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If your doctor determines that the loss of a few pounds is due to the aging process, he will probably recommend that you do nothing. Of course, many people who have struggled with their weight their entire lives will be thrilled at the fact that the pounds have seemingly come off effortlessly. If this continues, however, and is accompanied by weakness and malaise, your doctor may recommend that you increase your caloric intake with nutritious foods—not high-fat, high-calorie junk foods—and that you also step up your exercise program. The reason? Muscle weighs more than fat, and exercise serves the dual purpose of reducing fat stores and building up lean muscle mass, which will ultimately increase your strength.
If the aging process is not the culprit, your doctor will tailor your treatment to whatever underlying medical problem is responsible. Again, as with malaise, it’s important for you to be as specific as you can when you describe your symptoms to your physician, since this is what will ultimately help him to determine your treatment.
I want to tell you a story about a patient I once had who was about 60 years old and who had spent her entire life fighting and losing her battle with chronic obesity. She had been on numerous diets without success. Unfortunately, she ended up developing breast cancer—which can be more common in women who are overweight—and she subsequently underwent radiation and chemotherapy. In the process, she lost 50 pounds. At the end of her treatment, she was heartened to find that her cancer had been totally eradicated. She was healthy and doing quite well, so after her treatment stopped, she decided to continue to lose weight until she had lost a total of 60 pounds. To lose the extra weight, she followed the advice of her oncologist, who had recommended a low-fat, low-calorie diet to prevent a recurrence of her cancer.
All was well until she suddenly became concerned that the real reason why she was losing weight was that her cancer had returned. She became scared and returned to her old eating habits; she promptly gained back 30 pounds. She told me she was afraid to lose any more weight because everyone thought her weight loss was due to her cancer; therefore, she felt that as long as she gained weight, she was cancer free. She did remain cancer free, but her weight went up and down for many years. The moral of this story is: Despite past health conditions, if you lose weight and feel healthy, listen to your body. It’s telling you everything is working as it should.
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Diet and Exercise
Fat (especially saturated fat), cholesterol, complex carbohydrates, fiber, sodium, calcium. Caloric balance. Selection of exercise program.
Substance Use
Tobacco cessation.
Alcohol and other drugs.
Limiting alcohol consumption.
Driving/other dangerous activities while under the influence. Treatment for abuse.
High-risk groups. Intravenous drug users who share or use unstenlized needles and syringes.
Sexual Practices
Sexually transmitted diseases: partner selection, condoms, anal intercourse.
Unintended pregnancy and contraceptive options.
Injury Prevention
Safety belts. Safety helmets. Smoke detectors.
Smoking near bedding or upholstery.
High-risk groups. Back-conditioning exercises for persons at increased risk for low-back injury because of past history, body configuration, or types of activities.
Prevention of childhood injuries for persons with children in the home or automobile.
Falls by the elderly for persons with older adults in the home.
Dental Health
Regular tooth brushing, flossing, dental visits.
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Screening
History
Prior symptoms of transient ischemic attack.
Dietary intake.
Physical activity.
Tobacco/alcohol/drug use.
Functional status at home.
Physical exam.
Height and weight.
Blood pressure.
Visual acuity.
Hearing and hearing aids.
Clinical breast exam.
High-risk groups. Auscultation for carotid bruits for persons who have risk factors for cerebrovascular or cardiovascular disease (e.g., hypertension, smoking, coronary artery disease, atrial fibrillation, diabetes), neurological symptoms (e.g., transient ischemic attacks), or a history of cerebrovascular disease.
Complete skin exam for persons with a family or personal history of skin cancer, frequent occupational or recreational exposure to sunlight, or clinical evidence of precursor lesions (e.g., dysplastic nevi, certain congenital nevi).
Complete oral cavity exam for persons who use tobacco or drink excessive amounts of alcohol or those with suspicious symptoms or lesions detected through self-examination.
Palpitation for thyroid nodules for persons with a history of upper-body radiation therapy when they were a child, for an increased thymus gland, or previous history of thyroid nodules.
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Description and Possible Medical Problems
Since the primary function of the liver is to detoxify the blood, if the livet fails to do its job properly, the problem will immediately become evident through a routine blood test. An abnormal liver function test can be caused by many diseases, including hepatitis, viral inflammation of the liver, an injury to the liver, such as cancer or alcohol abuse, gallbladder disease, and certain medications, such as Cognex and Mevacor.
Treatment
Since each specific liver disease requires its own individual treatment, if your doctor discovers a problem with your liver, he will immediately order a regimen for you. This may include medication such as corticosteroids to reduce inflammation, a diet that’s restricted in protein, fat, and alcohol, and rest. Some liver diseases, such as viral hepatitis, can be highly contagious, so your doctor may recommend that your family members receive immune globulins against hepatitis.
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The Fallopian tube, which is very close by, has finger-like tentacles which help sweep the released egg into the tube. If at this point, the egg encounters a sperm that has managed to survive and make its way into the outer limit of the tube, a sudden fusing takes place, and a “fertilized ovum” develops.
This is the moment of conception, and at this point the heredity traits of the new life are sealed permanently. At this moment also, the sex of the new life is positively determined.
From this point on there can be no change. It is
an amazing thing that mental and physical characteristics which may not become evident for many years, perhaps decades, are intimately sealed into the newly developing life in this split second of time. At this time also, the possible production of twins, or triplets or other forms of multiple birth is determined.
Multiple pregnancy can occur from the simultaneous release and fertilization of two or more ova (the so-called “dizygotic multiple pregnancy”), or from the early division of a fertilized single ovum (called “monozygotic twins”).
The incidence of twins is one in ninety pregnancies, of triplets, one in 90 x 90, and of quadruplets, and one in 90 x 90 x 90 pregnancies in Western countries. Twins are more common in Africa and Asia. Dizygotic twins are more common in families in which there is a history of twins, in women who are older, and the chance increases with larger families.
In recent years, certain hormonal products used to treat women who are having difficulty in reproducing (called infertility), seem to make some more prone to multiple births than women conceiving normally and without difficulty.
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An enormous number of pregnancies never reach full term. For a large variety of reasons, they end prematurely. When this takes place before the twenty-eighth week of pregnancy, it is termed an abortion.
Many people prefer to use the more euphemistic term ‘ ‘miscarriage,” for abortion in some minds conjures up criminal acts or acts of an illegal nature. These of course play only a small part in the total picture, and they appear to be decreasing with variations in laws around the world.
When pregnancy reaches the age of twenty-eight weeks, it is legally considered to be “viable” or alive, even though a baby born at this age would be hard pressed to survive normally.
The figures for naturally occurring abortions or miscarriages vary considerably. Some experts claim that about 10 per cent of all normal pregnancies end in this manner. Others claim the figure is more like one in four, or 25 per cent. However, more recent work in the United Kingdom now claims that as many as 70 or even 80 per cent of all pregnancies terminate prematurely by natural events.
These latter claims are based on careful studies of many thousands of cases. Many now believe that an abortion is merely nature’s way of maintaining a healthy line in the human race. Now genetic studies and chromosomal patterns can be studied in more detail than ever before with newer techniques, it seems that the overwhelming majority of abortions are really the result of genetic deformities. Therefore, nature has shed them early in pregnancy to avert the multitude of hazards to which a genetically affected human is subjected throughout life.
By methods not clearly understood, a genetically deformed embryo has greater difficulty in being accepted by the lining of the womb. Certain natural influences, it appears, act against it. The result is a rapid shedding very early in pregnancy. Indeed, most women are completely unaware that pregnancy had taken place, and less aware that a miscarriage in fact has occurred.
Often this is reflected in a “late menstrual period.” When it does arrive, it may be heavier than normal, or there may be a few clots. It may be completely pain-free, or there may be a little more discomfort than usual. But this is invariably accepted as part of the lot of the female and little fuss or bother is made of the unrecognized event.
Other instances, of course, last longer. Nearly three-quarters of recognized abortions take place between the sixth and tenth week of pregnancy. Definite reasons are hard to come by. Some claim that there is a temporary reduction in production of the hormone called progesterone at this time. This could be responsible for the embryo becoming dislodged from its position in the uterine wall and being swept away.
It seems that some abortions may be generated by infections and fevers in the mother at the time implantation is occurring. Perhaps viruses in her system pass over the placental barriers and gain access to the embryo, producing damage that results in its prompt release.
Some experts believe that psychosomatic causes play a part. The nervous system and brain are highly complex structures. It seems that through the complicated neural networks they may cause the generation of hormones that also predispose to premature release of the embryo from the uterine wall.
Sometimes the male partner may be responsible. Fifty per cent of the chromosomes and genes of the fertilized ovum are from his spermatozoa. Therefore, when union occurs, if defects are present consistently in his contributing half, then this could regularly predispose to miscarriage. Cases are on record where a woman sustaining multiple (or habitual) abortions remarried, and the pregnancies occurring with the new partner proceeded uninterrupted to full term and the birth of a normal, healthy baby.
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The mother gains weight for many reasons.
There are two main components which are worth considering.
(1) The Foetal Components. These include the foetus itself, together with the placenta (later to become the afterbirth), and the fluid in which the baby develops, called the “Liquor amnii.”
(2) The Maternal Components. These include the womb (uterus) and breasts; the increased amount of blood present; the storage of fat and protein by the body, and storage of water.
The foetal components. As every mother knows, the weight of new-born babies varies considerably. Besides differing in babies born in the same country, there is also quite a difference from nation to nation.
In Australia, the average birth weight of babies is 3,300 g (7′/2 lbs). But in India, the average birth weight is 2,900 g (6′/2 lbs). Both may be equally fit and healthy.
The age of the mother has no bearing on baby’s weight, but there is a tendency for the weight to increase with subsequent babies born to the same mother. The more affluent the living standard, as a rough rule, the heavier the baby tends to be.
A well-established cause for below-average birth-weight babies is smoking by the mother during pregnancy. Indeed, this has now become such a vital problem in Western lands that mothers-to-be are definitely advised to cease smoking totally during pregnancy. Underweight (and premature) babies run many risks not shared by their normal-weighted counterparts.
In the early stages, and up to the twentieth week, the foetus gains weight very slowly. But after this, a steady increase takes place.
The placenta (afterbirth), the vital link between baby and mother, is a large meaty organ. In the early stages it grows rapidly up until the sixteenth week. After that its rate of growth slows down, so that by birth, it weighs about 20 per cent of baby’s weight.
The ‘ ‘liquor amnii,” the fluid contained in the womb, and which bathes baby throughout uterine life, is a major weight-producing factor. Its volume increases quickly throughout pregnancy. There are 300 ml at twenty weeks, 600 ml at thirty weeks, and around 1,000 ml at the thirty-eight-week mark. After this it falls rapidly.
The Maternal Components. The womb (uterus) quickly increases in weight during the early weeks of pregnancy, especially the first twenty. After this it increases more slowly up until the fortieth week. By the time baby is ready to be born, it weighs about 900 g more than its non-pregnant weight.
The breasts develop rapidly right from the start, under the influence of special hormones. The breasts are prepared for the day baby is born and they will provide its nourishment. A large increase in the total amount of blood in the system also occurs during pregnancy. This, too, adds to the overall weight increase.
A lot of weight increase is due to the storage of fat by the pregnant woman. In fact, an average of about 4,000 g is usual. Most of this is laid down before the thirtieth week. Most of this comes from carbohydrates and fat in the diet and a small amount comes from the extra protein eaten.
There is a very real reason for this extra fat. It has been shown that nearly 35,000 calories of energy can be obtained from these deposits if suddenly required by the mother in the weeks immediately following baby’s birth. In short, she is geared to perform more work. But a note of caution should be inserted here: this should not be used as an excuse to deliberately put on more weight. As shown earlier, excessive weight gains during pregnancy predispose to a permanent overweight problem after pregnancy. This may continue for a long, long time.
After the thirtieth week, the main reason for weight gain is the retention of water by the body. For the first thirty weeks, she will retain 3,600 ml, plus a further 3,000 ml between then and the time of birth.
Excessive weight gain must be eyed cautiously in the last ten weeks. Regular weighing is essential. If there is a gain of more than 900 g (2 lb) in any one week, it indicates excessive fluid retention, and may be an early sign of pre-eclampsia, a serious complication of pregnancy.
There is no need to be alarmed at all this discussion on excessive weight gain. Basically, it is quite straightforward and relatively simple.
The basics are that an increase in weight during pregnancy is normal and natural. Excessive gains are to be avoided, and this can simply be done by a commonsense routine that avoids the type of foods that should be avoided in any case during normal (non-pregnant) life.
There is the added precaution that any excessive weight gain needs immediate investigation, especially in the latter ten weeks of pregnancy. By sticking to sensible general principles, most women will come through their confinement and soon regain their former attractive appearance.
There is absolutely no need for a woman to “go to seed” during pregnancy. So often it is blamed for an unattractive figure later on, when, in fact, the true reason lay in foolish indiscretions and a lack of attention to simple detail by the woman herself.
It is really in your hands. Do not forget this.
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In very recent times, more and more attention is being given to congenital abnormalities and to the possible causes.
With increasing frequency, added pieces of well-documented evidence come from leading research hospitals in various parts of the world. Collectively, these make interesting and thought-provoking reading.
It has become apparent that the use of hormonal products in early pregnancy could be a consistent and important cause of many congenital deformities. Such may be taken by an unsuspecting mother in a variety of ways-.
The most likely is to continue taking the contraceptive pill even though pregnancy has occurred. Although pregnancy is most unlikely when taking the Pill strictly as prescribed, various situations can arise where it is inadvertently missed. Or the patient may suffer from a gastric upset for a few days, and unwittingly vomit the Pill. Protection lapses and pregnancy may subsequently develop. The Pill may be continued with the woman unaware of a pregnancy developing in her womb.
Although at present the evidence is still fairly sparse, enough documentation is on record that indicates this may produce developmental problems. So, pregnancy and the Pill seem to be definitely not recommended.
Another potentially serious cause of trouble in the same field is the use of hormonal products for performing pregnancy tests.
Before the widespread availability of the immuno-chemical pregnancy tests (which test the urine or blood for the presence of H.C.G.), hormones were used as a common method of checking.
This was administered in the form of injections or tablets. If the patient bled after the hormones, it was presumptive evidence she was not pregnant. But if bleeding did not eventuate, it was highly probable she was pregnant.
These tests were in use for many years, and were considered to be safe from producing congenital abnormalities. But evidence began to accumulate that this was not always the case. Now a substantial amount of evidence indicts the use of these hormonal products. In Australia they have been banned by the governmental authorities, and their use has virtually stopped. Similar precautions will no doubt be taken in other countries also, and it is highly probable this has already occurred by now.
Certain other hormonal products have also been incriminated. Progesterone, which was once given to mothers who showed a tendency to miscarry, has been incriminated as producing abnormalities in the developing infant. It is now no longer recommended for these purposes.
Another serious problem which has come to recognition only in the past few years is the long-term effect of certain hormonal preparations given to mothers during pregnancy. It seems that quite a few women were treated with the hormone stilboestrol. Although their babies appeared to be normal, many cases of vaginal cancer have subsequently been reported in their female offspring, several years later.
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In recent years, increasing evidence is indicating that very real dangers exist for the unborn baby under certain conditions.
Many of these situations are now well established. Many are completely avoidable.
However, some women are either completely unaware of the possible hazards, or are only slightly aware that these risks exist.
Seeing they are so important, as a follow-on from the previous chapter where general advice and precautions were outlined, these especially important warnings are being listed in this section.
Women who are pregnant, or who are contemplating pregnancy, are advised to study this chapter carefully, for the information given is up-to-date and very important. In fact, it could either make or mar an otherwise happy pregnancy. It can affect anybody at any time at any place. Nobody is immune. Every week, the world-wide medical journals – the chief method of informing doctors about new developments -publish fresh information testifying to the importance of these factors.
Some of this information has been known for some years. But in many instances, more recent documentation has strengthened and widened views previously held.
Other information is fairly new. The passage of time, in the future, will no doubt give further weight to much of it. It may modify or alter some of it. But it is more likely to reinforce ideas currently held.
The points to be discussed mainly involve substantial risks that exist for the unborn infant.
It is well known that enormous activity occurs with the developing embryo during the first eventful weeks. During the first ten weeks, “organogenesis” is occurring. Cells divide, re-divide and gradually develop to form the vital organs of the mature infant. Indeed, it is incredible the speed with which this takes place.
After the first ten weeks, the process slows down. But cell division and re-division continues at a less rapid rate for many more weeks. Indeed, new cells are being formed right until the moment of birth.
It is during this time of rapid cell division and organ formation that the embryo is at a very special risk.
If it is exposed to certain abnormal influences during this period of time, severe disasters can commence.
In turn, by adversely affecting cell division, disorders that are collectively termed congenital abnormalities can readily occur.
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The amount of sleep required for good health varies tremendously from person to person. Eight hours each night appears to be average, but the essential test is whether you feel rested in the morning and have sufficient energy to carry through the day’s activities. If not, chronic fatigue may accumulate and contribute to what can be a serious illness. Some men and women find they can get along on fewer than eight hours sleep a night as they grow older, but if you are concerned that you are really not getting the sleep you need, you should discuss it with your doctor. One suggestion: it could be that you are getting less sleep because you need less sleep. Inability to sleep is discussed under insomnia in the encyclopaedia section; see also the entry sleep.
We all know about the need for a good night’s sleep, but too few of us recognize the need for rest during the day. Businessmen, professional people, executives, and many others who not only work hard but are under heavy stress, could live more comfortably and probably longer if they managed to rest during the day. Even a brief period of relaxation would be healthful. You could relax by having lunch in a quiet restaurant instead of in a crowded, noisy one. Or you might bring lunch from home and eat it in a park.
I have always found it refreshing to rest at home for half an hour at the end of the day instead of rushing right to the dinner table. It is really sad that this time of day, which should be a peaceful meeting time for the family, can become a time of short tempers and unpleasantness, just because you, and perhaps your wife too, are tired. An eight-hour workday, plus another hour or two for travelling, is too long for many people.
Periods of relaxation which are found in pleasant recreation are necessary to most people at least once a week. More and more, it is being recognized that a yearly vacation helps to safeguard good health.
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