Сахарный диабет – заболевание, которое проявляется повышенным содержанием глюкозы (один из простейших сахаров) в крови. При значительном подъеме уровня глюкозы она начинает выделяться почками с мочой. Это сопровождается обильным мочеотделением, в связи с чем болезнь ранее описывалась как сахарное мочеизнурение. У больных появляется жажда, повышенный, «ненасытный» аппетит. Органы и ткани больных сахарным диабетом перестают усваивать глюкозу в необходимом количестве, испытывая дефицит в главном источнике энергии. Частично этот дефицит восполняется за счет жиров и белков, но если болезнь прогрессирует, больные впадают в коматозное состояние и погибают.

Чтобы выявить скрытый диабет, лицам, у которых есть основания заподозрить это заболевание, проводят нагрузку сахаром и определяют колебание его уровня в крови, а при необходимости исследуют и содержание инсулина в крови. Ранняя диагностика таких форм сахарного диабета и последующие диетологические мероприятия позволяют в большинстве случаев предотвратить прогрессирование болезни и избежать серьезных осложнений. Основным принципом такой профилактической диеты является щажение инсулярного аппарата поджелудочной железы, что достигается ограничением или исключением систематического потребления сладостей или продуктов, богатых легко и быстро всасывающимися углеводами.

Если говорить о причинах, по которым начинает развиваться сахарный диабет, то они на данный момент не выяснены до конца, но это заболевание относят к категории психосоматических, т.к. управление выработкой гормонов напрямую связано с функционированием нервной системы и именно при нарушении ее работы происходят различные гормональные сбои. Поскольку сахарный диабет любого типа, относится к психосоматическим заболеваниям, то, безусловно, в ходе его лечения нужно применять не только традиционные медикаментозные способы, но и активно пользоваться методами психотерапии и саморегуляции.  Наиболее эффективным из современных методов лечения сахарного диабета на сегодняшний день является именно метод применяемый в Центре лечения психосоматических заболеваний APERTAVIA , подробнее о котором Вы можете прочитать на странице Эффективные  методы лечения сахарного диабета.

При сахарном диабете страдают практически все органы. У больных инсулинозависимым диабетом риск осложнений выше, чем у больных диабетом второго типа.

Высокий уровень сахара в крови вызывает разрушение микрососудов – капилляров в различных внутренних органах, нарушая их кровоснабжение и функцию. В результате может развиться катаракта, кровоизлияния в сетчатку глаз и слепота. Очень часто поражаются почки, что приводит к хронической почечной недостаточности и уремии. Если затронуты сосуды нижних конечностей, возникают трофические язвы и гангрена пальцев и стопы. Нарушается функция периферических нервов – нейропатия, что приводит к появлению болей в ногах, а затем и к потере кожной чувствительности.

Сахарный диабет

Расстройство эндокринной системы организма, которое характеризуется синдромом гипергликемии, хронической формы, вызванное воздействием экзогенных и генетических факторов называется сахарным диабетом. Возникает он в результате недостаточного производства инсулина, что вызывает нарушение работы обмена веществ и других систем и органов, приводит к поражению сосудов – ангиопатия, нервной системы – нейропатия.

Распространенность этого заболевания среди населения составляет от 3 до 4 %. В мире насчитывается около 130 млн. больных, страдающих этим недугом. Сахарный диабет не имеет отношения к возрастным заболеваниям, он встречается во всех группах населения всего мира.

Диабет делится на два типа: инсулинозависимый – это тип сахарного диабета, который чаще всего проявляется у молодых людей. Его причиной является значительное отмирание клеточной структуры поджелудочной железы из-за вирусной инфекции или в результате ослабления иммунитета. По этой причине организм прекращает вырабатывать инсулин и больные нуждаются в пожизненной инсулиновой терапии, что и объясняет название «инсулинозависимый». Второй тип диабета – это инсулиннезависимый диабет. При этом заболевании инсулин наоборот вырабатывается нормально, либо даже в избытке, но организм не усваивает его в результате утраты восприимчивости к нему. Диабет второго типа является наследственным заболеванием, которым болеют люди старше 35 лет. Больные часто страдают ожирением, что иногда рассматривается как явный признак болезни.

Диабет обоих типов приводит к серьезным изменениям в организме. В ходе болезни кровообращение органов человека нарушается, что ведет к утрате их функции. Очень распространенное осложнение сахарного диабета – катаракта, которая приводит вначале к повреждению сетчатки глаза, а после и к слепоте. Другая проблема – почечная недостаточность. Влияние диабета на сосудистую и нервную систему ведет к образованию гангрены стоп и потере чувствительности в конечностях.

В современной литературе опубликовано огромное количество исследований, которые посвящены психологическим особенностям людей, страдающих лишним весом. На основании этих исследование можно точно предположить, что избыточный вес в основном является следствием психологической неприспосабливаемости. Необходимо отметить, что психология избыточного веса являет собой замкнутый круг: психологические проблемы – неприспосабливаемость – переедание – лишний вес – ухудшение качества жизни – неприспосабливаемость – психологические проблемы. Давайте обратимся к психологическим механизмам переедания и, прежде всего, вспомним, что после воздуха и воды, пища занимает третье место среди необходимых условий для существования. Желание покушать еще Эпикур, который вывел классификацию потребностей человека, отнес к числу естественных и необходимых желаний. Поэтому такое определение, как «психическая зависимость от еды» обладает таким же правом на существование, как и «психическая зависимость от алкоголя» или «психическая зависимость от наркотиков».

Синдром этой психической зависимости от еды включает в себя склонность к еде и способность достигать в процессе еды состояния абсолютного психического комфорта. Психическое влечение к пище характеризуется непрекращающимися мыслями о еде, отличным настроением от предвкушения скорого приема пищи, а при отсутствии изысканных лакомств подавленностью и неудовлетворенностью, не говоря уж о тех продуктах, которые необходимы в первую очередь. При этом, как правило, человек не осознает наличия у него психической зависимости от еды, вследствие чего, появляется эмоционально насыщенная привязанность, которая искажает мышление и снижает субъективную ценность не связанных с едой интересов. В конце концов, все это перестраивает психическую жизнь человека, его социальную ориентацию и межличностные отношения, в результате чего, все события рассматриваются с точки зрения отношений с едой, т.е. насколько, то или иное событие препятствует или способствует удовлетворению влечения. Способность достигать состояния полного психического комфорта, в каком-то смысле сродни наркомании, представляя собой не так переживание удовольствия, как уход от неудовольствия. Hе зря философ Спиноза, анализируя аффективную человеческую жизнь как патологию эмоций, сводит воедино три типа пристрастий: пища, алкоголь и сладострастье.

Эта ситуация имеет довольно простое психологическое объяснение. В повседневной жизни человек любой ценой стремится к психологическому комфорту, что удается не всегда, в результате чего, он погружается в какую-нибудь зависимость – алкоголь, курение, наркотики. При психическом неблагополучии или неудовлетворительных социальных условиях вариантом адаптации и источником положительных эмоций может стать переедание, которое лежит в основе зависимости от пищи. С другой стороны, исходя из современных представлений, избыточный вес является классическим, психологически обусловленным, расстройством, основанным на нарушениях пищевого поведения.

Стоит немного подробнее рассмотреть психосоматические расстройства и зависимость от пищи и ответить на вопрос: почему же человек, сидя на диетах, или не худеет вообще, или вес настойчиво возвращается снова и снова? А дело в том, что организм человека таким образом реагирует на свои ментальные и эмоциональные  состояния. Избыточный вес является защитой, блокировкой, кладезем лени и негатива. Хотя толстяки и считаются более добрыми, спокойными, уравновешенными и позитивными, но если вникнуть глубже, можно понять, сколько негатива, обид, установок и психологических блоков содержится внутри, большая часть которых – результат неадекватного реагирования на проявления внешнего мира. Вот почему избавление от избыточного веса будет эффективным, если, одновременно, избавляться и от лишнего мусора в голове и  душе.

На первый взгляд, парадоксальная ситуация, когда девушка уезжает учиться после окончания школы. Казалось бы, что общежитие, нехватка денег, питание в столовой никак не способствует появлению лишнего веса. Отчего же стрелка весов неуклонно добавляет килограммы? Потому что организм девушки переживает сильный стресс ухода из родного дома и защищается всеми доступными способами. Ведь еда — это удовольствие и защита. Этот же механизм срабатывает и при разлуке с любимым, и при утрате объекта любви и т.д. Также запуску процесса «накопления впрок», способствует гнев, общая подавленность, страх одиночества, чувство пустоты, сочетание опасности и активной деятельности, которое требует повышенного напряжения, страх перед людьми противоположного пола и т.д.

Во всех этих ситуациях пища играет роль замещающего удовлетворения и служит для безопасности, укрепления связей, ослабляет боль, разочарования, чувство утраты, как у ребенка, запомнившего с детства, когда для утешения ему всегда давали сладости.

Многие причины избыточного веса кроются в  детстве, когда мамы перекармливают детей, боясь, что они останутся голодным. Гиперопека также может быть причиной проблем с весом, потому что подросшие дети просто не умеют решать самостоятельно свои проблемы, не находят гармонии с окружающим миром. Следовательно, при появлении проблем они испытывают дискомфорт, а легче всего почувствовать мамину заботу — это наградить себя чем-то вкусненьким или хотя бы, просто поесть.

Причиной ожирения также может быть элементарная лень и отсутствие желания что-либо менять, страх перед жизнью,  нежелание взрослеть, непринятие ответственности за свою жизнь. Стыд также может компенсироваться избыточным весом, который служит, своего рода щитом от стыда, местом, где можно спрятаться.

Чтобы избежать подобных проблем, можно посоветовать снимать стресс всеми имеющимися способами, только не едой. Здесь могут помочь йога, танцы, секс, общение с друзьями и т. д. Поможет также коррекция своих мыслей. При каждом порыве покушать, задайтесь вопросом «Зачем? Мне просто скучно и грустно или я действительно хочу кушать?»

Главная задача состоит в том, чтобы разобраться со всеми установками, укоренившимися в сознании и полюбить себя, что очень просто и очень сложно одновременно. Полюбите себя и побалуйте шоппингом, интересными разговорами, общением с близкими людьми, красивым маникюром, новой прической.

Основные признаки и симптомы диабета І типа – это постоянная жажда в сочетании с частым и обильным мочеиспусканием, увеличение количества суточного объема мочи до 8-9 литров. Характерной чертой сахарного диабета І типа является значительная потеря в весе, достигающая 15 кг в течение месяца. Симптомом может быть общее недомогание организма, быстрая утомляемость, во рту появляется запах ацетона. Иногда признаком заболевания становится периодическое затуманивание зрения. У больного, страдающего сахарным диабетом, часто кружится голова, ощущается тяжесть в ногах. Косвенным симптомом считается длительное восстановление после инфекций, замедленное затягивание порезов. Часто наблюдается пониженная температура тела больного. Диабет часто подтверждают и другие симптомы, например, судороги икроножных мышц. Если вовремя не откликнуться на симптомы и оставить их без внимания, то у больного сахарным диабетом, может проявиться диабетическая кома, результатом которой является летальный исход.

Симптомы диабета ІІ типа, значительно не отличаются от названных выше, хотя развиваются гораздо медленнее. Первым признаком считается жажда и ощущение сухости во рту. Проявляются изменения на коже, такие как высыпания гнойничков, зуд на коже. Кома при сахарном диабете второго типа наступает очень редко.

Чтобы подтвердить диагноз не достаточно только симптомов, сахарный диабет устанавливается в результате двукратного исследования крови на содержание сахара.

Истинная причина диабета до настоящего времени неизвестна. Выявит её очень трудно, поскольку период скрытого развития заболевания может длиться сколь угодно долго. Одни учёные, относят сахарный диабет к издержкам цивилизации, поскольку во многих случаях его появление спровоцировано потреблением так называемой «цивилизованной пищи», избыточной пищи, а также пищей богатой легкоусвояемыми углеводами.

Другие учёные считают, что диабет имеет несколько причин. Очевидно, что речь идёт о нарушении обмена веществ, или же о нарушении гормонального баланса. Многие специалисты склоняются к тому, что в возникновении и развитии диабета не последнюю роль играют аутоиммунные нарушения, когда реакции иммунитета оказываются направленными против собственных тканей и органов.

Одна из основных теорий возникновения сахарного диабета – это теория наследственной предрасположенности и воздействия вирусной инфекции. Как это может быть связано с заболеванием?

Доказано, что причиной инсулинозависимого диабета является практически полное прекращение выработки инсулина из-за гибели бета-клеток. Происходит это на фоне особой генетической предрасположенности, которая при воздействии внешних факторов (например, вирусов) приводит к изменению состояния иммунной системы организма и в дальнейшем к развитию диабета.

Роль наследственности. Нужно понять, что наследуется не сам сахарный диабет, а только предрасположенность к нему. То есть, даже если она и есть, сахарный диабет может и не развиться. Иногда, чтобы предупредить возникновение инсулиннезависимого типа заболевания, достаточно сохранять нормальную массу тела.

При первом типе диабета картина несколько другая. Даже если никто из родственников заболевшего сам не имел сахарного диабета, то каждый из его родителей может иметь в своём генотипе ген, отвечающий за развитие сахарного диабета. Это не означает, что все дети в семье будут больны сахарным диабетом. Скорее всего, дети будут здоровы, поскольку вероятность того, что родитель с инсулинозависимым сахарным диабетом передаст ребёнку такой ген, очень мала (3-5%). Известны случаи, когда из двоих близнецов (у которых генетическая информация, полученная от родителей, абсолютно идентична), заболевал сахарным диабетом только один, а другой оставался здоровым. Так что даже при наличии в генотипе человека таких генов заболевание может никогда не возникнуть, если в организм человека не попадет определенный вирус.

Роль вирусной инфекции. Когда вирусы попадают в организм человека, то иммунная система организма распознаёт чужеродный материал и начинает вырабатывать антитела, которые должны уничтожить эти вирусы. Но при некоторых наследственных особенностях иммунитета, после того как будут уничтожены все вирусы, не происходит «отключения» защитных сил организма и антитела продолжают вырабатываться. Начинается атака на клетки собственного организма. В случае с сахарным диабетом первого типа этими клетками оказываются бета-клетки поджелудочной железы, т.е. клетки, вырабатывающие инсулин. Эти клетки гибнут, соответственно, количество вырабатываемого инсулина снижается. Когда клеток остаётся совсем мало – появляются симптомы сахарного диабета: выделение большого количества мочи, жажда, быстрая утомляемость, слабость, снижение веса, кожный зуд, медленное заживление ран и др.

Но гибель клеток не происходит мгновенно, хотя скорость её может быть неодинаковой у разных людей. Какое-то время (может быть, даже несколько месяцев) живые клетки ещё справляются с обеспечением потребности организма в инсулине, затем, по мере уменьшения количества этих клеток, снижается и количество вырабатываемого ими инсулина.

Именно недостаток инсулина приводит в итоге к развитию сахарного диабета первого типа. Но, от момента попадания вируса в организм, до того момента, пока у человека появятся симптомы сахарного диабета, иногда проходит достаточно много времени.

Диабет первого типа обычно развивается у молодых людей, у которых инсулин не вырабатывается в организме из-за повреждения или утраты бета-клеток поджелудочной железы.

В результате этого организм не может использовать глюкозу, и она накапливается в крови. В этом случae, почки начинают выводить избыток глюкозы с мочой. Один из первых симптомов заболевания – мочеиспускание – связан с тем, что организм старается как бы «вымывать» нарастающее количество глюкозы. Это приводит к постоянному чувству жажды и, следовательно, к потреблению большого количества воды. Со временем, почки перестают справляться с такой нагрузкой и возникают боли в животе, рвота, наступает обезвоживание организма. Когда организм не может использовать глюкозу для производства энергии, он расходует отложенный. Однако клеткам перерабатывать жир для производства энергии труднее. Поскольку клетки не в coстоянии «сжигать» жир полностью, в организме образуются так называемые кетоновые тела (ацетон). Они могут накапливаться в крови и, тем самым, вызывать разные осложнения. По мере накопления в крови кетоновых тел возникает состояние, называемое кетоацидозом. Для любого человека, больного диабетом, кетоацидоз представляет серьёзную опасность. Если кетоацидоз вовремя не распознать и быстро | не устранить, диабетик может потерять сознание и даже возможен летальный исход. Больные диабетом первого типа с самого начала находятся в зависимости от гормона инсулина, другими словами, они испытывают абсолютный инсулиновый дефицит. Именно потому такую форму диабета назвали инсулинозависимым диабетом, в отличие от инсулиннезависимого диабета второго типа.

Единственным методом лечения больных инсулинозависимым диабетом является пожизненное подкожное введение инсулина, который всасывается в кровоток и оказывает своё действие.

Такой диагноз предполагает постоянный контроль заболевания. Цель одна — максимальная компенсация диабета.

Диабет второго типа распространён значительно шире. Обычно он развивается у людей старше 40 лет, имеющих, как правило, избыточный вес. У человека может быть нормальное, низкое или даже высокое содержание инсулина, и, тем не менее, высокое содержание глюкозы в крови и диабет. Чем больше вес вашего тела, тем ниже восприимчивость к инсулину, т.е. клетки организма не могут использовать инсулин должным образом. Одной из причин этого является нехватки у клеток достаточного числа рецепторов для инсулина. В этом случае, глюкоза не может полностью проникнуть в клетки и постепенно накапливается в крови.

Если диабет находится в начальной стадии, в силах любого человека остановить его развитие минимальными усилиями. Лечение сахарного диабета второго типа предполагает соблюдение определённой диеты и увеличение интенсивности физических нагрузок. Кроме того, постарайтесь избавиться от лишнего веса, если он уже есть.

Если диета и физические упражнения не помогут скомпенсировать заболевание, врач, скорее всего, назначит сахаропонижающие таблетки.

Общее между диабетом первого и второго типов.

Очевидно, что оба типа сахарного диабета вызывают повышение уровня сахара в крови. Состояние, при котором уровень сахара повышается при нехватке инсулина или недостаточной восприимчивости к нему «тканей-мишеней», называется гипергликемией.

Гипергликемия является причиной развития основных симптомов диабета.

Иногда у больного диабетом уровень сахара в крови становится, наоборот, слишком низким. Это может произойти при передозировке инсулина, длительном перерыве в еде или после физической нагрузки. Такое состояние называется гипогликемией.

Очень высокая концентрация сахара в крови может привести к повреждениям различных органов, повлечь за собой тяжелые осложнения и даже привести к летальному исходу. Риск подобных осложнений со временем возрастает. Развиваться они могут скрыто, с течением времени постепенно достигая видимых проявлений. Вот почему при диабете необходимо постоянно контролировать уровень сахара в крови, проходить систематические осмотры и вообще тщательно следить за своим состоянием.

Если вы научитесь управлять своим организмом настолько хорошо, что сахар в крови практически всё время будет оставаться на нормальном уровне, то диабет из болезни просто превратится в особый образ жизни.

Если вы поймете важность этого вывода, будьте готовы к переменам в своей жизни и станете неукоснительно следовать рекомендациям врачей, то сможете избежать всех осложнений, связанных с сахарным диабетом

Конечно, этот образ жизни будет различаться в зависимости от того, какой у вас тип сахарного диабета.

Если действительно обнаружили сахарный диабет, то первой реакцией, возможно, будет состояние шока.

Вас может захлестнуть гнев, злость или отчаяние, появится чувство тревоги, подавленности, ощущение тоски, сожаление или останетесь полностью равнодушным. Быть может, это будет ощущение надвигающейся катастрофы или нереальности происходящего, может возникнуть страх перед якобы неибежным концом. Нахлынувшие чувства объяснить нетрудно, гораздо труднее с ними справиться.

Во всяком случае, не стоит забывать, что такая реакция на случившееся – естественна и даже необходима, поскольку она заставит мобилизовать все свои силы на борьбу с болезнью.

Ситуация, в которой оказывается человек, нова и неожиданна, поэтому организму необходимо определённое время для адаптации. Процесс привыкания для большинства людей неизбежен, зато после него обязательно наступят уверенность и спокойствие. А пока постарайтесь осознанно относиться к своим эмоциям. Попробуйте проследить их возникновение и развитие, понаблюдайте за собой как бы со стороны. Не позволяйте чувствам управлять собой.

И ещё, не забывайте, что время теперь приобретает особую ценность. Используйте каждую свободную минуту для приобретения необходимых знаний.

Для начала обзаведитесь необходимой литературой. Старайтесь быть внимательными и достаточно критичными.

Попробуйте узнать всё возможное о школе диабета, существующей в каждом городе. Преимуществами школы диабета являются диалоговая форма обучения, возможность доступа к необходимым материалам и, конечно, общение с людьми, у которых также был обнаружен диабет. Стоит помнить следующее: у каждого пациента – свой диабет, поэтому то, что подходит одному, не всегда подходит другому.

В случае заболевания инсулинозависимым сахарным диабетом человека обязательно обучат самым необходимым вещам в диабет-центре. Нужно узнаете, как вводить инсулин, как измерять уровень глюкозы в крови и корректировать дозы инсулина, как избежать гипогликемии и т.д. Конечно, останавливаться на этом ни в коем случае нельзя, ведь теперь это наука всей оставшейся жизни, которую придётся постоянно систематизировать и пополнять знаниями. Желательно, чтобы обучение прошли не только больной, но и вся его семья, это обеспечит уверенность в себе и укрепит внутрисемейные отношения.

Если есть подозрение на сахарный диабет, то врач обязательно даст направление на сдачу анализов, чтобы определить следующие показатели:

- уровень содержания сахара в крови;

- уровень содержания сахара в моче.

Для получения полноценных результатов нужно сдать кровь до приёма пищи, желательно утром, а также после того, как поели.

Перечень показателей.

Уровень содержания сахара в крови:

Норма – натощак (120 мг% (6,6 ммоль/л), после еды (140 мг% (7,7 ммоль/л).

Избыток – натощак (более 120 мг%), после еды (больше 160-180 мг% (8,8-9,9 ммоль/л).

Если уровень сахара в крови натощак более 6,6 ммоль/л, это свидетельствует о развитии сахарного диабета. В норме сахар в моче не определяется, т.к. почечный фильтр задерживает всю глюкозу.

Если же уровень сахара поднялся выше 8,8-9,9 ммоль/л, почечный фильтр начинает пропускать сахар в мочу. Именно с этого момента глюкоза начинает выводиться с мочой. Уровень глюкозы в моче можно определить с помощью специальных тест-полосок. Минимальный уровень содержания сахара в крови, при котором он начинает обнаруживаться в моче, называется почечным порогом.

Важная проблема для врача, диагностирующего диабет, состоит в том, что это заболевание имеет целый ряд стадий. После проведения серии анализов любой заболевший человек хочет получить от врача чёткий ответ на вопрос о том, есть ли у него диабет. И если есть, то насколько далеко всё зашло. Между тем, ответить «да» или «нет» часто бывает трудно. Дело в том, что «норма» для разных людей может заметно варьировать. Кроме того, уровень сахара в крови может повышаться при стрессовых ситуациях, инфекциях или при хирургических вмешательствах. Почему именно в эти периоды? По-видимому, выделяемые при стрессе из надпочечников гормоны резко изменяют обмен веществ в организме, влияют они и на метаболизм глюкозы.

Предположим, что состояние человека врач классифицирует как «пограничный» диабет. Это значит, что уровень сахара в крови ненамного, но постоянно превышает норму. Как правило, это те, кто имеют избыточный вес. По сравнению с установленной нормой натощак (115 мг%) показатели человека с избыточным весом 115-140 мг% рассматриваются как признаки диабета, но при небольшой потере веса (2,5-4,5 кг) уровень сахара в крови может нормализоваться. Иногда для нормализации достаточно изменить режим питания или объём потребляемой пищи.

К сожалению, большинство из нас не идеальны. Что же делать с сахарным диабетом? Нам кажется, что врачи – волшебники и в их власти сделать нас снова здоровыми и стройными. К сожалению, такое случается не так часто, для этого, в первую очередь, необходима наше внутреннее желание выздороветь.

Хорошо известно, что существуют две основные формы диабета: диабет I типа (инсулинзависимый диабет, его иногда называют также ювенильным, или юношеским) и диабет II типа (инсулиннезависимый диабет, или диабет взрослых). Симптомы этих заболеваний могут быть очень похожими, но истоки их возникновения, совершенно различны.

При диабете I типа больной нуждается в ежедневном введении инсулина.

Больные диабетом I типа составляют 10 – 15% от общего числа диабетических больных. Чаще всего это дети молодые люди, болезнь развивается у них очень быстро и требует незамедлительного медицинского вмешательства.

Диабет II типа существует в нескольких вариантах.

В одном случае бета-клетки остаются неповреждёнными, и проблема состоит не в недостаточности образования или высвобождения инсулина из бета-клеток, а в неспособности клеток организма реагировать на него. Этот феномен называется невосприимчивостью к инсулину.

Физиологическая основа другой разновидности диабета II типа заключается в том, что бета-клетки вырабатывают и накапливают достаточное количество инсулина, но не способны высвобождать его.

Заметим, что в случае диабета I типа инсулин почти не поступает в печень из поджелудочной железы, поскольку в ней очень мало или почти полностью отсутствуют вырабатывающие его бета-клетки; при диабете II тип некоторое (но недостаточное) количество инсулина поступает в печень.

В любом случае основная причина нарушения обмена веществ заключается в том, что при отсутствии или недостатке инсулина не способны функционировать клетки поджелудочной железы.

При сахарном диабете страдают практически все органы. У больных инсулинозависимым диабетом риск осложнений выше, чем у больных диабетом второго типа.

Высокий уровень сахара в крови вызывает разрушение микрососудов – капилляров в различных внутренних органах, нарушая их кровоснабжение и функцию. В результате может развиться катаракта, кровоизлияния в сетчатку глаз и слепота. Очень часто поражаются почки, что приводит к хронической почечной недостаточности и уремии. Если затронуты сосуды нижних конечностей, возникают трофические язвы и гангрена пальцев и стопы. Нарушается функция периферических нервов – нейропатия, что приводит к появлению болей в ногах, а затем и к потере кожной чувствительности.

Treatment

Hay fever cannot be cured, but there are a number of ways you can improve the symptoms and afford some relief to your child. Preventive measures play an important role in the treatment of hay fever.

Your doctor may advise the use of antihistamines to help relieve your child’s symptoms. These are tablets or mixtures which damp down the allergic response seen in hay fever. The newer types of antihistamines do not cause drowsiness. Steroid nasal sprays are used to prevent an allergic reaction and can be safely used for 2-3 months during the hay fever season. Decongestant nose drops and sprays need to be used with caution because the way in which they decrease swelling is by narrowing down the local blood vessels. With prolonged use they can cause permanent damage to the lining of the nose.

Prevention

As much as possible avoid direct exposure to pollens during late spring and early summer. Expect your child to have worse symptoms if he is playing outside.

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Hair

Some babies are born with a full head of hair, which is usually brown. This begins to fall out after several weeks, and is gradually replaced by permanent hair which is not necessarily the same colour. Fine, dark body hair (lanugo) is often present on the body for the first month, especially in premature babies.

Head

For several days after birth the baby’s head may have a strange shape because it has been moulded by pressure during the baby’s passage down the birth canal. This soon returns to normal and is no cause for concern. Some swelling of the scalp may also be present (caput), which soon disappears. The diamond-shaped soft spor, or fontanelle on the crown of the head is clearly felt. This is the point where the skull bones will join together when the baby is around 18 months old and the growth of the brain is completed. Pulsations may be visible with each heart beat over this area. A smaller fontanelle is present towards the back of the head, which may be more difficult to feel. Bruising may be present over the face or head, especially after a forceps delivery. This heals gradually and will soon disappear.

*65\90\8*

IGNORANCE: I found a profound lack of sexual knowledge in the couples and, even worse, the possession of «mym-information» based on the first three perspectives of sexuality. Super marital sex requires first and foremost knowledge, a knowledge that integrates all four perspectives of sexuality. Knowledge is the first key to super marital sex.

FEAR: Spouses were afraid, afraid of failure, embarrassment, of not living up to their partner’s or even society’s «sexpectations.» Confidence in self and in the marriage is necessary for our natural sexual-response system to flourish. Confidence is the second key to super marital sex.

OBLIGATION: Spouses reported feelings of «ought to’s» in their sexual system that took away from the opportunity to experience what they would like to experience. Natural sexual response is blocked by conscious attempts to «do something» that «should» be done. Freedom is the third key to super marital sex.

VOYEURISM: This is a form of «group» sex in which each partner is busy watching self, other, and «us» rather than experiencing and sharing in the sexual interaction. Involvement is the fourth key to super marital sex.

WITHHOLDING: This was the «economic problem» for the couples, feeling that one or both spouses had to «earn» sexual fulfillment through sexual expertise and good timing or activities outside the sexual area traded for sexual favors. Trust that you are accepted and desired sexually for who you are and not what you have done is necessary for spontaneous sexual response. Trust is the fifth key to super marital sex.

PERFORMANCE: Masters and Johnson felt that an orientation toward performance interfered with sexual response, and my interviews verified this. Making sex an event instead of an experience can destroy any real joy in the interaction. Sharing is the sixth key to super marital sex.

*256\97\8*

Vegetarian cuisine

Discussing benefits of pure vegetarian (vegan) cuisine as well as recipes is yet again a quite substantial topic and exceeds the scope of this book. For information about the vegetarian cuisine please read books by Ch. Lehman or M.Diamond listed in the References.

Microwaves

Using microwave radiation to cook or heat food changes the molecular structure of food. There is a consistent scientific evidence, that such food is harder to metabolise. We should avoid microwave cooking if possible.

How much to eat ?

This is also a very important question. The answer is quite simple . as little as possible to feel active and comfortable. Note, that eating too much is equivalent to overloading your body with additional duties, related to the processing and disposal of extra waste. Your mind is engaged too, reducing your intellectual and spiritual abilities.

During fasting, you will learn, that the feeling of hunger, as well as the tendency to overeat are typical reactions of a toxic body. If the body is pure and you try not to poison it excessively, your body will always tell you when you have had enough food. Just pay careful attention to what your body is telling you. That’s all.

It is easier to receive and understand such messages, when you eat slowly and chew your food well.

When should we eat ?

In the mountains of Georgia, where people live well beyond 100 years and even make babies at 100, they have a saying:

«Eat breakfast yourself share lunch with your friend, and give dinner to your enemy».

I cannot help admiring the beauty and wisdom of this ancient proverb. What it says is that we should take food before the activities of the day, and to not take any food before going to bed for the whole night. Doing so, we feel energetic during the day, and we greatly assist our mind-body system in the night’s rest, freeing the resources necessary for everyday healing, repairs, maintenance, as well as for spiritual development.

Note, that most people do exactly the opposite: dinner is their main meal. They all wonder why their health is deteriorating quickly with age.

*46\96\8*

The vaccine for influenza is effective. It is prepared from killed virus and contains the  virus and one, two or three of the current A strains.

Usually, only one injection is needed to stimulate the production of antibodies and immunity should be at its peak a month after injection.

However, its effect then tends to wane and it is relatively ineffective after six months but a further injection each year will ensure protection is kept.

When the virus radically changes its nature, the new vaccine usually requires two doses, a month apart, to achieve full protection. The vaccine is regarded as being between 75 and 90 per cent effective.

Most new strains appear in the northern hemisphere during their winter and do not affect Australia until our winter, some six months later.

This enables the Commonwealth Serum Laboratories, who make the vaccine in Australia, to produce a vaccine which will be effective against the current strain.

Although many people complain about the vaccine and believe it may cause an attack similar to the flu, the number of reactions are small.

In recent years greater purification of the vaccine has led to fewer reactions. There may be a sore arm for a couple of hours or even a day or so and, in a few people there may be a mild respiratory type illness for one or two days but severe reactions are rare.

Of course, those people incubating a cold at the time will blame the vaccine for the subsequent symptoms.

The vaccine is usually given in April or May. Who should have it? Certainly those at greatest risk should. This includes the very young, the very old, the very sick, and doctors and nurses, who come in close contact with patients, and those in close contact with the public.

*461/71/1*

Pressing in the left lower area of the abdomen may cause pain in the right side. It is always necessary to carry out an examination of the rectum in cases of suspected appendicitis. Pain is felt in the abdomen when the examining finger presses on the inflamed appendix.

Although appendicitis may occur at any age, it is rare before the age of two and uncommon in the elderly. In the very young, the very old and in pregnancy it may be difficult to diagnose.

In a condition so common, it is surprising just how difficult, at times, appendicitis may be to diagnose. Chest infections like pneumonia, gallbladder attacks, kidney stones or infection, gastro-enteritis and pelvic inflammation in women may all mimic appendicitis and cause confusion.

The acute attack may spontaneously subside over one or two days or grumble on for several days. An attack may develop and then rapidly progress so that operation becomes a necessity.

The attacks of acute inflammation may be recurrent and, although each attack in itself is not severe enough to warrant operation, both the sufferer and his doctor may decide «enough is enough» and elect to have the appendix removed, either during the next attack or at some more convenient time.

*206/71/1*

We have to refer to the original supposition that only white middle-class women contract endometriosis to understand why some doctors have misunderstood racial distribution of this disease. Medical textbooks told them SO. References to endometriosis tended to profile the «typical» patient, and. in nearly every case, she was the slightly privileged white woman. Endometriosis, then, had its own built-in bias, and in the minds of some doctors, it was as much a part of the diagnosis as any other telling symptom. This commitment to an outdated medical bias excluded black. Asian, Middle Eastern, and even Jewish women, among other ethnic groups. Doctors who treated such women dismissed the diagnosis of endometriosis—no matter how obvious a case it was and assigned the condition another name. What were the fates of these patients?

Kayla fits this indicator perfectly. A former dancer, Kayla is a native Californian of Japanese and Korean extraction, now teaching in New York and a patient of mine. She performed for ten years with a touring dance company, and many times she went on stage suffering from extreme pelvic pain. ‘The doctor said I had pelvic inflammatory disease, and that I’d probably gotten it from sexual contact with my boyfriend,» she told me. «I took antibiotics again and again, but they helped only for a short time. When I quit the troupe to start teaching. I tried a different doctor. She said I had endometriosis, and she put me on hormone pills.»

Being told that she had endometriosis was an unexpected revelation for Kayla. For nearly fifteen years, she was automatically diagnosed as having a sexually transmitted disease, and she believed it as fervently as she believed in the legitimacy of the medical system. Now she is questioning the diagnosis of endometriosis, even though she can measure the improvement in her health. What has happened is that Kayla’s sense of self-esteem has suffered because her friends have told her that Asian women do not gel endometriosis! She wants to know for certain what is wrong with her.

Kayla’s dilemma has been common among other Asian women and more so among black women, many of whom have faced stereotyping in medical care. Kayla has endometriosis, not pelvic inflammatory disease. The difference between the two needs to be clarified. In endometriosis, pelvic organs can appear inflamed due to a reaction to the prostaglandins released by endometrial tissue. Endometriosis is not caused by or related to bacterial or viral infection’, therefore, antibiotics will not help Pelvic inflammatory disease (PID), in contrast, is caused by bacterial infection, which will inflame pelvic organs. If antibiotics are not given to control the disease, it can lead to progressively severe symptoms of pain and progressive damage to pelvic organs.

Doctors in certain areas of this country do not see many cases of endometriosis and they may be confused when confronted with such patients, be they white, black. Off Asian. Others, referring to an older text tor guidance, accept the racial stereotype. But with an enigmatic disease like endometriosis, exceptions and modifying factors cross all facial lines.

If you are a black or Asian who tends toward menstrual cramps, often with increasing severity over time, if you arc active sexually and experience pain during intercourse, and if you are of child bearing age and have never conceived either with forethought or accidentally— you may have endometriosis. If doctors insist you are suffering from recurring viral infections of the bladder, pelvic inflammatory disease, or psychosomatic illness, do not hesitate to get a second or third opinion. Seek out doctors who arc specialists in treating patients with this disease. Endometriosis doesn’t discriminate!

*30\43\4*

Fungi are living organisms made up of chains of cells, called hyphae, which grow and become intertwined and matted, forming mycelia and spores. In everyday life they can be seen as the mould on old fruit or cheese. There are between 50 000 and 100000 known species throughout the plant and animal kingdom, and they are all parasites. Some are useful and productive, such as those which are used to produce Penicillin and the antifungal antibiotic, Griseofulvin. Relatively few cause problems in man. Those that do. however, affect many millions of people. It is estimated that 15 million individuals throughout the world have ringworm of the scalp!

The fungi which cause tinea are called dermatophytes. There are three species of dermatophytes: Microsporum, which rarely affects the nails; Epidermophyton, which rarely affects hair, and Trichophyton. All of them affect the epidermis of the skin. Some species are almost solely confined to humans, and these cause milder but more persistent infections than do some other species. Those species which normally infect animals, cause a more severe but less prolonged infection when contracted by man. Some species normally found in the soil may cause tinea in animals or man.

Tinea Cnpitits (‘Scalp Ringworm’). This is almost entirely a disease of children, and is mainly transmitted from cats and dogs or from other children. With this disease the appearance of the scalp is one of well-defined areas of Inflammation and hair loss. The condition is most easily diagnosed by a fluorescence of the infected hair shaft when it is placed under an ultra-violet Woods lamp.

Tinea Corporis (‘Body Ringworm’). This occurs at all ages and in all races, being more common in warm, humid climates. It may be acquired from infected animals and humans, or from infection of the patient’s own nails and feet. The classical ‘ringworm’ begins as a red pimple which enlarges peripherally, with relative clearing centrally. The border is raised, red and well defined. Frequently, it may be confused with discoid eczema. Unfortunately the appearances are not always classical and tinea may occur with many bizarre features.

The diagnosis is either made on direct examination of affected skin under the microscope or on cultures of the scrapings.

Infected skin does not, unfortunately, fluoresce under the Wood’s lamp.

Tinea Cruris (‘Bobbie itch’). Fungal infections of the groin are commoner in men than in women. Tinea cruris is predominantly a summer disease, and its appearance is made more likely by the wearing of tight occlusive clothing, particularly nylon. Transmission by towels and other objects may occur, particularly in saunas and communal showers. Cross-infection from the feet is also common. The infection usually begins on the upper inner thigh, with a well-defined border which gradually extends. It is commonly itchy, but never involves the scrotum.

Tinea Pedis (‘Athletes foot’). This is a common problem, but the mechanism of transmission is ill understood. Although this disease is more common in hot, humid climates, it virtually only affects people who wear shoes-it is rare, for example, amongst barefooted natives. The fungus is thought to be acquired by walking barefoot on fragments of infected skin or nail, particularly around swimming pools or in communal showers. It is uncommon in women, and very rare in children. Children with eczema of the toes are frequently thought, incorrectly, to suffer from tinea because the appearance of the two conditions is similar.

The infection may have symptoms of softening and cracking of the skin between the toes, ft may also appear as blisters or a diffuse scaling on the soles of the feet. It is very rare on top of the foot.

Tinea of the nails. This infection is almost always confined to adults, and is usually caused by the same fungus which affects the skin. The earliest change is usually a small area of white, yellow, or brown discolouration on one side of the nail, close to the cuticle. This discolouration spreads, and may involve the whole nail. Keratin tissue may build up under the nail and lift it from its bed. The nail may also crumble away, or become thick and distorted. These changes may be easily confused with either paronychia, which is a yeast and bacterial infection of the nailfold, or psoriasis, which has similar features but is not an infection.

*57\44\4*

The function of the hypothalamus is critical for body weight regulation. Research with rats has shown that damage to the hypothalamus can have serious consequences. Damage to the ventromedial hypothalamus (VMH) is associated with hyperphagia (over-eating), decreased thermogenesis and spontaneous aotrvity, and elevated insulin levels. Obesity is almost an inevitable result! On the other hand, destruction of the lateral hypothalamus, only microns away, is associated with decreased food intake and a reduction in body fat.

These changes are partly influenced by the actions of chemical messengers, called neurotransmitters. Different types of neurotransmitters function to stimulate specific areas of the brain responsible for certain mental states. There are a number of neurotransmitters that can either promote or discourage feeding. For example, seratonin, derived from the amino acid tryptophan, can reduce food intake and this is now the basis of several appetite-suppressing drugs. Ingestion of carbohydrate results in the release of seratonin which inhibits the norther intake of food. Conversely, another neurotransmitter in the brain, neuropeptide Y, stimulates food consumption. There are a number of other chemical messengers that either stimulate or inhibit food intake—the strength of specific signals after a preferred food has been eaten may affect that food’s desirability for further consumption.

Isolation of a ‘satiety’ gene, by geneticists working at Rockefeller University in 1994, suggests that genetics may play an important part in hunger. Research carried out over several years has suggested there may be a mechanism coded for by a gene or genes, which ‘switches off hunger signals in the hypothalamus. Scientists have searched for, found, and now synthesised a protein hormone which they have called ‘teptin’ Qeptos is Greek for ‘thin’ which may result in major advances for drug therapy for obesity—if it lives up to its early promises.

In addition to dealing with neurotransmitter signals and proteins, the hypothalamus integrates a wide variety of messages, from the first smell of food to its metabolic fate as stored energy, by a series of neurotransmitters, hormones and signals from circulating nutrients.

Physiological signals—Stomach and intestinal distension are mechanisms for terminating feeding by negative feedback via the nervous system. The release of hormones such as cholecystokimn and the stirnulation of special receptors in the gut also provide signals to reduce feeding.

Nutrient -Circulating glucose, amino adds and may also signify that food has entered the body’s system and reduce the desire to eat. Low blood sugar levels promote hunger and it is possible that lesser degrees of changes in blood sugar may also influence appetite mechanisms.

Hormonal signals—A variety of hormonal changes occur in response to ingested and absorbed nutrients and some of these may influence appetite mechanisms. Insulin is one of the main hormones involved in nutrient metabolism but its role in appetite mechanisms has not been clearly identified.

Metabolic signals—The conversion of nutrients into storage tissues may influence appetite mechanisms. For example, the amount of carbohydrate and glycogen stores or fat in adipose tissue may feed back signals to the hypothalamus, giving it important information about the status of the body’s energy reserves.

From this wealth of feedback the brain must sort out relevant signals and make decisions about food intake. When hunger is high, an individual’s ability to inhibit inappropriate food choices is reduced. Many food companies, especially snack food manufacturers, exploit this by advertising their products on television around meal-times.

*110\186\4*

Endometriosis is a disease that can affect any girl or woman who is menstruating.

In order to understand endometriosis you need to know how your menstrual cycle works. The tissue that lines the inside of the uterus is known as the endometrium. Each month the hormones in your body stimulate the endometrium to grow and thicken and then break down and bleed. This bleeding is your period.

In endometriosis small patches of endometrium grow outside the uterus in other areas, such as on the ovaries or on the surface of the other organs inside the pelvis. These patches of endometrium respond to the hormones in your body in the same way as the lining of the uterus. Therefore, the misplaced endometrium thickens each month and then breaks down and bleeds. Unfortunately, there is no way for this blood to leave the body so it irritates the surrounding area causing pain and the other symptoms of endometriosis.

The most common symptoms of endometriosis are period pain, backache, heavy bleeding, pain when using your bowels, pain with sexual intercourse and difficulty in becoming pregnant.

There are two main types of treatment for endometriosis: drugs and surgery.

Drug treatment is most commonly used for teenagers. Most of the drugs work by stopping your periods and drying up the patches of endometriosis. Surgery involves burning or cutting out the patches of endometriosis.

*100\83\2*

Immediately after the operation you will probably feel drowsy and have some abdominal pain or discomfort and you may experience some nausea and/or vomiting. You may require an injection for the pain or nausea.

When you are awake enough to comprehend and remember what is said, your gynaecologist should come and discuss the results of your laparoscopy with you. The severity, location and likely impact of your endometriosis should be explained, as well as the nature of any surgical treatment that was done. Sometimes, the gynaecologist will leave you a diagram showing the location of your endometrial implants and cysts.

For the first 24 to 48 hours after your laparoscopy you will probably experience some generalised abdominal discomfort and bloating due to the manipulation of the internal organs and vagina during the operation. You may also experience mild to severe pain in the shoulder region due to leftover carbon dioxide gas accumulating under the diaphragm and irritating it, causing pain to be felt in the shoulder region (this is known as referred pain). The tube that was placed in your throat may give you a sore throat for the first day or so. Usually, painkilling tablets such as Panadeine or Panadol will be sufficient to relieve the pain. You may also have some bleeding from the vagina, especially if a D&C was performed, and your stitches may bleed a little.

Even though a laparoscopy is said to be only a minor operation many women feel pretty terrible afterwards. Some women say that they feel like they have had ten rounds in the boxing ring or have been run over by a truck! So in most cases you will need a day of bed rest after your operation and you will be able to return to work in two to five days. However, it will usually take five to seven days or more before you get back to your normal level of activity. It is advisable to avoid heavy lifting for a week or so and to avoid strenuous exercise, such as running, jogging, swimming or brisk walking, for one to two weeks.

Sexual intercourse should be avoided until any vaginal bleeding has ceased, as should the use of tampons, vaginal sprays and suppositories.

If you develop a fever, a vaginal discharge with an unpleasant odour, heavy bleeding, swelling of the lower leg or severe abdominal cramps you should notify your doctor immediately.

Risks and complications of a laparoscopy

In general, the risks associated with a laparoscopy are minimal and the rate of complications is low. Since a laparoscopy involves the use of a general anaesthetic it has the usual risks associated with undergoing a general anaesthetic, including an allergic reaction and chest infection, especially if you are a smoker. The more common, but still unusual, possible complications are wound infection, accidental injury to an internal organ such as the bowel or bladder, and internal bleeding during or after the operation.

*41\83\2*

There’s a general belief that if you have back problems, then your bed should be as hard as possible, even to the extent of sleeping on a hard board rather than a mattress. That belief is a dangerous fallacy because a bed that’s too hard can be just as bad for your back as one that’s too soft.

Says The National Back Pain Association (NBPA): «We do not recommend rock-hard mattresses for bad backs. The term ‘orthopaedic’ has misled people into buying ultra hard beds in the hope of finding relief. Far from easing a back problem, an impossibly hard bed could simply make the condition more uncomfortable than ever. On the other hand, a bed which is too soft can inhibit ease of movement and makes the spine sag, stretching and straining the ligaments that support it.»

The NBPA suggests a simple test to assess whether your bed provides the correct support. This is what you do:

Lie down on the bed (preferably wearing only very thin clothing or none at all) and slide one of your hands, palm down, between the small of your back and the mattress.

Now ask yourself how easy it was to insert your hand between your back and the mattress. If you had to struggle to push your hand through, then the bed is probably too soft. If your hand slipped in so easily that there was quite a gap between it and the two surfaces, then the bed is probably too hard. However, if your hand slid through fairly easily but without there being a large gap, then the support provided is just about right. Simple though this test is, it is nevertheless a remarkably good guide as it takes into account the two major variables that determine whether the support is correct: the firmness of the mattress and the weight of the sleeper. Naturally, if you share your bed, then this test should be carried out by both of you at the same time.

There are two inexpensive ways to ‘cure’ a bed that’s too soft to provide adequate support:

The simplest and least intrusive solution is to place a board between the mattress and the top of the bed’s base. While almost anything that’s solid and big enough can be used as a bed-board, it’s really best to have one made from plywood or blockboard that’s cut to the right size. Alternatively, you can buy bed-boards – including some that fold away – from specialist suppliers (see the Appendix).

m Another possibility is to place your mattress directly on the floor. Of course, one drawback to this approach is that it will mean that your bed will be very low indeed and you may experience considerable difficulty getting in and out of it. Making it won’t be good for your back, either!

Do keep in mind that the methods above will only make a difference if your bed has a sprung base – if you have one with a solid base, that will already be as hard as it can be, and all that’s left in that case is to change the mattress for a firmer one.

A bed that’s too hard is more difficult to improve and it may be best to think about replacing it. In the meantime, you may find that placing a foam or fibre-filled overlay on the mattress can help.

*46\124\2*

Some of the symptoms of depression may be the result of a different condition. Low energy level and fatigue may be symptoms of medical conditions, such as low thyroid functioning, which can be diagnosed easily by means of a simple blood test. But there are other conditions as well that can masquerade as depression.

A neighbour of mine, a highly successful scientist and a charming person in his mid-fifties, seemed to undergo a change of personality over the course of about a year. During this time he walked around feeling fatigued and down in the dumps for many months. His sleep was restless and he would frequently wake up during the night. These symptoms might easily have been mistaken for depression. A visit to his doctor and, subsequently, to a sleep laboratory, revealed that he had a condition known as sleep apnoea. He stopped breathing for short intervals numerous times during the course of the night, which would wake him up. As a result of his breathing difficulties, his brain was not receiving sufficient oxygen. Small wonder that he was exhausted during the day, felt miserable and had difficulty concentrating. The problem was entirely corrected by a continuous positive air pressure (CPAP) machine, which ensures that he receives sufficient oxygen throughout the night. He became once more his cheerful self and I would see him tirelessly mowing his lawn and attending to his garden. We would once again chat and share jokes and his mood was completely restored with the help of one critical substance upon which all of our lives depend, namely oxygen.

This same person later developed weakness and tiredness and again lost his usual ability to concentrate and function normally. Another visit to the doctor and some simple blood tests revealed that his blood chemistry was abnormal. This turned out to be due to a rare tumour of the adrenal gland. Removal of the tumour corrected the problem and restored him once again to his previous high level of functioning.

In summary, many of the symptoms of depression are not unique to this condition, but may also be the result of medical conditions, some of which such as low thyroid levels or sleep apnoea are relatively common, while others such as tumours of the adrenal are rather rare. A visit to a competent doctor can often help sort out whether there may be a medical condition masquerading as depression. Even if you choose not to go to a doctor in the first instance but decide instead to try and treat your own depression, it is still worth bearing these other medical conditions in mind in case the symptoms do not resolve within a reasonable amount of time.

*62\75\2*

There are all sorts of problems about epilepsy. Epilepsy is the name given to recurrent ‘seizures’ (also known as ‘fits’, or ‘attacks’), of which the fairly well-known grand mal convulsions are only one type. A whole variety of brain disorders can cause epilepsy, which should perhaps be considered no more than a stereotyped reaction of the brain to a variety of stresses. It is not generally known that, in spite of the most modern methods of investigation, an underlying cause can only be identified with certainty in about one third of people with epilepsy. The good news that has emerged from research studies over the last twenty years is that the long-term outlook for the cessation of seizures is very much better than was previously considered to be the case, as earlier research referred only to people with epilepsy whose seizures were the most difficult to control.

People with epilepsy have many worries. Children with epilepsy may be upset or worried about telling their friends and what will happen to them in the future. Women with epilepsy are understandably concerned about the possible effects of anti-epileptic medication when pregnant. Not everyone understands the impact of epilepsy upon the eligibility to hold a driving licence. Many employers understand little about epilepsy, and people with epilepsy may not have the same possibilities of employment, or of career advancement.

Epilepsy can begin at any age in life, but is particularly likely to begin in early childhood. One of us is a paediatric neurologist with a particular interest in epilepsy, and the other works with adults with epilepsy.

*1\188\2*

During the past 20 years, American apple-growers and farmers have more than doubled their use of insecticides containing organophosphates, carbamates, propoxur or pyre-thins, and, at the same time, have suffered increasingly from aplastic anemia and leukemia.

Although there is no proof of cause-and-effect, according to aLancet (2:300) report, the evidence strongly suggests that many of these potentially fatal bone marrow disorders result from exposure to insecticide mist or fog. Malathion, DDVP, Raid, Holiday Fogger, and Baygon were among the household insecticides to which the aplastic anemia and leukemia victims were exposed. Children, it seems, are much more susceptible than adults, and insecticide inhalation is more dangerous for them than is contact with the skin. Most victims were exposed to mist or fog for only a few hours and did not begin to feel unwell until several days or weeks later.

*191\143\2*

Symptom

A bulge in one of the typical locations:

• just above or below the crease of the groin

• just above or below the navel

• at the navel

Home care

If you suspect a hernia, take the child to the doctor.

Precautions

-    A strangulated hernia is a medical emergency that must be immediately corrected surgically (within hours). Signs that a hernia has become strangulated are: swelling; severe pain; nausea; vomiting; severe weakness or collapse. If these symptoms appear, take your child to the hospital immediately. Never attempt home care for a strangulated hernia.

-    Trusses or belts used to reduce a hernia are useless and may be harmful or dangerous.

-    Doctors do not consider it beneficial to strap an umbilical hernia.

A hernia (or rupture) is a protrusion of tissue through the wall of the body cavity. It might be compared to the protrusion of an inner tube through a hole in an automobile tire. Several types of hernias may occur in children.

The most common hernia in a child is an indirect inguinal hernia, which is present at birth but may be or may not be recognized immediately. In fact, this type of hernia is not usually noticed until some later age. The hernia begins as a bulge just above the midpoint of the crease of the groin. It then enlarges toward the middle of the body until it reaches and enters the scrotum (the pouch containing the testes) of a boy or the labia majora (outer folds of the external genitals) of a girl. The bulge is actually a pouch-like sac underneath the skin made of peritoneum (the membrane that lines the abdominal cavity). The sac usually contains either a portion of the veil-like apron that overlies the intestines or a loop of the small intestine. Less often, it contains a loop of the large bowel, part of the urinary bladder, or an ovary.

A rarer hernia in children is a femoral hernia, which appears below the crease of the groin, near where the pulse of the main artery to the leg can be felt. Occasionally, a ventral hernia appears in the midline of the abdomen, above or below the navel. In infants, an umbilical hernia often appears at the umbilicus (the navel). This is not a true hernia, however, because it contains no sac. An umbilical hernia usually disappears on its own before the child reaches five years of age.

*108/84/5*

Alcohol

Both you and your partner need to eliminate alcohol. If your infertility is caused by problems such as polycystic ovaries, fibroids or endometriosis, alcohol can compromise the efficient functioning of your liver and make it less able to get rid of excess circulating hormones. Alcohol will also stop you absorbing essential nutrients like zinc which are crucial for fertility.

Genetically Modified Foods

We know that the fertility of animals feeding on genetically modified foods can be reduced, so it is only common sense for you to eliminate these foods, as best you can, from your diet. We do not yet know the long-term health risks of GM foods but anything that may compromise good health needs to be avoided when you are aiming to increase your chances of conceiving.

Genes are a set of coded instructions, made from DNA, which control physical and behavioural characteristics such as hair colour. Genetic modification means that genes from other species can be introduced into a particular plant, usually to make it more resistant to pests, viruses, weed killers or other hazards. For instance, it is now possible to buy a tomato which contains a fish gene to boost its frost resistance. The gene is from a flounder because they survive well in cold water. This same flounder gene has also been introduced into salmon which could be on the market in two years time. In the cold dark days of winter a salmon stops eating and growing but adding a flounder gene keeps them eating all year round, speeding up their growth rate by 400 per cent. This kind of ‘tampering with nature’ explains why GM foods have been called ‘Frankenstein foods’.

There are worries that GM foods will make various diseases resistant to the antibiotics which have saved millions of us from death in the last few decades.

This is because, when genes are transferred in the lab, marker genes are transferred along with the DNA. This enables scientists to identify which cells have become modified. Usually a gene for antibiotic resistance is used as a marker. The British Medical Association (BMA) fears that resistance to antibiotics might transfer to animals or humans and leave patients vulnerable to diseases such as meningitis. For example, genetically modified maize contains a marker gene which passes on resistance to ampicillin, an important antibiotic used to treat bronchitis, ear infections and urinary tract infections in humans. Some urinary tract infections can impair fertility so we need the medical ammunition to deal with these infections.

The BMA has issued a report, called The Impact of Genetic Modification on Agriculture, Food and Health, and has called for studies to see whether these foods could damage our immune system or cause birth defects.

It is also possible that the DNA from our food could be transferred to the natural bacteria in the human gut, creating lethal substances and a whole generation of new diseases which won’t be killed off by antibiotics.

*31/73/5*

It’s a myth that tornadoes «suck up» cows, small dogs, and houses into their funnel. So don’t worry about becoming an accessory to the storm if a twister’s heading your way. What you should worry about is getting struck by Bessie, Toto, or even a Toyota, because with winds in excess of 250 miles per hour, a tornado can lift and toss large objects hundreds of feet from its path. It can also leave a path of destruction 1 mile wide and 50 miles long, so it’s best to take cover when a tornado blows into town. Here’s how you can keep from twisting in the wind.

Stay tuned. «Doppler weather forecasters can locate a tornado before it touches down,» says Johnson. Since tornadoes occur as the result of a nasty thunderstorm, you should check out the radio or television news if there’s a bad boomer in your area. You also can buy a weather radio with a warning alarm that will turn on automatically and warn you when a tornado watch or warning has been issued. They are available at electronics stores.

Go when it’s green. If you’re out and about, be warned when the sky turns green, there’s large hail, you see a wall of clouds, or you hear a loud roar like a freight train. These are signs that a tornado may be on the way – unless, of course, you live next to the railroad tracks.

Get down. «Get to the basement if you can,» says Johnson. «If you can’t, go to a center hallway, a bathroom, or a closet on the lowest floor. You want to find a strong, low location.»

Get out of the car. If you’re in your car or a mobile home during a tornado, get out and find shelter. If you can’t get into the basement of a nearby building, lie flat in a ditch or low-lying area.

*119/36/5*

How does the extract work in practice and not just under laboratory conditions? If we consider this treatment in relation to human beings suffering from rheumatoid or osteo-arthritis, then, in general, the first signs of a beneficial reaction will be noticed after about three weeks from the time of commencing the treatment. Before we go any further this statement needs some qualification because each case can be different and this assertion refers to the general situation.

Some people respond to this treatment in the first week, whilst others may take as long as fifteen weeks before noting any change in their condition. Another important factor is that the change in condition is not usually dramatic or sudden but is in the form of a slow and progressive improvement. Usually the first change noticed is a decrease in pain and, as the days pass by, this is followed by an improvement in mobility and increased freedom of movement. There is probably also a degree of psychological therapy induced at this stage. So begins a cycle of treatment involving internal medication, through taking the extract, coupled with physical therapy, by using the muscles and joints. Of course, care has to be taken not to overdo things but in general progress is steady and good.

It is only fair to point out that some people may temporarily get worse before getting better. The number of such cases, however, compared with those experiencing direct benefit, is small. The general symptoms described by people who have experienced such a deterioration preceding improvement have been as follows.

At periods ranging from one to four or five weeks after taking the mussel extract capsules, an increase in pain and sometimes also in stiffness occurs. In some cases the pain is very sharp and intense and is accompanied by considerable heat and tenderness in the affected area. Also, in some cases, this effect spreads to other areas of the body. Some people describe these symptoms as being like an attack on all potential sites where arthritis might have set in but has not yet become evident. In any event, this situation can lead to the affected person consuming some form of pain killing preparation (such as aspirin) for the temporary relief of the symptoms.

Usually after such a ‘flare-up’, which tends to last for a few days only, people enjoy a steady and pain-free improvement. The main difficulty which arises in cases like this is to know whether in fact the flare-up is created by the substance and precedes improvement, or whether in fact it is a flare-up due to a change in treatment. Usually, of course, the changes in treatment that would cause this to happen do not take place because most people take the mussel extract capsules in conjunction with their existing treatment until beneficial results become evident. Fortunately, the flare-up condition does not happen frequently and it is usually an indication that the extract is working and that good results will follow.

Neither the age of a person nor the duration of suffering diminishes the help this treatment offers. A person of eighty may respond just as quickly as a baby. Again, a person who has had arthritis for many years may notice improvement just as quickly as someone who has just developed the condition and the overall results may be just as satisfactory. This is not to say that this extract is capable of eliminating deformities or of rendering degenerated bone surfaces wholesome and new again. We are discussing improvement in general terms, and whilst it is perfectly true that some people have seen nodules disappear and deformed fingers become straight, flexible and active again, there are stages of deformity associated with arthritis which only surgery could rectify, and sometimes which are even beyond the help of surgery.

Mussel extract, of course does not work for everyone, but having said that, the success rate is good. Of people undergoing trials on this substance, some of whom were chronic cases who had not responded to any other treatment, more than 60 per cent benefitted. This percentage has also been confirmed by private reports from numerous subjects with varying degrees of affliction. The evidence to date suggests that relief from symptoms of osteo-arthritis can occur in thirty to fifty per cent of cases. The significance of these figures is enhanced by two factors which are of great importance when considering the beneficial aspects of any product – length of time that the results last and the absence of side-effects.

*14/48/5*

Repeated cycles of dieting may actually increase the body’s metabolic efficiency and make it even harder to lose weight. Such cycles may also change the way fat is deposited, with more fat being laid down in the stomach region.

There are certain factors that can modify the set point weight to some degree. Exercise has been shown to lower set point. In other words, regular exercise doesn’t just burn calories; it actually seems to shift the regulation of body weight to a lower level. Similarly, certain drugs can lower set point. Anyone who has stopped smoking cigarettes and subsequently gained weight can attest to the effects of nicotine in keeping set point weight down. What’s more, evidence suggests that long-term response to a high-fat diet can raise set point. Thus, lowering the percentage of fat in your diet may help you lower set point.

The set point model has much to tell us, not just about obesity, but about the eating disorders as well. For the anorexic, self-starvation and severe weight loss cause the metabolism to slow to a crawl. The greater the loss, the more the body fights to return to its preprogrammed level. This explains why a person with this illness feels she must maintain such vigilance against hunger. Her body is fighting for its very life, and will muster all of the available resources to defend its existence.

Although they may have lost as much weight as an anorexic, bulimic women may be at a statistically «normal» weight or above. But the set point model suggests that «normal» can’t be defined by referring to some chart, such as the Metropolitan Life tables of height and weight. Normal weight can be defined only for a particular individual.

In fact, I would throw out the word normal altogether and substitute natural instead. To illustrate: Woman A may be five feet four with a small frame and a set point range of 114 to 120 pounds. Some insurance-company chart somewhere probably says this particular woman is «average.» But woman Â-same height, same frame-may have a set point range of 130 to 136 pounds. She’s above the statistical average, but she is at a good and healthy weight for her. Each of these women has a set point range that reflects her natural weight.

But now Woman  reads an article that says her weight is «above average.» She feels compelled to diet and loses twenty pounds. She now weighs about the same as Woman A, around 116 pounds. No one would consider her emaciated, yet she has lost 15 percent of her body weight-the same percentage required for a diagnosis of anorexia! Although statistically «normal,» her body may be in a state of semistarvation. Because she needs more food than she is eating, she is at risk of developing uncontrollable binge urges, thus trigg ering the vicious cycle of bulimia.

To break the cycle, people may need help. They need a teacher who will show them the way to regain a healthy balance between the mind and the body.

*48/35/5*

Stephanie Caviness wanted to slim down. But the 33-year-old Jersey City, New Jersey, woman had a hard time sticking with an exercise routine. So she turned to her computer for help, and she ended up losing 23 pounds.

For Stephanie, exercise was nothing new. She had tried it several times in the past as a way of getting in shape. «I had been gaining weight ever since I was in college,» she recalls. «I wanted to look better and feel better. But every time I started an exercise program, I’d lose interest. Eventually, I’d abandon my workouts.»

By 1998, Stephanie weighed 173 pounds. «I’m 5 foot 9, so I wasn’t really obese,» she says. «But I was having problems with my heart—it raced and sometimes skipped beats. My doctor attributed those irregularities to the fact that I was in such poor condition aer-obically.»

At last, Stephanie found her motivation to lose weight and get fit. She pursued a variety of activities—step aerobics, aqua-aerobics, running, even salsa dancing. She made some dietary changes, too, eating more fruits and vegetables, watching her fat intake, measuring portions, and drinking lots of water.

Her efforts paid off: Her heart health improved, and as a bonus, her body looked trimmed and toned. She marveled at how the pounds disappeared so quickly, but worried about whether she could continue losing. More and more, exercise seemed like a chore. «Even though I was doing a lot of different things, I felt myself losing interest,» she says. «But I didn’t want to sabotage the progress that I had made.»

Convinced that others must be facing the same problem, Stephanie pondered the idea of forming an exercise support group.

«There’s strength in numbers,» she says. «Staying motivated is a lot i «* easier when you’re working with a group rather than on your own.»

Stephanie decided to post a message on Diet Talk, a Web site that she had been frequenting for information and support since starting her weight-loss program. «I had gotten to know a number of people through the message boards and chat rooms, and I suspected that some of them were struggling with exercise, as I was,» she explains. She was right: About-15 people responded to her message.

In January 1999, Stephanie and her online buddies kicked off their Exercise Challenge. Each person has a goal of exercising at least five times a week. «Everyone’s workout is a little different, based on individual abilities and objectives,» Stephanie explains. «But that doesn’t matter, as long as we’re doing something.» The group members e-mail Stephanie at least every 3 days, and often daily, to report on their activities. Stephanie posts the results online on a monthly basis.

«Every month, 80 to 90 percent of us meet the challenge,» she says. «That’s been really encouraging.»

Even more encouraging is the support that participants give one another. «The group changes in size from month to month, from the core membership of 15 to as many as 40,» Stephanie says. «We’ve become almost like a family. We talk about our weight struggles, but we talk about other areas of our lives as well. And when one of us succeeds, all of us succeed.»

*102\89\8*

A 33-year-old man came to see me because he was depressed, irritable and had many aches and pains. He slept poorly and had little interest in his work, his wife or his hobbies. «Business is terrible,» he told me. «I sit by the phone all day and twiddle my thumbs, waiting for it to ring.»

The physical examination and laboratory tests revealed no medical problems. It was clear, however, that he had a very negative attitude toward himself, his business, his wife and life in general. Since his lack of business seemed to bother him the most, I gave him a success affirmation.

«When you wake up in the morning,» I told him, «I want you to say: ‘I’ve got so much work I can’t handle it! I love my work!’ And I want you to see and feel yourself as having all that work.»

He looked at me like I was crazy. «Listen, Arnold,» he said, «I sit on my hands all day. My tools are getting rusty. I do all my jobs in two hours, then I sit around waiting for the phone to ring.»

«Nevertheless,» I answered, «I want you to say it 50, 60 times a day: I’ve got so much business I can’t handle it all! Say it, see it and feel it.»

He agreed to write the affirmation down on a card, tape the card to his phone and repeat the affirmation 50 times a day. But he didn’t seem to have much faith in the idea. When he left, I wondered if I would ever see him again.

A few months later he came back to my office and said, with a big grin, «Doc, you’ve got to turn it off! I’ve got so much business I can’t handle it. This affirmation stuff really works! Look, when I left here last time I was going to find a real doctor who would give me some real medicine. But I said the affirmation anyway, and I’ll be damned if it didn’t change my attitude. I started saying and visualizing that I had lots of customers and was happy. I guess my good attitude rubbed off on my customers, because they called me more and more and told their friends about me. The more business I got, the better I felt, and the more I affirmed, the more business I got!»

*150\80\8*

Due to our sedentary life-styles, we spend a great deal of time sitting down. This leads to the contraction of leg and back muscles. Stretching helps to prevent the muscles of the back and lower legs from becoming excessively tight. This, in turn, helps to relieve the tension and pain that gathers in these muscles during the day. It’s amazing how good you feel after you stretch out.

There are many good stretching books and programs available. You can stretch almost anywhere. In my office I stand about three feet from a wall, facing the wall. I lean up against the wall, the palms of my hands at about shoulder height, supporting my weight. Then I stretch my calf muscles (in the back of the lower legs) by pushing my heels toward the ground. I like to hold a comfortable (painless) stretch for three minutes, not bouncing back and forth, just holding the position. I also stretch my back muscles by bending over to touch my toes, although I can’t quite reach my toes, and stay in this position for 20 or 30 seconds, several times a day. Finally, I stand with my feet about shoulder-width apart, arms half-way out at my sides, and turn from side to side, twisting at the hips to face to the right, then the left, over and over again, for 20 or 30 seconds. You don’t have to be as flexible as a gymnast or a ballet dancer, but you should be able to twist, turn and move your muscles to meet the demands of everyday life. You’d be surprised at the number of my patients who have difficulty simply bending over to pick something up or turning their heads while driving to see if there’s a car in the next lane! There’s no medical problem making it so difficult for them to move; they’ve simply allowed their muscles to become very tight.

My general philosophy is to stretch whenever you can, which in my case means a few times a day. Again, stretch gently. If you’re having pain, there’s something wrong. Have your physician check it out. And always stretch before and after strenuous exercise.

*108\80\8*

SPINACH LASAGNA

1 lb. whole-wheat lasagna noodles

2 bunches spinach 1 lb. hoop cheese

1 32 oz. can tomato sauce (no salt added) spices to taste

Boil and drain noodles. Wash and chop spinach and mix with hoop cheese. Thinly cover bottom of a large baking dish with the tomato sauce. Place a layer of noodles over the tomato sauce, then a layer of spinach and cheese, then another layer of sauce. Repeat until baking dish is filled. Make sure a layer of sauce is on top. If you like, sprinkle top with diced green peppers and shaved carrots. Bake 30-40 minutes at 350°.

PITA SANDWICH

Fill pita bread with sprouts, diced tomato and cucumber, chopped onions, some garlic and a tablespoon of low-fat cottage cheese.

HERBED VEGETABLE SAUTE

1 celery stalk 1 onion

1 sweet red pepper

1 cup broccoli florets

2 carrots 1/4 lb. mushrooms

1/2 clove garlic, minced

3 cups brown rice, cooked lemon juice spices to taste 1/4 cup sunflower and sesame seeds parsley

Wash all vegetables. Chop celery, onion, red pepper and broccoli, slice carrots and mushrooms. In water, saute garlic, celery, onion, red peppers, carrots, broccoli and mushrooms. Add cooked rice and a little water to skillet; cover and let sit for a few minutes. Season to taste; garnish with parsley. Sprinkle with lemon juice and seeds, and serve.

*65\80\8*

I treated a patient, a 4 5-year-old accountant, who had gone to his physician for a routine physical. Finding that his blood pressure was a little high, the doctor put him on a diuretic called hydrochlorothiazide. This is a medication designed to lower blood pressure by getting rid of excess sodium and water in the body. Unfortunately, the medicine also flushed potassium out of the man’s body, so his doctor had to give him a second medication to bring the potassium level back up. Oh yes: the diuretic also caused his cholesterol level to rise.

Meanwhile, because the man didn’t change his life-style in any way, the original diuretic soon failed, and his blood pressure went back up. Now his doctor had him take a beta-blocking agent as well. This controlled his blood pressure but caused him to develop fatigue, weakness, depression, episodes of vertigo and an inability to perform sexually. These new problems occurred so insidiously that he didn’t connect the symptoms with the medication.

When he went back to see his doctor, lab studies showed that the uric acid in his blood was high. The doctor didn’t realize that this was also due to the diuretic. Soon, the man was back in his doctor’s office with clinical gout and severe pain and swelling of his large right toe. So he was given a new medication, this one to handle the gout. The diuretic also raised his blood sugar, so he was given yet another drug to lower the blood sugar.

By now a year had passed. He still had the high blood pressure, plus gout with gouty arthritis, low potassium, high cholesterol and diabetes. On top of that he was weak, tired, depressed and impotent.

I realized that the medications were as dangerous as the original problem. By carefully discontinuing all the medications and having him adopt the program described in this book, I eventually resolved the man’s medical disorders.

Sometimes it’s easy to treat patients who come to see me with a strange collection of symptoms. Taking them off their many medications clears up the problems. But sometimes it’s not so easy. A study conducted for the Armed Forces Institute of Pathology indicated that the deaths of 6 to 12 thousand people a year can be blamed on reactions to drugs prescribed by their physicians.

Don’t look to doctors, drugs and surgeries for your health and happiness. We physicians can help you battle certain diseases. But health is more, much more, than the absence of disease. The glowing, vibrant health you want depends on you making your «doctor within» as strong as possible. That’s where the Immune For Life program can help you.

*21\80\8*

If Dr Darlington is right, then why did a similar trial, carried out three years earlier, produce such different results? This trial was conducted at Northwick Park Hospital in Middlesex, by Dr Michael Denman, Dr Bruce Mitchell and Dr Barbara Ansell. They studied 18 patients with rheumatoid arthritis, putting them on diets which excluded various foods for periods up to six months. In their opinion, the effects of eliminating foods cannot be assessed over shorter time intervals, because rheumatoid arthritis is such a variable disease. (Dr Darlington’s study overcame this problem by using a large group of patients and measuring their symptoms as a whole – in this way, the week-to-week variations in individual patients should cancel each other out.)

Only three of Dr Denman’s patients stuck the course for the full six months. Thirteen dropped out before two months, and the report does not say how long they were on the diet. None of the patients showed any improvement.

One problem with this study was that the diet did not eliminate wheat, which other studies of food intolerance have identified as one of the most common offending foods. The diet also allowed chicken, tea, coffee, and all kinds of vegetables – including commonly eaten ones such as potatoes that are often incriminated by elimination diets. This failure to exclude several suspect foods, combined with the small number of patients involved, could well explain the poor results.

*109\180\8*

Can you get by using one of these less invasive approaches?

THE ANSWER DEPENDS ON SEVERAL FACTORS…

• Condition of the heart. If the heart can pump enough blood despite the blockages, bypass surgery can probably be avoided.

Bypass surgery is preferable if the heart has been weakened by heart attack.

• Location and number of blockages. The more severe and numerous the blockages, the greater the need for bypass surgery.

Bypass is preferable to angioplasty if blockages are «upstream» (close to the point where the arteries branch off of the aorta)…if the patient has one or more blockages of the left main coronary artery… and/or if two or all three coronary vessels are blocked.

• Level of chest pain. If angina isn’t relieved by medication, bypass is probably the best option.

Angioplasty may be more appropriate if the patient has had just one tiny heart attack, with minimal damage to the heart… has just started to experience angina…or is highly motivated to follow a low-fat diet and regular exercise regimen.

If your doctor recommends bypass, consult a bypass surgeon and a cardiologist who specializes in angioplasty.

*88/47/1*

Patients discuss private matters with their doctors with the implicit understanding that the information exchanged is private. In reality, more and more people are gaining access to these confidential medical records and using the information in ways you never intended.

These days, insurance companies, credit bureaus and the like have assembled sophisticated databases that contain loads of private information. Unbeknownst to you, this information may be shared with other insurers, potential employers, marketing firms—and sometimes sold to anyone who will pay for it.

Worst of all, information you divulged to help your doctor help you may be used with just the opposite result, here are

four true horror stories…

A company changes its insurance policy to limit coverage for AIDS-related problems after learning that an employee has tested HIV-positive.

A man is denied life insurance after telling his doctor he was feeling «down» because he feared his company might be the victim of a hostile takeover.

A woman is fired after her employer learns she needs a kidney transplant.

A hospital employee uses a computer to access the phone numbers of teenage female patients, then calls them up and sexually harasses them.

*79/47/1*

I usually tell my overweight patients to set a target weight, then take 1,000 milligrams (mg) of chitosan 30 minutes before eating lunch and dinner. Once the goal is reached, they can stop taking the chitosan.

Taking chitosan does not give you permission to eat whatever you want. But it will give you an extra push in the right direction.

There’s no evidence that chitosan causes any side effects— but consult your doctor before trying it just to be safe, especially if you’re taking any other medications.

caution: Avoid chitosan if you’re allergic to shellfish, or are pregnant or breast-feeding. Don’t take vitamins A, D or E within four hours of taking chitosan. If you do, the health benefits of these vitamins will be lost.

Chitosan pills are available at most drugstores.

*70/47/1*

This condition {onychomycosis) can lead to warped and discolored toenails.

self-defense: Make a paste with lukewarm water and baking soda. Rub it on the affected area daily. Rinse and dry.

also helpful: Wear cotton socks…change shoes twice a day…and use antibacterial drying powder and foot deodorant. Avoid garlic and other spicy foods if they cause your feet to perspire.

Do not use opaque nail polish. It darkens the nail bed, making it vulnerable to fungal growth.

If symptoms persist, ask your doctor for the oral medication itraconazole (Sporanox).

Most cases are caused by Candida, the same yeast that causes vaginal infections, and/or by T. rubrum, another type of fungus.

self-defense: Keep your feet dry. Change socks at least once a day. Avoid colored socks—some are made with dyes that promote the growth of fungus.

Use Tinactin, Halotex or another antifungal ointment or spray containing a broad-spectrum antifungal agent of the azole family.

*60/47/1*

In one recent study, the participants who took standardized word- and picture-recall tests scored significantly better several hours after taking a 1,600-milligram (mg) capsule of dried lemon balm leaf than when they were given a placebo.

theory: The herb binds to brain chemical receptors, enhancing their ability to send and receive information.

What òî do: Add three teaspoons (or three tea bags) of dried lemon balm to two cups of boiling water. Steep for five minutes and then strain. Drink daily. Or take a 1,600-mg supplement daily.

British researchers say there’s no clear evidence that spinal fusion surgery for chronic low back pain is better than intensive rehabilitation in relieving discomfort.

What’s more, these surgeries may not be as cost-effective as other interventions, they add.

*51/47/1*

An appointment three months after the postnatal visit is usually given to check the coil or give further supplies of contraceptive pills. For physical reasons, the method chosen may be no longer appropriate. Bleeding with a coil or with the injectable contraceptive may be unacceptable, and a decision to stop breast feeding may mean a change from the progestogen-only to the combined Pill. However, now that physical healing has taken place, lactation well established or stopped, the baby often sleeping through the night so that tiredness is less, it can be a time when emotional problems and anxieties may be revealed. Tobert has described some of the feelings that can occur after the birth of a baby, and which may present with psychosexual problems such as loss of libido (Tobert, 1983). The woman may have strong feelings of pain, rage, humiliation or disappointment about her delivery. These feelings can be especially acute for the woman whose delivery has been with the use of forceps or by caesarian section, so that the hoped-for natural delivery has not been possible. Feelings of damage to the body may have been reinforced by insensitive words at the postnatal examination such as ‘of course you have not been stitched up too tight; you could drive a cart and horses through there.’

*178/197/1*

Control is an important theme in psychosexual medicine. The matter of who is in control colours many psychosexual problems. Impotence may be a dumb protest against a controlling partner. Desire for sex can evaporate when advances are rebuffed, or one partner demands attention in circumstances that they know are unevenly disempowering. Vaginismus enters self-perpetuating cycles when the woman is kept from being allowed to take charge of herself. Premature ejaculation is frequently a feature of a man frightened of what could happen if his feelings were truly out of control.

Likewise it is useful to look at how contraceptive decisions are made and where the power base lies in the compromise. Many men were keen to explain how their decision had been made jointly with their partner. However, when given the opportunity to talk further it often became clear that one partner had relinquished more control than the other.

In the following sections some of the conscious and unconscious feelings about the common methods are dicussed.

*141/197/1*

The patient who brings someone to the clinic may give valuable information about herself. She may feel too immature or helpless to cope alone, or she may anticipate a battle and bring a friend to fight on her behalf. Partners may come out of true caring but they may also come to make sure she ‘gets it done’, or they may be dragged along to suffer.

Questions posed by the patient may give clues as to how she feels about herself; for example, a question as to how many women suffer from infertility or have a severe emotional reaction suggests an anxiety that she herself may have anxieties about her own fertility and worries about how she will feel afterwards. It is important to give the patient the facts wherever possible, but also to look at the anxieties underlying the question.

*104/197/1*

In a specialist psychosexual clinic, those under 20 years comprise less than 10% of the total workload. However, they are an important group. Some patients in this age group are able to tell their doctor openly about the problem (see Miss A., Chapter 12, p. 181). However, others do not find it easy to raise the subject, and doctors need to be alert to cover problems that may be suggested by a patient’s discomfort with her genitals or breasts. Problems that develop in a patient on the Pill may be straightforward physical side-effects, or a covert presentation of a psychosexual difficulty. Many younger patients feel they should report side-effects, more or less obeying the doctor’s instructions, whereas older contraceptive pill-users tend to report side-effects that they are worried about. Young patients who develop one side-effect after another, or those who cannot find a method to suit them, should make the doctor particularly alert to the possibility of underlying difficulties. The following case quickly developed a ‘thick folder’, that sign that general practitioners recognize so well as a warning of possible emotional problems.

*68/197/1*

By this time Mrs H. had stopped taking the Pill as she said it made her depressed. Soon she left home again, returning pregnant a few months later. While discussing what she wanted to do she began to talk about her own childhood, when her mother had often left home, eventually for good when Mrs H. was 11 years old. She and her seven brothers had been put into care. She described her father as strict and hard working, but she was fond of him. This discussion seemed to help her to decide to have an abortion, and this was arranged. At the follow-up visit she recalled her mother trying to perform an abortion on herself with soap and water. This seemed an obvious reference to herself and her own abortion, and perhaps a need to be punished, as she admitted she expected it to be painful. Contraception was discussed with the couple and, despite the misgivings of the doctor and the social worker, Mr H. decided to have a vasectomy.

A year later Mrs H. recontacted the domiciliary service. She had left her husband, had a new partner and was five months pregnant. She decided to keep the baby, but felt guilty as the youngest child was still in care, and she was ashamed to tell her social worker. The doctor encouraged her to do so, and reassured her that no one would force her to have an abortion against her will.

*30/197/1*