite peaceful,» says Dr. Iserson, a near-drowning victim himself. Here’s a quick look at how we die.

The big three. The three top causes of death-heart disease, cancer, and stroke-are also the easiest to understand. They cause death by shutting down vital organs. Most heart attacks occur because the heart is not getting enough oxygen through plaque-constricted coronary arteries. The heart stops, and the lights go out. Stroke is similar but occurs when the brain, not the heart, fails to get enough blood (which is why some doctors now refer to stroke as brain attack). And cancer kills by impairing the functions of the organs it invades.

Bang! You’re dead. Fatal events such as car crashes, falling from high places, or being shot cause trauma. More than half of the time, death in trauma cases is actually the result of injury to the heart, a major blood vessel, the brain, or the spinal cord, which causes blood loss and shock or massive injury to the brain or other vital organs. «That’s why the Safety Council folks are so adamant about people wearing seat belts, helmets, and other protective gear,» says Dr. Wecht. «Often if you can protect your head, you can stay alive.»

Bleeding to death. We tend to think of bleeding as something we do on the outside. But internal organs such as the spleen, liver, and lungs are like miniature blood banks. Rupturing such organs can cause massive internal bleeding, which takes precious amounts of blood out of circulation. A quick loss of 40 to 50 percent of your blood, which is approximately five to six pints in a 170-pound man or four to five pints in a 130-pound woman, is enough to cause coma and death. When too much blood is taken out of circulation, the heart speeds up to try to compensate for the loss. But once the pressure and volume get too low, the person falls into a coma, and the oxygen-deprived heart stops.

From gallows to swallows. Finally, there’s asphyxiation. One sure way to put your heart to rest and your brain to sleep for good is to cut off your air supply. When you can’t breathe, whether a chicken bone is lodged in your throat or cement shoes tied to your feet haul you down to drown, you experience asphyxia. During asphyxia, the pulse quickens, the blood pressure rises, and the amount of carbon dioxide in your blood shoots up due to the lack of new air coming in, or of old air being expelled. In a few minutes, the heartbeat becomes irregular from lack of oxygen and then stops.

Though death accounts are predictably grim, experts say that your final moments, if you are dying from a chronic, natural illness, probably aren’t all that bad-even if they aren’t exactly pretty. «In many cases, it’s just a slip out of consciousness,» Dr. Iserson says.

*25/36/5*

In the face of unhealthy pressures all around us it would be surprising if self-help methods unfailingly succeeded in improving the health of the individual. But how reasonable is it to place the burden on the individual when cigarette and alcohol advertising continue to bombard him or her from all sides? Can children be brought up to take control of or responsibility for their health when they learn so soon that what they try to do has so little impact? And supposing our man described above did cut out all his vices, what would he do instead – and might it not be even more hazardous?

So if individuals often cannot help themselves, how about the State lending a hand? This only works if the public is ready for the legal restrictions. Prohibition in the US did not work because people weren’t ready for it, yet penalties for driving when under the influence of drink and for not wearing seat-belts are apparently acceptable in the UK and elsewhere. Increased taxation on illness-producing habits works at least to some extent but research shows that real devotees simply give up other things (a healthy diet perhaps) to fund their addictions. Anyway, how far does a government have the right to impose its will on the masses? In other words there is a considerable ethical dilemma involved in preventive medicine. Should 1 be allowed to behave in any way I want, even if it affects others adversely? We all want to see laws such as those that prevent drunken driving, but a balance must be struck between measures like this, which benefit us all, and the reasonable liberty of the individual And then there is the question of individual freedom to act in ways that don’t directly affect others. It could be argued that the man who smokes heavily in private is doing society a favour in several ways. First, he is relieving the society of the cost of the drugs that might otherwise be consumed if he were not smoking and being tranquillized by his cigarettes. Second, his habit will kill him younger, and relatively quickly, by lung cancer (the average lung cancer victim lives only eight months from the discovery of the tumour) or heart attacks-the other major smoking disease. Both kill very quickly, so reducing his capacity to be a burden on society and its medical facilities. Lastly, he will probably not live long enough to collect his old age pension-another saving to society.

Looked at coldly, then, a case could be made for allowing people to do what they want if it kills them quickly and prematurely, if only because we have so many old people and too large a burden of chronically ill already.

My approach to prevention, then, is not a dictatorial one, mainly because after fifteen years of preventive medical experience I know that forcing it on people does not work. In the last analysis everyone must be free to choose his or her way of death-and most of us will do so whatever governments or health educators do. Some kill themselves with overwork, some on the road, some through their hobbies, while others smoke themselves to death, and so on. What I as a health educator can do is to make them aware of the dangers of these harmful pursuits so that they have a choice. I never tell a patient to stop smoking. That’s his or her choice. I don’t expect patients to tell me to stop driving my car-and that could kill me. What I do is to lay before them the facts as they are currently understood about the harmful effects of smoking. The choice is then theirs.

The difficulties come when another person’s behaviour affects my life and health adversely, and most of us agree that the State should step in here. But here again the problems are formidable. Should the State, for example, pass laws to prevent any form of extramarital sexual activity on the basis that it harms innocent third parties? Such a suggestion seems preposterous yet we happily go along with similar laws that stop people polluting the air of innocent third parties with cigarette smoke on far flimsier evidence.

*20/72/5*

«I was always thinking about what my next meal would be,» says the 28-year-old Glenwood, Iowa, native. «When I’d go out to eat, I’d try to pick places with the biggest portions or the most courses. I especially liked Quarter Pounders with Cheese, nachos, pizza with extra cheese, and anything with Alfredo sauce.»Always on the hefty side, Kelly couldn’t stop eating—or stop: gaining weight. By Christmas 1997, she had reached 220 pounds. «In a picture with my husband and my two kids, my little 1-year- old looks like a doll in my huge lap,» she recalls. «I thought to myself, ‘I don’t want my children to have a fat, unhealthy mother/»

It was time to change her life.

Using information she gathered from magazine and books by weight-loss guru Richard Simmons, Kelly determined that she would need to trim her daily calorie intake to 1,400 in order to achieve and maintain a healthy weight.

Obviously, that was far fewer calories than she had been consuming. To help herself stay on course, she began keeping a food diary. Kelly would write down every morsel she ate and every drop she drank—usually before she ate or drank it. She also noted the calorie and fat content of each item.

To help herself burn calories, Kelly started using a Health Walker, a nonimpact machine that allows the legs to swing back and forth to simulate striding. At first, she worked out for 15 minutes per session, then gradually built up to an hour a day—a schedule that she still maintains. She also does strength training twice a week, exercises to a kickboxing video, and jumps rope.

In 1 year, Kelly lost 95 pounds. And the weight hasn’t come back. For that, she credits her food diary. «I never really knew how much I was eating until I starting writing it down and reviewing it,» she explains. «Even though I’ve learned what I can eat and how much, I still keep a diary. It’s a good tool for helping me maintain my present weight.»

WINNING ACTION

Keep a diary. Buy a small spiral-bound notebook and carry it with you. Immediately after meals and snacks, write down what you’ve consumed, along with the food’s fat and calorie content. Studies show that people tend to be more true to their diets when they keep a record of what they eat. At first, you’ll probably be amazed at how much—and how often—you eat. Later, you’ll be proud of the positive choices that you’re making.

*14\89\8*

most of it is now made by chemical processes). Carbon black is banned in the United States. Apart from their potentially carcinogenic effect, many of the azo-dyes have been reported as causing sensitivity reactions, especially in children.

*409\180\8*

The most likely explanation is that you are developing a new sensitivity to something allowed on the exclusion phase – probably something you are eating a lot of. Look at your food record for the exclusion phase, and try to work out what this might be – foods you ate plentifully before the diet are also suspects. Cut out any such foods and see what happens. Meanwhile make great efforts not to eat too much of any one food. Introducing some rare foods – may be the answer, but don’t overindulge in these either or you may spoil your chances of doing a rare-food diet later.

If you get better again, and stay better for two or three days, then you can begin the reintroduction phase. Continue to vary your diet as much as possible during this period – if you can, go on to a rotation diet. If you can’t manage a four-day rotation, then three days will be some help at least.

If you are still not well, or if you have unclear results during the reintroduction phase, then the best plan is to go straight on to Stage 3, preferably a rare-food diet. As a last resort, you could try an elemental diet but only with medical supervision.

*262\180\8*

If neither parent has allergies, but one or both come from families with a history of allergic disease, then there is also an increased risk of the child being affected. However, almost a third of atopics are born into families where no allergic symptoms have ever been noticed. So predicting which babies will be prone to allergies by looking at their families is, at best, an inexact science.

A more accurate prediction can be made by laboratory tests that measure the amount of IgE being produced by the child. The level can be measured by taking a sample of blood from the newborn baby, or by measuring the IgE level in blood from the umbilical cord. A high level indicates that a child has a greater chance of going on to develop allergies. However, this test requires very sensitive chemical analysis, and is unlikely to be available in most hospitals.

*315\180\8*

The evidence for the second point of view is limited, but certainly stronger than that for the first. A Swedish study of 19 bottle-fed babies with colic found that over 70 per cent improved when changed to formula feeds that did not contain whole cow’s-milk protein. The same research team found that cow’s milk in the mother’s diet could cause colic in breast-fed babies.

Another trial carried out in New Zealand, and widely quoted in the medical literature, apparently failed to find any link between the mother’s diet and colic in breast-fed babies. In fact there were several serious flaws in this trial, and its findings have been widely misrepresented anyway. Twenty mothers were involved, and the main focus of the trial was the role of cow’s milk in causing colic. The mothers were asked to avoid cow’s milk, and were then challenged with it in a disguised form, so that they would not know when they were drinking milk and when they were drinking the ‘control’ substance. Soya milk was used for this ‘control’ without any investigation of whether the babies might be sensitive to soya proteins. The mothers were given milk-with-soya to drink for two days or soya only for two days – there was an interval of two, four or six days between the milk challenges. Experience suggests that this may not be long enough to detect changes in the baby’s symptoms -although some babies recover within 24 hours of the mother eliminating offending foods from her diet, others can take many days, sometimes as much as two weeks, for their colic to settle down. The whole trial only continued for 12 days.

*264\180\8*

Food allergy usually persists for many years, often for a lifetime, even though the food is scrupulously avoided. Food intolerance, on the other hand, may well disappear if the food is not eaten for a few months. But it will tend to recur if the food is ever eaten regularly again.

The symptoms of food intolerance are extraordinarily varied and affect almost every body system. The illustration opposite summarizes the major symptoms that are generally agreed upon. Most doctors working in this field would probably wish to add various other symptoms to this list, and there is intense debate over symptoms that might or might not be attributed to food.

An important aspect of food intolerance is that the symptoms are not constant – they tend to come and go and vary in severity. Non-food factors may play an important part, particularly stress, which can greatly exacerbate the symptoms. One of the most curious facets of food intolerance is that the person concerned often has a craving for the particular food or foods that cause the problem. In such cases – which account for as many as 50 per cent of food-intolerant patients – eating the food initially gives a sense of great well-being.

*16\180\8*

At first the couple may find this game fun, but after a while the repeated message and the image of themselves in the mirror quite likely will begin to grate and arouse other feelings. The game may then seem silly, and they may even want to stop. It is hoped that their motivation, fueled by a desire to achieve a better sex life and a better relationship, will inspire them to suspend judgment and see the game through. They may also become embarrassed, giggle uncomfortably, or get in touch with sadness or anger. Yet by the time they tire of looking at the mirror and shut off the recording, they will have reached a higher plateau of relating, being imbued with the realization that it does not matter whether or not they are the fairest couple in the world—only that they truly love one another.

*121/196/1*

Aim: Use of paradoxical mirroring of wife’s headache maneuver by husband in order to provoke an authentic confrontation.

Game Plan: Like the passive, the hysterical woman gets headaches—often migraines—and uses them as an excuse to refuse sex. However, the hysteric’s headaches^ju?f øÿãåsevere and are sometimes accompanied by fits, «I said I haye a headache, and I mean I have a headache! Don’t you have any consideration or respect for me at all?» The angrier variety of hysteric, therefore, will not respond to the game called «Headache» (see chapter 3) nor to any pleas, demands, or discussions. That type needs a more forceful brand of emotional communication.

In this present game the husband imitates the wife’s behavior in a way somewhat like what children do to one another. He does not ask for sex from her anymore but rather waits until she asks something of him and then refuses—saying «I have a headache.» It can be a small or large request by her which elicits this response. For example, they may be watching television and she may say, «Would you change it to ‘Wheel of Fortune’?»

*96/196/1*

Then he gently bites the calf of her left leg, and asks if that is all right. If so, he licks the area in back of the left knee. Then he bites the calf of her right leg. Then he licks the dimple in back of the right knee. Then he bites the back of her left thigh, then the back of her right thigh. Then he bites her left buttock. Then he bites her right buttock. Then he licks her spine, from her waist all the way up to her neck to where her hair starts.

If by any chance she does not like any of this, then he should persuade her to try it anyway, even if it feels strange or offensive—for only by trying it will she reap the benefits of the massage. It is her depression, he should tell her, that is offended by the massage, for it does not want to receive pleasure, does not feel worthy of it, needs always to negate everything. To overcome this depression, she should go with the massage—even it if does not at first seem enjoyable.

*71/196/1*

The wife struts past him, smiling mysteriously, then returns to the desk again to dust off the top. Naturally, she must stoop to do this, and it is also of course necessary for her to wiggle her rear as it protrudes toward her husband. Her naked behind flexes this way and that, and now it is only a few feet from his face. He can smell a new brand of perfume she has apparently dabbed onto her secret region and can hear her humming something softly under her breath.

The wife continues to cross smilingly before him and to stoop provocatively in front of him, wiggling and swaying and dipping and squirming while fooling with the furniture and fixtures, until he cannot help but ask, «What are you doing?»

«Oh, just looking for something I once lost,» she demurely replies.

«For something you once lost? I see.» «You see? What do you see?» She wiggles her rear some more.

At this point he will begin to feel both aroused and frustrated. He may respond by jumping up right then and rushing forth to take her from behind. Or he may get angry and snap at her, «Why don’t you put on some pants? That’s disgusting. You look like a whore.» Or he may walk out of the room to avoid this seduction, which arouses feelings he has long strived to avoid and does not want to deal with.

*46/196/1*

Generally only one partner is feeling boredom, but on occasion both are. One of my patients, a man in his late thirties, complained to me of being bored by his marriage: «My wife is a very boring lady. She’s a complainer. All she does is complain, complain, complain. But if I say anything to her about her constant complaining, she accuses me of not being empathic enough. She just wants to complain but never wants to really examine herself. She can never be there for me. Even when we .have sex, which isn’t very often, I feel she’s just sort of taking a break between complaints.»

This patient’s boredom was a defense against both the anger he felt toward his wife for constantly complaining and shutting him out and the taboo wishes and fantasies he harbored of a sexual or violent nature. His wife was doing to him what she did to every other man (creating distance and desex-ualizing the relationship), and the patient was doing to her what he did to every woman (subtly rejecting her emotionally, and depriving her by withholding his anger).

*21/196/1*

One clarification of the difference between the two models is provided by Wachtel’s consideration of the unconscious processes. He argues that these processes may be viewed as either independent variables or as dependent variables.

When these unconscious processes are considered as independent variables, it is assumed that they are tendencies within the person, locked in the past and unresponsive to current events in the person’s life. They exert a pressure unchanging in quality or intensity. Behavior is the dependent variable in that these unconscious forces influence feelings, perceptions, and actions. Changing the independent variables, the unconscious processes, thus is the only way to change the dependent variables, the behaviors. Insight, conflict resolution, working-through, abreaction, and other methods stemming from the Freudian paradigm are the only means of altering the behavioral disturbance, in a meaningful way.

But when considered as a dependent variable, it is the reverse: the person’s action and life-style influence the unconscious processes. Although the unconscious processes originally may have caused the person to act in certain ways, to form a given life-style, it is these actions and their consequences that now perpetuate and maintain these very same unconscious forces. By deliberately changing specific behaviors (now considered the independent variable), not only may various symptoms be made to disappear, but also the (dependent) intrapsychic forces maintained by these behaviors may be changed. Following this line of reasoning, changing behaviors does lead to «deeper» change even in the Freudian sense of these words. The technology of behavior therapy is the most effective means for achieving these behavioral changes.

*231/187/5*

Initially the therapeutic goal is for the patient to achieve success in the two-year, real-life test. During this period, hormonal reassignment is instituted. With the exception of deepening of the voice in the female-to-male transsexual, hormonal changes are reversible if the test proves to the patient that his or her transsexualism does not warrant further pursuit of reassignment.

The following male-to-female hormone dosages have been found satisfactory: Estinyl (ethinyl estradiol) 0.02 mg. daily, or Premarin (conjugated equine estrogens) 0.6 to 1.25 mg. daily. Before gonadectomy, the treatment would be every day for a minimum of four to eight months. Following surgery, treatment should be cyclic, for the first three weeks of each month, missing the fourth week.

An alternative to the foregoing would be a commercial product combining estrogen and progestin, for example: Lo-Ovral 1 mg. (norgestrel 0.3 mg. and ethinyl estradiol 0.03 mg.), or Ovral (norgestrel 0.5 mg. and ethinyl estradiol 0.05 mg.). The dosage of those preparations is one tablet daily for the first three weeks of each month.

If the patient prefers not to accommodate to a daily oral therapy, but to an intramuscular one instead, then the following could be prescribed: Delestrogen (estradiol valerate) 5 mg. plus Delalutin (hydroxy-progesterone caproate) 62.5 mg. every two weeks. Another intramuscular combined treatment could be: Depo-Estradiol cypionate 1 mg. plus Depo-Provera 25 mg. every two weeks.

After four to eight months of biweekly therapy, the same dosages could be given once every three or four weeks.

If in the preoperative state, the above dosages prove insufficiently effective after four to six weeks, then the dosage could be doubled. Otherwise, the rule is to use the dosage that is thought presently to be replacement therapy for normal women.

Hormonal feminization of male-to-female transsexuals promotes a female appearance insofar as it brings about a feminine redistribution of subcutaneous fat. It also stimulates breast enlargement (gynecomastia), and may somewhat retard the growth of facial and body hair.

Hormone dosage for female-to-male transsexuals which has provided satisfactory results is: Delatestrel (testosterone enanthate) 400 mg. intramuscularly once a month.

Hormonal masculinization of the female-to-male transsexual induces suppression of the menses, but breakthrough bleeding may eventually occur. Permanent suppression requires castration (ovariectomy) or hysterectomy, preferably both. Other effects of hormonal masculinization include deepening of the voice and growth of facial and body hair. The shrinking effect on the breasts is minimal. The clitoris enlarges, but not sufficiently to permit masculinizing surgical reconstruction as even a very small micropenis. Its erotic sensitivity increases. The feeling of orgasm is reported as increased with no loss of the female capacity for multiple orgasm.

The above hormonal dosage does not prevent menopause-like symptoms following ovariectomy. Control of such symptoms may require additional estrogenic therapy with gradual withdrawal over a period of three to six months.

During the period of the real-life test, male-to-female transsexuals may take voice retraining. They may also begin electrolysis for removal of facial hair and perhaps body hair also. These services are provided by trained and certified experts, usually in private practice, not in a hospital.

In some cases of female-to-male transexualism, mastectomy is necessary during the period of the real-life test, especially if the patient works as a male in a job in which exposure of a female chest contour, however disguised, is incompatible with continued employment.

A few patients need cosmetic and etiquette counseling, but most are masters of these arts without special help.

To a variable extent, local legal advice may be needed during the period of the real-life test, especially if a divorce is necessary, and also with regard to change of name and sex on documents. Complete legal recognition of the change of sexual status, in the form of a reissued birth certificate, varies according to legal jurisdiction. Usually a medical statement is needed for the legal change, after the sex reassignment has been completed.

The amount of counseling needed during the real-life test varies according to individual need and traveling distance. Patients from far away need a local counselor working in collaboration with the main center.

Some transsexuals disown their families, and others are disowned by their families. The ideal of rehabilitation is to have the reassigned transsexual acceptable to the family, however limited the personal contact. Therefore, family counseling is also a prerequisite. The siblings, especially the young ones, should not be overlooked in the overall plan of counseling. Non-family members, including the lover, personal friends, teachers, and employers also may be given information and advice on how to contribute to the transsexual’s total rehabilitation.

Sex reassignment surgery is too highly technical a procedure to be discussed here in detail. Male-to-female surgery has been reasonably well perfected, though in some cases there are residual problems of contracture and constriction of the vaginal canal requiring an additional operation. The end result can be convincingly feminine in appearance and function. Female-to-male surgery of the external genitalia presents insurmountable problems as great as in the case of congenital aplasia of the penis or accidental amputation of the penis. A plastic surgeon can make a penis of grafted skin, but it requires from five to fifteen surgical admissions, and the end result is a penis that is numb, unable to erect, and subject too easily to urethral constriction and urinary infection. For sexual intercourse, such an organ can penetrate the vagina only if supported, as in a hollow dildo. Thus, there is very good reason for the female-to-male transsexual to settle for a strap-on prosthetic penis and to avoid the expense, pain, and poor result of very time-consuming surgery.

Female-to-male transsexuals who undergo genital surgery do not lose the clitoris and so retain the capacity for orgasm. In fact, the orgasm is enhanced under the influence of androgen therapy. Male-to-female transsexuals lose the kind of ejaculatory orgasm they once knew, but without regret, for it is replaced by a climactic feeling which, even though more diffuse, satisfies them all the more because they are able to satisfy a male partner.

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