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CHANGING THE HORMONE BALANCE BY HAVING TABLETS OR INJECTIONS – SIDE EFFECTS OF CORTICOSTEROIDS (CONCLUSION)

Extra corticosteroids interfere with fluid and mineral balance. While taking them, you will tend to retain fluid and salt—your ankles may swell and you may get short of breath, especially when lying down. This can be corrected with fluid tablets. You may also lose excessive amounts of potassium which can cause a general feeling of tiredness and muscle weakness. Ask your doctor to check the amount of potassium in your blood if you feel very lethargic. If it is low, it can be corrected by taking extra potassium in tablet form.
While taking corticosteroids, you will also have a lowered resistance to infections, especially those due to germs other than bacteria—thrush, for example. Any cuts, scratches or other wounds you have will not heal as well as they would normally. You should be sure to look after any wounds you have especially carefully. Keep them clean and protect them from further injury.
Extra corticosteroids can produce indigestion and heartburn, mainly through increasing acid in the stomach. Antacids will help these symptoms. It is quite dangerous to take corticosteroids if you have had stomach ulcers. They are likely to be aggravated and to bleed as a result.
High blood pressure can be caused or made worse by corticosteroids. Make sure your blood pressure is checked regularly while you are taking them.
If you take them for more than a few months, corticosteroids may weaken your bones. They will also stunt the growth of anyone who has not already reached their full height. This last one is a permanent effect.
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FEMALE PROBLEMS: GOOD NEWS ABOUT MENOPAUSE

•   The hormonal imbalance that occurs at menopause is temporary, much like the changes that occur at puberty.
•   No more than 10 to 20 percent of women going through menopause suffer extreme discomfort.
•   The appearance of hot flushes usually last no more than two years, and, as a general rule, is not incapacitating.
Ginseng: Helps alleviate hot flushes (often limiting them to eight weeks). Though containing estriol, a variant of oestrogen, ginseng is an anti-carcinogenic (anticancer) substance. As a supplement, I’d recommend 500 mg., taken on an empty stomach, a.m. and p.m. (Vitamin С has been said to diminish ginseng’s effectiveness; but taking a time-release С supplement will make counteraction less likely.)
Vitamin E (With Selenium): Helps alleviate menopausal symptoms by interacting with thyroid secretions and oestrogen, moderating hormonal fluctuations. Both vitamin E and selenium are antioxidants, slowing down aging and tissue-hardening due to oxidation. They’re also synergistic, which means that the action of the two combined produces an effect more potent than either would alone. I’d suggest starting with 200 mg. and increasing to 400 mg. (mixed tocopherols preferred), 1 to 3 times daily.
L-tryptophan: One of nature’s pharmacy’s best antidepressants and sedatives, and enormously helpful to women going through menopause. As a supplement, I’d recommend 3 tablets, 1/2 hour before bedtime, taken with water or juice (no protein).
Calcium And Magnesium: Aside from being effective natural tranquillizers, calcium and magnesium can help in the prevention and treatment of osteoporosis (the porous bone disease caused by demineralization due to lack of oestrogen), backache, and muscle cramps that often cause insomnia during menopause. As a supplement, I’d suggest 1 chelated calcium and magnesium tablet, 3 times daily.
B-complex Vitamins: These are your best insurance against the adverse emotional and physical effects of stress. (In fact, there is increasing evidence that an adequate B-complex vitamin intake throughout life helps prevent menopausal symptoms.) As a supplement, I’d suggest taking a stress В complex, 100 mg., 1-3 times, daily.
Herb Teas: For a soothing, mood-elevating drink, chamomile (and chamomile-based) tea is highly recommended. Teas containing passion flower (passiflora) are also helpful and work as effective sleeping aids.
Valerian is another calming herb – and a potent one. If using the root to make tea, add only half a teaspoon to a cup of boiling water, and then let it cool. Drink only one cup a day – and no more than a mouthful at a time.
Exercise: Brisk walking will tone up the circulatory system and can even prevent bone loss and strengthen the ligaments between bones. Swimming and bike-riding are also effective, as is jumping rope. (Caution: Check with your doctor before beginning any sort of exercise regimen.) I’d suggest fifteen minutes a day or a half-hour three times a week.
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REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: EATING FOR BETTER HEALTH – BASIC EATING GUIDELINES – Use FATS SPARINGLY—NO MORE THAN 6 TO 8 TEASPOONS OF SPREAD-ABLE OR POURABLE FAT IN YOUR DAILY DIET

The most obvious way to cut fat from your diet is to reduce the amount of pure fat—butter, margarine, shortening, and vegetable oils—you add to food during cooking or serving. Teaspoon for teaspoon, all types of spreads (except for the “diet” varieties) and oils contain about the same amount of fat.
Although they are similar in calories, there are meaningful distinctions between butter and margarine, for example. First, only animal fats such as butter or lard contain cholesterol. No vegetable fat contains cholesterol. Another distinction among fats is their degree of saturation. Saturated fats tend to raise total blood cholesterol levels. Unsaturated fats, classified as mono-unsaturated and polyunsaturated, do not raise total blood cholesterol levels. In fact, when you eat monounsaturated fats in limited amounts, they tend to raise the “good” type / of cholesterol—high-density lipoproteins (HDLs).
No fat is 100 percent saturated, mo-noun saturated, or polyunsaturated. For example, olive oil is called a monounsaturated fat because it is predominantly monounsaturated, but it also has smaller proportions of saturated and polyunsaturated fatty acids.
The first strategy to keep in mind is to reduce the amount of any type of fat that you use. Then, the next strategy is to make selections that are lower in saturated fat and cholesterol. Avoid hydrogenated fats—common ingredients in commercial baked goods and other processed foods—to decrease your saturated fat intake. You can also reduce the amount of fat in your diet by selecting lower-fat alternatives to mayonnaise, salad dressing, and sauces that are made with fat and oils.
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SURGICAL APPROACHES TO EPILEPSY: SURGERY FOR PARTIAL (FOCAL) SEIZURES – CONFIRMING THAT YOUR CHILD IS A CANDIDATE FOR SURGERY

The second step in the process of evaluating your child for surgery should take place in an epilepsy center capable of carrying out the full evaluation and the surgery.
If the center does not know your child, they will want to review his records carefully and may want to repeat EEGs and scans before deciding if further evaluation is in order. The center might also think that further trials of medication might be useful before considering further evaluation. Sometimes we find that patients referred to us have pseudo-seizures, not true seizures. Other children have multiple areas of abnormality and thus are not candidates for surgery. However, if the person is still a possible candidate, then the next step is to document that there is indeed a single seizure focus and that it is in an operable location. This will require video-EEG recording.
Video-EEG monitoring is the use of continuous monitoring of the EEG with simultaneous video recording to document both the clinical and the electrical onset of the seizures. It is essential to appropriate evaluation for surgery. The duration of this monitoring will depend on the center and on the frequency of the seizures. In general, we schedule one week in the monitoring unit, although for an individual with frequent seizures, a few days is often sufficient to analyze enough spells and determine if there is a consistent focus. If the seizures are less frequent, or if they subside in the hospital setting, as they often do, then we may withdraw one or more of the medications to permit seizures to be recorded. Since this drug withdrawal is done in the hospital setting, with trained personnel readily available should status epilepticus occur, the risk of abrupt withdrawal is minimized.
If, after careful analysis of the recorded seizures, a focus is identified, then consideration of surgery can proceed. If the abnormal area is situated far forward in the temporal or frontal lobes, areas that can be safely removed, then it may be possible to proceed directly to surgery. Surgery should never proceed, of course, until you and the surgeon have fully discussed the risks to your child, the chances of controlling the seizures, and any other questions you or your child may have.
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PUTTING THE CARBOHYDRATE ADDICT’S DIET TO WORK: ASSESSING YOUR PROGRESS

The combination of the enjoyable diet and your slow but steady weight loss will make daily weighings an enjoyable habit. If you are like most people who have used the Carbohydrate Addict’s Diet, you will begin to look forward to the end of the week and the averaging— it promises you an accurate look at your progress rather than potentially misleading readings that can occur with the once-a-week approach.
When you weigh yourself, you must also give up the idea that one weight at that particular moment is your weight; it really isn’t. That may sound strange, but look at it this way: that daily number cannot reflect minor and unpredictable fluctuations, for the same reason that a once-a-week weighing does not. Rather/your daily weight is to be thought of as but one part of seven parts of a week’s worth of weights.
If your weight is higher or lower than it has been, try to treat it simply as a piece of information. Don’t compare your weights from day to day—forget about it until week’s end.
Record your weight each day on your weight chart.
For the weeks that follow, continue to weigh yourself every day and record your daily weighing, averaging your weight (instructions above) every seven days. After fourteen days, you can compare the second week’s average with the first; that should be the first time you compare weights.
Don’t overreact to your weight: don’t abandon your eating plan just because your weight rises or falls. This program has been designed and refined by years of research, trial, error—and success. Stay with the program, and don’t decide to cheat or be harder on yourself just because of a daily fluctuation in your weight. Trust the Carbohydrate Addict’s Diet to work for you. This is a lifetime program, not a day-to-day diet.
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FOODS THAT PREVENT AND CONTROL CANCER: CARROT, CITRUS FRUITS AND CURD

Carrot
This vegetable is one of the richest sources of beta carotene. It has been found valuable in preventing lung cancer.
Beta carotene, it may be mentioned, is an orange pigment isolated from carrots more than 150 years ago. It acts as an antidote to lung cancer. A recent study at the State University of New York at Buffalo shows that eating beta carotene-rich vegetables more than once a week dramatically reduced chances of lung cancer when compared with people who do not eat such vegetables. Munching a single raw carrot at least twice a week reduces the risk of lung cancer by 60 per cent. The anti-cancer power of beta carotene comes from both its antioxidant capabilities and its ability to enhance immunological defenses, which are very important in preventing and fighting cancer.
Citrus Fruits
Citrus fruits like grapefruit, lemon, lime and orange possess powerful anti-cancer properties.   Toxicologist Herbert Pierson, Ph.D., a diet and cancer expert, formally with the American National Cancer institute, considers citrus fruits a total anti-cancer package, as they possess every class of natural substances like carotenoids, flavonoids, terpenes, lemonades and coumarins, which individually, have neutralized powerful chemical carcinogens in animals. One analysis found that citrus fruits possess 58 known anti-cancer chemicals, more than any other food. Dr. Pierson further says: “The beauty of citrus is that several classes of phytochemicals are highly likely to act more powerfully… as a natural mixture than when they appear separately.” In other words, whole citrus fruits are marvellous combinations of anticancer compounds. One such anti-cancer compound is glutathione.
Whole oranges contain high concentrations of this tested disease-antagonist. However, when extracted, the juice tends to lose glutathione concentrations. Oranges, of all foods, are also the richest source of glucarate, another cancer-inhibitor.
Curd
Curd or yogurt is a potential preventive against colon cancer. It is a rich source of vitamin D and calcium, both of which are highly beneficial in preventing cancer. Research studies show that Lactobacillus acidophilus helps suppress enzyme activity needed to convert otherwise harmless substances into cancer-causing chemicals in the colon. This has been brought out in the studies conducted by leading researchers Barry R. Goldin and Sherwood L. Gorbach at the New England Medical Centre. For a month, volunteers drank two glasses of plain milk every day, thereafter, they switched to acidophilus milk. When enzyme activity was measured in the subject’s colon, it was found that drinking acidophilus milk helped dangerous enzyme activity to drop by 40-80 per cent. This means certain carcinogenic activity in the colon was dramatically suppressed.
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HOW BDD AFFECTS LIVES: SELF-SURGERY

Some people with BDD are so desperate to fix their perceived defect that they do surgery on themselves. One colleague told me of a patient with BDD who thought the fingers on his left hand were too long, so he cut them off. Some patients scrape their face with coarse sand paper to smooth out their skin. Others try to do a facelift with a staple gun. A nurse tried to change the shape of his forehead by cutting into it with surgical instruments. Another person was so desperate to improve the appearance of his nose that he did his own surgery, cutting his nose open with a knife and attempting to replace his own cartilage with chicken cartilage in the desired shape.
While self-surgery appears infrequent, it’s a dramatic manifestation of the severe emotional pain and extreme desperation that some people with BDD feel. More commonly, people with BDD say that they hate their defect so much they’d like to do surgery on themselves—for example, cut their nose off—but they don’t actually do it.
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HIV: SKIN PROBLEMS-PURPLE OR BLACK SPOTS

The skin is commonly affected in people with HIV infection. The conditions affecting the skin include a diverse array of infections and an unusual tumor called Kaposi’s sarcoma. Other skin conditions—psoriasis, seborrhea, molluscum, fungal infections, and allergic rashes—are also common in people without HIV infection, but are more common and more severe in people with HIV infection. Since most of these conditions are treatable, people should see their physicians, especially if the skin problem is painful, disfiguring, or accompanied by a fever.
As expected, the diagnosis of a skin condition is largely dictated by its appearance. In many cases, a diagnosis can be established simply by observation, but occasionally diagnosis will require a biopsy.
Purple or Black Spots-Purple or black spots on the skin are characteristic of Kaposi’s sarcoma (KS), a tumor of the cells of the blood vessels. In most cases, there are several tumors, each approximately a quarter of an inch to an inch in diameter. They can usually be felt as a nodule or a fleshy collection of tissue. They can—but do not usually—cause pain. In light-skinned people, the tumors are usually red-purple or purple; and in dark-skinned people, they are very dark brown or black. The tumors are not like freckles, either in color or to the touch.
KS tumors can appear any place on the skin, including the face, scalp, back, chest, abdomen, arms, legs, or inside the mouth. They appear most commonly on the tip of the nose, around the eyes, on the ears, behind the ears, and on the arms, the legs, the chest, and the genitals. Usually there are several tumors in different places. At times the tumors occur symmetrically, appearing in almost identical places on both arms, on both sides of the face, or on both feet.
Kaposi’s sarcoma is second only to Pneumocystis pneumonia as the initial AIDS-defining diagnosis in people with HIV infection. KS can occur when the CD4 cell count is relatively high, though sometimes KS does not occur until late in the infection, after PCP or another
AIDS-defining diagnosis.
Some have argued that KS is a sexually transmitted disease because it is extremely common in gay men with HIV infection and is quite unusual in hemophiliacs, children, or those who became infected through transfusions. If KS is sexually transmitted, the safer sex practices that prevent transmission of HIV also seem to prevent transmission of KS: among gay men with HIV infection, KS is disappearing.
KS on the skin is suspected based on its appearance and is diagnosed with a biopsy of the tumor. This is a simple outpatient procedure; Novocain is injected into the skin to make the procedure painless.
The treatment of KS is controversial. Many people do not have serious problems with the disease, and the overall prognosis is substantially better than when PCP is the original
AIDS-defining diagnosis. Most people simply have KS on the skin, and though they may also have KS on their internal organs, it usually causes no problems. Moreover, many of the treatments for KS are either ineffective or have serious side effects. Cosmetic problems can often simply be covered with opaque makeup. Treatment can be considered necessary under several circumstances: if people have KS tumors on the face or other exposed areas of the body that they feel are unsightly or carry the stigma of AIDS; if the tumors are obstructing lymph channels and causing swelling of the legs, abdomen, or face; if KS is causing pain, most commonly on the bottoms of the feet or roof of the mouth; if KS has spread to internal organs and is causing disabling or serious symptoms, like pneumonia or problems of the gastrointestinal tract; or if KS is causing fever, fatigue, weight loss, and similar symptoms.
The usual treatment of skin tumors is radiation, freezing, or drugs. If KS has spread to internal organs, the treatment consists of taking the same drugs used to treat other cancers. A drug called interferon, taken by injection, is effective in some cases, but generally works best early in the course of KS, when the CD4 count is above 400.
The best advice about treating Kaposi’s sarcoma will come from any physician with extensive experience in this area, particularly from an AIDS physician, from a dermatologist, or from a cancer specialist (an oncologist). Which physician does the treatment will depend on which therapy is used: radiation treatment will require referral to a radiation therapist, cancer chemotherapy will require referral to an oncologist, and interferon will require referral either to a dermatologist, an oncologist, or a specialist in AIDS or infectious diseases. The person contemplating interferon treatment for KS should be forewarned that interferon is the substance produced by the body during flu that causes the aches of influenza. The same achiness is a common side effect of interferon treatment.
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SKIN DISORDERS IN ADULTS: PARONYCHIA (SWOLLEN NAIL FOLDS)

Paronychia occurs almost exclusively in women, particularly in those who work as householders. The main cause of the condition is having hands in and out of water, which damages the cuticles. Cuticles provide major protection to the nail growth plate, and once they are inflamed an effective barrier to infection is removed. As a result, Candida and other bacteria can invade. The other main cause of this condition is pushing back the cuticles when the nails are manicured. For some reason, women and manicurists seem to view the cuticle as an ugly structure and so try to remove it, thus contributing to nail fold infections.
Paronychia is totally preventable. When manicuring the nails the cuticles should not be pushed back or tampered with. When doing wet work cotton gloves should be worn inside rubber or vinyl gloves to protect both the nails and the nail folds. After washing your hands, it is best to dry the nails with a hair dryer. Using clear nail polish over the nail fold and cuticle provides a physical barrier to water and infection. The clear nail polish can be re-applied each day without first being removed, as nail polish removers irritate the cuticles.
Paronychia often takes six to nine months to clear if all the preventative measures are strictly adhered to. Anti-fungal paints can be helpful and, in severe cases, when the nail fold is very swollen, oral antibiotics are necessary.
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TYPES OF SURGERY FOR TREATMENT OF RHEUMATOID ARTHRITIS: JOINT REPLACEMENT

New techniques of joint replacement, or arthroplasty, have dramatically improved the outlook for people with RA. In arthroplasty, a severely damaged joint is reconstructed. This may involve only resurfacing the damaged ends of bones on either side and realignment of the joint, or it may involve replacing the entire damaged joint with an artificial one.
In the past, total joint replacement was performed only in older, inactive individuals who had less chance of wearing out their new joints. Current trends in surgery reflect the opinion that preserving function is mandatory for good health, however, and therefore the use of artificial joints in younger, more active individuals has increased. Total joint replacement is frequently performed in the knees, hips, and shoulders with excellent results. Replacements for the elbows, wrists, and ankles are available, but the outcome is not as predictable. New designs, however, are continually becoming available and will likely provide better and more consistent results.
Artificial joints can be attached to the bone by two different methods. In the first, surgeons insert the stem of the replacement joint into a hole drilled into the bone; the hole is filled with cement. This method is less painful and facilitates rehabilitation with faster healing, but the cement may crack and the joint may loosen in time, particularly in very active individuals.
Recently, surgeons have begun utilizing cementless joint replacements, the second method of attaching the artificial joint to the bone. In this method, the replacement stem, which has small pores in it, is inserted snugly into a perfectly matched hole in the bone. The patient’s own bone slowly grows into the pores to provide stability. If successful, this method of replacement has the benefits of increased strength and durability, with (theoretically) a decreased need for additional replacement surgery in the future. Its disadvantages include prolonged rehabilitation and potential problems with delayed healing, as well as bone growth inadequate to support and stabilize the replacement. This bone growth inadequacy may be more likely to occur in individuals with RA whose bones have already been weakened by arthritis and some medications.
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TYPES OF SURGERY FOR TREATMENT OF RHEUMATOID ARTHRITIS: JOINT REPLACEMENTNew techniques of joint replacement, or arthroplasty, have dramatically improved the outlook for people with RA. In arthroplasty, a severely damaged joint is reconstructed. This may involve only resurfacing the damaged ends of bones on either side and realignment of the joint, or it may involve replacing the entire damaged joint with an artificial one.In the past, total joint replacement was performed only in older, inactive individuals who had less chance of wearing out their new joints. Current trends in surgery reflect the opinion that preserving function is mandatory for good health, however, and therefore the use of artificial joints in younger, more active individuals has increased. Total joint replacement is frequently performed in the knees, hips, and shoulders with excellent results. Replacements for the elbows, wrists, and ankles are available, but the outcome is not as predictable. New designs, however, are continually becoming available and will likely provide better and more consistent results.Artificial joints can be attached to the bone by two different methods. In the first, surgeons insert the stem of the replacement joint into a hole drilled into the bone; the hole is filled with cement. This method is less painful and facilitates rehabilitation with faster healing, but the cement may crack and the joint may loosen in time, particularly in very active individuals.Recently, surgeons have begun utilizing cementless joint replacements, the second method of attaching the artificial joint to the bone. In this method, the replacement stem, which has small pores in it, is inserted snugly into a perfectly matched hole in the bone. The patient’s own bone slowly grows into the pores to provide stability. If successful, this method of replacement has the benefits of increased strength and durability, with (theoretically) a decreased need for additional replacement surgery in the future. Its disadvantages include prolonged rehabilitation and potential problems with delayed healing, as well as bone growth inadequate to support and stabilize the replacement. This bone growth inadequacy may be more likely to occur in individuals with RA whose bones have already been weakened by arthritis and some medications.*114/209/5*

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