THE SELF-POISONER: PATTERNS OF SELF-INDUCED TOXICITY – HELEN-LOUISE’S CASE

Helen-Louise is a self-poisoner. To others in her world she is a "wonderful person"—always doing things for everyone. She is conscientiously and deeply devoted to her husband and three children.

As she walks into the office for her first consultation, Helen-Louise forces a smile that scarcely covers the pain and tension her wrinkled brow reveals. She sits down struggling to maintain her composure, looks at the doctor, forces another smile, and makes a trite joke about needing to talk to a head-shrinker. The doctor waits for her to proceed. The silence is too overwhelming; she cannot play her game any longer and bursts into tears. A few minutes later, she begins to talk.

H-L: "I can’t stand it any longer. I feel like I’m being used up by my family. They always want something from me. I never have a moment’s peace. Every time I talk to my husband, one of the children breaks into the conversation. They even barge into our bedroom and insist on being there with us. My husband feels too guilty to say anything about it. I can’t stand the looks on their faces when I tell them that their father and I want to be alone. My son is constantly demanding something. As soon as I do one thing for him, he is after me to do something else. They keep me so busy I no longer have any time to do what I want to do. My husband and I have no chance to talk, and I feel we are growing apart. Lately, I find myself resisting his sexual advances, and I don’t understand it at all—I love my husband. Yet I know I’m becoming increasingly irritated with him and the children. I feel very guilty when I find myself wishing the children were all grown up so that I could be alone with my husband. I know they love me, but I’m beginning to resent everyone and everything in that house—as if it were poison. Sometimes I feel as if 111 die if this keeps on."

The "problem" that Helen-Louise brought to the psychologist’s office is a case in point. While she lived within the potentially nourishing atmosphere of a family that loved and cared about one another, she poisoned herself by playing "victim” to the toxic manipulations of her children. The fact that she was unaware of the deadly games in which she participated did not make their toxic effects any less devastating to her well-being and her ability to nourish both herself and her family.

ACNE

Just about everyone gets it at one time or another

Acne vulgaris refers to a spectrum of skin eruptions — blackheads, whiteheads, pimples, cysts and nodules — that can be sore, painful or itchy. Few people escape adolescence without a pimple or two.
Acne begins when a fatty oil, called sebum, and dead cells are manufactured too quickly and clog the pores around small hair follicles. The results can range from whiteheads to blackheads and pimples.
Acne tends to occur in areas where there are high concentrations of these sebaceous glands — the face, neck, shoulders, and upper and center back. In both sexes, elevated secretion of androgen hormones during puberty stimulates these glands to produce extra sebum, increasing the likelihood of acne.

What you can do

PRACTICE SMART PERSONAL HYGIENE

Use a cleansing agent or soap that dries the skin enough to cause minor shedding (avoid too much drying since this can cause further irritation).
Use a clean washcloth — gently.

Never scrub the skin. If acne is not too severe (skin is not infected, pussy or raw), cleansing with a gentle abrasive such as Buff-Puff may help.
Always rinse thoroughly.

Give yourself an occasional mini-steam bath by placing a warm, wet towel on your skin for 10 to 15 minutes. This will help open pores and allow deeper cleaning.

For infants with acne, wash the face daily with a clean cloth, water and mild soap.

SKIN MEDICATIONS

Acne medications unblock pores by drying up oil and promoting peeling. Many are available without a prescription and come in solutions that help cover up redness and scarring. Sunlight may temporarily clear up skin, but it can have other damaging effects — especially if drying agents or antibiotics are being used.

A doctor can prescribe stronger versions of topical skin medications or a special formulation of vitamin A, called retinoic acid (Retin-A), and antibiotics. Vitamin A also may be prescribed for severe cases and should be taken only as directed by your doctor — too much of it can be toxic.
Final notes

Carefully follow the directions, warnings and precautions on any drugs you use. Call your doctor if you have questions. And be patient — it may take two to six weeks or more to see progress with any of these self-care treatments or medications.

AGGRESSION AS A CAUSE OF ANXIETY

We all have a certain amount of aggression within us. If we didn’t, we would not succeed as a species or as individuals. Man’s aggression has led him to master the other animal species, and has to a large extent enabled him to control his immediate environment. However, the way in which man has progressed toward civilization has of itself imposed great restriction on his native aggression.

 He no longer has the opportunity to vent open aggression on animals that threaten him, or on a neighbouring tribe who would take his food or his woman, nor can he turn his aggression on weaker members of his own kin and take what they have for himself. In our present evolutionary state man is struggling to control the aggressive impulses that are still within him. This struggle with our own aggression is one of the greatest causes of tension. In many ways it is even more difficult to cope with than sexual problems, because while we usually have some awareness of our sexual difficulties, the struggle to control our aggressions may make us tense without us having any knowledge as to the cause of the tension.

A man of middle age came to see me for a skin rash which he had had on and off in front of his elbows and behind his knees for almost twenty years. He had had a lot of illness as a child which had left him undersized and with a bent back.

From the beginning he took charge of the interview. He was aggressive in his attitude, and rather contemptuous in his references to all the past failures of medical treatment. He mentioned that his family called him aggressive. He said that he loses his temper and blows up with his children, and then feels sorry for it. He added that he often drank heavily from sheer impatience and boredom. His wife disclosed that he really terrorized people—not only herself and the children, but other members of the family, and his friends at his place of work. The condition of his skin would wax and wane according to his state of frustration.

His aggression resulted from an inferiority complex, a reaction to compensate for his small size and weakly appearance. The anxiety engendered by his efforts to control his aggression had caused the skin condition.

Because he was so tense and aggressive it took him some time to learn how to relax, but when he did, his skin cleared up. A report from his wife indicated that those around him had come to have a happier time.

CHILD’S HEALTH: PNEUMONIA

Pneumonia is an infection of the smallest airways of the lungs (alveoli). It can affect children of any age.

Cause

Pneumonia is usually caused by a virus, but can be caused by a germ.

Clinical features

The most striking features of pneumonia in children are a moist cough and a high fever. Sometimes the child is short of breath too and may complain of sharp pains in the chest on breathing deeply. Younger infants may just look very ill and breath rapidly, without having any other symptoms.

Investigations

Pneumonia can usually be diagnosed on clinical grounds, but your doctor may suggest a chest X-ray to confirm the diagnosis. Sputum and blood tests may also be helpful.

Treatment

Some types of pneumonia are due to bacteria which are responsive to antibiotics. It is difficult to distinguish between a viral and a bacterial pneumonia, so sometimes antibiotics are given just to be safe. If the illness is relatively mild, your child can be treated at home with oral medication, bed rest and paracetamol to lower the fever. Use a humidifier in your child’s room to make his breathing easier. Also make sure that your home is smoke-free.

If your child is very ill, admission to hospital may be advised, so that antibiotics can be given intravenously or by injection. Once treatment is commenced, recovery is usually rapid and complete.

When to see your doctor

• if your child has a cough and a high fever;

• if your young baby is listless and breathing rapidly;

• if there is no improvement after 3 days on antibiotics.

Take your child to hospital immediately if his lips look blue.

IMMUNE POWER DIET: AMINO ACIDS: YOUR ENERGY THERMOSTAT

Amino acids make your body’s energy thermostat—the way you absorb, digest and use protein, carbohydrates, fats, and sugars—run more smoothly. Ideally, our body should work to keep us on a smooth course of constant high energy and cheery moods. But for many people, it doesn’t work that way because imbalances in the body’s energy regulators cause periodic bouts of low blood sugar.In my opinion, this is one of the most common undiagnosed medical problems in this country. The medical term for it is reactive hypoglycemia.

 This means that instead of smoothly maintaining the constant sugar and protein balance we need, the body responds jerkily, flooding itself with sugar energy (“hyperglycemia,” or “high-sugar”) then abruptly slamming on the energy brakes (“hypoglycemia,” or “low sugar”). We all know people who are “touchy,” apt to fly off the handle, with what psychiatrists call “mood lability.” Often, such people are stuck on this “hyper-hypo” seesaw, victims of a faulty energy thermostat.People suffering reactive hypoglycemia may also be susceptible to every passing germ that comes along, and often plagued with hay fever, skin rashes, or allergies. In short, their erratic energy thermostat seems to go along with a weakened immune system. I am indebted to Dr. Jeff Bland, a noted nutritional researcher, for first bringing this constellation of symptoms to my attention.

MENOPAUSE AND CLIMACTERIC

The end of the child-bearing period is the menopause. This is the second time in a woman’s life when the workings of the sex organs are greatly modified and produce disturbing symptoms. The first time is at puberty. I imagine that most girls are elated to feel that they are really becoming women and no longer need to dress in their mothers’ old dresses and play “grown up.” Hence they bear with equanimity some unpleasant aspects.

Difficulties with menstruation, the unpleasant symptoms of the menopause, and a few other situations may call for the use of sex hormones, but the frequency of their use is generally in inverse proportion to the knowledge of the physician who is prescribing them. The psychic effect is particularly difficult to separate in these cases, but we may remember that over several generations, when these hormones were not in use, a large fortune was made and maintained by dispensing only vegetable compounds for female troubles. The vegetables were inert physiologically and safer than the powerful hormones.
Women at their menopause, the “change of life,” do have an upsetting of their endocrine balance.

 In fact they have some upsetting at every menstrual period. Some have a great deal of disturbance every month, leading them to refer to the “curse.” But, at the time when these periods are ceasing and the whole hormonal system is readjusting, a woman is likely to have a lot of other things bother her, too. The menopause notifies her that she is losing her youthful charm – she is on the verge of becoming elderly. Naturally the psychic effect is bad. She is, in some cases, unnecessarily upset by the belief that she will soon lose her sexual attractiveness to her husband. This is not the case. She ceases to have a menstrual flow and to ovulate, but her other sexual functions and desires are unimpaired.

Along with the change of life other physical causes of discomfort become more common. X-rays demonstrate that practically everybody is then developing some arthritis, and arthritis often is uncomfortable. Pseudo-medical literature in modern abundance, and advertising, keep up the suggestion that the woman in the late forties is in for trouble. What Woman has not seen, in the advertising pages, photographs of her unhappy sisters who, she is told, look thus because of the change of life? It is a tribute to the female sex that, as far as a mere man is able to notice, most of them are able to show little change in their equanimity at this time.

The menopause is complete when the ovaries have ceased to perform their normal function. There are rare occasions when a woman may menstruate regularly for years and then abruptly cease for the rest of her life. Usually it is a gradual change, in reverse, to that which occurs at puberty. Most young girls do not immediately start into a normal menstrual cycle. They are irregular at first and it is well known that they are apt to have irritable, nervous symptoms as well as physical difficulties at that time. At the menopause the same irregularity and symptoms are the rule.

 The age at which it may occur is variable. Not too uncommonly it appears at about thirty-five, and two of my gynecological friends have told me that they thought the average age is over fifty. It frequently is difficult to say with certainty when the menopause is fully completed. If I may use an arbitrary figure, I should therefore say that any woman, who has ceased to menstruate for six months and then appears to start up again, should have a careful physical examination, as there are numerous bad conditions which may simulate menstruation.

POISONING OF THE STOMACH AND INTESTINES – APPENDICITIS (GENERAL INFORMATION)

The appendix is a worm-shaped offshoot from the cecum, the blind intestine at the beginning of the ascending colon. It is this small tube which can become inflamed, the condition referred to as appendicitis, and is often removed surgically.

 The vermiform appendix is located exactly half way between the navel and the right iliac crest, the highest portion of the ilium and the pelvis. Imagine, for a moment, the face of a clock; if the navel were the centre, the small hand when it is on eight o’clock would then indicate the direction in which the appendix is located, exactly in the middle between the navel and the protruding hipbone.

Occasionally, an inflammation of the ovary (Novartis) on the right side is mistaken for an attack of appendicitis. When the area of the appendix is depressed by the hand and suddenly released, the sensation of pain is radiated to the right, whereas in the case of ovaritis the pain would be local and of a dull nature. Appendicitis may also be diagnosed through the rectum. It generally makes itself known through severe, sudden pain in the right lower portion of the abdomen, appearing without warning and usually accompanied by malaise and vomiting. As a rule the tongue is coated and the patient runs a slight temperature of 37.5-38 °C (99.5-100.4 °F). If the diagnosis is difficult, the physician may also take a blood test to determine whether the number of white blood cells has increased. In cases of inflammation the usual number of 6,000-9,000 may have jumped to 15,000, and the pulse rate also climbs above 100.

THE EXPLANATION FOR LINGERING BACTERIAL PROSTATITIS

One of the explanations for lingering bacterial prostatitis may be the presence of infection in tiny stones, called calculi, in the prostate. Prostatic calculi (the prostate’s version of gallstones or kidney stones) are quite common—about 75 percent of middle-aged men and 100 percent of elderly men have them. They can be detected with an imaging process called transrectal ultrasound.

 They’re usually small, found in grapelike clusters, and, most important, harmless. But when they get infected—as they often do in men with chronic bacterial prostatitis—prostatic calculi can cause an infection to persist, and symptoms of urinary tract infections and prostration to return again and again. (What causes calculi? Molecular analysis has shown that these stones contain ingredients generally found in urine but not prostatic secretions—which suggests they form when urine somehow “backs up,” or refluxes, into the prostate.)

When a man has both prostatic stones and a history of chronic bacterial prostatitis, it’s pretty safe to assume that the stones are infected. The significance of this is that infected calculi have never been cured by medication alone, although antibiotics can certainly treat the symptoms. The only way to cure infected prostatic stones permanently is to remove them surgically, by a procedure known as transurethral resection of the prostate.

HERPES SIMPLEX VIRUS: PATHOGENESIS AND CLINICAL PRESENTATION

Herpes simplex virus (HSV) encephalitis due to HSV type 2 occurs in babies infected perinatally. However, HSV type 1 is the most common cause of acute non-epidemic viral encephalitis among healthy children (older than 6 months of age) and adults. The estimated frequency of HSV type 1 encephalitis in the United States is 1 in 250,000 to 1 in 500,00 persons per year.

 This encephalitis has no seasonal preference and can occur at any time of the year. In the absence of therapy, the mortality rate exceeds 70%, and only 2.5% of patients overall (11% of survivors) regain normal function. Early treatment is the most important factor in ameliorating the morbidity and mortality of this infection.

Pathogenesis

Encephalitis with HSV type 1 can be due either to reactivation of virus or to primary infection. Approximately one third of patients develop HSV type 1 encephalitis during primary infection, and approximately two thirds acquire the disease through reactivation. Reactivation of latent HSV type 1 in the trigeminal ganglion leads to active replication of virus with subsequent spread directly to the temporal cortex. Primary HSV type 1 encephalitis results from either intranasal inoculation with direct invasion of the olfactory tract or from oral inoculation with spread along the trigeminal nerve. Whether primary infection or reactivation, the clinical syndromes are identical, producing inflammation and necrotizing lesions in the inferior and medial temporal lobes arid orbital-frontal cortex.

Clinical Presentation

HSV type 1 encephalitis typically has an abrupt onset, although an insidious, subacute presentation has been reported.

Fever is almost always present, and headaches are prominent early in the disease course. More than 90% of patients have signs that suggest a localized lesion in one or both temporal lobes, and this localization often takes the form of intense personality changes. Seizures, hemiparesis, visual field defects, and paresthesias may also be present. Symptoms often take 2 to 3 weeks to reach maximal severity, and some patients can progress rapidly to coma and death. Coexistent oral herpetic lesions are rare in HSV type 1 encephalitis.

WHAT SIDE-EFFECTS MIGHT I EXPECT IN USING ST JOHN’S WORT?

The best data base on side-effects comes from a large German study in which over 3,000 patients on St John’s Wort were monitored by their doctors, over 650 of whom participated in the survey. Only 48 patients (about 1.5 per cent) discontinued the medication in the study, and side-effects were reported by only 79 people (2.4 per cent). Of these side-effects, the most commonly reported problems were gastro-intestinal irritation, restlessness and allergic reactions, all of which were reported by fewer than 1 per cent of individuals. European experts whom I have interviewed about St John’s Wort side-effects agree with these very low percentages. Such low side-effect frequencies are especially good news for the treatment of depression in the elderly, who are typically highly susceptible to the side-effects of all sorts of medications.

Although time will tell whether the initial observations of such low frequencies of side-effects are correct, I have been impressed in my own clinical practice by the absence of any side-effects in some people who have proven to be highly sensitive to side-effects from a wide variety of other anti-depressants. It seems likely that St John’s Wort will indeed prove to have fewer side-effects than the synthetic anti-depressants currently in use.

As noted above, anyone with a history of hypomanic or manic episodes should be especially vigilant for the typical symptoms of activation after starting any anti-depressant. Sleeplessness, racing thoughts, pressured speech and euphoria or irritability are early warning signs of hypomania or mania that must be heeded. If these develop, you should stop St John’s Wort immediately and consult a doctor. The loss of sleep (which is often not experienced as unpleasant but rather as an extra opportunity to get more accomplished or have more fun) is harmful in itself as it can fuel the manic process. If caught early, the symptoms of hypomania or mania can often be checked with appropriate actions; if not, however, they can escalate into mania, which can be very unpleasant and damaging.

A few of my patients have developed increased anxiety after beginning St John’s Wort. Such reactions have also been reported to occur in certain individuals after starting all forms of antidepressants. People with a history of panic attacks or extreme anxiety are especially susceptible in this regard. Yet anti-depressants have actually been given for the treatment of anxiety and panic. In order to overcome the initial anxiety response, which may occur after taking even a single dose, it is necessary to back down on the dosage. For example, in treating such sensitive patients with Prozac I have often started with as little as 1 to 2 mg of liquid Prozac per day. After the person has become used to that dosage, it is then possible to increase the dosage slowly and carefully over the ensuing weeks until a therapeutic level is reached. If you are eager to persevere with St John’s Wort but happen to develop anxiety after taking 300 or 600 mg, it is possible to overcome the problem by obtaining an herbal extract in the form of an elixir. Begin by taking very low dosages of the elixir (say one-tenth of the recommended number of drops) and increase gradually at a rate that you can comfortably tolerate until you reach therapeutic levels.

Some people on St John’s Wort have complained about increased sensitivity to sunlight both with regard to the skin, with more reddening occurring than usual, and the eyes. At this time there is no reason to believe that either of these side-effects is of clinical concern, but if they cause discomfort, protecting your skin with sun block or the eyes with sunglasses would be a sensible preventative measure.

ABOUT COMMON VITAMINS: VITAMIN B17

Nitrilosides. Amygdalin. Known as Laetrile when used in medical dosage form. Measured in milligrams (mg.).
Functions
Specific preventive and controlling anti-cancer effect, as proposed by its discoverer,

Deficiency symptoms

Prolonged deficiencies may lead to diminished resistance to malignancies.

Natural sources

Most whole seeds of fruits and many grains and vegetables, such as apricot, peach and plum pits;

apple seeds;

raspberries, cranberries, blackberries and blueberries; mung beans, lima beans,

garbanzas;

millet, buckwheat and flaxseed.

MDR (minimum daily requirement):
Vitamin B17 is not accepted officially as a vitamin, and, thus, no need in human nutrition has been established. Therapeutic doses are determined by doctors who use it in cancer treatment. If apricot and other fruit pits are included in the diet for preventive purposes they should be used only in small amounts, only a few pits a day. It is considered that if the diet contains an abundance of whole seeds, grains, nuts, beans and other foods mentioned above, deficiency of this factor will be unlikely.

SURGICAL TREATMENT FOR WEIGHT LOSS

Methods of surgical treatment

History is littered with unsuccessful procedures intended to cause weight loss:

No further surgical treatment of obesity has apparently been attempted since the tragical fate of a German Duke who in order to get leaner had the fat cut away by a Doctor in Upper Italy, and naturally succumbed to the operation (manuscript communication from Professor Dr DeLagarde 23 February 1882)

Other obsolete methods of surgery include jejunoileal bypass and jaw wiring, both of which are described later in this chapter.

There are two commonly used categories of bariatric surgery – restrictive and malabsorptive – and these are used either alone or in combination. More recently, implantable gastric pacing devices have been introduced.

Surgical treatment of obesity is a vital facet of weight management and, in many, patients is the only effective method for losing weight. As in every other branch of surgery there have been massive technological advances in surgical procedures, resulting in safer, better and cheaper operations. The surgical option is limited to a few extremely obese people but for such patients it is an important means of significant long-term weight loss, and a huge improvement in health and quality of life.

FIGHT CANCER OUTSIDE THE PROSTATE

Studies have found that men with higher tumor stage and grade were more likely not to be cured by radiation seeds (which makes sense, considering that most implantation programs don’t do anything to fight cancer outside the prostate).

 Also, some studies have found that a significant number of men—20 percent in one study—who got radioactive iodine implants required radical prostatectomy to help fight cancer that had returned. With external-beam radiation therapy, this number is much lower, about 8 percent. (Note: Many urologists feel that radical prostatectomy after any radiation treatment is not going to be very successful and will not perform the operation on these men.)

And in studies comparing seed implantation’s results in controlling cancer to other therapies, the seeds have come in a distinct third to radical protectorate and external-beam radiation therapy. In no major study has interstitial brachytherapy ever proved a better method than the other two main forms of treatment for prostate cancer. However, many studies looking at “relapse-free survival” have shown, at ten years after seed implantation, that 58 percent or more of men are still alive and cancer-free, and one study found that 53 percent of men who didn’t have cancer in the lymph nodes were alive and cancer-free after fifteen years. The bottom line from a host of studies seems to be that seed implantation—if it doesn’t ultimately cure prostate cancer—can at least delay it significantly, for years.

HETEROSEXUAL OFFENDERS VS. ADULTS: AGE OF COITAL PARTNER

In studying the ages of the companions with whom the offenders vs. adults first had coitus, we see that for only a moderate number the girls were thirteen or younger; for 29 per cent the girls were fourteen to fifteen, for 28 per cent, sixteen to seventeen, and for 21 per cent eighteen to twenty. In the next age-category, that of women twenty-one and over, the offenders vs. adults plummet to the bottom of the rank-order with only 11 per cent of their members having had their first coitus with females who had attained legal age.

 This drop does not reflect any marked age preference, but is chiefly the result of the fact that nearly all of the offenders vs. adults had had coitus before they were twenty-one; there were very few virginal offenders vs. adults left to have coitus with women their own age or older.

A direct question regarding age preference revealed only a moderate predilection for girls aged sixteen to seventeen. The fact that 16 per cent (fifth in rank-order) of the offenders vs. adults at the time they were interviewed (and the average age then was nearly thirty) preferred girls aged sixteen to seventeen does indicate an above-average though not extreme desire for youth. Note that only 8 per cent of the control group shared this preference. Obviously, while the majority of offenders vs. adults may not have preferred girls of sixteen to seventeen, they did find them quite acceptable as coital partners, as is demonstrated by the fact that about three fifths of the “victims” were girls of that age.

GROWING OLD

What is growing old, anyhow? A half century ago, people thought that the most obvious aspects of growing old—senility, strokes, heart disease, and cancers—were part of the natural process of aging. Now we recognize that they may often be wreckage from our collisions with the microbial world. If most microbes deal with us benignly, then we are compelled to ask how much of the less obvious part of aging is caused by microbial fender benders. Logic tells us that it may be much. If so, what can we expect from human life simply by preventing the damage from our encounters with microbes?

The diversity of activity among the elderly gives us a clue. The bodies of some 50-year-olds are falling apart, whereas some people pushing 80 seem to be cavorting like teenagers. I know this from personal experience because my mother, Sara Jeanne Ewald, is one of these teenagers in her late 70s. She does not respond in ways typical of a person of this age group. For instance, she was run over by a truck in November 1998 and brought to the hospital with a badly fractured pelvis, a broken set of ribs, and a punctured lung. She left the hospital in December and was walking with a cane in January. In April she discarded the cane and departed on a European tour with her boyfriend, leaving in her wake doctors and nurses who were happily scratching their heads in disbelief.

Could the recovery rate from such injuries depend on whether someone was lucky enough to be resistant to chronic infections? I don’t know. Many of the elderly and some middle-aged people have problems with osteoporosis; if infections play a role in this condition, then an elderly person who is resistant to such infections might be especially well able to heal broken bones. Sara Jeanne has been incredibly resistant to acute infectious diseases throughout her eight decades of life. “I must have a strong immune system,” she would often say to me as I was growing up. Perhaps that may help explain why she is zipping around like a college student on spring break instead of being hobbled by the ailments of old age.

Of course this account is just an anecdote. But what is an anecdote? In an effort to be scientifically rigorous, twentieth-century medical science has made anecdote a dirty word. Ardent attempts to codify rigor have stripped us of the benefits anecdotes provide. Anecdotal observations are essential for rigorous science because they provide possible clues to the solution of medical puzzles. Their true value often cannot be discerned without follow-up studies. They may turn out to be junk or gems. When anecdotal observations are followed up with careful studies, some will be recognized as spurious coincidences, whereas others will be recognized as the signposts that guided research to new breakthroughs.

The vision of medicine is sometimes blinded by the average. Any large cohort of 80-year-olds will include some who are youthfully active and others who have become immobilized by the “process of aging.” We see the same in 70-year-olds and 60-year-olds. But as the cohort becomes younger, our sense of what is normal changes. We begin to see the debilitation as something out of the ordinary and therefore deserving of a special explanation. We therefore begin thinking of the debilitation as disease rather than as part of the normal process of aging. Once this transition in thinking occurs, we are spurred to understand the cause of the illness. Perhaps when we understand the full scope of infectious causation and effectively prevent its damaging outcomes, vibrant 80-year-olds will be the rule rather than the exception.

PROSTATE CANCER: THE VERY UNDERSTANDABLE PROBLEM

The very understandable problem most people have in accepting this approach is the uncertainty associated with it. What is my cancer going to do? Will it just sit there for years, or will it begin to spread quickly? And, the biggest worry of all, how long have I got to live? Am I going to die soon?

No doctor can answer these questions, because in every man, prostate cancer is different. However, although we don’t know the absolute answers for your specific cancer, we do know some things, and they are reassuring.

We know what generally happens to men in your situation who are followed carefully with watchful waiting: Gradually, over time, the PSA level will go up. At some point, the bone scan will become positive. This is the time to begin hormone therapy. Once hormone treatment is under way, the PSA level almost always falls dramatically and stays low indefinitely—for some men, this can mean many years. However, at some point down the road, if the patient lives long enough, the PSA will begin to rise again, as the hormone-resistant cells start to multiply. This is when both patients and their physicians begin to worry, because if these cells cannot be stopped, a man’s lifespan is generally only one or two years from this point.

Now, having said this, we also add that for men facing this today, there is great hope. Within the next five to ten years, we expect major new advances that will make it possible for us to control these hormone-resistant cells. Monumental research efforts are being focused on finding new and better ways to treat advanced prostate cancer. And it is entirely possible, if and when you ever reach the point where the hormonal therapy is no longer working, that more effective treatments will be there waiting for you.

Therefore, it is impossible to tell any man with prostate cancer how long he will live today because there is great and reasonable hope that he will have a much brighter outlook tomorrow.

So, to sum up: All of this means that if you have positive lymph nodes and embark on a plan of watchful waiting, you will be avoiding unnecessary side effects today from treatments that will not prolong your life; that these treatments will be there tomorrow, if you develop symptoms and need them. And that, in the future, there is a strong likelihood that we will have new treatments available for you that will do a better job of controlling this cancer.

HORMONE COMBINATIONS AND SINGLE-DRUG FORMATS: WHAT STAGE ARE YOU AT?

If you are having irregular, heavy and prolonged menstrual periods and distressing menopausal symptoms

Your hormone therapy options include the following:

- HRT pill that combines oestrogen and progestogen

- natural oestrogen daily plus progestogen for ten to fourteen days a month

- low-dose combined Pill for women needing contraception

- the synthetic oestrogen ethinyl oestradiol, in combination with the progestogen-like substance cyproterone acetate (the combined formulation Diane-35) if acne and worrisome hair growth are problems and contraception is also needed

If you are postmenopausal and have a uterus

Your options for hormone therapy include the following:

- natural oestrogen pill daily or continous oestrogen by patch or implant, teamed with progestogen for ten to fourteen days a month (combined cyclical therapy)

- continuous natural oestrogen and continuous progestogen (continuous combined HRT)

The first of these approaches usually causes monthly withdrawal bleeds that become lighter after a few months and may continue for however long you use HRT. With the second approach, irregular bleeding may occur for the first few months but most women no longer have any bleeding a year later.

If you are postmenopausal and do not have a uterus

Your options for hormone therapy include the following:

- natural oestrogen by pill daily or continuous oestrogen by patch or implant

- natural oestrogen daily and low-dose progestogen daily (for about six months immediately after surgery for endometriosis)

- oestrogen with or without testosterone implants

POST-OPERATIVE DIETS IN GASTROINTESTINAL SURGERY: DIET FOLLOWING GASTRIC RESECTION

Following gastric resection, the period of readjustment to eating follows no predictable pattern; the diet needs to be adjusted frequently to meet the patient’s increasing tolerance.
The troublesome feature is the dumping syndrome.

Dumping syndrome is caused by a reaction to the hypertonic stomach contents which have passed into the ileum with abnormal rapidity. In this, the following dietary considerations are important:
1. Milk often causes difficulty, as in many gastrointestinal disorders.
2. Concentrated sweets and carbohydrates in general are poorly tolerated.
3. Volume of feedings, especially liquids should be limited.
4. Proteins and fats should be used in increasing amounts according to the individual tolerance.
The diet should be adequate in calories, high in protein and low in carbohydrates. The diet regimen is outlined in three steps for the convenience of the physician and the dietary personnel.
After gastric section patient should follow the following regimen:
1. Clear liquid diet.
2. Semi-solid diet (no milk, no cheese).
3. Regular diet, i.e., high protein, low fibre.
Avoid milk as beverage, raw fruits and vegetables, nuts and
concentrated sweets.

OTHER INEFFECTIVE TREATMENTS FOR BDD: NATURAL REMEDIES

This is one of a number of other treatment approaches and coping strategies that are sometimes used for BDD but appear ineffective.
Natural remedies   Some people try “natural remedies,” such as homeopathic approaches, megavitamins, St. John’s wort, and other substances found in health food stores or on the internet. These treatmerits don’t seem to work.

 None of them have been studied in BDD, and there’s no evidence they’re effective. Just because substances like tryptophan and 5-HTP (5-hydroxytryptophan) are natural and have links to serotonin doesn’t mean they effectively treat BDD. While some-of these substances are potentially harmless, others may actually be harmful. In fact, a number of years ago the U.S. Food and Drug Administration withdrew tryptophan from the U.S. market because a toxic variant of this compound was inadvertently produced, which caused at least 37 deaths and 1,500 cases of a severe syndrome called eosinophilia myalgia syndrome. 5-HTP, too, may be dangerous. The weight loss herbal supplement ephedra (ma huang) was linked to many heart attacks, strokes, and even deaths. So not everything that’s “natural” is healthy; arsenic, too, is natural but can kill you.
The problem is that the Food and Drug Administration generally doesn’t regulate herbs and dietary supplements, and they can be marketed without any proof of safety or effectiveness. Some are contaminated with toxins like mercury lead, or dangerous pesticides. Prescription medicines, such as SRIs, in contrast, must undergo extensive and rigorous scientific testing to demonstrate that they’re both safe and effective before they can be marketed. You’re much better off trying an SRI, since they’ve been extensively tested for safety, safely taken by many millions of people, and shown by research studies to often effectively treat BDD.

TREATING MIGRAINE WITHOUT DRUGS: MEDITATION AND YOGA

Meditation The many different forms of meditation can be grouped into two general categories: those concerned with ‘emptying the mind’ and those in which internal thoughts are built up and maintained by an effort of concentration.Transcendental meditation became very fashionable in the West during the 1960s and much is claimed for it by headache sufferers. It is not surprising that an act of relaxation or withdrawal from everyday activities is associated with relief of tension which produces a reduction in headache frequency. It is less likely to be effective once a headache has started, presumably because the metabolic changes which occur during the headache make it difficult to maintain the appropriate state of mind.

Yoga Yoga is an ancient Indian technique of achieving total bodily and mental control in an attempt to reach new heights of awareness and in promoting relaxation. There have been several trials of yoga methods of meditation in the prevention of migraine and the results, although preliminary, are encouraging.’Yoga of the body’ is concerned with making the body a fit vehicle for the mind as it meditates. The first precepts of control are based on the type of foods ingested, and are similar to much of the dietary advice often given for migraine: no citrus fruits, little cheese, no alcohol or wine, no garlic or onions and, in addition, no smoking.

 Garlic and onions are excluded because they may cause gastric upset. Meals are taken three times a day, the stomach being ‘half filled with food, a quarter filled with water and one quarter left empty’, to avoid any feeling of fullness. Food has to be chewed thoroughly and eaten slowly (in contrast to the gulping of quick snack lunches seen in British pubs). Constipation is avoided by adding bran to the diet. Much of this advice is commonsense and it is understandable that, with this regime, the body will function in a better way.The exercises of yoga are divided into those in which breathing is the main concern, and those which exercise the rest of the body.

 The breathing exercises are designed to establish conscious control over respiration as well as using the stomach muscles to ensure that the lungs are fully inflated.The bodily exercises are performed very slowly and involve either stretching movements or the maintenance of particular positions for periods of time. Physiologically, the maintenance of posture utilizes the stretch reflex of muscles. The whole system can be likened to a cat stretching and rolling, with movements being slow and graceful. It is essential that these exercises become comfortable and patience is needed for this but, after three months’ practice, many patients find they feel much better, fitter, and much less likely to develop headaches.There are many techniques of teaching yoga.

 The meditation aspect of yoga is the most important so that those techniques controlling thought, or holding thoughts in the mind and so building on them, are likely to be of benefit in developing control.Current approaches involve combining certain yoga techniques with biofeedback and it will be interesting to see how much this will achieve; it is conceivable that migraine patients who practice these techniques will not be so much at the mercy of stress and therefore will suffer fewer headaches.

INCEST OFFENDERS VS. ADULTS: EARLY LIFE

The incest offender vs. adults was rarely the youngest or oldest child, and rarely an only child. In fact, he was reared with more siblings (an average of 5.1) than any other type of offender. He was well supplied with sisters: 80 per cent had sisters, and the average incest offender vs.

 adults had 2.67 of them—the second largest number recorded. In addition, an astonishing 40 per cent had two or more older sisters—a proportion far beyond that of any other group. This group was even better supplied with brothers: 84 per cent had male siblings and had, on the average, 2.75 of them—again the largest number recorded. The sex ratio was 107.4 brothers for every 100 sisters, which comes close to that of the prison group (106.5) and is not too far removed from that of the control group (101.5).

The incest offenders vs. adults had, at ages fourteen to seventeen, the best relationships with their fathers. In this respect they did slightly better than the heterosexual offenders vs. adults who, incidentally, are the only other group whose offenses consisted mainly of mutually voluntary sexual contact with adult females. It is no accident that as far as getting along well with their fathers is concerned, the groups closest to the incest offenders vs. adults are the heterosexual offenders vs. adults and minors, and that they are followed by the control group.

The incest offenders vs. adults got along extremely well with their mothers, being second only to the offenders vs. minors. Significantly the next “best” groups are again the heterosexual offenders vs. adults, with the control group once more following in fourth place. If one devises a rating system measuring relationship with both parents, the incest offenders vs. adults and the heterosexual offenders vs. adults share first place in excellence, the heterosexual offenders vs. minors are in second place, and the control group is third.

Most of the incest offenders vs. adults said that they got along equally well with both parents (50 per cent), fewer were partial to the mother (36 per cent) than any group except the heterosexual offenders vs. adults, and fewest favored the father (14 per cent). This is the “normal” ratio that characterizes four groups: the control, prison, and heterosexual offenders vs. minors and adults. At this point it is worth recalling that this favorable ratio did not obtain for the other incest offenders, although the incest offenders vs. minors approximate it. One can say that the normalcy of parental preference correlates, in the incest offenders, with the age of the daughter.

While relatively few of the incest offenders vs. minors came from broken homes, some 60 per cent of the incest offenders vs. adults did, a figure close to that for the incest offenders vs. children. The average, offender vs. adults was almost seven years old when his first home broke up, a not uncommon average age. All incest offenders are within the upper half of a rank-order of average age at the breakup of the original home.

Slightly over half of the incest offenders vs. adults said that when they were between fourteen and seventeen years old their parents got along together well; this percentage is somewhat low. On the other hand, few (18 per cent, a figure below that of the control group) said that their parents got along poorly or badly. To put it briefly, the parents of the incest offenders vs. adults got along better than the parents of the other sex offenders, although not so well as the parents of the men in the control and prison groups.

Despite the rather high incidence of broken homes, the incest offenders vs. adults are second only to the control group in a rank-order of those who had lived 15 or more years in a home in which there were both a husband and wife. This agrees with the fact that none of them had been sent to institutions such as orphanages.

While the incest offenders vs. adults got along exceptionally well with their parents, they seem to have been unable to socialize effectively with their contemporaries at ages ten to eleven. Whereas one fifth to one fourth of most groups said they had had many boy and girl playmates, only 12 per cent of the incest offenders vs. adults could make the same claim. As far as female companions are concerned, they make the worst showing of all: slightly over half had no girl playmates. This is an early intimation of the later limited sociosexual life characteristic of this type of offender. Since we have seen some groups with poor parental relationships having compensatory good relationships with their peers, one wonders if the excellence of the relationship of the future incest offender vs. adults with his parents may represent some sort of withdrawal from life outside the family, a tendency to be a stay-at-home mama’s (and papa’s) boy, obedient to his parents and later to the moral dictates of society.

This picture of poor socialization with females of their own age in childhood becomes even worse when one recalls that the incest offender vs. adults was unusually well supplied with sisters. What with all his sisters and their friends, he was in a singularly advantageous position to learn about females, to learn to socialize effectively with them, and to have prepubertal sex play. The fact that he failed to utilize his opportunities seems in retrospect a bad sign.

This initial impression of restraint is fortified by an examination of the prepubertal sex life of the incest offender vs. adults. Forty-eight per cent (the highest number of any group) had no sex play; only 36 per cent had heterosexual play, the second lowest percentage of any; and 28 per cent (the smallest percentage of any group) had prepubescent homosexual play. Also, they were strongly inclined to be exclusive in their type of sex play: only 12 per cent had both heterosexual and homosexual experience. This low percentage plus the small amount of prepubertal sex play combines to give a picture of restraint and sexual psychological rigidity which we shall see carried into adult life.

As one would anticipate, the duration of sex play was correspondingly brief, and there is nothing distinctive about the techniques involved. The number who had prepubertal sexual experience with adults is too small to permit analysis, but this in itself is significant. No case was found of physical contact with an adult female, and only one case of physical contact with an adult male. This latter case is worth noting only because the other two incest groups also had extremely little contact with adult males.

Like the incest offenders vs. minors, the incest offenders vs. adults were reasonably healthy during childhood, so their social deficiencies and sexual restraint in preadolescence cannot be attributed to ill health.

Their early reticence is evident from the fact that by age ten only 10 per cent had seen the genitalia of an adult female; this is the lowest percentage of any group, and indicative of moral restraint, lack of interest, or an especially conservative environment. Even by age nineteen one quarter of them had never seen adult female genitalia.

Another sign of excessive sexual inhibition is that despite having had a large number of sisters, and the fact that 40 per cent had two or more older sisters, not one of the incest offenders vs. adults reported that his first sight of postpubescent female genitalia was sight of a sister’s genitalia. One can only envision a large but prudish family or a boy so inhibited that he actively avoided opportunities that some other boy would exploit or at least passively accept.

Still another evidence of minimal sexual activity is seen in the record of prepubertal masturbation: only 32 per cent of the incest offenders vs. adults had this experience and thereby share with the incest offenders vs. minors the distinction of having had the smallest percentage of their members with prepubertal masturbation. This in conjunction with their record of having had the lowest percentage of constituent members with sex play makes the incest offenders vs. adults the least active sexually (in preadolescence) of any group.