If you’ve ever wondered how, precisely, people die, we can tell you the one place you should not look for answers: television. On TV, sometimes folks die an agonizing death from the slightest case of sniffles. Other times, the helicopter slams into the bridge and the whole A-Team emerges unscathed.
“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*
Tags: General health
Most people know that if they stopped smoking, drank very moderately, ate the right food, exercised regularly and got enough sleep they would live longer and be healthier. Yet most of us continue to do all or most of the things we know we shouldn’t. True, mortality rates for heart disease and strokes have been falling in the US (heart attack deaths have fallen by 30 per cent over the last 10 years), but the number of people having heart attacks has not fallen as dramatically. Clearly at least some of these improved statistics are the result of better medical care, once a heart condition is apparent.
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.
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*
Tags: General health
For Kelly Jens, food was once an all-consuming passion.
“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*
Tags: Weight Loss
Colourings, E100-180. These include both natural colourings and synthetic ones. Some of the ‘natural’ colours are extracted from grass, nettles and other plants, or produced by a chemical process. There is a new trend towards colours produced by fungal cells or plant cells in culture – because these too can be labelled ‘natural’, even though we would not consider eating the items from which they are derived. Such colours are being sought as a replacement for the synthetic colours known as azo-dyes, which have caused much concern. Azo-dyes include colours such as tartrazine, sunset yellow and amaranth – a complete list is given at the end of this section. Eighteen of these artificial colours are permitted in Britain – of these, eleven are banned in the United States, and six are not approved by the EEC, because they are suspected of being carcinogens. Two of the ‘natural’ colours – caramel (E150) and vegetable carbon black (E153) – are also potential carcinogens (some forms of caramel appear to be safe but not others
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*
Tags: Allergies
If you go through the withdrawal symptoms, feel greatly improved for a while, but then begin to go downhill again, this is a rather bad sign. It does not happen to many people, but if it does happen to you then you need to think very carefully about the situation.
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*
Tags: Allergies
The risks of a child developing allergies can be gauged, very roughly, from the health of the parents. If one parent has allergic symptoms, the chances of the child being atopic – predisposed to allergy – is 20-35 per cent. If both parents have allergies, the likelihood rises to 40-60 per cent. Where both parents are affected in the same way – if both have asthma, for example, or both have rhinitis (runny or congested nose) – then the chances are 50-70 per cent.
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*
Tags: Allergies
Is there any scientific evidence for either of these opposing views? The main piece of evidence for the ‘tense-mother/crying-baby’ idea is that first babies tend to cry more than subsequent ones – doctors infer from this that the mother’s inexperience is an important factor. However, there is no data to show that first babies really do cry more – it is just a subjective impression. One study that investigated this idea found that there was little difference between first babies and later ones. Even if a first baby does cry more, the link with maternal anxiety is still only a speculative one, and there are other, far more plausible explanations.
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*
Tags: Allergies
Whereas food allergy reactions can be provoked by quite small amounts of the food – a smear of the food from a badly washed saucepan for some highly allergic individuals – much larger quantities are needed to provoke the symptoms of food intolerance. Food intolerance is also far more insidious than food allergy: it is often difficult to say when it began, because the symptoms are very mild at first but gradually get worse. There are exceptions to this rule however, for in some cases a bad bout of influenza or diarrhoea can spark off food intolerance. As in Susan’s case, those with food intolerance tend to col-lea more and more new symptoms as the years go by, and become intolerant of more and more foods.
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*
Tags: Allergies
Now they should turn on a recorded tape of their own voices, which repeats over and over, “You are the fairest couple of all! You, you, you\ You are the fairest couple of them all! You and only you! No other couple will do! You and you and you\” This recording of their voices continues to play as they make love.
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*
Tags: Men’s Health
Players: Husband and hysterical wife. Activist: Husband. Setting: Home.
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*
Tags: Men’s Health