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I have read some alarming things about diabetes. Are these true?
Books can be misleading. Sometimes they have been written many years ago and not been properly brought up to date. This means that they do not contain recent knowledge and there is no doubt that we know a lot more about diabetes than we did in earlier days. Many of the problems which used to be encountered can now be helped and are no longer such a worry. If you do read something which seems alarming, you should discuss it with your doctor.
I have heard that diabetes can have ‘complications’. What are these?
A. These are seldom a worry in childhood, but it is true that some people, as they grow older, develop other problems of health due to their diabetes. Some of these could have been prevented, or would have been less troublesome, if the diabetes had been more carefully looked after. On the other hand, some problems may develop despite every care. Not everyone has these complications, and it is probable that as a result of the enormous amount of research in progress, we may one day be able to prevent them completely. The important complications that you may hear about are as follows:
1. Poor circulation in the legs with slow healing sores
You may also have heard of old people developing ‘gangrene’ of the feet. This can be a problem in old age but trouble can be avoided by proper care of the feet. This means keeping feet clean and dry and treating minor cuts and sores promptly and properly.
It is important to cut toe-nails correctly and have ingrowing toe-nails looked after properly. Always be sure shoes are a good fit. With these measures, and careful control of the diabetes, there is no reason why gangrene should ever develop.
2. Impaired vision or blindness
It is true that some persons with diabetes develop poor vision as they get older. We think that good diabetic control may help minimize this, and only a small number of people are likely to be seriously affected. There are some forms of treatment available for those with diabetes who show signs of eye complications, and sometimes these are very effective in preventing blindness. There is a lot of research work being done at present to study the way the blood vessels of the eye are affected by diabetes and how we can maintain good vision. The very early signs of eye problems can be detected by tests that photograph the back of the eye.
3. Kidney trouble
Once again, as with visual disorders, some people do get kidney disorders later in life as a result of diabetes. It would be surprising if modern research does not point the way in the next few years to the prevention of this.
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Cancer is bad cells, pure and simple. Something goes wrong with the DNA, and eventually, a fast-growing collection of toxin-spewing, energy-absorbing, organ-destroying cells have begun to take over some part of your body. It can start just about anywhere, from your brain to your testicles, and end up just about anywhere else. Once cancer starts to migrate from its place of birth (a process known as metastasis), it’s hard to treat.
Your mission is to keep all that stuff from happening. Some of the risk factors, such as heredity and age, are out of your hands. But- and hear this well-most are not. Nearly two-thirds of cancer deaths in the United States are caused by factors entirely within your control. And guess what? Those controllable factors are none other than the usual suspects-smoking, a lousy diet, and a lack of exercise.
Studies have shown fairly clearly that obese men run a higher risk of at least colorectal and prostate cancer. Know that about 31 percent of American men are overweight (that is, 20 or more percent above their ideal weight) and you start to get the picture. What’s more, the extra pounds may affect men more than women, probably because men tend to carry the fat in their abdomen, where it’s more biologically active.
One way you get fat is by eating fat, especially animal fat. Not only does fat intake put you on the fast track to obesity but also there are strong indications that foods high in animal fat, such as dairy foods and red meat, increase your risk for a number of cancers, including prostate, colorectal, and even non-melanoma skin cancer.
Another way you get fat is through inactivity. It’s also another way you get cancer, especially colorectal cancer
Now to smoking. What don’t you already know about smoking’s sinister deeds? How about this: Smoking causes a whopping 30 percent of all cancer mortality, but not only because it’s responsible for more than 90 percent of lung cancer deaths. If you smoke, you also increase your risk for oral, esophagus, pancreas, larynx, bladder, and kidney cancers. And there’s newer evidence linking it to prostate and colon cancer, the latter in a special way. “Smoking seems to be an ‘early’ risk factor for colon cancer,” says Dr. Edward Giovannucci of Harvard Medical School. “If you’re smoking at age 20, that may not show up as a risk factor for colon cancer until age 60 or 70, whether you quit or not.”
So smoking, eating junk food, getting fat, and being lazy aren’t merely abstractions that are “bad for your health,” whatever that means. They can cause cancer. Put another way, not smoking, eating well, staying trim, and exercising are real things you can do to help prevent cancer.
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The comparatively recent “discovery” of the sleep apnoea syndromes and the heightened community awareness of problematic snoring has given rise to the misconception that it is an entirely new phenomenon, an affliction of the modern era like repetitive strain injury (RSI) suffered by computer keyboard operators. In fact snoring has been with us for centuries, but only recently has the technology been available to investigate the sleeping patient in a way that will not result in sleep disruption.
Unfortunately we will never know whether pre-historic man was a snorer but, with some exercise of the imagination, it is not difficult to picture our cave dwelling ancestors sharing this attribute with modern man. Snoring has been observed in animal species other than man, the most notorious being the easily recognizable brachycephalic or short nosed breeds of dogs such as the bulldogs, pugs and Pekingese; admirable dogs in many respects but with an unfortunate predisposition to respiratory problems. Laboured breathing after exercise, frequent infections and snoring all result from a distorted airway, particularly the elongation of the soft palate, a part of the airway which plays a crucial role in the development of snoring in both man and beast.
Some of the greatest writers and poets are responsible for the earliest references to snoring. Homer, the ancient Greek poet, believed to have lived around 800 B.C. wrote in his epic work, The Odyssey: “Then nodding with the fumes of wine, Dropt his huge head, and snoring lay supine.” ‘The great writers obviously knew something about the relationship between alcohol, sedatives and snoring, as William Shakespeare was to write in Macbeth (1605): “The surfeited Groomes doe mock their charge with snores. I have drugg’d their Possets.” Again from Shakespeare, and with a touch of artistic license in The Tempest: “Thou do’st snore distinctly, There’s meaning in thy snores.” Perhaps the most celebrated snorer appears in the pages of Charles Dickens’ novel, The Pickwick Papers (1837) as the fat boy Joe who was forever nodding off to sleep. Dickens’ portrayal of young Joe made an impression on the medical world, as the Pickwickian Syndrome became synonymous with obese and excessively sleepy patients which probably represented an early recognition of the sleep apnoea syndromes.
Snoring has not only provided subject material for poets, playwrights and novelists for centuries, but has without doubt been keenly observed by the medical profession for at least the same period of time. The very first volume of the British Medical Journal (1889) published a letter on the subject of snoring which, although somewhat dated by the quaint prose of the nineteenth century, recognized the effects of nasal obstruction and alcohol, and alluded to the sleep disturbance associated with severe snoring.
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If you develop breast pain for which there is no obvious cause, and you cannot detect any swelling in the breast, it may first be worth checking that you are wearing a correctly fitting bra. Specialists see many women whose bras are too small or too large and are causing them considerable discomfort or failing to provide support for their breasts. Good lingerie departments in large department stores and specialist shops have trained staff who will measure you for the right size of bra, and many of whom have experience in assisting women to find well-fitting bras following breast surgery. Bras of sizes outside the normal manufactured range which cannot be ordered by shops can be specially made. A breast care nurse, consultant, or someone in the appliance department at your local hospital should be able to give you advice and information about where to obtain these. After gaining or losing weight, you will need a larger or smaller bra, but many women continue to wear the same size for many years, even though their dress size may have altered.
How to measure yourself for a bra
It is quite simple to measure yourself for a bra if you prefer not to be measured by someone else, or if you want to check that the bra you are wearing is right for you.
1 First, with your bra removed, measure around your back and across your ribs, with the tape measure passing under your bust. If the measurement (in inches) is an even number, add 4 to obtain your bra size. If the measurement is uneven, add 5.
For example:
actual measurement = 31 inches
add 5 (as this is an uneven number) = 36. (1)
Therefore, your correct bra size is 36 inches.
2 Next, measure from the centre of your spine, under your arm and across the fullest part of one breast to the bone between your breasts. This gives a more accurate figure than measuring around your back and across both breasts. (You may need to ask someone to do this for you.) Double the number of inches obtained to give the full measurement. Then take away your bra size (measurement (1) above), and use the chart below to find your cup size.
For example:
measurement of half body = 20 inches
double this (20 x 2) = 40 inches
subtract bra size (1) = 40-36 = 4 inches (2).
Measurement (2) above Cup size
1 inch A
2 inches Â
3 inches Ñ
4 inches D
Therefore, in the example given above, the correct bra size is 36D.
This method is useful as a guide when buying a bra. However, sizes vary slightly amongst the different manufacturers, and the only way to be sure you get a well-fitting bra is to try some on.
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The principle of breaking the chain in the transmission of an infective illness became the king-pin of the measures taken to fight the next major health hazard to hit Europe-bubonic plague. By this time there were laws that made it an offence not to report plague to the health authorities. Many public health measures were adopted to control this killer disease but from the preventive medicine point of view perhaps the most important was the introduction of quarantine regulations. The pandemic of plague in the middle of the fourteenth century forced the public officials of Italy and southern France to create cordons sanitaires, observation stations, isolation facilities and disinfection procedures. By the seventeenth century these procedures were widely accepted throughout Europe.
All this effort effectively removed plague as a scourge and as England approached the eighteenth century it was a far healthier place to live than at any time since the Romans left 1,300 years before. At least the upper classes could look beyond the problems of immediate survival. It was from this group that the first real preventive medicine was to appear. In 1662 John Gaunt, a haberdasher, was the first to show that more boys were born than girls and that more births occurred in urban than rural areas. In 1676 William Petty wrote a book on Political Arithmetick which asserted that health and education were as much a part of a nation’s wealth and power as were its trade and manufacturing. This was something of a bombshell at a time when society simply didn’t think of health as a valued commodity. You were either healthy or sick. Petty, valuing the worth of a King’s subject at 20 a head, estimated that a 25 per cent reduction in natural death rate would add 4 million per year to the wealth of the nation. He estimated that it would take a century to achieve such a vast change in death rate but suggested that in the meantime the State should use the knowledge of illness rates to work out how many health-care professionals it needed.
Unfortunately, both of these far-sighted men were all but ignored-if only because they were centuries ahead of their contemporaries. Remember, this was a time during which people mainly accepted ill health as inevitable and during which the majority of society lived and worked with an overall condition of health that would appal most of us today. Chronic illness and early death were considered normal and diseases such as scurvy blighted the lives of millions yet did not kill them.
It was not until the eighteenth century that attitudes to health and disease began to change for the better-if only among the middle and upper classes. The concept that disease was simply divine retribution was being seriously questioned by the discovery that certain diseases at least had specific and provable causes. In 1757 James Lind proved that scurvy could be cured if sailors ate fresh fruit and vegetables, and environmental hazards such as lead poisoning were shown to be responsible for certain, hitherto mysterious, conditions. In 1798 Edward Jenner proved that smallpox could be prevented by vaccination and John Snow clearly proved the link between cholera and infected drinking-water supplies. Remember that all this was occurring long before bacteria were discovered.
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Sweet Almond: (Prunes amygadalus) oil is cold pressed from the kernel and is very pale yellow. Contains calcium, phosphorous, magnesium and is rich in protein.
It is the most versatile oil, light and easily absorbed by the skin. It can be used for any skin type for it promotes elasticity and slows down wrinkling. It helps to relieve itching, soreness, dryness and inflammation of the skin. Suitable for all skin types, and used in massage oils.
Wheatgerm: (Tritium durum or Ttitcum aestiva) the oil is extracted from seed, it is yellow to orange in colour. Rich in vitamin E&B6, protein, phosphorous, zinc, iron and sulphur. Because of its vitamin E content it is a natural anti-oxidant, use in a 10% dilution with other oils. The oil is used for all skin types, prematurely aged skin and helps to relieve symptoms of dermatitis, eczema and psoriasis.
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Your answers to the above questions will determine the form of treatment your physician will advise, since treatment will depend largely on what is causing your malaise. For instance, if you have recently lost weight and noticed that your bowel habits have changed, the cause could be the fact that you’re worrying about one of your children who recently moved across the country to take a new job. At worst, you could be suffering from cancer or bleeding in the gastrointestinal tract, but this is a very rare cause of malaise. The more specific you are in narrowing down your symptoms and your recent health history, the better your physician can treat you.
If you’ve lost weight and are frequently thirsty, it’s a cleat sign of diabetes. And if you’ve recently traveled to an area where deer roam freely and you feel tired and under the weather, you may have been bitten by a deer tick; a rash will help alert your physician to a possible diagnosis of
Lyme disease. There is also always the chance that your discomfort is caused by menstrual changes that are leading you toward the onset of menopause. Then again, a general feeling of malaise may simply be due to physical deconditioning if you have recently adopted a more sedentary lifestyle.
Your age, of course, will have some bearing on your physician’s final diagnosis. If an elderly person complains of malaise, her doctor will be looking for signs of cancer, a blood disorder, or lymphoma. For people in their 40s, 50s, and 60s who are feeling unwell, a physician will probably investigate certain infectious diseases first.
You should keep in mind that the above are only a handful of the possible causes of malaise; there are, in fact, many different illnesses in which this symptom is present. Because of this, make sure your doctor has as much information as possible so she can prescribe the most effective and fastest-acting treatment possible. I feel that an investigation of both your recent and lifelong medical history is vital to ensure proper diagnosis and course of healing.
Special Mention for the Elderly
In an elderly person, other factors may be causing malaise. These can include thyroid disease, a rheumatological disorder such as temporal arteritis, polymyalgia rheumatica, heart disease, and interaction among several of the medications she is taking. Again, making sure she is as specific as possible about recent changes in her health will help guide her treatment.
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Americans treat weight gain as a modern-day blasphemy of sorts, no matter whether they’re talking about 5 pounds or 50. I feel far too many men and women are totally obsessed with a process that I view as pure physics most of the time: weight gain is the body’s natural reaction when a person takes in more calories than his body needs. Most of the time, it’s as simple as that. Excess weight is one of the major contributors to America’s health problems and is so common because of the high-fat, high-calorie, sedentary life many people lead. When a person weighs more than 20% above his ideal weight, he automatically becomes more prone to developing high blood pressure, increased cholesterol levels, diabetes, and arthritis, as well as the psychosocial problems that go along with carrying extra weight, such as low self-esteem and emotional isolation.
As a physician, I become very concerned when one of my patients gains a lot of weight in a short period of time and/or morbid obesity develops.
However, the aging process works in such a way that a weight gain might actually be due not to an increase in body fat, but rather to an increase in the amount of water the body retains. This excess water can be the result of kidney, heart, or liver failure, and it accumulates most often in the abdomen or in the legs. Weight gain that results in fat and occurs without a corresponding increase in caloric intake can be a side effect of corticosteroid preparations such as prednisone, which are prescribed to treat arthritis or asthma. The face will commonly take on a round, moonlike look, and a hump may develop on the upper back. Prednisone can also raise blood sugar levels and aggravate an existing case of osteoporosis. However, the good news is that these symptoms and the weight gain will develop only in people who take high doses of the steroid for more than three or four months. Many times, however, an inactive thyroid is the first condition your doctor will check for. This can be diagnosed with a physical exam and a simple blood test.
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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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