FUNDAMENTAL BASIS OF IRISDIAGNOSIS: INTERPRETATION OF THE TOPOGRAPHY OF THE ORGANS IN THE THREE MAJOR ZONES

(SIX MINOR ZONES)-1ST MAJOR ZONE—STOMACH AND INTESTINAL ZONE

In considering the topography of the organs we commence with the first minor zone—the stomach zone. The stomach zone has already been indicated as the first zone in the circular division of the iris. It is now necessary to identify the parts of the stomach in the right and left iris.

If the body is divided down the middle by a perpendicular line we have: Pylorus with about one-third of the stomach in the right half of the body. Cardia and two-thirds of the stomach in the left half of the body.

All organs on the right side have their place in the right iris, and all organs on the left side have their place in the left iris, thus:

Pylorus and one-third of the stomach in the right iris. The remaining two-thirds with cardia in

the left iris.

By dividing the stomach horizontally through the middle we obtain an upper and a lower part for each iris. Considering the right upper part of the stomach, this will include an anterior and posterior view of the upper part of the pylorus with the right side of the lesser curvature. Since we have in both upper and lower halves of the iris a representation of the anterior, posterior and lateral views, we may determine precisely the different regions of the stomach from the iris. Similarly, we place the right lower part of the stomach in the right iris, and both upper and lower left regions of the stomach correspondingly in the left iris.

Pylorus is exactly in the middle, lying between the upper and lower halves of the right iris. Thus:

Upper half pylorus—Right iris nasal side—n’-is’—anterolateral aspect. —Right iris temporal side—45′-48′—posterolateral aspect. Lower half pylorus—Right iris temporal—42

‘-45′—anterolateral aspect. —Right iris nasal—15′—18′—posterolateral aspect.

The cardia, lying in the left side of the body, is represented only in the upper half of the left iris, at:

Left iris nasal—45′-50′—antero-lateral aspect.

Left iris temporal—10′-I5′—postero-lateral aspect. In my view we cannot place the cardia in the lower half of the left iris.

The second small zone is designated the Intestinal zone, which includes the duodenum, small intestine, and the large intestine with sigmoid flexure. We shall again require to identify the regions of the right side intestine in the right iris, to show right upper and lower intestine with anterior, posterior and lateral views.

Of especial interest to us here is the duodenum. Since this, and that part of the stomach lying in the right side of the body is more frequently affected, there must be reserved to this area a large part of the iris. We find on considering the indications that the proximal part of the

duodenum lies over the pylorus.

For this part of the duodenum we have shown in the iris the area 10/-15′ and 45′-50′ in the upper half, corresponding to the anterior, posterior and lateral aspects. The part of the duodenum which lies below the pylorus is seen in the lower half of the iris from 15′-20′ and 40 ‘-45′.

The junction of the duodenum with the small intestine lies in the left half of the body, so the area for it is found in the lower half of the left iris from 40′-45′. That part of the small intestine lying in the right half of the body is found in the right iris from 5 ‘-35′ with an intermediate position for a part of the duodenum.

At 35′ in the right iris, the ascending colon commences with the caecum, and extends to 50′, allowing for the insertion of a part of the duodenum. Here the right flexure indicates the commencement of the transverse colon which extends to 5′. Where there is a diseased appendix (it possesses much lymphatic tissue as is well known) the signs are to be seen outside the intestinal zone at 35′.

In the left iris, the area for small intestine extends from 35′-55′, with inclusion of that part of the duodenum which lies on the left side of the body—as already referred to above under Duodenum.

The transverse and descending colon is to be found in the area 55′-25′. The sigmoid and rectum then extend from 25′-35′. The last part of the rectum with ampulla and anus lies at 32-34′ in the muscle, bone and skin zones.

*12\78\2*

MENSTRUAL PROBLEMS: HOW TO COPE-IN VARIOUS SITUATIONSC-AT WORK:

GIVE YOURSELF A BREAK

If you suffer from fatigue at period time, your body will be letting you know how much rest you need and, if you’re extremely tired, insisting that you take it. The trouble is that so many women feel compelled to make the effort to go on working even when they are tired. We shop in the lunch hour, or work through the tea break to oblige somebody. It may seem noble, but it isn’t sensible. I have a sneaking feeling that this willingness to sacrifice ourselves goes right back to the attitudes we imbibed when young. Little boys are usually told to ‘stand up for themselves’ and ‘be a man’. Little girls are usually expected to help with the housework and told not to ‘make a fuss’. Standing up for your rights may seem unfeminine if you have grown up feeling that a woman’s role is to serve and be unselfish. You are lucky if you’ve grown up in a household where boys and girls both help with the housework, because you’ll be more likely to insist on your rights at work. A woman needs her rest breaks just as much as a man does, and at period time she needs them even more. So take all the rest you’re entitled to, sit down whenever you can and make sure you eat a meal in your lunch break. And if you are one of those girls who usually spend the lunch hour window shopping, give it a miss for those few crucial days when you’re low — however tempting the windows maybe.

Lack of balance may make you inaccurate, which can be a great nuisance whether you’re a supervisor, managing director or a typist; indeed in any job that requires detailed and painstaking acuracy. You can help yourself by making sure that you aren’t tense when you’re working and that you deliberately do everything more slowly. Take a few minutes to relax before you begin work and breath in a lower gear. If you feel yourself rushing, check that you haven’t tensed up again. Your neck, shoulders and hands are often the first parts of your body to show stress in this way, particularly if your work involves a lot of writing. And if you notice your mistakes and start to panic because you’re doing so badly, don’t forget what a help relaxation and breathing in a lower gear can be if you’re in a flap. If you are the boss, it’s simpler to do; but if you work for someone else it might be a good idea to let him or her know what you’re doing, and why, so that he or she will realize that you’re not slacking, merely sacrificing speed for efficiency, just for a few days.

Many women find that an approaching period makes them very forgetful. Their minds ‘go woolly’. If that’s your problem, take a fellow sufferer’s advice and get into the habit of writing yourself a list of all the jobs you have to attend to, and pin it up where it will catch your eye.

People like telephonists, actresses or teachers, who use their voices a lot during their work, are more liable to suffer from throat infections or laryngitis during the run up to their periods. Obviously it makes good sense to ensure that you’re eating well and getting enough rest when you’re vulnerable, because that will give you more of a chance to fight off infection. But it also helps if you can pitch your voice a little lower than normal. We tend to speak up, in every sense of the word, when we want to be heard and if you have pitched your voice too high, that will put your throat and vocal chords under unnecessary strain. If your face, neck or throat are tense, that’s another source of strain, so don’t forget to relax them, and to keep checking that they stay relaxed.

*56\177\2*

CHILDREN HEALTH: MEDICINE CHEST

Although most of the medications your child will take will be on a doctor’s prescription, there are certain items every parent ought to have on hand at home. Some of these are nonprescription medications that you can buy over the counter at your drugstore. These are usually called OTC medications. Other items, like a thermometer, are basics of a home health care kit. You’ll also need antiseptics, ointments, gauze pads, and bandages in preparation for the inevitable bangs, bruises, scrapes, cuts, and other minor crises of childhood.

When you’re assembling this kit, however, remember a few safety rules:

•     Do not buy or administer any but the most basic drugs without the advice of a doctor.

•     Only buy medications in containers that have child-proof caps. Keep all medications in their original, clearly-labeled containers.

•     Unless your child takes a prescription medication on a regular basis, do not keep leftover medicines. Flush liquids and pills or capsules down the toilet and throw out the containers.

•     Keep all medications locked away from children. If you and your young child are visiting friends who do not have children, make sure that no dangerous substances are within reach of the child.

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ANIMAL BITES IN CHILDREN

Animal bites that break the skin are cuts, puncture wounds, or scrapes. However, animal bites may result in serious complications. First, animal bites often become infected by the bacteria in the animal’s mouth. Second, animal bites may cause tetanus (lockjaw) or rabies.

Tetanus (lockjaw) is a serious disease caused by a germ that lives in soil, dust, and the intestines and intestinal wastes of animals and humans. It can easily enter the body through puncture wounds or scratches caused by animal bites and claw wounds. A vaccine to prevent tetanus is available.

Rabies is unknown in Australia. It is a fatal disease of the central nervous system that may affect any mammal. It is caused by a virus that can be identified within the brain of an affected animal. Rabies is transmitted through the saliva of the sick animal.

Signs and symptoms

Even in younger children, an animal bite is usually obvious from its appearance. It is sometimes difficult to tell a bite from a claw wound; however, claw wounds should be treated in the same way as bites because a claw wound can also contain bacteria from the animal’s saliva. U the bite has caused a bruise, but there is no break in the skin, you do not need to worry about tetanus.

Home care

Scrub the wound with soap and water for five to ten minutes and flush with water. Apply antiseptic to minor wounds. Report the wound to your doctor immediately for advice concerning tetanus, and repair of the wound. Let your doctor know when your child was most recently vaccinated against tetanus.

The chance of an animal bite becoming infected is very high. If redness begins spreading out from the wound, or if the wound becomes more tender, call your doctor.

Precautions

• Be sure your child has regular tetanus boosters.

• Always contact your doctor about treatment in the case of animal bites.

Medical treatment

Because of the high possibility of infection, your doctor may decide not to stitch the wound. However, if the wound is located where scarring is not desirable (such as on the face), the doctor may choose to stitch the wound. Before stitching, treatment first includes removing the injured tissue and a thorough cleansing. Antibiotics taken by mouth may be prescribed. If necessary, your doctor may give the child a tetanus booster or antitoxin (a substance that counteracts the poisonous effects of the tetanus germ).

*12/84/5*

DIABETES: QUESTIONS ASKED BY CHILDREN AND YOUNG PEOPLE

Can I join scouts or guides or a youth club?

Certainly there is no reason at all why you should not join any youth club or group. Make sure that the leader knows that you have diabetes and is told what to do if you should have an insulin reaction.

Can I go camping with my youth club?

Yes, as soon as you are able to do your own injections, measure your own insulin dose, do your blood tests, and know how to measure your diet. Most children can do all these things by the time they are 12 or 13 (and some younger) and if you cannot, you should only go if there is some adult with the group who is prepared to take responsibility and can do these things for you. One of the important objectives of learning about diabetes is to make you self-reliant so you can

Who should you tell that you have diabetes?

Your parents of course will tell your close relatives and perhaps your adult friends who have a lot to do with you. They would need to know about your diabetes if you have meals with them or so they could help if you should have a hypo when they are responsible for you. Clearly your schoolteacher ought to know and so should any youth club leader or sports instructor or coach. They will want to know so that they can allow you to have extra sugar to cover extra physical exertion and so that they will know what to do if you should by any chance have a hypo.

The major problem may be to decide which of your own friends and acquaintances should be told and how to tell them. Sometimes this problem is very easily resolved and certainly any boy or girl who is a good friend should be told that you have diabetes.

Perhaps your friends will ask you where you have been when you go back to school after developing diabetes. Then it is easy to say, ‘Well I got sick and had to go to hospital where they found I had diabetes. I have had treatment and I am perfectly all right now.’ Perhaps your friends will want to know a little more about it and you can tell them that you have insulin injections each day and that you have to restrict certain foods. If your friends are interested in a sensible way then, there can be no harm in discussing it with them and giving them as much information as they want.

There is really no need for other people who are not particular friends and who are not responsible for your care to know about your diabetes. You might tell your friends that although you are not ashamed about having diabetes you see no point in having it generally discussed around. In general, it is better to adopt the attitude that diabetes is not particularly important, it is just something you have got; it does not affect you in any way.

*97/54/5*

LIVING LONG: MEN OF AGES

Back in biblical times, longevity wasn’t such a big deal. Heck, Moses lived 120 years without missing a step, according to the Bible. Noah kept trekking 350 years after the flood-living a colossal 950 years. And we hardly need mention Methuselah’s claim to fame. At 969 years of age, he’s credited with being the oldest man in history.

How’d they do it?

With all due respect, they most likely didn’t. Theologians have mulled this question for years. By considering traditions of the time, they have developed very human explanations for what appear to be superhuman life spans.

«No one really has the answer, but there are two very plausible explanations,» says the Reverend Glenn Asquith Jr., Ph.D., professor of pastoral theology at Moravian Theological Seminary in Bethlehem, Pennsylvania. «One is that the Israelites counted time differently. Some have theorized that they followed a lunar rather than a solar calendar.»

An even better explanation is that the Israelites loved their heroes much in the way we do-by making them larger than life. It’s like all of the embellishment surrounding George Washington, the Reverend Dr. Asquith says. «Most of these stories were passed down orally. So, with each telling, they likely became embellished. Since longevity was a sign of God’s blessing to the ancient Israelites, it makes sense that they would make their heroes out to be ancient.»

*4/36/5*

HOMOCYSTEINE

Homocysteine is an amino acid that forms in our body as a result of breakdown of dietary protein. It is also an intermediate molecule in the synthesis of the amino acid cysteine from methionine, (another amino acid). The main role of methionine in the body is to provide methyl groups for metabolic processes to occur. When methionine loses a methyl group it becomes homocysteine. In order for homocysteine to be converted back into methionine, it must receive a methyl group from either folic acid (vitamin B9), or vitamin B6. Vitamin Â12 is needed as a co-factor for this reaction to occur.

Homocysteine can be measured in our bloodstream; a high reading usually indicates we do not get enough vitamins B6, Â12 or folic acid in our diet. These vitamins are found in high amounts in fresh fruit and vegetables, as well as animal protein such as red meat, eggs and fish. Betaine is another nutrient helpful in keeping homocysteine low; it is found in high amounts in eggs. Diets high in processed foods are often lacking these nutrients. Having high blood levels of homocysteine is thought to be a major risk factor for heart disease, and several other diseases.

The inner lining of our arteries is called the endothelium. In healthy arteries the endothelial cells form a continuous protective layer, regulating which substances can pass from the bloodstream into the deeper artery wall. If our endothelial cells are injured and inflamed, it makes the artery lining more permeable, allowing molecules to enter the artery wall. Homocysteine has an abrasive action; it scrapes the inner lining of our blood vessels. People with high homocysteine levels have greater damage to the lining of their arteries and more atherosclerotic plaques. High levels of homocysteine also seem to activate platelets and increase the tendency for clots to form. A study published in the Journal of the American Medical Association showed that men with the highest homocysteine levels are three times more likely to have a heart attack, regardless of their cholesterol or triglyceride levels. High blood homocysteine levels have also been strongly linked with the following diseases: Alzheimer’s disease, osteoporosis, depression, diabetes, multiple sclerosis, rheumatoid arthritis and birth defects.

What Causes Elevated Homocysteine?

•    Inadequate intake of folic acid, vitamin B6 or vitamin B12 in your diet, or malabsorption of these.

•     Genetics. Some people have a genetic defect which affects their ability to absorb and use folic acid. These people need higher amounts of folic acid than a normal diet can provide, and they are best off taking a supplement.

•     Stress. Adrenaline and noradrenaline are stress hormones and their metabolism requires methylation. This increases our need for vitamins B6, Â12 and folic acid. If our intake is inadequate, homocysteine will build up.

•     Coffee consumption. The more coffee we drink, the higher our homocysteine tends to be.

•     Oral contraceptive use. This is because oral contraceptives deplete the body of vitamin B6 and folic acid. This may be one reason why oral contraceptives can increase the risk of heart disease.

•     Impaired kidney function.

*5/53/5*

ASSESSMENT OF OSA (OBSTRUCTIVE SLEEP APNOEA)

Although a physical examination and detailed medical history can tell a great deal about the likelihood of OSA, confirmation of the syndrome can only be done in properly equipped sleep laboratories which are now established in many large public hospitals and some private institutions. Formal sleep studies (technically referred to as polysomnography) make it possible to observe the patient in a clinical setting under the supervision of trained personnel.

Many of the functional and physiological changes mentioned previously, such as airway obstruction, hypoxaemia and irregularities of heart rate, are monitored during the study, giving investigators enough information to decide on the best course of action for the hapless snorer. Most people are apprehensive about the need for hospital admission and comprehensive testing procedures, and it is important that they be informed and reassured of the non invasive nature of these procedures. A nervous patient is likely to have a poor night’s sleep from which little useful information can be extracted.

Oxygen saturation

Probably the single most important measure of the severity of OSA is the level to which blood oxygen falls. Blood oxygen concentration, or saturation, can be estimated quite accurately by attaching a probe to either a finger or ear lobe. A special light emitted from the probe is able to detect oxygen saturation in the blood supply of the site to which it is attached, which in turn reflects the circulating oxygen level.

Sleep states

Airway obstruction is more pronounced in deep sleep, particularly during REM, and it is therefore important to document sleep stages to confirm that the patient slept soundly, preferably with several episodes of REM. Sleep states are monitored via several electrodes which are glued to various sites on the head which detect electrical activity °f the brain, eye movements and muscle tone, all of which help to define sleep states.

Chest wall movement: Obstructive and Central

The two broad categories of sleep apnoea, central and obstructive, are defined by the type of respiratory efforts made. One way of measuring this is to look at the movement of the chest wall as it expands and contracts with each breath, in conjunction with a detector of airflow at the opening of the nasal passage. When the upper airway collapses in obstructive sleep apnoea, the chest wall continues to move but there will be no detectable airflow through the nose. Falling oxygen levels stimulate the patient to take bigger breaths resulting in ever increasing signals from the monitor of chest wall movement. Eventually, the obstruction is overcome, airflow is again detected and breathing returns to normal until the next obstructive event. With central apnoea, the chest wall shows little or no sign of movement, indicating an absence of respiratory effort. This is also accompanied by a cessation of airflow.

Heart monitoring

The final obligatory assault comes in the form of a heart monitor (or ECG), the electrodes of which are attached to the chest. The ECG records the heart rate and provides information about the electrical impulses which stimulate the heart to beat regularly.

The process of «wiring up» for a sleep study can be an intimidating experience for those with an innate fear of hospitals and high technology. A small percentage of patients never relax enough to get a good night’s sleep, but most adapt quickly to the novel circumstances and sleep soundly enough for the purpose of the investigation. In this respect, patients with advanced OSA have no problems, often falling asleep while being attached to their monitoring equipment.

The capacity to measure oxygen saturation, sleep states, chest wall movement, nasal airflow and heart rate is a minimum requirement for a unit specializing in sleep-related breathing disorders. Some units, however, are capable of measuring other parameters of sleep and breathing and have the resources to screen several patients on the same night.

*12/51/5*

PREVENTION: DIFFERENCES BETWEEN HEALTH AND ILLNESS BEHAVIOUR

The large differences in health and illness behaviour between groups and cultures suggest that it must be learned. Research shows that Jews and Italians claim that their mothers were over-protective and over-concerned about their children’s health and participation in sports and that they were constantly warned to avoid colds, fights and other threatening situations. Perhaps this kind of upbringing fosters a type of personality which is particularly concerned and even anxious about illness.

First-born and only children are more likely to want the company of another person when they face stress in adult life-probably because they are so much more psychologically dependent than later-born children. This is interesting in the light of studies which show that early-born children use more medical services than do later-borns (in whatever size of family).

We have already seen that psychological manoeuvres that are going on, usually quite unconsciously, are much more complex. Illness behaviour is part of a well-defined social pattern and we all have our views of how doctors (them) and patients (us) behave. I firmly believe, to paraphrase Shakespeare, that, ‘All the world’s a surgery and all the doctors and patients merely role-players.’ It is my view that many of those going to their doctors are quite unconsciously playing a role-the sick role. Studies suggest that only about four out of ten people going to a general practitioner have anything physically wrong with them and that about 80 per cent of all ailments are self-limiting. So what are we all playing at?

Illness behaviour (adopting the sick role) is a very effective way of being relieved from social expectations, and is an excuse for failure, a way of obtaining privileges and sympathy, and so on. For those who have few social ties, poor support and feel isolated, the medical system is a well-recognized and comfortable way of obtaining at least some of these. Thirty or more years ago perceptive doctors realized that what their patients came to them for was often quite unimportant but what it did was to establish a relationship with the doctor who would then confirm them in the sickness role. Doctors need people like this to make them feel wanted so that they, the doctors, can live out their role as health-givers. Unfortunately, many doctors do not understand this role-playing and as a result go along with their patients’ endless demands for medical care. This results in numerous return visits, many if not most of which would be unnecessary if the patient’s real problems and motivations had been perceived and adequately dealt with by the doctor at the first consultation.

Just as certain people unconsciously retreat into the sickness role because it is a release from unpleasant or unacceptable situations, others sacrifice their health to ambition, expediency or the good of others. Young parents overwork in the full knowledge of what they are doing, sometimes also going without things ‘because of the children’ and so on. The health of general practitioners is perhaps a good example. British GPs have alarmingly high rates of alcoholism, drug abuse, broken marriages, coronary artery disease and suicide, yet they presumably know all the answers. To some extent at least, they are choosing to sacrifice their own health in favour of that of their patients.

But closely allied to all this illness and sickness behaviour is society’s concept of what is normal, and how it defines ill health. Mental illness for example, has been seen, at different times over the centuries, as demonic power, witchcraft and madness. The labels, the treatments and the social attitudes are all different and yet the ‘reality’ of the illness in question may well have been the same. Alcoholism is another example. When does social drinking become an illness? Sexual deviations and hypochondriasis or malingering are especially difficult to define yet somewhere along the line is a point beyond which sufferers could be said to be ‘ill’. Certainly fashions and fads are all-important when trying to define behaviour of any kind, let alone illness behaviour. Forty years ago oral sex was a ‘perversion’-today it is a fashionable pursuit that raises few eyebrows. Today we accept the fact that 30 per cent of the population has backache-it is ‘nor-mal’-and that thousands are killed on the roads every year. In developing countries parasitic diseases, infectious diseases, civil war or poverty may be similarly accepted as ‘normal’.

*12/72/5*

RECOMMENDATIONS FOR WEIGHT LOSS: GET MOVING

An active lifestyle is extremely important for everyone, regardless of whether they want to lose weight. Time and again, studies have shown that those who exercise regularly tend to live longer and feel more satisfied with themselves than those who never get off the couch. Just think of the people that you know. Chances are that those who get out and move around regularly are more energetic and vital than those who don’t.

If you’re just launching an exercise program, the important thing is to start slowly. Five minutes of something as simple as walking is enough at first, especially if you’ve been inactive. Just increase the length of your walks by about 5 minutes a week, until you’re getting 45 to 60 minutes of exercise at least 5 days a week.

This doesn’t mean that you need to spend all of that time on a treadmill or stairclimber. There are dozens of activities that can provide an aerobic workout. The choice is up to you. Dust off your old 10-speed bike and go for a ride. Play a couple of sets of tennis, or sign up for an aqua-aerobics class at the local YMCA. Find an activity that you enjoy. That way, you’ll be more likely to stick with it.

Also, try varying your exercise routine so that it doesn’t become tedious. If you ride a stationary bike for 45 minutes on Monday, go for a walk in the woods on Tuesday. Or take your bike outside on the patio for a change of scenery. Once in a while, throw in an activity that you’ve never done before, like rock climbing or inline skating or tai chi.

And don’t overlook the little things that you can do to enhance your health and fitness—and burn a few extra calories. Instead of driving around the supermarket parking lot three times, looking for the space closest to the door, leave your car out in the hinterlands. Clean out the garage, rake up the leaves in the yard, or hang the laundry outside rather than using the dryer.

Over time, activity and exercise will become a natural, even en¬joyable part of your life. Have faith and give it a try.

*5\89\8*

Что это такое

Болезненные изменения в организме, возникающие вследствие первичного повышения артериального давления, называются гипертонической болезнью. В определении заболевания подчеркивается именно первичная гипертония, в отличие от вторичной гипертонии -повышения давления при таких болезнях, как воспаление почек, поражение клапанного аппарата сердца, заболевания щитовидной железы, придатка головного мозга и др. Повышенное давление в этих случаях является одним из признаков страдания. При выздоровлении или улучшении состояния больного вторичная гипертония исчезает или становится менее выраженной.

Вместе с тем, при гипертонической болезни также возможны изменения в почках, сердце и других органах, но это уже не причина, а следствие первичного повышения артериального давления.

Какое давление можно считать нормальным и каковы пределы его колебания?

Артериальное давление подвержено существенным колебаниям даже и в норме. Оно зависит от возраста, пола, характера питания и даже от географических и социально-экономических условий жизни. В младшем возрасте средняя цифра колеблется: максимальное (систолическое) — 110-130, минимальное (диастолическое) — 70-80 мм ртутного столба.

Предлагается формула для определения нормального артериального давления:

- для максимального давления 120+(0,6Xчисло лет);

- для минимального давления 63+ (0,4Xчисло лет).

В разные дни показатели давления бывают неодинаковыми. Колебания возможны и в течение суток. Иногда бывает неодинаковое давление на правой и левой руке. В этих случаях более высокое давление чаще находят на правой руке.

Многие больные постоянно с тревогой ожидают, каковы будут результаты измерения кровяного давления. Такое тревожное состояние само по себе может его повысить. Этим больным полезно знать, что высокие цифры кровяного давления далеко не всегда соответствуют тяжести заболевания: иногда высокое давление находят больных, общее состояние и самочувствие которых остаются вполне удовлетворительными. И у совершенно здоровых людей при некоторых условиях, например, при волнении, во время бега или при пребывании на холоде, кровяное давление может временно значительно повыситься, но потом быстро снижается.

Замечено, что у некоторых давление легко «подскакивает». На сравнительно незначительные физические или психические раздражения они реагируют значительным повышением кровяного давления, которое дольше держится на высоких цифрах, чем при тех же условиях у большинства людей. Таких людей нельзя считать больными, но при одинаковых условиях они легче и быстрее, чем другие, могут заболеть гипертонической болезнью. Однако они могут и не заболеть, если вовремя принять соответствующие меры.

Если же такие меры не будут приняты, то при неблагоприятных условиях может развиться гипертоническая болезнь, и тогда кровяное давление все реже и реже падает до нормальных цифр, но может установиться на нормальном уровне после полного покоя в постели.

PREPARING FOR THE ELIMINAYION DIET: REINTRODUCTION PHASE

Reintroduce one item each week, for example:

week 1 – food containing additives

week 2 – tea

week 3 – coffee

week 4 – beer

week 5 – white wine

week 6 – red wine

week 7 – spirits

week 8 – chocolate Take some of the test food or drink every day, starting with a small amount and continuing for a week. If there is a reaction, then stop immediately. Wait until you are better, then go on to the next item. If there is no reaction then give it up again after a week, and test the next item. At the end of the testing period, you can reintroduce all the things that produced no reaction.

If you react to food containing additives, then leave these out again for a while, while you test other items. Then test them again individually – see pp305-6 for details of the different groups of additives. If you react to one member of a group, you may well react to others in that group too.

Try to continue your good eating habits after the diet is finished – don’t go back to eating a lot of salt and sugar, or drinking huge quantities of tea, coffee or alcohol (even if these didn’t cause any specific symptoms). Keep eating fresh foods, particularly green vegetables, and stay away from junk food.

Once you have established which items cause your symptoms, you will probably need to avoid these entirely for some considerable time, although you might be able to consume a small amount occasionally. Try them out from time to time, to see whether your reaction has abated.

*354\180\8*

WHAT CAUSES FOOD INTOLERANCE? BUGS IN THE SYSTEM

Our digestive tract is home to a great many bacteria and other microbes, which do not cause any disease, and are actually important for good health. They are known as the gut flora. Some doctors believe that the gut flora may become ‘disturbed’, causing the beneficial bacteria such as Lactobacillus to become less abundant, and other, more damaging microbes, to take their place. This might then lead on to food intolerance.-

The main evidence for this has been gathered by Dr John Hunter of Adden-brooke’s Hospital in Cambridge. Dr Hunter noticed that many of his patients with irritable bowel syndrome or IBS, dated their illness back to a bout of diarrhoea caused by an infection, or to a long course of antibiotics. Both these things are known to disturb the gut flora . Some women patients had first suffered from IBS after having a hysterectomy operation. This seemed puzzling, until Dr Hunter discovered that antibiotics were always given before such operations, to help prevent infections. An experiment followed in which some hysterectomy patients had the antibiotic treatment while others did not -11 per cent of those in the first group developed IBS but none of the second group did. In a further experiment, Dr Hunter looked at the bacteria found in the stools of IBS patients, and detected some differences from the bacteria of healthy people.

*306\180\8*

FOODS CONTAINING YEAST

Main sources of yeast

Bread, including pitta bread and pizza, but excluding soda bread, matzos

and chapattis. Buns and cakes made with yeast eg doughnuts Yeast extract (Marmite, Vegemite etc)

Oxo cubes and most other stock cubes

Anything labelled ‘hydrolysed vegetable protein’ Beer, wine and cider Vinegar and pickles Sauerkraut

Vitamin tablets containing B vitamins, unless labelled ‘yeast-free’

Secondary sources of yeast

Dried fruit

Over-ripe fruit

Any unpeeled fruit

Commercial fruit juices

Anything labelled ‘malt’

Yoghurt, buttermilk and sour cream

Synthetic cream

Soy sauce

Tofu

Any leftover food, unless eaten within 24 hours, or 48 hours if in a refrigerator

Whiskey, vodka, gin, brandy and other spirits

*256\180\8*

ALLERGY: THE DISCOVERY OF IGE

The discovery of IgE was a breakthrough for classical allergists. Laboratory tests showed raised levels of total IgE in most patients displaying classical allergic symptoms..If the patient knew what antigen caused their symptoms, then a radioallergosorbent test or RAST (described on p79) could be applied to measure IgE for that specific antigen. The RAST result usually confirmed that there was an excessive amount of IgE antibody that would bind the incriminated antigen. In a very short space of time, IgE became the touchstone of respectability for classical allergists. Some even changed the definition of allergy, yet again, to mean reactions involving IgE only. This definition is still used by a few allergists.

When immunologists tried RASTs on patients diagnosed as food-allergic, they found a basic division. Those like Jane, with immediate, violent reactions, even to a very small amount of the offending food, almost always had high levels of IgE for that food, confirming the status of such reactions as classical allergies. Those like Susan, with ‘delayed’ or ‘masked’ reactions to foods, rarely produced positive RAST results for their culprit foods. More recently, some studies have shown that a small IgE reaction in the gut wall could be a contributing factor in people, but IgE is certainly not the major cause of the problem.

*8\180\8*

GAMES FOR NARCISSISTIC COUPLES – GAME 2: I LOVE YOU JUST THE WAY YOU ARE (PART 3)

If these initial reactions can be worked through in a spirit of good faith, eventually the couple will develop a more honest relationship, instead of pretending they still admire one another when they do not, and end up being hypercritical or silently sulking or gloating. As their relationship becomes more true, so does the sex. So, while each partner takes turns saying, «I love you just the way you are,» and then says what comes up next, their sexual experience will take some surprising twists and turns. It may be angry, sad, rough, incredulous, and much less exploitative. They will say the sentence, say their thoughts, and then find themselves engaging in rougher sex than usual. Or they will say the sentence, say their thoughts, and cling to one another almost desperately, like infants. The impulse to use the other as a narcissistic sexual extension will diminish. This exercise can be done again and again, with new thoughts coming up, each time accompanied by new kinds of sexual feelings.

To go a step further, couples might also try a variation in which they take turns saying, «I love myself just the way I am,» and then say the next thought that comes into their mind. This will allow them to trace back to its source the judgment that was being projected onto the lover.

*113/196/1*

GAMES FOR HYSTERICAL COUPLES – GAME 1: THE KISSING BANDIT (PART 6)

She opens the treasure box and finds a necklace or bracelet.

«For me? Really?» «That’s right.»

She tries it on and primps before a mirror. «So you think you can buy my love?»

«A bandit doesn’t have to buy anything. He steals it.» He takes her into his arms and steals a kiss. «Please,» she murmurs. «Be gentle.»

He undresses her and himself, then makes love to her in a more authoritarian way than ever before. He can do this by using a different variation of foreplay (perhaps doing something she has requested but he has heretofore felt squeamish about), insisting on a different position, or just being a little more forceful. Afterwards, the couple will find that this game has either invigorated their sex life or has brought up feelings that stand in the way of a better sex life. Even in cases where the game at first seems corny and either the wife or husband abandons it, good results can eventuate. The game will put the husband in touch with both his fear of self-assertion and his need for his wife’s approval. It will put the wife in touch with her fear and loathing of sex and her deep-seated need to be swept away so that she doesn’t have to feel guilty about doing something «dirty.»

*88/196/1*

GAMES FOR DEPRESSED COUPLES – DEPRESSION

As an infant, this patient was rejected by his mother, who seemed to have been a depressed personality herself. He was born with big ears and crossed eyes, and his mother used both unfortunate inheritances as excuses to be disappointed in him. Eventually his father and sisters also scorned him, cementing his development of low self-esteem and lifelong depression.

When two people like my patient get together, you generally have two people who have suffered from some kind of traumatic loss or some kind of emotional abuse. Naturally, they then displace their depression onto their primary relationship. Having been made to feel unworthy, they make their spouse feel unworthy; having not been soothed adequately, they have no sympathy for their spouse; having been emotionally abused, they emotionally abuse their spouse; having been deprived of attention, they are themselves depriving.

The games in this chapter are designed to deal with the negation that such people continually act out.

*63/196/1*

GAMES FOR BORED COUPLES – GAME 4: DESERTED ISLAND (PART 2)

Before the travel agent leaves the couple, he or she asks the husband and wife each to hand over a previously agreed-on sum of money (for example, $100), then says the following: «I’m leaving now and will return in two days. During that time you may only make love if you do so in a way you have never done before, and each time before you make love you must each say to the other, ‘We’re all alone here,’ and then express the next thought that comes into your head. There’s a telephone in the cabin, so you can call me if you want me to come get you. If you call me before the weekend is over, or if you haven’t made love in three new ways, you forfeit the money.»

The agent repeats these instructions several times, so that the effect borders on the hypnotic, and asks both husband and wife separately to repeat the instructions verbatim. Only when they are able to do so does the agent leave.

The couple find themselves thrown off-balance in many ways. They are lost physically, stuck in a strange environment without any idea of where it is located. They also are in a no win situation psychologically, because if they do not have sex in three new ways, they’ll lose not only their money but also the game—yet if they do have that sex, they will be forced to do something they have been studiously avoiding precisely because it is anxiety provoking. They are literally deserted, with nobody to turn to—except each other.

*38/196/1*

JUNK SEX VS LOVING SEX – SEXUALITY

Sexuality is the key to restoring vitality and tenderness to marriage, to self-actualization and to harmony with nature, why doesn’t everybody just have more sex? Of course, it is not that simple. It is not so easy for people who have been blocked since early childhood (or who have developed blocks following a traumatic situation in adulthood) to suddenly become unblocked and be capable of achieving deep and gratifying sexual play leading to love. It requires far more than the intention to do so. Usually it entails help from others—a therapist, a doctor, an understanding friend, a lover, a spouse.

The games in this book are designed for use as an aid to becoming unblocked sexually and emotionally. They can be used in conjunction with therapy or with the assistance of a doctor. They can be used by therapeutically sophisticated couples for a self-directed form of sexual therapy. Or they can simply be used for fun.

*13/196/1*

SEXUALITY IN MARRIAGE: FREQUENCY

The increase in reported sexual activity over the past decade or so is reflected in the data on marital intercourse. Hunt makes the interesting observation that the smaller increase for females may mean that women are perceiving the frequency of their sexual intercourse more accurately today. If frequency of intercourse were tied more to the male’s desire than to the female’s, so that she had to meet his needs rather than her own, she might tend to overestimate the incidence of such events. By contrast, if we assume that wives today have more control over the frequency of intercourse, then their estimates should be closer to reality. If this hypothesis is valid, then the smaller increase in females’ reported frequency is related to subjective factors.

Though not directly comparable to the data from the Hunt study, the median frequency is calculated at 8.5 times per month, or about twice a week. This is nearly identical with the medians which Hunt obtained for the twenty-five to thirty-four and thirty-five to forty-four age groups. Since three out of four women in the Redbook sample were under thirty-five, the frequencies for the two groups appear to be very similar.

Obviously median frequencies are only one kind of indication of how often married people have intercourse. Individual variation, as one would expect, was considerable in all the studies. For example, even in Kinsey’s younger groups, a few individuals had marital coitus less often than once in two weeks, while in every age group, from the youngest to age forty, some persons were having marital coitus on an average of four times a day, seven days a week (Kinsey and others).

Neither Kinsey nor Hunt found a relationship between frequency of coitus in marriage and either education or occupational status. Religion, however, was related to frequency in both studies. Kinsey and others reported that less religious husbands had intercourse 20% to 30% more often than did religious mates; such an effect was not found for women, however, leading Kinsey and others to remark that the wife’s coital rate was more likely to be tied to her husband’s desires than to her level of devotion. Hunt found the opposite effect: churchgoing females reported a lower frequency of marital coitus than did churchgoing males or non-churchgoing males and females. Hunt thought that this, too, might reflect the greater influence that wives now have over marital sexual activity. The frequency of sex for married women now might reflect more closely their own wishes than their husbands’ desires.

Although intercourse with the spouse is the chief sexual outlet for married people, it falls far short of being their only outlet. Kinsey and others found an interesting relationship between social level and percent of the total outlet which the married male derived from intercourse with his spouse. For the lower group, marital intercourse accounted for 80% of the outlet during the early years of marriage, increasing to 90% by age fifty. College-educated males on the other hand derived 85% of their total outlet from their wives during the early years, but only 62% by age fifty-five. Kinsey thought that one explanation for this dramatic decline was an increasing dissatisfaction «with the relations which are had with restrained upper level wives».

Wives, likewise, derived only part of their sexual outlet from marital coitus. The maximum part of the sexual outlet derived from marital intercourse was 89%, reached between the ages of twenty-one and twenty-five, after which the percentage steadily dropped. By age sixty, only 72% of the total outlet of the married women was derived from marital coitus (Kinsey and others).

A recent study (Edwards and Booth) provides evidence that marital intercourse tends to be discontinuous for a sizeable segment of the population. Their stratified probability sample consisted of 144 men and 221 women who had been married between one and twenty years. As part of a two-hour interview, subjects were asked whether intercourse had ever stopped for any reason other than pregnancy, and if so, why and for how long. One-third of the respondents indicated that they had experienced such a cessation, the median length of which was eight weeks. Significant differences emerged between the men and women reporting such cessation: for the men, social background factors such as recent emigration from Europe, being non-Catholic, and lack of employment for the wife were important; for the women, avoidance of intercourse was related to factors in the marriage: perception of the husband as dominant, as not affectionate, or as threatening to leave home. The only common factor for the two sexes was perception of a lack of privacy. Self-reported causes, however, were the same for both men and women: surgery, illness, marital discord, and type of birth control used were some of them. The incidence of discontinuity in marital sex for this sample suggests that the phenomenon is by no means uncommon and enhances, as the authors point out, the sense of intercourse as a symbolic communication between spouses who are otherwise distant from each other’s true feelings.

*75/187/5*

NO-ALLERGY DIET: CORN-FREE AND YEAST-FREE DIETS

Corn-free diet

Corn may be a gift from the Aztecs. But if you have corn allergy, it’s a nuisance. Perhaps it’s easy enough to avoid corn meal, corn-starch, corn flour, corn syrup and maybe even corn oil. But a glance at Table 5 shows how easily corn can creep into practically every meal, obvious or disguised, unless you plan your diet carefully. As with milk-free and wheat-free diets, you have to learn the tricks of the food trade when it comes to hidden sources of corn. Oil added to peanut butter, for instance, isn’t peanut oil at all, but corn oil.

Sometimes the corn problem is in the container. ‘You think you’re avoiding corn, but then you drink from a paper cup, and that may be coated with cornstarch,’ says Dr Failiers. ‘Or your milk carton may have cornstarch. I know people who get their milk in glass containers for that reason.’

The less processed and sugar laden your diet, the easier it will be to avoid corn in its many guises. In addition, follow these general rules.

1. Read labels carefully. Avoid any food listing not only corn, cornflour, corn oil and com syrup, but the sugars: glucose, dextrose, dextrin, dextrimaltose and fructose. Corn is also a major source of sugar. Any sugar not specifically marked ‘cane sugar’ or ‘beat sugar’ may contain corn.

2. Cough syrups, cough drops, lozenges, pills, tablets and suppositories often contain corn. ‘If your allergy pills contain cornstarch,’ Dr Failiers told us, ‘they may actually make you sicker.’ If you must take medication, ask your pharmacist for a corn-free product. Consult your doctor before changing or stopping any medication.

3. Vitamin and mineral supplements may also be corn based. See the Appendix for a list of corn-free nutritional supplements.

4. Arrowroot or tapioca may be substituted in recipes calling for cornflour as a thickener.

If you’re puzzled because you can eat corn on the cob but not commercial canned or frozen corn, you may be allergic to the sulphur dioxide used in corn processing rather than the corn itself.

Yeast-free diet

Yeasts are wondrous little one-celled plants that turn dough into bread and cider into vinegar. Like moulds, yeasts are a fungus – and just as apt to cause allergies in people sensitive to fungus. To avoid yeast (and mould) in your diet, you’ll need to steer clear of not only the obvious foods – mushrooms, bread and vinegar – but also certain cheeses, condiments, drugs and nutritional supplements. It’s a lot easier to eliminate a food ingredient of any kind if you avoid commercial packaged foods and stick to whole, unprocessed food.

*19/65/5*

NO-ALLERGY DIET: WHEAT-FREE DIET

Bread was so basic to the Roman diet that the word was synonymous with food. Most of us today still eat bread or a similar grain food at least two or three times a day. Cereal or toast for breakfast. A sandwich for lunch. Noodles, pasta or breaded fish or chicken for dinner. Plus crackers, biscuits and cakes. And a flaky-crusted pie or quiche now and then.

Wheat is by far the most popular grain in the West, where people put a premium on light, springy baked goods and pasta. However, gluten – the elastic protein in wheat that makes baked goods springy and light – is a prime cause of wheat allergy. Some people are sensitive not only to wheat but to grains low in gluten like barley, rye and oats. Symptoms commonly caused by wheat or gluten allergy are: eczema; abdominal problems like indigestion, cramps, colitis, bloating, gas and diarrhoea; and respiratory problems like asthma and hay fever. Wheat and gluten sensitivity is now being recognized as a possible cause of headaches, depression and even symptoms resembling neurosis and schizophrenia. (Coeliac disease, a food-related illness that responds to the elimination of grain from the diet, is not an allergy.)

Much of the problem can be solved by cooking foods yourself rather than buying prepared foods. To sidestep wheat or gluten completely, however, you have to know a few tricks. Commercial bread and baked goods labelled ‘wheat-free’ or ‘gluten-free’ don’t always hold to their word. Getting bread to rise without gluten is like trying to make a fluffy souffl? with too few egg whites. So some bakeries add just a little wheat anyway. Other bakers and food manufacturers may list wheat in a disguised form. Look out for products that list not only the obvious – flour, wheat flour, wheat starch, gluten flour or cracked wheat – but also monosodium glutamate, hydrolyzed vegetable protein or durum flour.

Malt is derived from barley or other grains and is a hidden source of gluten. Most dry breakfast cereals and baked goods contain malt in some form.

Start a wheat-free diet by eliminating just wheat. If you still experience symptoms, eliminate wheat plus barley, oats and rye.

*18/65/5*

NO-ALLERGY DIET: ABOUT CHEESE AND EGG-FREE DIET

The cheese stands alone

You may find you can tolerate every other milk product except cheese, not even lactose-free varieties. The trouble may stem from the mould-type fermentation that turns milk into cheese. Cottage cheese is mould-free. Dr Breneman told us that some cheese-sensitive people can tolerate farmer’s cheese and homemade cheese, which are often mould-free.

If moulds aren’t your problem, but cheese still makes you miserable, you may be sensitive to tyramine, a natural substance in cheese and other foods — notably chocolate, yoghurt, beer, red wine, gin, bourbon and vodka – that tends to trigger migraine headaches. If that’s the case, you may be able to eat only a tiny sliver of cheese, as long as you don’t eat any other tyramine-containing food or drink along with it.

Egg-free diet

We tend to forget that a lot of foods contain eggs. They show up in all kinds of goodies. Puddings, cakes, pancakes and waffles all contain eggs. And eggs are the stuff noodles, custards and mayonnaise are made of. Eggs show up in ice cream and marshmallows. Occasionally, eggs are even used to make root beer foam.

Like those allergic to milk, people allergic to eggs may be sensitive to only a part of the food: in this case, either the white or the yolk. (Whites are usually the problem.) The method of cooking also makes a difference. Some people can tolerate hard-boiled eggs, but not soft-boiled. Others can cook their eggs until they’re tough as golf balls and still be allergic. Very rarely, a person is so sensitive to eggs that he or she can’t tolerate chicken either. Another egg-related product – vaccines grown on egg cultures – should also be approached cautiously if you’re allergic to eggs. (Ask your doctor about a vaccine’s base if you are allergic to eggs.)

So what can you eat, if not eggs? Plenty. Practically all meats and vegetables. Potatoes. Rice. Fruit. Watch out for code words for eggs on food labels: vitellin, ovotellin, livetin, ovomucin and albumin.

A word about egg substitutes: so many of these products contain other highly allergic substances and additives – notably yellow food dye – that we can’t recommend them. You may end up trading one allergy for another.

*17/65/5*

FINDING NO-ALLERGY DIET: MILK ALLERGY OR LACTASE DEFICIENCY?

Still others cannot digest lactose, the main carbohydrate (or sugar) in milk. Normally, fingerlike projections along the intestinal wall, called villi, secrete lactase, an enzyme specifically designed to digest lactose. But lactose-intolerant people produce little or no lactase. So the milk passes through undigested, producing one heck of a belly-ache: abdominal discomfort, bloating, gas pains and often diarrhoea.

Lactase activity is generally highest at birth and slows down as we grow into adults. Many of the world’s peoples – including blacks, Mexicans, Indians, Asians and those of Mediterranean descent – lose lactase in childhood. Others, particularly whites from northern or western Europe and their descendants, lose lactase later. Also, a bout with the flu or another virus can shut down anyone’s lactase activity for several days. When the intestines are inflamed the tips of the villi are broken off and produce little or no lactase. That’s why a milk-loving child may spurn the drink – or get a tummyache from it – after a stomach virus.

Many lactase-deficient people find they can tolerate milk if they simply cut down on milk and milk products, or consume small amounts throughout the day. Others can drink milk that’s been treated with Lactobacillus acidophilus, special (and perfectly safe) bacteria that breaks down the lactose, doing the work their intestines can’t.

Lactobacillus, incidentally, is the same bacteria that turns milk into yoghurt. In Mediterranean, Asian and African countries, where people are frequently lactase deficient, yoghurt is the most widely used milk product.

Some cheeses, such as Cheddar and Cheshire, are very low in lactose, while aged Gouda and Edam are lactose-free. Cottage cheese has 86 per cent less lactose than milk.

You can also try adding Lact-Aid powder, a lactose-digesting enzyme product, to milk. (All these products, incidentally, are available in most health food stores and many supermarkets.)

Until recently, milk allergy and lactose intolerance were regarded as totally separate problems. If you had both, it was considered a coincidence. Now, some doctors are convinced that, in many people, lactase deficiency actually develops as the result of an allergic reaction to either milk or some other food. That’s because food allergy usually causes intestinal inflammation, which mows down the villi and creates lactose intolerance. Doctors who advance this theory believe that 95 per cent of the people who experience stomach distress after drinking milk have lactose intolerance secondary to an allergy of some kind. Of course, you can be allergic to milk without developing lactose intolerance.

In any case, many people with food allergies – children and adults alike – will have to eliminate milk in all forms if they’re ever going to feel better. ‘If a child comes in with a stomach ache, leg aches and a stuffy or runny nose, and they’re also drinking a lot of milk, we take them off milk,’ Dr Stigler told us.

For parents who are concerned that growing children will miss out on much-needed calcium without milk in their diet, Dr Stigler has some reassuring words. ‘Many of us working in the field of allergy feel that allergic people don’t absorb a lot of the calcium in milk. If you’re sensitive to milk, the intestines reject it. So allergic kids aren’t necessarily using the calcium in milk anyway.’ Take away the milk, says Dr Stigler, and as with most people who give up a food to which they are allergic, a child will probably feel worse for the first couple of days.

‘But their symptoms will start to clear up after the first three or four days,’ Dr Stigler predicts. ‘In a week’s time, if milk was the cause of the stomach aches and the leg aches and the runny nose or whatever, it will all go away.’

Dr Stigler also told us that, when milk is eliminated, children may eat ravenously for three or four days, whereas before they were just picking at their food. ‘Take away the quart and a half or two quarts of milk a day – the average amount an allergic kid will drink – and they’ll then make up for milk calories with other food. They’ll eat extra of something else to make up the difference.’

Milk allergy, like simple lactose intolerance, may be dose related, Dr Stigler adds, especially when it causes digestive or respiratory upset. ‘It may take half a pint or more to cause the stomach ache. But if you have a child who has eczema – a skin rash often caused by milk allergy – very often as little as a teaspoon of milk will cause the reaction.’

Avoiding milk may sound easy at first, but you have to stay on your guard against hidden sources.

‘You think you’re staying away from milk. But if you eat a hot dog or spaghetti, they may contain milk,’ pointed out Constantine J. Falliers, an allergist and asthma specialist in Denver, Colorado.

So you’ll need to read labels carefully – advice that applies to any allergy elimination plan. Look for the code words ‘caseinate’, ‘lactose’ or ‘whey’ – all are milk additives. As we mentioned before, most ‘non-dairy’ creamers contain just such milk additives. (Non-dairy creamers also contain ingredients from other foods – corn, soya, animal and vegetable fats; flavour additives; and petroleum-based chemicals – which may trigger allergy on their own.)

You can confidently buy bread, margarine and other foods marked pareve or parve – those are made without a trace of milk to conform to kosher food laws. And if you’re anywhere in the neighborhood of an ethnic bakery, drop in and stock up. Kosher bread (challah) is free of milk, as are some French, Italian and Syrian breads.

If you’re allergic to penicillin, check to find out if your dairy supplier uses penicillin before you reintroduce milk to your diet.

To cook without milk, experiment by substituting water, soya milk or fruit juice in your family’s favourite recipes.

By the way, a small number of people with milk allergy are also allergic to soya, so switching to soya milk may not clear up their symptoms. Some people can tolerate goat’s milk as a substitute; others cannot. Only trial and error will tell.

*16/65/5*

NURSING IN THE CASE OF ALZHEIMER’S DISEASE: THE SIDE-EFFECTS OF MEDICATION

If a change occurs in the behaviour of people with dementia or they seem otherwise to be behaving abnormally, it is important to consider whether or not the change is the result of a side-effect of any medication that is being prescribed. Older people are much more sensitive to unwanted effects of prescribed medicines and also those that you can buy over the counter without a prescription. Medication ought not to be repeated indefinitely, every month say, without a formal review taking place from time to time. The frequency of the review will depend to a certain extent on the problems being treated and the nature of the drugs being prescribed. Many older people, even those not suffering from a dementing illness, can be prescribed a medicine for a particular problem and then three years later it is discovered that they are still taking the same drugs even though the problem may long ago have receded.

Every so often, people with dementia may refuse to take their pills. If a medicine is being taken two or three times a day, it probably doesn’t matter very much if an occasional dose is omitted. This is best checked with the doctor who prescribed the pills as there are some exceptions. If refusal to take medication is a consistent and protracted problem, it may be necessary to ask the doctor to prescribe an alternative form of the drug, for example a liquid that can be mixed with a cold drink or a capsule containing a powder such that the capsule can be opened and the powder mixed with jam, honey, or something else that is palatable.

It is better always to assume that a person who is confused and forgetful will need to have his or her drug-taking supervised. In the early stages, if this is impossible, there are various tricks that may help to ensure that medication is taken properly. Some drugs come in calendar packs and if not, it is possible to buy a similar gadget, such as a plastic box divided up into compartments, each labelled with the day of the week. In some such boxes the compartments are further divided into three or four subsections so that the medicines for morning, noon, and night can be placed in their own compartment. This is helpful to those supervising the medicines as it may give an indication of how frequently the pills are being forgotten.

Finally, there are three types of side-effect that commonly occur when a medicine is given to try to control abnormal or difficult behaviour in a person with dementia, and which you should look out for. These are: difficulty in walking — a tendency to fall or stumble, especially after rising from a chair or getting out of bed; increased sedation, i.e. sleepiness in the daytime; and restlessness.

*95\138\2*

BEHAVIOURAL AND PSYCHOLOGICAL PROBLEMS IN THE CASE OF ALZHEIMER’S DISEASE: AGGRESSION

Some people with dementia can become extremely aggressive, irrespective of the underlying disease that is causing the illness. Although spouses are often very expert at managing the aggression, the involvement of children can be a very serious problem. An aggressive or violent, confused adult can cause major distress to children and even teenagers who don’t understand what is going on. When children are affected it is a natural reaction to become angry with the sufferer, but although the situation must be resolved, it is important not to lose sight of the fact that the aggression is not a conscious, considered action of the sufferer. It results from brain damage and something has triggered off an abnormal behavioural response. This ‘something’ may be a misinterpretation of events going on around the sufferer, a feeling of inadequacy that is exaggerated by the attitude of younger people, or a hundred and one other things. The main thing is to stay calm and this will usually be a help to other people. As is the case with so many other abnormalities of behaviour in these circumstances, the best approach is often that of diversion, distracting attention in another direction and gently persuading the sufferer to become interested in an alternative activity.

Try to work out what it is that might be precipitating the outbursts and hope to avoid similar situations in the future. Above all, if this type of behaviour becomes a real problem, seek advice earlier rather than later. Very rarely, aggressive behaviour is consistently directed against one person for no obvious reason, with threats of harm or even expressions of intent to kill. This situation has arisen many times, but actual physical violence occurs exceptionally rarely. Nevertheless it is absolutely essential that carers seek support and help as soon as they find themselves threatened. Having to live in fear of being attacked will affect not only carers, but also their relationship with the demented relative. Aggressive behaviour can usually be treated successfully by the careful administration of medicines.

Never react to violence with violence or anger, as this won’t prevent a further occurrence; try to avoid aggressive situations developing and step back out of reach if there is any obvious evidence that you are about to be assaulted. If threats of physical harm become a reality, seek medical help at the first opportunity.

*73\138\2*

RISK FACTORS FOR DEVELOPING ALZHEIMER’S DISEASE: OTHER POSSIBLE FACTORS

One potential cause is a past head injury that resulted in unconsciousness. There is a direct link here between the changes that are found in the brain of some boxers who develop neurofibrillary tangles, and the pathology of Alzheimer’s disease. At the moment the evidence is probably insufficient to link firmly head injury with the development of this type of dementia, but this evidence is slowly accumulating. The families of people with Alzheimer’s disease are often worried that the disease has been caused because the brain has been worn out by excessive use or conversely, that it has wasted away because of too little use. There is no evidence at all to indicate that either of these possibilities is true.

Environmental toxins have been linked to certain conditions. Parkinson’s disease which, like Alzheimer’s, is caused by degenerative processes within the brain, has been linked in a specific sub-group of sufferers to a toxin that is present in the environment. A group of drug abusers inadvertently dosed themselves with a substance called MPTP. Unfortunately it proved to be very toxic to those parts of the brain which if damaged lead to Parkinson’s disease. The substance was discovered because doctors in America began to wonder why Parkinson’s disease suddenly seemed to be occurring in patients who were forty or fifty years younger than the age group that normally suffers from it.

The chemical structure of MPTP has been well characterized and it is known to be similar to other chemicals, including some weedkillers. Although it is unlikely that Parkinson’s disease is actually caused by toxic chemicals introduced into the environment, this possibility needs to be eliminated. Since Alzheimer’s disease is also a chronic degenerative condition of the brain, the search is on for toxic substances, other than aluminium, which might be responsible. So far there is no obvious candidate.

There have been, and probably will continue to be, other factors under investigation as potential causes of Alzheimer’s disease. The quality of the scientific evidence in support of many that have evoked much interest in the media has been poor and the hypotheses associated with them have died, either for lack of proof or because under careful scrutiny the evidence has been discredited. Although it is extremely important that the search proceeds for environmental agents that might contribute to the development of Alzheimer’s disease, it is equally important that we don’t jump to the wrong conclusions too readily.

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SYMPTOMS OF ALZHEIMER’S DISEASE: DEPRESSION

The manner in which the symptoms of Alzheimer’s disease occur in many people is complicated by the coexistence of depression.

This is usually assumed to be a reaction to the disease – the result of patients realizing that something has gone seriously wrong with the way in which their mind works. This may well be an oversimplification because we know that some of the biochemical changes in the brain that are found in Alzheimer’s disease are similar to those that are found in the brain of people with depression. These biochemical changes may occur in the Alzheimer brain when the person concerned did not appear to be depressed while alive. It may also be that in some people these depressionlike biochemical changes are sufficiently severe to result in depression. As the disease progresses, the depression will often lift. Doctors have to be very careful if they try to treat an Alzheimer’s disease sufferer for depression since many of the drugs that are used can actually make memory function worse.

Depression may also mimic a dementia, including Alzheimer’s disease. If there is any doubt about the nature of the depressive symptoms, careful assessment by a psychiatrist is essential and sometimes a trial of treatment is also needed.

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THE NORMAL BRAIN AND HOW IT AGES: THE STRUCTURE OF THE BRAIN

The brain can be divided in simple terms into four parts. Two of these are the cerebral hemispheres, a left and a right, stretching from just behind the eye to the back of the head. Each hemisphere is divided into four different lobes. The lobe at the front – that which is just behind the eye – is called the frontal lobe, and among its many functions is the control of our behavioural pattern.

Behind the frontal lobe is the parietal lobe and behind that, at the back, is the occipital lobe. The parietal lobe has many functions and is probably best considered as one of the most important parts of the brain for the interpretation and correlation of sensory input — what we can feel when we touch something or are touched. It is also responsible for our interpretation of our body image, that is, our image of our own bodies. Damage to this system may result in an individual neglecting a useful limb or failing to recognize that a limb is paralysed, as occurs after some strokes. The parietal lobe is also responsible for coordinating some functional activities, so that damage to it may result in an inability to execute planned movements, for example doing up buttons. This should be distinguished from a similar difficulty that can result from damage to nerves and muscles. The occipital lobe is important for the interpretation of visual sensation and damage to it will result in disturbance of vision.

The fourth lobe of the brain, the temporal lobe, which lies a little below the parietal lobe and behind that part of the skull that is often referred to as our ‘temple’, is important for many of the dementias, especially Alzheimer’s disease. In lower forms of animal life it is particularly concerned with taste and smell, as it is also in humans. In us, however, it is most important for the organization and processing of memory and has close connections with other areas of the brain. Loss of memory is of course one of the first signs in the development of a dementing illness. The temporal lobe is also important for some aspects of hearing and speech.

As well as connections occurring within the brain between one part and another, each of the hemispheres sends out nerve fibres to the rest of the body, mainly to control what the muscles in the limbs do. They also receive fibres from sensory organs, such as those that are hidden in the skin that tell us about sensations of touch, pain, and temperature. Strangely – and nobody really understands why – each hemisphere makes its connections with the other side of the body; in other words the left hemisphere controls movements in, and receives information from, the right side of the body.

At the back of the brain, sitting below the hemispheres, is a small structure about the size of a man’s thumb. This is called the brain-stem and it joins the hemispheres to the spinal cord. As well as being a structure that has fibres passing through it, to and from the hemispheres and the body, it also has its own specialized functions. These include many of the nerve cells that control the muscles of our face, the muscles that move our eyes and those that are responsible for eating and swallowing, etc. It is also to this area of the brain that sensation from the face is first sent. In addition, the brain-stem contains special centres that are responsible for controlling our breathing, our heartbeat, and other body functions automatically. These are, of course, vital centres that help to keep us alive and as they and many other structures are crammed together in a very small area of brain tissue, damage in the brain-stem can have a very profound effect upon the integrity of the rest of the body. The brain-stem is affected in many of the illnesses that cause dementia, but probably to a lesser extent than the cerebral hemispheres.

Sitting beneath the occipital lobes and behind the brain-stem is the cerebellum, whose importance lies in the control of the reflexes that determine our posture and the state of contraction of the muscles. It is essential for maintaining the body’s equilibrium and for the performance of smoothly coordinated muscular actions. It is involved in some types of dementia, but not very much, if at all, in the commoner illnesses that cause intellectual impairment.

Within the brain are hollow spaces that contain the same fluid, the CSF, that has been mentioned already. The CSF in these hollow spaces, which are called ventricles, escapes through small openings to join the CSF that is contained within the membranes surrounding the brain. A disturbance to this system can result in a particular form of dementia that will be described in a later chapter.

The brain is, roughly speaking, also divided up into white matter and grey matter. The grey matter is not really grey in the living brain but is so described because of the appearance it takes on when it is treated in a particular way after a person has died. It is these grey areas that contain the bodies of the nerve cells, as described below. The largest collection of grey matter lies on the outside of our brains, rather like the rind of an orange, and it is called the cerebral cortex. This structure is affected in many of the dementing illnesses. Buried deep within the brain are other collections of grey matter, some of which are also affected in some of the conditions that cause dementia.

The white matter is only white because it contains a lot of fatty material. This is made up of nerve fibres which pass from the cell bodies to other areas of the brain or the body – the arms and legs for example. Most of these nerve fibres are surrounded by a fatty material which has an important function in helping messages travel down the fibres. It is this fatty material that is white, giving the brain its characteristic appearance. In summary, therefore, the brain can be considered to contain grey matter, which is the cell body of the nerve cells, and white matter which is made up of the fibres either connecting different nerve cells, or parts of them, or travelling to the rest of the body outside the brain.

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