People who insist on controlling their environment poison themselves with their “control madness.” They are unwilling to express themselves, reach out, or experiment with new ways of being. When in a position of power, they use the power to inhibit others. This pattern is observable in some “old maid” schoolteachers (of both sexes) who, in their need to control, choose to teach the lower grades. Their primary interest is to control and manipulate, and this is easier with younger children.Another form of controlitis occurs in the person who continually interrupts himself with trivial matters that must be taken care of immediately. Everything must be under control or he can’t relax. When someone else is doing something, he typically observes with a scrutinous eye as to whether the person is doing it right (according to him). The bolder poisoners of this type are full of unsolicited helpful suggestions. Those who are more timid squirm with irritation and restlessness as they observe someone doing something differently from their way. They insist on calling the shots, and they torture themselves when they can’t.*63\350\8*
The Tobacco Connection Revealed. At the end of the Second World War the link between smoking and lung cancer was not widely recognized. The rapid increase in the frequency of lung cancer was a cause of some concern but doctors were among the heaviest smokers, and smoking as a cause was, oddly enough, overlooked. How the connection was made has been recently summarized by Sir Richard Doll, who was closely involved and the following account is based largely on his report.Tobacco had been in use for over three hundred years, but it was probably the advent of cigarettes at the beginning of the twentieth century that started the lung cancer epidemic. Perhaps the clearest warning had been sounded by a researcher named Pearl from Johns Hopkin’s University in the United States in a scientific paper in 1938 in which he reported that, ‘the smoking of tobacco was statistically associated with an impairment of life duration and the amount and degree of the impairment increased as the habitual amount of smoking increased’. Before the war, therefore, Pearl had told us that smoking shortened life and that the more we did it the more it was likely to do so, but nobody took much notice.The change in attitudes can be dated to 1950 when five reports of the tobacco-cancer link were made and Sir Richard Doll and Sir Austen Bradford Hill concluded that smoking caused lung cancer. There was a change in approach to examining the relationship; and large studies, drawing on all the skills of epidemiologists, were established to follow large numbers of individuals over several years. By 1954 it was very clear that smoking caused lung cancer. Doctors played a part here in twoways. Doll and Hill were the investigators but one important group of subjects consisted of doctors. When it looked likely that smoking caused lung cancer, many doctors stopped quickly. Showing that this group then became less likely to get cancer than those who continued to smoke was a strong piece of evidence.From that time on links between smoking and other diseases, including heart attacks and other cancers, were increasingly demonstrated, and the complex interaction between the three thousand different chemicals to be found in tobacco smoke and the dozens of illnesses with which tobacco is now associated began to unfold.*39\194\4*
Eating well helps your immune system, provides energy, and prevents muscle loss. People with HIV infection are beset with a variety of conditions that make eating difficult. In general, people with HIV infection should be careful about their nutrition. Remember the four basic food groups: every day, you should have two to four servings of milk or milk products, meat or meat substitutes, fruits and vegetables, and cereals and starches. For more specific advice, ask a registered dietitian. (A registered dietitian is usually trained and licensed in nutrition and problems of nutrition; nutritionists need not be either trained or licensed.) Registered dietitians can be found at hospitals, clinics, and county health departments, and in private practice. Dietitians often advise people with HIV infection to be careful of infections by microbes like salmonella that live in perishable food. These infections occur only rarely in people with HIV infection. If you want to be extra cautious, however, the microbes’ growth can be inhibited by very hot and very cold temperatures, and by cleanliness. Keep hot foods hot: cook at 165 degrees F to 212 degrees F, keep warm at 140 degrees F to 165 degrees F. Keep cold foods cold: refrigerate at 40 degrees F, freeze at 0 degrees F. Keep everything clean: wash fresh fruit and vegetables; use cutting boards of plastic, not of wood; and wash the cutting boards. Do not eat moldy food. Do not eat rare meat, raw fish, or raw meat, and do not drink unpasteurized milk. Thaw meat in the refrigerator, not at room temperature. Do not eat raw eggs; cook eggs thoroughly.*242\191\2*
For those who already have bone density low enough to increase their fracture risk, there’s another important level of risk reduction: safety-proofing your home to reduce the risk of falls or other accidents that might provoke a fracture. If these steps don’t concern you directly, they may still be valuable advice for a friend or loved one. The following list will get you started:Avoid clutter on the floor, and especially on steps, so you won’t trip or slip.Carpet slippery floors. Avoid cleansers, waxes, or polishes that make floors slippery. Wipe up spills as soon as they occur. Use rubber nonskid mats under area rugs.Install handrails in the shower and bathtub, and use rubber decals on the floor to keep you from slipping.Replace tables or other furniture low enough to be out of your normal line of vision that you might trip over.Keep phone and electrical cords short, off the floor, and properly affixed against walls or baseboards so you won’t trip over them.Make sure hallways, closets, and especially stairs are well lit—bright enough, but without glare.Install handrails on both sides of all staircases.Keep flashlights handy, and put in night-lights anywhere you might be walking during the night. Don’t walk around your house in the dark.Some additional safety strategies:Choose supportive shoes without slippery soles, but also avoid those with such heavy rubber soles that they might actually trip you up.Avoid clothes long enough to get caught under your foot, particularly on stairs.Be aware of medication side effects or interactions that affect your balance or coordination, and ask your doctor or pharmacist about alternatives.Keep your blood pressure within the normal range.Exercise to build strength, flexibility, balance, and coordination, all of which help prevent falls.Have your hearing and vision tested and corrected as well as possible, and be rescreened regularly.Keep phones in as many rooms as possible in case you do fall and need to call for help.Use the appropriate assistance for walking: cane, walking stick, or walker. It won’t do you any good to have one you don’t use.If you fall and think you’ve broken something, don’t move—or let anyone else move you—until you get professional assistance. In general, after a fall, don’t put weight on an injury, and move slowly. See your doctor.If you have a pet, keep careful track of its whereabouts— and the whereabouts of its balls and toys—so you don’t trip over a snoozing animal companion.Organize your things so you don’t have to bend over or reach overhead for things you use frequently. Don’t climb on chairs to reach what is up too high. Use a sturdy stepping stool designed for the purpose if you must, but you’d be better off asking for help.Get help with heavy lifting, or opening stubborn doors or windows.To pick up something from the floor, bend at the knees, not the waist.As the old joke goes, the falling isn’t so bad. It’s hitting the ground that really gets you. Take the time to protect yourself so you don’t have to find out for yourself.*35\228\2*
WARNING: The diet should not be attempted on your own. The diet will only work when it, and you, are carefully supervised by a dietician familiar with using the diet. The diet may be dangerous if not done properly.WARNING: The diet is deficient in vitamins B and C as well as in calcium and these must be given as supplements in a sugar-free form. Also, remember that today many things like toothpaste, vitamins, and children’s antibiotics and cough syrups have added glucose. If your child is on the ketogenic diet, you must read every label carefully and, if in doubt about added sugar, check with your physician, the dietician, or the manufacturer.Small deviations in the diet can result in a seizure. Indeed, if a child has been well-controlled on the diet and has a seizure, you can almost be sure that the child has eaten a cookie, a piece of candy, or a bit of dog food. (Yes, small children can get into the dog food!) Should this happen, a day of starvation followed by reinstitution of the diet usually will re-achieve control.*145\208\8*
In large amounts, nicotinic acid stops the liver from making certain lipoproteins that give rise to LDL. Result: the body slows production of the “bad cholesterol.” Nicotinic acid’s side effects include your face and body possibly becoming very flushed, and nausea may occur. If you can get through the first 3 or 4 weeks, the side effects vanish. Nicotinic acid also cuts the risk of heart disease.Three other drugs – gemfibrozil, lo-vastatin, and probucol – slow the making of LDL to varying degrees and help lower cholesterol in the process. In a study done in Helsinki, Finland, gemfibrozil was shown also to cut the risk of heart disease.If your total cholesterol count exceeds 240 mg/dl, your doctor will order the LDL tests for you. If you’re at high risk, or if your LDL level soars above 160 mg/dl, you will be told to follow a stringent diet program and, depending on the doctor, a regular exercise regimen too. If this fails to lower your cholesterol, drugs probably will be prescribed.Some people maintain that if you have a high HDL level, regardless of how high your total cholesterol is, you have nothing to worry about. Still, the experts also caution that if the LDL level is high, there is cause for concern.Dr. DeWitt Goodman, a professor at Columbia-Presbyterian Medical Center in New York who headed a panel of experts for the National Heart, Lung, and Blood Institute, says data show that lowering LDL lowers the risk of heart disease. “The vast majority of people,” he says, “can reduce their risk of heart disease by lowering total cholesterol.”If you get your total blood-cholesterol below 200 mg/dl, you have optimized your chances of escaping a heart attack.Will programs to lower cholesterol result in a higher risk of cancer, as some people have said? All the experts we consulted denied that it was a proven risk. In fact, Dr. Goodman says, by eating a lowered-fat diet, you may reduce your chances of colon cancer a well as several other kinds of cancer.Dr. LaRosa of the American Heart Association says, “It is most important or one with high cholesterol levels and other risk factors to reduce those levels.”Dr. Jeremiah Stamler says you can add up to 8 years to your life expectancy, and even more under some conditions. He compares two men: One smokes and has a high cholesterol level; the other doesn’t smoke and has a low cholesterol level. The chances are that the low-risk man will live up to 10 years longer than the other man. Some critics assert that lowering cholesterol would yield only small increases in life expectancy, from a few months to a year. Dr. Goodman counters that if the cholesterol treatment delays the onset of a heart attack that alone makes it all worthwhile.*12/266/5*
SUPPORTIVE CARE OF CHILDREN WITH CANCER: PREVENTION AND TREATMENT OF URINARY TRACT TOXICITY (ASSESSMENT OF RENAL FUNCTION)
Assessment of renal function can provide information for early detection and monitoring of nephrotoxic treatments. Measurements of renal function that can provide information related to the etiology, site of injury, current activity, extent, and potential reversibility of nephrotoxicity are needed. Traditional screening tests of renal function (blood urea nitrogen, serum creatinine, and urine output) are inadequate.As always in pediatric patients, carefully consider the importance of age-related reference values and physiologic developmental variations. Although rarely applicable in oncology clinical trials, the dynamic early postnatal renal changes can complicate treatment with potentially nephrotoxic medications.A. Radioisotopic techniques”Tc-diethylene pentacetic combines low patient radiation dosimetry (40 mrad/mCi) and good correlation with inulin clearance. Using a compartmental analysis model, calculate glomerular filtration rate (GFR) after a single bolus injection of radioisotope. The two-compartment model has an error of approximately 3-4 mL/min when compared with inulin clearance. Errors in measurement can be introduced by edema, intravascular volume contraction or expansion, or severe renal failure. A correction factor for volume of distribution can be used.B. ElectrolytesScreening for renal tubular dysfunction should include serum potassium, sodium, chloride, glucose, magnesium, phosphate, alkaline phosphatase, bicarbonate, and pH. To aid interpretation of these values, corresponding evaluation of urine lytes is required. Screening for distal renal tubular function should include osmolality and pH of an early morning urine sample. Proximal tubular damage is associated with aminoaciduria and glucosuria.*33\168\2*
As we have seen, sleep apnea is an interval of interrupted or arrested breathing followed by loud gasping, choking, or snoring, which may result in partial or full arousal. The victim struggles to regain breath, sometimes with a great heaving of the chest. While the heaving, often desperate breathing pattern of an apnea victim does serve to restore airflow, it can actually aggravate the condition. Trying to breathe against the “gag” reflex creates abnormal air pressure in the passageways and can impair blood flow. Consequently the blood pressure rises as the heart beats irregularly, sometimes almost frantically. When the victim finally does breathe again, the massive inrush of air into the lungs produces a loud choking gasp or snore. You can easily see the effect for yourself: try inhaling while consciously blocking off the intake of air by preventing it from passing through your throat. Then, while still trying to inhale, suddenly relax f your throat—and notice the impact.*133\226\8*
What to do when you feel well What to do when you feel sick Lung problems Skin problems Mouth problems Problems of the digestive system Eye problems Head and nerve problems Problems affecting the whole HIV infection affects virtually every part of the body. The virus’s effect is either direct or indirect, through opportunistic infections. Moreover, its effects, both direct and indirect, resemble symptoms of other diseases. As a result, people easily become confused and worried: Which symptoms should I see the doctor about? Which should I ignore? Which result from HIV infection and which are the normal flus and headaches everyone has? How are the conditions diagnosed? What are the usual treatments? What are the side effects of the treatments? For those who feel well, there is a separate question: What can I do to maintain good health? This article, describes the different: conditions that accompany HIV infection. Unlike the earlier article, the purpose of this article is to provide guidelines for the medical care of a person with HIV infection. The article is divided into two parts. The first part discusses what to do to maintain good health when you feel well. The second part discusses the medical complications of HIV infection: the symptoms for which people should see a physician, the most likely diagnosis of those symptoms, the tests that establish the diagnosis, and the best treatment. The second part of the article is organized first by which parts of the body the particular condition affects, then by what symptoms people notice. So someone worried about a red rash needs to go to the section on skin problems, and look up red rashes.
Nickel Nickel is present in fake jewellery, particularly earrings, which can cause dermatitis around the ears. The most common way people become allergic to nickel is by having their ears pierced. Nickel is also present in bra clips, coins, keys, jeans studs and watch clips. There is a number of things you can do if you are allergic to nickel:- Wear real gold or silver jewellery. You must remember, however, that the clips, especially those on clip-on earrings, must also be made of real gold or silver.- Glue a small sequin or button onto the earring clips so that the nickel will not come directly into contact with your skin.- Metal watch clips can be changed over to plastic or painted with clear nail polish.- Sew material over jeans studs or bra clips so that the metal will not touch your skin.- A chemical called dimethylglyoxine can be used to test whether nickel is present in a metal object. If nickel is present, the liquid will turn pink.
Plants Not everything natural is good for the skin. Although many plants are beautiful in the garden, they can produce nasty reactions on the skin. In children especially, severe allergic reactions can afflict the face and can also produce a streaky rash on the arms. Rhus is well known for producing this sort of reaction, but chrysanthemums, grevillea, lilies, oleander and primula can all cause similar reactions.Decorative plants and flowers are more likely to produce allergic reactions, particularly in those who work in florist shops and nurseries. Alstramera, a member of the tulip family, is increasingly used in bouquets and can cause severe and even chronic hand dermatitis.