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CORONARY HEART DISEASE: HIGH BLOOD CHOLESTEROL AS A RISK FACTOR

High blood cholesterol is one of the most known risk factors of coronary heart disease. Previously cholesterol was supposed to be the most important cause of heart artery blockages but with more and more research data coming in, it has become one of the first three risk factors.Cholesterol is a type of fat particle present in the blood in small quantities. This waxy particle is made up of a single chain of fatty acid with 27 carbon atoms. The structure is so complex that this fatty acid is rotated in four rings – in combination called cyclo-pentano-perhydro-phenantherene ring. It is one of the most decorated molecules known to medical science. Cholesterol has very important functions in the body as it forms a part of the cell wall, nerve coverings and the brain cells. We cannot imagine life without this molecule. So important is the requirement of cholesterol in the body that the liver has a manufacturing capacity of the minimum amount of cholesterol required by the body.But if this molecule is present in a high quantity in the body or blood, the excess can be deposited to create coronary blockages. Not only is the heart affected; high cholesterol can also get deposited inside the brain arteries, leg arteries and also in the skin below the eyes.Cholesterol carried in the blood is in free form, which is very dangerous and it can be also carried in combination of proteins (known as lipo-proteins). There is a strong relationship of blood level of free cholesterol and the rate of deposition of blockages in the heart arteries.Previously it was presumed that a cholesterol level of 250mg/100ml of blood was normal and safe. This was about 20 years back. After further research, it was found that a level less than 220mg/100ml was okay in the next ten years. But the latest scientific research has now proved that any level more than 200mg/100ml is definitely not good. The normal range of this fat is now considered between 130 and 200mg/100ml of blood. Blood levels of cholesterol are high in those people whose diet is rich in cholesterol. Foods that contain high cholesterol are egg yolk, meat of any kind (mutton, beef, chicken, pork – red meat and white meat, fish). Another rich source is milk and its products like ghee, cream, butter, ice cream, chocolates, paneer, curd etc. This becomes the culprit in vegetarians, who depend heavily on milk. Any other fat, especially the saturated fatty acids are used in the liver to manufacture cholesterol.Cholesterol is mostly deposited in the heart arteries, after it is converted into LDL cholesterol, the so-called bad ‘low density lipo-protein cholesterol’.It is recommended very low cholesterol (130-160mg/ 100ml) in the blood. The total intake of cholesterol in the diet of a person should be as low as l0 mg/day. A vegetarian on milk diet consumes as high as 200-500mg cholesterol while a non-vegetarian consumes as high as l000 mg per day.In most of the developed countries it is compulsory to put a display on the food labels – the exact content of cholesterol in every food. Regular physical exercise, stress management, stopping of smoking can also lead to lowering of the cholesterol in the blood, besides control of diet.*12/283/5*

WHY YOU CAN’T STAY AWAKE: ANYBODY CAN SNORE

Anybody can snore—great and near great, famous and infamous. Among the American presidents who shook the walls of the White House were Adams (both of them), Van Buren, Fillmore, Pierce, Buchanan, Lincoln, Andrew Johnson, Grant, Hayes, Arthur, Cleveland, Harrison, McKinley, Roosevelt (both of them), Taft, Harding, and Hoover. (Washington snored too, but he never lived in the White House.) Teddy Roosevelt once so disturbed the hospital where he was being treated that nearly every patient in the wing filed a complaint. Other historical noisemakers include Emperor Otho, Cato, King George (II and IV), Lord Chesterfield, Beau Brummel, Winston Churchill, and Benito Mussolini. And although snoring is rarely fatal, the nineteenth-century gunman John Wesley Hardin is reported to have been so annoyed by the noise generated by a guest sleeping in the same hotel that he went into the room and shot him to death.One patient told me his wife complained that she couldn’t hear the phone when he snored. Another was referred for treatment because his wife, a musician, couldn’t bear his off-pitch nocturnes. In Cincinnati a man who had been sentenced to three months in jail was released after only a few days; the other prisoners complained that his snoring constituted cruel and unusual punishment, and the warden agreed.(And humans are not the only players in this nighttime symphony. Among the animals who have been found to snore are buffaloes, camels, cats, chimpanzees, cows, dogs, elands, elephants, gorillas, horses, leopards, mules, oxen, sheep, tigers, and zebras.)One writer, motivated by complaints about his own nighttime noise, researched the topic and devised a classification system identifying eleven different types of snoring, to which he gave the names laryngeal, nasal, obesial, neurotic, pathologic, physiologic, functional, lateral, supine, prone, and pseudosnoring— noise which is made to add verisimilitude to the pretense of sleep. I must confess, however, I find that most of these labels fall far short of having any practical value in the management of sleep apnea.*142\226\8*

WHAT IS MIGRAINE: FACIAL, BASILAR AND OTHER FORMS OF MIGRAINE

Facial migraineIn some patients the pain of migraine is felt in the face, either in a distribution similar to that found in cluster headaches or lower down the cheek. In these cases, the pain is less severe, less sharp, and may last for a much longer time than in a classical or common migraine attack.
Basilar migraineThis usually occurs in young women. The headache is commonly over the back of the head and, besides nausea; the symptoms may include giddiness, double vision, unsteadiness, and slurred speech. Perhaps the most alarming symptom is loss of consciousness. These symptoms are due to a diminished blood supply to parts of the brain supplied by the basilar artery, a blood vessel at the base of the brain which goes into spasm to produce an attack.
Hemiplegic migraineThis is a very rare form in which there is a paralysis of the arm and leg on one side of the body. Fortunately the paralysis is temporary but it may be repeated. There is often a strong family history of similar attacks.
Ophthalmologic migraineThis, too, is rare and occurs particularly in children. During the attack, the eyelid droops, the pupil dilates, and the eye squints outward. Again these features are temporary and usually go when the headache stops.
Abdominal migraineThis occurs more commonly in women and its onset is usually in childhood. The pain is often over the upper part of the abdomen and lasts a few hours. The diagnosis is revealed by the family history of migraine and the occasional attacks in which the pain is preceded by about an hour of migraine, more commonly classical than common.
*5/152/5*

CANCER: SKIN, SUNLIGHT AND MELANOMA

Sunlight causes cancer of the skin. Fortunately, the evidence suggests that we can cope with this tact quite easily without retiring to darkened rooms for most of our lives.
In discussing this matter it is important to distinguish between two quite different types of skin cancer. The first kind is the common cancers of skin that arise from the cells which make up most of the body’s covering, the epithelial cells of the skin. Although common, such skin cancers are among the most minor kinds of cancer and are usually recognized relatively easily and treated effectively by simple means. These common cancers occur in the sun-exposed areas of the body (the head, neck and hands) and tend to occur in elderly people. The second kind of skin cancer is quite different. This is known as malignant melanoma and arises from the pigmentation cells within the skin (melanocytes). These are responsible for producing the dark colour of the skin by manufacturing a material called melanin. They are distributed mainly in the deep parts of the skin, although small numbers of melanocytes are found in the eyes and in internal organs. In the body’s development, melanocytes have a quite different origin from the main skin cells. Melanocytes may be collected together in the skin in the form of moles. While moles are in themselves quite innocent, they can occasionally be the focus of the development of malignant melanoma which carries with it much more serious import than other kinds of skin cancer. When a malignant melanoma develops many people can be cured simply by having the tumour excised from the skin, an operation which often leaves only a minor scar. Early detection leads to curt. However, for a proportion of patients who have melanoma, particularly those diagnosed late, the disease will persist and recur and spread to other pans of the body. It is then a serious and life-threatening condition and unlike other kinds of skin cancer.
Before going on to talk about the link between melanoma and sunlight it is worth talking a little bit about the radiations that are included in sunshine. Sunshine is made up of electromagnetic radiation of various wavelengths that include light itself. These are quite different from the radiations that we think of in association with nuclear energy or nuclear bombs, which are called ionizing radiations and are discussed in a later chapter. In sunshine the part of the electromagnetic irradiation which is of concern in relation to melanoma is called ultraviolet irradiation (or UV). This is divided into UVA, UVB and UVC. UVA causes the skin to darken and tan, and docs not burn the akin, although too much of it can do damage at deep levels. UVB has a shorter wavelength and is therefore of greater energy. UVB ultra violet irradiation causes redness and burning, and if you get too much UVB irradiation it causes blistering. UVC irradiation is short-wavelength, high-energy ultraviolet irradiation and is extremely damaging to skin. Fortunately, we and everything else on earth are shielded from UVC irradiation by the ozone layer – a gas layer around the earth. The ozone layer protecting us against UVC is vital to our health and that of other animals and plants. At this stage it is enough to say that there is serious concern about the damage being caused by man-made gases.
*38\194\4*

WHAT IS CANCER? (part 1)

The human body, like most living organisms, is assembled from millions and millions of individual cells. The cells are the building bricks of the body, making up the skin, blood and every functioning part. We start life as a single cell, which is brought about by the fertilization of a single egg by a single sperm. Each cell multiplies by dividing into two cells (called ‘daughter’ cells), and the resulting collection of cells develops into the unborn child. Growth into adult life requires further huge multiplication of cells, a process known as cellular proliferation. Once we reach adult life certain parts of our bodies require continuous repair and renewal. We are continuously shedding our skin, the lining of our intestines and the lining of our lungs and bladders; and, as these are shed, the cells in these organs are replaced by further proliferation. Cellular proliferation is therefore a basic process for maintaining life and health.
The proliferation of cells is linked to a process by which cells in different parts of the body develop different functions. Heart cells have to contract to push blood around the body, liver cells become chemical factories altering the content of our diet to turn it into the essential nutrition for all parts of the body. Cells which line the gut or cover the skin are developed specially for these purposes. The process by which cells develop different functions is called differentiation.
Cancer is a disease in which cellular proliferation and differentiation become disordered. The problem with cancer cells is that they continue to proliferate when they should not. This means that too many cells accumulate and this is how tumours are formed (the word tumour comes from the Latin word for a swelling); the accumulation of too many cells as a consequence of proliferation results in tumour masses in the affected part of the body. In addition to exhibiting disordered proliferation, the cancer cell usually fails to behave in the correct way for a cell in a particular location. It lacks correct differentiation. This means that it will look abnormal through a microscope and will behave abnormally, often manufacturing the wrong substances or failing to manufacture the substances that it should be making.
So if cancer is the result of a disorder of the way cells multiply and the way they function, how does it cause the extensive damage that we associate with this disease? Every medical student is taught that there are three essential characteristics of a cancer. These are growth, invasion and spread.
The process of growth of a cancer is easy to understand. We have already explained that the controls that normally act on the multiplication of cells are deranged and that excessive numbers of cells accumulate. Sometimes, the multiplication of cells occurs very rapidly but, equally often, the process may not be particularly rapid but may simply continue when it should be switched off. Either way, the result will be an uncontrolled growth of cells within the organ affected. With lung cancer, such a growth will be seen as a shadow on a chest X-ray. For breast cancer, a lump will appear in the breast. For a cancer occurring in the intestines, the lump will not be visible unless special X-rays or scans are used, but it will usually alter the function of the bowel or tend to obstruct it, a process which can produce pain. Sometimes these lumps may bleed, which is why bleeding is a common symptom leading to the diagnosis of cancer in many sites. The process of growth of the cancer is in itself dangerous. For instance, large cancers within the lung will interfere with the function of the lungs and sometimes, when cancers occur in particularly vital situations like the brain, the presence of quite a small growth is capable of causing catastrophic damage. However, growths can often be removed and it is the other features of the cancer which represent the greatest challenges to effective treatment.
*3\194\4*

WHAT IS CANCER? (part 1)The human body, like most living organisms, is assembled from millions and millions of individual cells. The cells are the building bricks of the body, making up the skin, blood and every functioning part. We start life as a single cell, which is brought about by the fertilization of a single egg by a single sperm. Each cell multiplies by dividing into two cells (called ‘daughter’ cells), and the resulting collection of cells develops into the unborn child. Growth into adult life requires further huge multiplication of cells, a process known as cellular proliferation. Once we reach adult life certain parts of our bodies require continuous repair and renewal. We are continuously shedding our skin, the lining of our intestines and the lining of our lungs and bladders; and, as these are shed, the cells in these organs are replaced by further proliferation. Cellular proliferation is therefore a basic process for maintaining life and health.The proliferation of cells is linked to a process by which cells in different parts of the body develop different functions. Heart cells have to contract to push blood around the body, liver cells become chemical factories altering the content of our diet to turn it into the essential nutrition for all parts of the body. Cells which line the gut or cover the skin are developed specially for these purposes. The process by which cells develop different functions is called differentiation.Cancer is a disease in which cellular proliferation and differentiation become disordered. The problem with cancer cells is that they continue to proliferate when they should not. This means that too many cells accumulate and this is how tumours are formed (the word tumour comes from the Latin word for a swelling); the accumulation of too many cells as a consequence of proliferation results in tumour masses in the affected part of the body. In addition to exhibiting disordered proliferation, the cancer cell usually fails to behave in the correct way for a cell in a particular location. It lacks correct differentiation. This means that it will look abnormal through a microscope and will behave abnormally, often manufacturing the wrong substances or failing to manufacture the substances that it should be making.So if cancer is the result of a disorder of the way cells multiply and the way they function, how does it cause the extensive damage that we associate with this disease? Every medical student is taught that there are three essential characteristics of a cancer. These are growth, invasion and spread.The process of growth of a cancer is easy to understand. We have already explained that the controls that normally act on the multiplication of cells are deranged and that excessive numbers of cells accumulate. Sometimes, the multiplication of cells occurs very rapidly but, equally often, the process may not be particularly rapid but may simply continue when it should be switched off. Either way, the result will be an uncontrolled growth of cells within the organ affected. With lung cancer, such a growth will be seen as a shadow on a chest X-ray. For breast cancer, a lump will appear in the breast. For a cancer occurring in the intestines, the lump will not be visible unless special X-rays or scans are used, but it will usually alter the function of the bowel or tend to obstruct it, a process which can produce pain. Sometimes these lumps may bleed, which is why bleeding is a common symptom leading to the diagnosis of cancer in many sites. The process of growth of the cancer is in itself dangerous. For instance, large cancers within the lung will interfere with the function of the lungs and sometimes, when cancers occur in particularly vital situations like the brain, the presence of quite a small growth is capable of causing catastrophic damage. However, growths can often be removed and it is the other features of the cancer which represent the greatest challenges to effective treatment.*3\194\4*

ARTHRITIS: COD-LIVER OIL CAN BUILD NEW TISSUE

The mixture of oil, taken as described in the last chapter, will by-pass the liver almost in its entirety. It will go on to build new tissue throughout the body wherever it is needed. Doctors know and agree that cod-liver oil has tissue-building power.
Dr. I. Smedley-MacClean, for instance, conducted tests which proved cod-liver oil rebuilt tissue, and stopped kidneys, ovaries, etc., from degenerating.
The question now arises as to how we can best deliver this oil to the joint linings and cartilage to check osteo- and rheumatoid arthritis.
Or, if need be, so that it can fill the sac with oil in bursitis, cover the nerve with oil in neuritis, lubricate the muscles in myositis, and nourish the connective tissue in fibrositis.
To gain the fastest benefits from cod-liver oil, we repeat, it must be taken on an empty stomach. To empty your stomach requires three to four hours of fasting. If there is any food in the stomach, too much of the cod-liver oil will be seized by the liver. On an empty stomach, the cod-liver oil is simply pushed on to the small intestine. It by-passes the liver, which is what we have been trying to accomplish.
The major reason for mixing cod-liver oil with orange juice or cool milk is to defeat the liver. An emulsified mixture with orange juice or cool milk cheats the liver, beats it at its own game.
When we “sneak” the oil past the liver, we also gain added benefit from the iodine in cod-liver oil.
Organic iodine is of tremendous value to arthritics. Dr. E. R. Eaton in the Journal of the American Institute of Homeopathy (March 1941) lists the many accomplishments of iodine in the bloodstream.
1. Tends to “loosen” fibrous tissue.
(Arthritics with stiff joints have fibrous tissue which can certainly stand “loosening.”)
2. Iodine stimulates metabolism.
(More than 30 per cent, of arthritics have a slightly lower than average basal metabolism.)
3. Dilates the blood vessels.
(The rheumatoid arthritic often needs bloodvessel dilation.)
4. Helps in the formation of haemoglobin. (The anaemic rheumatoid can definitely use this property.)
5.  Improves circulation.
(Arthritics frequently need better circulation, when they have clammy, tingling or numbness in hands and feet.)
6.  Helps correct uric-acid metabolism. (Gouty arthritics need this form of help.)
7.  Diminishes fatigue.
(Which is a common problem of the rheumatoid arthritic.)
The above seven services of iodine are added reasons why we should take cod-liver oil. To gain iodine!
There are only twenty-five milligrams of iodine in our entire body. In other Words, our whole supply could be placed on the head of a small common pin. About 60 per cent, of this is tied up by the thyroid gland. No wonder we need all the iodine we can get from our diet.
In a random sampling of cartilages from human beings—ages twenty to ninety-five—Dr. W. Bauer and others found the cartilage was progressively wearing out. Certainly the cartilage wore out; it was probably losing its elasticity. The oils which could feed iodine to the joint fluid were missing from the diet!
We agree that the cartilage has no blood vessels, but cartilage can still take nourishment throughout its life by means of osmosis.
This filter-exchange process of osmosis is of no use, however, if the very substance the cartilage needs—a trace of iodine—is missing from the oil. If the liver captures the iodine first, the cartilage suffers the loss.
*42\146\2*

DIABETES: TWENTY DOLLARS FOR TWO MAPLE BARS?

A few years back—before diabetes and really having to watch my diet—Bill and I decided to work on our mutual weight problem by walking. So, at night we would walk to the Baskin-Robbins ice cream shop to have an ice cream cone night cap. And in the mornings we would walk to the Yum Yum Donut shop for our usual hot coffee and warm maple bars. On one particular morning, we had made it to Yum Yum’s in record time, and I reached in my sweater pocket for the twenty dollar bill I had brought along. Bill didn’t have his wallet with him, and I had left my purse at home because heavy purses aren’t much good on brisk walks.
We ordered our usual, and when the girl brought it, I plunked my twenty down on the counter. She took my money and disappeared to the back room to get cream and more napkins. When she returned, she asked for two dollars and fifty cents. She didn’t speak very distinct English, but she made it clear she expected money. And I told her she had just picked up my twenty dollar bill when she had gone out back for more cream.
It didn’t make any difference. All she could keep saying was that we owed her two dollars and fifty cents, and she didn’t seem to “understand” about the strange disappearance of my twenty dollar bill! By this time, people were coming in the door and standing in line, all waiting to order their coffee and donuts. Bill was getting annoyed with all this fumbling around and tried to come to my aid. After all, he had seen the girl pick up the twenty dollar bill I’d laid down. So had another lady who had been sitting near by.
I thought, Who do you call at a time like this? Bill suggested cleaning out the cash register and PROVING she had taken our money. I also thought of calling the police but decided against it. They might not believe us, and we couldn’t prove we put the money on the counter.
Very much embarrassed, we took the coffee and maple bars to a little table and sat down. I began planning on how we could leave if she still insisted we owed her money. We had no more money with us. And what if she called the police and said we couldn’t pay her for what we ordered? Bill already had taken a bite out of his maple bar, and we couldn’t return it . . .
I tried to appear unobtrusive, glancing at a newspaper lying on the seat next to me and reading the signs on the window, but Bill kept muttering loudly, saying things like, “This is the most expensive donut and coffee I’ve ever had—TWENTY DOLLARS FOR TWO MAPLE BARS AND COFFEE!”
We finished our maple bars and coffee and left without the girl trying to stop us. Bill kept yakking about it as we walked back home, wanting ME to call the main office of the Yum Yum Donut Shops and complain that they had taken our money. All the way back he fumed about paying twenty dollars for our small order. Suddenly I remembered that several years ago, in front of our church, I had FOUND a twenty dollar bill.
“Hey, Bill, remember when I found that twenty dollar bill a few years ago by our church?”
Bill didn’t remember. But I told him, “Why not look at it this way? That was the same twenty dollar bill we lost today, so really we got the maple bars and coffee for FREE!”
Bill looked at me as if I were someone from outer space and continued being depressed about losing that much money. For a couple of weeks, his irritation over the whole episode left a heavy cloud over everything.
With his melancholy temperament, he harbored ill feelings. He didn’t want to go back to the Yum Yum Donut Shop and preferred nourishing the idea that he had been done wrong. But I had decided I had more enjoyable things to do than worry about a lost twenty dollar bill, especially since, the way I looked at it, we really got the maple bars for free!
*3\316\2*

DIABETES: TWENTY DOLLARS FOR TWO MAPLE BARS?A few years back—before diabetes and really having to watch my diet—Bill and I decided to work on our mutual weight problem by walking. So, at night we would walk to the Baskin-Robbins ice cream shop to have an ice cream cone night cap. And in the mornings we would walk to the Yum Yum Donut shop for our usual hot coffee and warm maple bars. On one particular morning, we had made it to Yum Yum’s in record time, and I reached in my sweater pocket for the twenty dollar bill I had brought along. Bill didn’t have his wallet with him, and I had left my purse at home because heavy purses aren’t much good on brisk walks.We ordered our usual, and when the girl brought it, I plunked my twenty down on the counter. She took my money and disappeared to the back room to get cream and more napkins. When she returned, she asked for two dollars and fifty cents. She didn’t speak very distinct English, but she made it clear she expected money. And I told her she had just picked up my twenty dollar bill when she had gone out back for more cream.It didn’t make any difference. All she could keep saying was that we owed her two dollars and fifty cents, and she didn’t seem to “understand” about the strange disappearance of my twenty dollar bill! By this time, people were coming in the door and standing in line, all waiting to order their coffee and donuts. Bill was getting annoyed with all this fumbling around and tried to come to my aid. After all, he had seen the girl pick up the twenty dollar bill I’d laid down. So had another lady who had been sitting near by.I thought, Who do you call at a time like this? Bill suggested cleaning out the cash register and PROVING she had taken our money. I also thought of calling the police but decided against it. They might not believe us, and we couldn’t prove we put the money on the counter.Very much embarrassed, we took the coffee and maple bars to a little table and sat down. I began planning on how we could leave if she still insisted we owed her money. We had no more money with us. And what if she called the police and said we couldn’t pay her for what we ordered? Bill already had taken a bite out of his maple bar, and we couldn’t return it . . .I tried to appear unobtrusive, glancing at a newspaper lying on the seat next to me and reading the signs on the window, but Bill kept muttering loudly, saying things like, “This is the most expensive donut and coffee I’ve ever had—TWENTY DOLLARS FOR TWO MAPLE BARS AND COFFEE!”We finished our maple bars and coffee and left without the girl trying to stop us. Bill kept yakking about it as we walked back home, wanting ME to call the main office of the Yum Yum Donut Shops and complain that they had taken our money. All the way back he fumed about paying twenty dollars for our small order. Suddenly I remembered that several years ago, in front of our church, I had FOUND a twenty dollar bill.”Hey, Bill, remember when I found that twenty dollar bill a few years ago by our church?”Bill didn’t remember. But I told him, “Why not look at it this way? That was the same twenty dollar bill we lost today, so really we got the maple bars and coffee for FREE!”Bill looked at me as if I were someone from outer space and continued being depressed about losing that much money. For a couple of weeks, his irritation over the whole episode left a heavy cloud over everything.With his melancholy temperament, he harbored ill feelings. He didn’t want to go back to the Yum Yum Donut Shop and preferred nourishing the idea that he had been done wrong. But I had decided I had more enjoyable things to do than worry about a lost twenty dollar bill, especially since, the way I looked at it, we really got the maple bars for free!*3\316\2*

ACUTE BACTERIAL MENINGITIS: NEUROIMAGING

When a history and physical examination suggest bacterial meningitis, the practitioner should proceed swiftly to lumbar puncture to establish a diagnosis. However, the clinician is faced with the question of whether the procedure will put the patient at risk for herniation and subsequent neurologic deterioration. To assess this risk, physicians often order head computed tomography (CT) scans prior to performing the procedure. In certain populations, provided there is no delay in delivery of empiric antibiotics, this approach may be appropriate.
It is generally accepted that patients with coma, papilledema, or other focal neurologic deficits should undergo neuroimaging prior to lumbar puncture for suspected acute bacterial meningitis. Hasbrun et al have determined that in such patients, head CT scanning should be used in making the decision to perform lumbar puncture.
A recent prospective study has confirmed, however, that clinical features can be used to determine which patients are unlikely to have an abnormal CT scan and can thus undergo lumbar puncture without delay. In this study of 235 patients who underwent a head CT scan prior to lumbar puncture, abnormalities were more often associated with certain historical features and neurologic findings. Patients older than 60 years with known immune deficiency (due to human immunodeficiency virus, immunosuppression, or transplantation), central nervous system disease, or a history of seizure 1 week prior to presentation were more likely to have abnormal head CT scans. Patients with focal neurologic findings were also more likely to have abnormal scans. In the patients with none of these features, only 3% of the CT scans were abnormal, and there was no evidence of mass lesion or herniation risk that precluded subsequent lumbar puncture. Kastenbauer et al retrospectively studied the records of 75 adults with pneumococcal meningitis and similarly determined that patients with focal neurologic deficits, seizures, and reduced level of consciousness (Glasgow coma score <12) were more likely to have head CT abnormalities.
*3/348/5*

STRESS BREAKDOWN: MISTAKING STAGE TWO FOR ENDOGENOUS DEPRESSION

It is very important, therefore, that we discern stage two symptoms for what they are, so that stress breakdown can be prevented from getting worse. The most common misdiagnosis in stage two stress breakdown would be to mistake the symptoms for those of endogenous depression.
Endogenous depression is primarily a mood disorder in which the person feels weak and tired, experiences broken sleep or early-morning waking, feels worse at a particular time of day, especially in the mornings, and feels generally sad, sometimes enough to suicide. Stage two symptoms can resemble depression, but there are differences:
1.   The sleep disorder in stage two stress breakdown tends to be one of difficulty in getting off to sleep, while in endogenous depression, the patient has difficulty in staying asleep.
2. The person with stress breakdown often feels better after a night’s sleep, while the person with endogenous depression may feel worse.
3.   There may be a tendency to burst into tears in depression, but the emotional lability of stress breakdown is one of inability to control both high and low swings in mood, momentarily.
4.   In endogenous depression, the atmosphere portrayed by the patient is one of loss – loss of energy, loss of enjoyment of life, loss of the will to live. In stress breakdown, the atmosphere is one of load. Suicide threats expressed in stress breakdown are impulsive gestures of despair and not based on the quiet, sad conviction of the patient with endogenous depression that the world would be better off without him.
*22/129/5*

ASTHMA AND PARASITES: A NEW CONCEPT

One of the important questions scientists ask about allergies is: ‘why did these responses develop in the first place?’
Surprisingly, some of the latest theories suggest that the allergic response initially evolved to help humans cope with parasites. We have known for some time that there are more allergies in advanced, developed countries where hygiene measures are more likely to have reduced exposure to these micro-organisms.
Eric Ottensen, head of the Clinical Parasitology Section at the National Institute of Allergy and Infectious Disease in Maryland, USA, studied the native population of a Polynesian island, Makue, where there is a high incidence of filarial worm infestation. When he first started, in 1974, he found that hardly anyone suffered from allergies. When he returned to the island in 1992 he found the levels of parasitic infestation considerably reduced. The population, however, had suffered a considerable increase in the incidence of allergies. Could it be, Ottinger speculated, that when a change in someone’s lifestyle caused a greatly reduced exposure to parasites, the immune system starts to respond to other substances that are, in themselves, non toxic? After all, house dust and pollens are not poisonous to the body. Why does the body make such a fuss in the first place? Because the specific immunological response to parasites is mediated by immunoglobulins E (IgE), the very ones that are usually involved in allergic responses to inhalants such as pollens and dust. Ottinger speculates that once humans reduce their contacts with parasites through more hygienically prepared foods and other measures, the IgE immune reaction is ‘all dressed up with nowhere to go’. It then directs, or misdirects, its attention to otherwise innocuous factors, and all of a sudden, we have an allergy. (‘Life Death and the Immune System’, Scientific American, September 1993, and Discovery, August 1993)
A number of clinicians and researchers, notably Dr Leo Gallant in New York, Dr Tom Borody in Sydney and Dr Jeff Bland in Seattle, have indeed noted that different types of intestinal micro-organisms can cause a variety of symptoms associated with different conditions, ranging from asthma to chronic fatigue. All have reported cases in which the presenting condition has been cured once the intestinal problem was successfully resolved.
So what do we do if it is not a food allergy or intolerance or a Candida infection? Call it what you like, when your digestive system does not work properly the symptoms can vary from constipation or diarrhoea, migraine headaches, skin rash and vomiting. You would be surprised to learn that digestive infections by a number of organisms can so profoundly alter our biochemistry that they can trigger or contribute to a wide number of illnesses, especially asthma, mood swings and emotional instability. Depression, anxiety and aggravated premenstrual symptoms are also common in people with poor digestive function.
In spite of what many people believe, the problem is not always caused by a food intolerance. We are often confronted with patients who appear to react to so many different foods that any elimination regimen would leave them unable to eat a balanced diet. Then there are those who are already so underweight that diets pose a danger. Finally some people cannot tolerate any food. They will experience abdominal swelling, indigestion, stomach discomfort, loose bowels or constipation, no matter what food they ingest. Many will also find their asthma symptoms get worse. Some of those people do not have a Candida problem and many of them do not suffer with a food allergy but with ‘dysbiosis’. This is a condition in which the normal gut flora is unbalanced, perhaps because of too many antibiotics during childhood, often as a result of micro-organisms such as giardia, camplylobacter, enteroviruses or helicobacter pylori. The gut ‘leaks’, allowing undigested particles to enter the circulation. These polypeptides, as they are known, may then cause an allergic-like reaction. And here lies the problem. Treating the allergy will not cure the problem simply because another, and then another, and then another food will cause the same problem sooner or later. The gut linings of these people are so sensitive that they react to almost anything. If you have a sore boil on your back and someone slaps you vigorously on the back, it will hurt! And it won’t make any difference whether the person who pounded your back is a friend or an enemy. Similarly, it is often irrelevant whether one is allergic to a food or not. Eating it will cause problems anyway. We call these ‘pseudo-allergies’. So what may the underlying cause of all these problems be?
We are now able to diagnose, treat and reverse the majority of these problems. To our delight, we have found that when some asthmatics with digestive problems have these cured, their asthma improves greatly.
When the digestive tract is assailed by some organisms, for example, Candida, Campylobacter, helicobacter pylori and others, two things are likely to happen. First the body can make antibodies to these organisms and thus we can ascertain their presence with a simple blood test. When this is not possible, other tests and special investigative procedures can identify the responsible mechanism.
Secondly the liver detoxification system will be either overworked or incapable of keeping up with the load because of a pre-existing malfunction. This can happen in the case of past alcohol or drug abuse, previous viral infections or the earlier use of many pharmaceutical drugs, including some antibiotics, which affect liver function. In this case a new test (a liver detoxification profile) will warn us of the existence of a problem. This in turn enables us to take appropriate measures to increase the liver detoxification (Cytochrome P-450) ability and to devise a personalised nutritional programme that will assist in minimising the burden on the liver.
Furthermore, special techniques devised by Dr Borody may allow us to actually rebuild the gut flora by re-colonising it with a mixture of friendly flora, introduced directly into the gut via the rectum.
For example, we have now seen and cured cases of suspected ulcerative colitis, duodenal and gastric ulcers, chronic constipation and irritable bowel syndrome. When properly diagnosed, the ulcers turned out to be caused by helicobacter pylori. This bacterial organism can probably be acquired through poor hygiene. Its presence can be accurately diagnosed with a simple blood test and confirmed with a special breath test or a stomach biopsy. Helicobacter pylori invariably causes chronic active gastritis and is found in 95 per cent of cases of duodenal ulcers and some 60 per cent of gastric ulcers. This organism is also implicated in the development of gastric cancer, so that its eradication is also a useful preventative measure. Helicobacter can release toxins that play havoc with one’s health.
Unfortunately the presence of helicobacter pylori does not exclude other digestive pathologies and we often find that patients infected with it also have other digestive pathological abnormalities. The tests and investigative procedures which we use look for those as well as the possibility of cancer.
The success of this new diagnostic and treatment procedure is evident from recent statistics which show a recurrence rate of less than one per cent (0.7 per cent) four years after treatment.
Even more interesting is the fact that, while Dr Galland had already reported several cases in the USA in which patients were cured of Chronic Fatigue Syndrome following treatment of their intestinal parasites, we in Australia have also found that several of our patients have been completely cured of chronic fatigue after successful treatment of their gastrointestinal problems, whether these were due to parasites, intestinal Candida or helicobacter pylori. Asthmatics as a whole tend to respond well to treatment, and most report not only a general improvement in well-being, but also a reduced need for medications.
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