No other element or compound comes close to selenium’s versatility of functions. My own research and that of other investigators—conducted on cells in animals and epidemiological studies—suggests that adequate selenium intake helps to reduce the risk of developing most major forms of cancer, including malignancies of the breast, lung, prostate, colon, rectum, stomach, ovary, pancreas, kidney, bladder, liver, skin and blood (leukemia).

Subsequent selenium supplementation trials in humans also found evidence of selenium’s cancer-protection effects. One of the best-known studies is the Nutritional Prevention of Cancer Trial, sponsored by the National Cancer Institute and conducted from 1983 to 1996. It was intended to determine whether 200-microgram (meg) supplements of selenium could prevent the recurrence of skin cancer in 1,312 American adults, 75% of whom were men.

Although skin cancer recurrence rates were the same for both the placebo and selenium groups, the overall cancer mortality in the selenium group was reduced by 56%. Specifically, selenium reduced the incidence of prostate cancer by 64%, and of colorectal and lung cancer by 58% and 46%, respectively. Although the study involved mostly men, previous research suggests that selenium protects women from cancer, too.

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How else does selenium work in the body?

Twenty-five selenoenzymes have been discovered so far, but the functions of only some have been identified. One group of selenoenzymes converts the inactive thyroid hormone T4 into T3, its active form. For this reason, the thyroid gland is particularly rich in selenium.

High levels of selenoenzymes have been detected in the testes, where they are believed to protect sperm from oxygen radical damage. Selenium also protects us against environmental irritants, such as ozone in the atmosphere, and several toxic heavy metals, such as mercury and cadmium.

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Ask a health-conscious adult to name the key nutrients that are necessary for optimum health, and you’re likely to hear vitamins, such as Ñ and E, and minerals, including calcium and iron.

How many people would name selenium? Not many. Few people are aware of the disease-fighting powers of this essential nutrient.

What is selenium, and how important is it for good health? To maintain our health and, in fact, to stay alive, we need not only vitamins and minerals, but also more than a dozen trace elements. As the name implies, trace elements are nutrients that our bodies require in very small amounts. Selenium is one such nutrient.

Is selenium an antioxidant, like vitamin C?

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This is a short but important phase of the consultation which only Neighbour (1987) has separated out. The doctor summarizes in the patient’s language what has been heard. This gives the patient an opportunity to check that the doctor has fully understood the problem and has taken into account her ideas, concerns, expectations and feelings. The patient has her own ideas about the nature of the problem, its causes, its importance and its possible outcomes. Likewise, the patient may have concerns, for instance that the Pill may cause some damage to her body. Or she may have expectations about the management of problems, such as that the doctor will refer her to a gynaecologist on account of breakthrough bleeding.

Summarizing provides direct feedback to the patient. If accepted, the consultation moves on. If not, the patient explains what it is that she feels the doctor has misinterpreted and then the doctor tries again.

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Suddenly the memory of the ‘fifth partner in six years’ flashed into the doctor’s mind. Tentatively she continued, ‘I noticed in your records that you have changed partners several times. Do you find it difficult to let them into how you are feeling as well?’ The girl muttered again and the doctor just caught, ‘One of the doctors said I didn’t need a smear if I wasn’t doing it.’ ‘Wasn’t doing what?’ asked the doctor stupidly, and then realized what Miss K. had said. ‘Oh, you mean that you’re not having intercourse. Why do you keep coming for the Pill, then?’ (Oh dear, thought the doctor, I’m really making a mess of this.) The girl lifted her head enough to give the doctor a glimpse of dark brown eyes and dilated pupils. ‘Tricia brings me down with her every time I start going out with a new man. She’s worried that I’ll get pregnant like she did, but there’s no chance of that!’ and she laughed harshly. The doctor felt very intrusive and clumsy. ‘Do you want to tell me about it?’ There was a long pause and then Miss K. gave a great shuddering sigh. ‘I don’t think I can,’ she whispered. There was another pause. ‘Could I see you again next time I come?’ she said and then, with a great effort, ‘You won’t make me have one of those things?’ and gestured at the couch. ‘Not until you’re ready,’ promised the doctor, feeling very protective, and made special arrangements to see Miss K. herself in two weeks.

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Mrs R. presented complaining that she felt slightly sick when taking her Pills, which she had been on for several years with no problems. She thought that now she was 40 she and her husband would use sheaths. The doctor agreed with what she wanted to do, saying the sheath was a good method, but not as efficient as the Pill, and how would she feel if she did get pregnant? Mrs R. then confided that this was really what she wanted. Her children were now at school and growing up, she had often wondered if she wanted a fourth child and now at 41 she felt she had to make that decision. Using a sheath would give her some chance of getting pregnant. Her ambivalence was shown by her inability to stop all contraception, and such a non-verbal clue may suggest that she is not altogether happy with her decision.

For the doctor there are the additional difficulties of weighing up the medical risks of a pregnancy in a woman of this age. It has been shown that in the years 1976 to 1987 in the UK, the risk of death in pregnancy for a woman over 40 was 10 times that of a woman between 20 and 24 years; 5 in 10 000 against 0.5 in 10 000 according to the report on Confidential Enquiries into Maternal Deaths (1991). However, there is some evidence that this risk is decreasing in the UK, as figures for 1985 to 1987 show a rate of only 2 in 10 000 deaths of women over 40 (Drife, 1992). In the end it is the couple who must be allowed to make the choice with the help of up-to-date information from their doctor. It is a delicate balance for the doctor to share the patient’s joy while providing her with realistic facts.

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For some patients, the importance of following their religious precepts is strong enough to allow them to ask for concessions directly.

Hamida Kamali had an IUCD fitted nine months ago. She had no problems with it but wished for it to be removed during Ramadan. When the period of fasting (and sexual abstinence) was over, the couple felt that they would like to return to the IUCD rather than continue with condoms. At this point the doctor was able to discuss the disadvantages of such frequent coil changes, but at the beginning this had not been possible because of their apparently implacable attitude towards their religion. In subsquent years, the couple felt that the advantage of an undisturbed coil outweighed their religious scruples.

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The doctor working with people with mental handicap may need to develop entirely new techniques. Interpretive therapy is more difficult. There is a need to be very clear and simple in the conversation. It may be that the doctor is in the role of sex educator (Fraser, 1991), and needs to explore what is really going on in the relationship. People who have been institutionalized have quite often been strongly indoctrinated with the idea that they must not have sex before marriage. They may not know what this means. If marriage occurs it can be very confusing and people often feel guilty. For instance, after a long engagement, maybe up to as much as 10 years, it can be incomprehensible that it is now all right to have intercourse: indeed it is expected. A whole mixture of feelings, including naughtiness and fear of punishment, may exist.

If the doctor endeavours to continue with his or her usual technique, he or she may feel at a loss when inconsequential remarks are made, like, ‘I am going to tea with Jack today’ or ‘Look at my new shoes’. A new style has to be developed where the comment is acknowledged, but then the doctor is able to pull back to the matter in hand.

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Description and Possible Medical Problems

If your scalp is itchy and frequent shampooing has no effect, you may have either head lice or dermatitis, an inammation of the scalp that may or may not be accompanied by flaky dandruff. Though it’s commonly believed that only children get head lice, adults can get them, too, though the experiences that most adults have with lice are restricted to those in the pubic area.

Head lice are very contagious and are spread through physical contact and clothing. Though it is hard to see a louse itself, you will be able to see lice nits, or eggs, which resemble small grains of rice, in your hair.

If you have contact dermatitis, your scalp will be red, swollen, and itchy. You may also experience blistering and/or flaking if the condition becomes chronic. Dermatitis may appear for a variety of reasons, from contact with a chemical irritant to an allergic reaction to hair sprays or gels, shampoos, or coloring products.

Treatment

If you have head lice, you should see your physician, who will prescribe a special shampoo for you to use along with a special comb to remove any remaining nits. It’s a good idea to throw out and/or burn any hat or headgear you might have been wearing during the period of infestation. You should also make sure that all bed linens are thoroughly washed in hot water.

If you have dermatitis, the treatment depends on the specific cause. The best treatment and preventative are avoidance of the particular irritant or allergen. Your dermatologist may recommend the use of a special corticosteroid cream or ointment to reduce the swelling and redness. In most cases, you’ll feel better in a day or so.

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Description and Possible Medical Problems

The last time you spent the night away from home and without the pillow it’s taken you years to mold just right, you may have woken up with a stiff neck and maybe even a headache. The stiffness may have subsided as the day proceeded, but you were bound to be greeted by the same discomfort when you woke up the next morning, until you got back home and back to your pillow.

One kind of neck stiffness isn’t so easy to fix, and, in fact, is a sign of a serious problem. If your neck is stiff when you try to move your head up and down and you have a headache and fever and feel nauseous, you may have meningitis, which is an inflammation of the lining of the brain. If the stiffness occurs when you try to move your head from side to side and you also feel achy, you may have a variation of meningitis called meningismus. This condition differs from meningitis in that it appears to originate from spasms in the muscles of the neck, not from an infection in the brain. Also, while one sign of meningitis is stiffness when you try to touch your chest with your chin, the primary characteristic of meningismus is overall aches and pains.

Though meningitis is usually caused by a virus, it can also be caused by bacteria. Bacterial meningitis tends to be more severe and therefore more serious than meningitis that is caused by a virus. While the symptoms of bacterial meningitis and viral meningitis are initially similar, with bacterial meningitis you’ll eventually appear more confused and have a higher fever than with viral meningitis. In addition to the other symptoms, it’s possible that you may also have encephalitis, which is an inflammation of the brain itself.

Treatment

To diagnose meningitis, your doctor will need to perform a spinal tap and sometimes will also order a CAT scan (for a description of the procedure, see the treatment under “Headache in the Morning, Made Worse by Sneezing, Coughing,” above). If the cause is due to bacteria, the treatment will be with antibiotics, and you may need to be hospitalized. If the meningitis is viral in origin even though it may not be severe, you may need to be hospitalized anyway to make sure that you are properly hydrated and treated with an antiviral medication. With proper rest, lots of liquids, and proper medication, recovery usually takes two to three weeks. If you are also diagnosed with encephalitis, the treatments prescribed for meningitis will also help ease the symptoms of encephalitis. Your doctor may also prescribe a corticosteroid preparation like prednisone to reduce the inflammation.

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