The important word here is ‘prevent’. At the moment there is no treatment that will significantly replace bone that has been lost Once bone is lost through osteoporosis, it is, for all practical purposes, lost forever. Spinal vertebrae that become deformed through osteoporosis remain deformed forever. If you are at risk of developing a condition which is virtually irreversible, prevention becomes very important.

There is considerable evidence to show that starting oestrogen therapy within two years of the menopause, and staying on it for at least five years, can reduce your risk of getting a fracture of the hip or of a vertebra by 50 per cent. If you have had an early menopause you will have more years without oestrogen ahead of you, so you will need to stay on it for longer, probably until 65 or 70. Obviously HRT is more effective if started early and before you have lost much of your bone mass, but it really is never too late to start. In the United States, women sometimes go on it for the first time after a fractured hip in their nineties! Even in quite elderly women, HRT can slow bone loss.

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Women consider having a hysterectomy for reasons such as chronic abdominal pain and excessive bleeding, and because of a doctor’s recommendation. Non-medical reasons may also influence the advice of medical practitioners, and of a woman’s family and friends. According to recent Australian and US studies, a doctor’s advice about hysterectomy may have more influence on a woman’s decision about surgery than her understanding of the reason(s) for the operation, its probable aftereffects, or the alternatives available. Presumably, a doctor’s recommendation for a non-surgical approach may be equally persuasive.

Dorothy’s ‘decision’ to have a hysterectomy followed her admission to hospital to have bladder repair surgery. The night before the operation her doctor visited her and, as he was leaving, said casually, ‘We might as well take your womb out while we’re in there, because you don’t have any need for it now.’ When asked how she felt about this, Dorothy said she accepted it without question because she believed her doctor knew what was best.

There is no doubt that some women prefer to leave decisions about their health care entirely to their doctors, even to the extent of preferring the doctor to decide whether or not they should have major surgery. But it is becoming increasingly common for doctors and women to work together, exchanging information and ideas and, in the end, coming to a mutual agreement about the best course of action.

Psychologists have identified five basic patterns of behaviour used by individuals when faced with choices about things like health investigations and treatments.

• Complacently continuing whatever has been familiar until then, which may involve discounting new and relevant information.

• Uncritically adopting whichever new course of action is most strongly recommended or is considered to be ‘the fashion’.

• Escaping the conflict by delaying decision making, shifting the responsibility to someone else, or making wishful excuses to bolster a particular alternative, meanwhile refusing to consider pertinent information.

• Searching frantically for a way out of the dilemma and impulsively seizing upon a hasty solution that seems to promise immediate relief. This type of decision making means that the full range of consequences of a particular choice are never considered.

• Searching painstakingly for relevant information, thinking carefully about it in as unbiased a way as possible, and weighing the alternatives carefully before making a choice.

Although the first two patterns may save time, effort and emotional turmoil, they often lead to decision making that is less than ideal and has unfortunate consequences. The third and fourth patterns likewise tend to be associated with undesirable results. The fifth pattern, termed the Vigilant approach’, usually leads to high-quality decision making. Its major features include identifying the feasible options; sorting out personal values, objectives, barriers to particular actions and incentives to others; assessing the consequences of a particular choice; planning how best to put the decision into effect; and anticipating what will happen as a result of that decision.

Today, many women are participating actively and responsibly in making decisions about their health and are having a major say about investigations and treatments. Your consent should always be sought before a procedure is carried out, except in the most unusual of circumstances, such as an emergency during major surgery when your life would be threatened if a particular action was not taken. In addition, your consent should always be sought for participation in medical research. Remember also that it is your right to withdraw from treatment by a particular practitioner at any time.

For most women, a decision for or against a hysterectomy involves the following considerations:

• an assessment of the impact of the existing medical condition and its symptoms on quality of life

• a comparison of physical risks and effectiveness of various forms of treatment

• a personal assessment of the importance of the uterus and of emotional reactions to the current situation and to removal of the uterus

• careful consideration of any relevant social and cultural factors

• the views of a doctor or doctors, a partner and close friends

• an assessment of the skill and care of medical personnel available to you.

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In the sleep laboratory it is shown that REM sleep occupies about 25 per cent of the time spent in sleep. When a person takes sleeping pills, REM sleep is reduced to 5 or 10 per cent of sleep time, but if the pills are continued for many days the REM component gradually returns to 25 per cent However, it has been shown that if sleeping pills are suddenly stopped there is an increase in REM sleep to about 40 per cent of sleep time, and, in the following nights, more dreams and nightmares are experienced. This is because the sleep induced by drugs is not a natural sleep—it has less of a REM component. When the drugs are stopped, there is a catch up in REM sleep, and this is called ‘rebound of REM sleep’ or ‘rebound insomnia’.

Initially benzodiazepine is prescribed for the treatment of insomnia arising from stress or some other reason. When the original stress is over, and the reason for taking these pills is gone, the drugs are stopped abruptly. This is when rebound insomnia sets in. People who suffer from rebound insomnia believe that they have lost the innate ability to sleep. This rebound insomnia is only transient and lasts just a few days. If these people persevere, the rebound insomnia passes and their sleep becomes normal again. However, there may be some who become psychologically dependent on these pills, meaning their confidence to sleep has disappeared. These are the people who should find this book useful, as it will help them regain their confidence to sleep.

It has also been shown that sleeping pills stop working after two weeks. The reason is that the body develops an increasing tolerance to the pills. The same dose of sleeping pill is no longer resulting in sleep as it used to. But then why do people persist in taking them? The answer is to prevent the withdrawal symptom—rebound insomnia.

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Those of us who have difficulty with our speech can use the relaxing mental exercises to gain greater fluency. Those who stutter, and who are tense when speaking, can be helped because the practice of the exercises lowers the general level of anxiety. Tension is reduced and the words come more easily.

We can also incorporate our relaxing mental exercises into our speech therapy. We practise the exercises, and while still completely relaxed in both body and mind we count aloud—slowly, easily, clearly—and all the time we maintain the relaxation of body and mind. In the same way we can practise by reading and reciting.

Speaking on the telephone is often a major problem for those who stutter. This situation is very well suited for help from our mental exercises. As we take up the receiver our eyelids close, and we relax completely. We are leisurely, and we take our time before replying, and as we do so we feel the relaxation through the whole of us.

Difficulty in speaking in public is due to the mobilization of anxiety. The practice of relaxing mental exercises reduces our general level of anxiety, and also makes us less inclined to overreact to stressful situations. We thus come to have a little more in reserve, as it were, for the stress of making a speech. Sometimes a real phobia can develop in relation to making public speeches. In these circumstances we can get help by following the principles which.

Some years ago a man from a country town came to see me on account of his speech difficulty. He was in his middle thirties. He had had two or three previous periods when his speech had been bad, but each time it had settled down in a matter of a few months. But this time it seemed to be getting worse. He was under increased stress at his work, which had made him tense, and his speech difficulty was associated with a jerky movement of his head. I had him relax several times in my consulting room and his trouble subsided. However, this was some years ago at a time when I had not realized the importance of the patient learning to do the relaxing himself.

He returned with a recurrence of his trouble a couple of years later. This time I showed him how to do it himself. His symptoms again subsided, and I have not seen him since. As he was very appreciative of the help I had given him, I think it fair to assume that he would have contacted me if he had had any further trouble.

If real stuttering is associated with anxiety and nervous tension it can be helped by this approach. On the other hand if you should be one of those who stutter in the absence of anxiety it is better to seek help through orthodox speech therapy.

A lad of eighteen had stuttered since he had first learned to talk. He was extremely tense and anxious, and when he would go to speak, his anxiety would seem to become quite uncontrolled. With the relaxing exercises over a period of some months he developed a rather careful, but almost normal pattern of speech.

On the other hand a man of twenty-six, with a terrible stutter, who had come some distance to see me, failed to obtain any material help at all. This man, unlike the previous patient, was really quite unconcerned about his stutter. He had no real anxiety. His purpose in coming to see me was that his firm had offered him a better job if he could get rid of his stutter.

*86\57\2*

In this country, the idea of having some citrus fruit or citrus juice every day is so popularly spread and associated with the concept of a wholesome diet, that even a suggestion of citrus being anything but beneficial is met with skepticism.

Let me state right at the beginning that there is nothing wrong with citrus fruit per se. All fruits, including oranges, lemons, and grapefruits, are excellent foods and used with wisdom and in moderation could constitute an important part of every diet

However, in recent years many nutritionists and medical researchers have questioned the value of citrus in the diet. It was shown in tests that citric acid in citrus fruit can cause tooth damage. It has also been shown that citrus juices are finked with peptic ulcers and can unfavorably affect the general health.” Some nutritionists and health writers, impressed by the findings of these researchers, have concluded that all citrus fruits should be eliminated from the diet

It seems to me that the citrus question has been handled rather unscientifically. It is unfair to condemn citrus fruit as such when so many other factors related to its use are not taken into consideration.

First, in tests, which put citrus fruit in a bad light, usually only citrus juices are used, not the whole fruit.

Second, most citrus fruit in this country has not been given a chance to ripen fully on the trees. They are harvested unripened to assure an early market Unripe citrus has a much higher content of acids, which can be very harmful, even when the fruit is eaten whole. It is, of course, even more injurious in the form of a concentrated juice.

Third, we should not forget that citrus fruit today is so loaded with toxic chemicals of various kinds—preservatives, artificial colorings, insecticide sprays, waxes, etc.—that some of these are bound to be consumed; this is especially true in regard to commercial juices, where the whole fruit, skin and all, is squeezed in huge, powerful presses.

Then, how many of us do use fresh juices anymore? The great majority of Americans drink frozen, reconstituted, or canned fruit juices, not to mention so-called fruit drinks, where there is actually not much of real juice or fruit at all, only artificial colorings and flavorings and various chemicals and preservatives.

Citrus fruits are rich in vitamin C, which is very important for arthritis sufferers, because it is essential for the health and stability of collagen and all connective tissues of the body, as well as for all vital processes of the body and proper functioning of organs and glands. The juice of half a lemon in a glass of warm water, sweetened with one teaspoon of honey, is an

excellent morning drink for anybody, including persons with arthritis. But it should not be taken every day for prolonged periods. It should be alternated with vegetable broths and herb teas.

Likewise, half a grapefruit once or twice a week, or one whole orange two or three times a week, will do no harm but lots of good. Again it should not be continued endlessly, but alternated with periods when other fruits are used.

The modern, efficient communication and cold storage system makes it possible to buy any kind of fruits and vegetables, anywhere in the United States, any time of the year. This is called progress. But from a nutritional point of view this is a very unfortunate development. This is admittedly great “marketing progress,” but it has contributed to the establishment of such unhealthy habits as using certain fruits or, which is even worse, certain fruit juices every day of the year, year after year.

All fruit should be eaten “in season.” Eat citrus only for a few months during winter when it is harvested. Then switch to the other fruits as they come “in season”—various berries, peaches, cherries, apples, etc. This way you will get fruit always when it is fresh and at the peak of its nutritional value, and your body will be afforded an opportunity to obtain a great variety of nutritive elements. In storage, even cold storage, all produce gradually loses its vitamin content.

The nutritive value of various fruits—vitamins, minerals, enzymes, trace elements, etc.—varies considerably. Also, the habit of eating fruit in season will be a good protective measure for possible damage by an overdosage, as is the case with citric acid in citrus fruits.

In summary, citrus fruits are good for you if you eat them whole and in moderation, not more than two to three in a week. (Lemon is an exception. It can be juiced and used diluted in water in drinks and in salad dressing.) But use citrus only in season and sec that it is organically grown without poisonous sprays. In practice, it would mean that you have to buy it only from sources you can trust or from the better health food stores which sell certified, organically grown produce.

If you live in northern parts of the country you can leave citrus fruits out of your diet entirely and replace them with vitamin C-rich apples and other fruits grown in the area.

*43\176\2*

The effect of menstruation on seizure frequency. The interaction between anticonvulsant drugs and oral contraceptives. The effects of anticonvulsant drugs on the fetus.

Some mothers report that their seizures become more frequent, others less frequent during pregnancy, and others have seizures which remain more or less unchanged in pregnancy. There seems no way of predicting what is going to happen in the first pregnancy, except that those with very frequent seizures are unfortunately, likely to get worse. By and large, subsequent pregnancies in any one mother follow much the same pattern. An unexpected and totally unexplained finding has been that those pregnant with a male baby are rather more likely to have more frequent seizures. Although epilepsy may start for the first time during pregnancy, this usually seems to be coincidental, and there is no good evidence that pregnancy itself is a

particularly potent event in inducing seizures. One possible reason for an increase in frequency of seizures during pregnancy is that the body processes anticonvulsant drugs differently. The interactions between pregnancy and drug metabolism may be complex.

Some anti-epileptic drugs pass through the placenta into the fetus. Phenobarbitone is perhaps the best-known example. After delivery the baby’s serum phenobarbitone falls, and during the early days after birth the baby may be much more fractious and irritable than most new-born babies.

Many mothers on anti-epileptic drugs wonder whether they can breast-feed their babies. Careful studies have been made on this point, and only small quantities of the drugs are secreted into milk, so it is quite safe to breast-feed.

*80\188\2*

DLPA (DL-phenylalanine) is a very interesting substance that reduces pain quickly and effectively. It can help patients promptly gain a satisfying level of comfort while waiting for the long-lasting benefits of CMO to take effect. In the body endorphins are the natural substances produced to control the transmission of pain signals. Although they are non-narcotic, endorphins can be thought of as a sort of natural morphine.

DLPA prevents the normal hasty destruction of endorphins and thus inhibits the transmission of pain signals. It works by inhibiting the enzymes that break down endorphins, which results in extending their beneficial effects for a much longer time. In some people, DLPA sometimes acts as a mood enhancer as well.

L-phenylalanine and D-phenylalanine are natural amino acid substances commonly found in many protein foods. DL-phenylalanine is a combination of the two. Most people enjoy very prompt pain relief with DLPA and experience no negative side effects. It is safe and effective, gentle on the stomach, and not habit-forming. And it does not contribute through joint cartilage deterioration as do aspirin and other NSAIDS.

However take note that although not common, some people experience headaches or nausea from taking DLPA. People with high blood pressure, women who are pregnant or lactating, persons with psychoses, those suffering from malignant melanoma, those with phenylketonuria, or those with any sensitivity to phenylalanine should consult their physician before taking DLPA containing products. Taking DLPA with MAO or tricyclic antidepressants can lead to dangerously high blood pressure.

*96\142\2*

Signs and symptoms

In severe cases of scoliosis the curvature of the spine can easily be seen when the child stands up. Even a slight curvature may be easy to recognize because the child stands in a hip-shot position, with one hip more prominent than the other. Scoliosis in almost any degree can be observed when the child bends forward at the waist with the knees straight. In this position scoliosis causes the chest to rotate, making one side of the back more prominent.

Home care

The important aspect of home treatment is to watch for the onset of the condition by observing your child’s posture periodically, particularly during periods of rapid growth.

Precaution

Any curvature of the spine is abnormal. Since scoliosis can become severe in a matter of months, your child should be checked as soon as you notice any abnormality. The child should then continue to see the doctor regularly.

Medical treatment

After confirming the presence of the condition, your doctor will often refer you to an orthopedist (bone specialist) who is skilled in treating scoliosis. The specialist will X ray the spine.

Idiopathic scoliosis occasionally corrects itself during growth. However, it must be checked several times a year. Correction of idiopathic scoliosis may require the use of a back brace or surgery of the spine. Differences in leg length will be treated by placing lifts in the child’s shoes or by surgery.

Exercise and physical therapy are not known to be helpful in treating any type of scoliosis.

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Elimination Diets

There are two kinds of elimination diets. The first one eliminates for a period of one week a single food item in order to observe the effect of that elimination. The second one eliminates for one week all the highly allergenic foods. During this period, the child is fed the following hypoallergenic diet which does not contain wheat, eggs, or milk. Bread should be banana rye, potato bread, or Ry-Krisp. The only beverage should be tea with sugar. Olive oil and lamb drippings should be used as fats. The only meat should be lamb. Beets, spinach, and sweet potatoes (all thoroughly cooked with no sauces added), and apricots, cherries, peaches, and prunes (all thoroughly cooked with nothing added except sugar) should be the only vegetables and fruits.

To this diet, one suspected food item can be added each week, and the effect of that addition observed. If the diagnosis is still not conclusive, then the child’s food intake for the next week should be limited to water, sugar, and allergy-free proteins. (Allergy-free proteins are called Amigen by Baxter, Nutramigen by Mead Johnson, Amino Acids by Stuart. Their purpose is to provide healthy nutrition on a restricted diet.) To this restricted allergy-free diet, one suspected food item can be added every two to three days, and the parent can observe how that addition is tolerated.

Provocative Diet

This consists of adding a large quantity of a suspected food item to the regular diet to observe the effect of that addition.

*6/99/5*

Toxoplasmosis

Toxoplasmosis is an infection of the parasite Toxoplasma gondii which is found in most animals but the only reproductive host is the cat, which acquires the cysts by eating infected birds and mice. It can be transmitted to humans by contact with cat litter, eating raw or partially cooked meat, drinking contaminated water and in unpasteurized dairy products.

If a woman acquires toxoplasmosis during pregnancy, the baby is usually infected in 45 per cent of cases and it is a very serious disease for the foetus. The risk to the baby is greater in the first trimester (first 12 weeks) of pregnancy, when an infection of toxoplasma can cause hydrocephalus (accumulation of fluid on the brain), eye problems, convulsions, blindness and brain damage. Toxoplasmosis can also increase the risk of an early or late miscarriage.

In France pregnant women are routinely tested for toxoplasmosis, sometimes as often as once a month. If a pregnant woman becomes infected then, depending on the stage of pregnancy, advice is given as to the course of action. In this country, the Royal College of Obstetricians and Gynecologists have concluded that routine screening of toxoplasmosis for pregnant women is not ‘appropriate’, perhaps due to financial constraints. Once infected with toxoplasmosis, the person acquires life-long immunity.

Prevention is the best approach and that means that, up to four months before pregnancy and during pregnancy, the woman must not handle cat litter. If this is impossible then disposable gloves should be worn. Gloves should also be worn while gardening and hands should be washed thoroughly after changing cat litter, gardening and handling raw meat. If you eat meat only eat it when it is well cooked, wash all fruit and vegetables thoroughly to remove soil, avoid unpasteurised dairy foods such as milk and cheese, and wash your hands before eating.

Genital Herpes

This virus is sexually transmitted. Once acquired, it can come and go, with attacks varying from slight red bumps to blisters. If a woman gets herpes for the first time during the early part of pregnancy it can increase the risk of miscarriage by up to 25 per cent. If herpes is active when the woman gets to term then she is usually offered a Caesarean. This is because, if delivered vaginally, the baby could contract herpes during the delivery and there is a possibility of brain damage, blindness or death.

Gardnerella

This vaginal infection, gardnerella vaginalis, needs to be cleared up before conception. It can cause a burning sensation and also a grey or yellow discharge with a fishy smell.

Group  Haemolytic Streptococci

This is a very common bacteria, but it has links with premature rupture of the membranes and premature birth. If this infection is present during birth the mother needs to have antibiotics to prevent the infection spreading to her baby.

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