Weight loss and diet plan for a healthy lifestyle.

The nails are often affected, usually with evidence of psoriasis elsewhere but, occasionally, they alone are involved. In this case, the diagnosis may be missed and the problem thought to be due to fungal infection or some other cause.

The nail may show small pin-head size pits or the nail may separate from the underlying nail bed or it may be thickened and discolored.

Unfortunately, treatment produces little benefit. Psoriasis on the skin responds well, in most cases, to local applications but the nail seem particulary resistant.

Patients undergoing treatment with methotrexate often show an improvement in their nails.

It is worth repeating that most cases of psoriasis are mild and can be controlled by simple means. Self-medication should be avoided, as it may irritate the skin.

Sometimes a previously satisfactory treatment loses its effect. When this happens the sufferer will need to change to something else. Later, the original treatment may again be effective.

*540/71/1*

The most common symptoms are abdominal pain and diarrhoea and the diagnosis may be missed and thought to be either an episode of mild appendicitis or the irritable-bowel syndrome.

Sometime ulcerative colitis may be suspected, if Crohn’s disease affects the large bowel. At times there is a fever and weight loss.

When the rectum and anus are affected there may be localised pain, bleeding and sometimes a fistula or track leading from the bowel and opening out on to the skin around the anus.

Involvement of large areas of the small bowel may lead to poor absorption of food, anaemia, vitamin deficiencies and malnutrition.

Treatment is not altogether satisfactory, as this is often so in diseases where the exact cause is not always known. Cortisone or its derivatives are often used as in any chronic inflammatory disorder.

One of the antibacterial sulpha drugs can be of value in acute flare-ups, but is of little use in long term maintenance.

It may be necessary to operate and remove the affected segment of the bowel when medical treatment fails.

Most patients can be kept in reasonable health and can live full and active lives.

*283/71/1*

Almost one in three babies have episodes in which they cry vigorously, sometimes for several hours, draw up their legs and go red in the face.

It is usually assumed they have abdominal pain. This “three-month colic” usually starts in the first six weeks of life, nearly half having stopped by three months and 90 per cent by six months.

The cause is unknown, but is often said to be due to intolerance to cows’ milk. However, breast-fed babies seem as prone to get it as those artificially fed.

Cows’ milk proteins are thought to enter the mother’s breast milk and taking the mother off cows’ milk may be of benefit.

Many of these babies seem to settle with a mixture containing antispasmodic drugs with a sedative.

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You are probably wondering why your practitioner can’t tell by a blood test whether or not your cancer has spread through the bloodstream. Remember how tiny the cancer cells are? They travel fn the blood singly or in very small groups and there are only very few of them in the bloodstream at any one time. This means that the chances of actually seeing them in a small sample of blood are minute. The only way we can know they have been in the bloodstream is by finding secondary growths in other parts of the body.

There are also some types of cancer which develop in many different places throughout the body from the start. These cancers include leukaemias, myeloma and many lymphomas. Leukaemias and myeloma begin in the bone marrow. The bone marrow is where we form new blood cells. In a child it occupies most bones but in adults it is concentrated in the central bones—spine, ribs, skull, pelvis and upper parts of arms and legs. Because leukaemias and myeloma are cancers of certain types of white blood cells, they begin where those white cells are normally formed, which is throughout the bone marrow. With leukaemias, the cancerous white blood cells can be found in a blood sample whereas in most cases of myeloma they are not released into the blood and can be found only in a bone marrow specimen.

The lymphomas are a group of cancers which originate in the lymph system. Most of these appear in many different nodes at the same time. There are some types, such as Hodgkin’s disease, which tend to spread in a fairly orderly and predictable way from one group of nodes to another and, in some cases, can be successfully treated with radiation therapy directed only to the affected parts of the body.

*40/40/1*

Imagine you are quietly going about your normal life, when suddenly you trip and fall. You stretch out a hand to save yourself, and the next thing you know you have fractured your wrist. Unfortunately, most Accident and Emergency doctors are so busy that they just don’t have time to explain that your Colles’ fracture is probably caused by osteoporosis, even less to explain what you might do about it. An X-ray will have shown up the fracture, but osteoporosis does not show up on an ordinary X-ray until one-quarter or more of the bone density has been lost, so if you have lost less than that so far the chances are that no one will notice that die cause of your fracture was osteoporosis, let alone tell you about it, and what you can do to stop it getting worse. A Colles’ fracture should be seen as a warning sign about die state of your bones, while still giving you time to do something about it.

Sudden or severe backache in the years after the menopause can have many causes, and it may not occur to your doctor that osteoporosis could be the cause in your case. He may arrange an X-ray (which doesn’t show anything wrong), possibly physiotherapy, probably painkillers, but eventually you get the message that you will ‘just have to learn to live with it’.

It needn’t be like that. Dual energy X-ray absorptiome-termachines, known as DEXA (or DXA) for short, are the best way to screen bones for osteoporosis, and are now becoming available all over the country, both on the NHS and privately. DEXA scanning is quite painless, and involves no undressing or embarrassment. DEXA machines scan your hip and spine, and produce a reading of your bone density, which will give a good idea of whether or not you have got osteoporosis, how severe it is, and what your chances are of getting a fracture; the lower your bone density, the more likely you are to sustain a fracture. Bone mineral density at the time of the menopause is the best predictor of osteoporosis, so in an ideal world, all women who are at risk of developing this disease would have a DEXA bone scan when they reached the menopause, and if their bone density was lower than it should be they would be advised on ways of reducing their chances of getting a fracture, including information on HRT. Until this happy day comes, don’t ignore any back pain you get, or a Colles’ fracture of the wrist, or loss of height – ask your doctor about osteoporosis.

You may see advertisements offering private screening for osteoporosis, and if this is on a DEXA bone scanner and will scan your hip and vertebrae, the reading will give your doctor a clear idea of your bone density and therefore of how likely you are to develop osteoporosis. Some companies are jumping on the osteoporosis bandwagon and offering screening that is less reliable; if you are in any doubt, ask your doctor. As a general rule, the only way to tell what the bone density is in your hip is to scan the hip, and the same with the vertebrae; scanning other parts of the body (such as the heel and wrist) does not give a truly accurate impression of your bone density in the important hip and spine areas. However, such a scan will show if your bone density is very low or very high; it’s those people in the middle who will need more precise measurement.

Scanning poses a difficult dilemma for the National Health Service. To scan all post-menopausal women would be prohibitively expensive, and large-scale dials have shown that it is not cost-effective to do this. To scan all women who are at risk of developing osteoporosis is still expensive, but if it can reduce the number of osteoporotic fractures (which currently cost the NHS over ?600 million a year) by identifying women who have a low bone density and offering them treatment, such as HRT, to reduce their chance of having a hip fracture, then considerable savings can be made. On the other hand, if millions of women take HRT for many years, that, too, is very expensive.

*50\42\4*

More than 25 000 Australian women had hysterectomies in 1975 and at that rate it was estimated that at least four out of every ten would have this form of surgery by the time they turned sixty-five. Twenty years later, with an ageing population that includes a high proportion of older women, it is estimated that 30 000 hysterectomies are performed in Australia annually.

Current evidence suggests that 20-30% of Australian women will have a hysterectomy during their lifetime, usually between their mid-thirties and mid-fifties. About three-quarters of these are performed before women go through a natural menopause, that is, before their menstrual periods stop of their own accord. The Melbourne Women’s Midlife Health Project is documenting the situation in 2000 randomly selected Melbourne women aged from forty-five to fifty-five. The Project, undertaken by the Key Centre for Women’s Health in Society at the University of Melbourne, has found a 22% rate of hysterectomy among the women, and a peak age for the operation of just over forty years.

Another study, conducted by the Australian Institute of Health and Welfare, suggests that one explanation for an apparent downward trend in hysterectomy rates in Australia is the rapid introduction of the surgical procedures known as endometrial resection and ablation. This study has found that approximately 4000 Medicare benefit payments were made for endometrial resection in 1991-92, and in the same period the rate of hysterectomy (for heavy, uncontrolled bleeding) in public hospitals in Australia declined by one-third. Although the effects of endometrial resection on bleeding patterns are still being evaluated and the technique itself is still undergoing development, it appears to offer a credible alternative to hysterectomy for some women. Equally, it is fairly certain that hysterectomy will never be eliminated completely. For the several thousand women in Australia each year who are diagnosed as having cancer of the cervix or of the endometrium, survival itself may rely on a hysterectomy.

Recently, there has been a surge of interest in new treatment alternatives to hysterectomy, some of which are surgical, while others are psychological, medical and lifestyle-oriented. At the same time as we applaud the effort that is going into developing new or revamped treatment approaches, we believe that significant information gaps remain about their long-term safety and effectiveness. Research needs to continue and women must be informed of the current gaps in medical knowledge when making treatment decisions.

*64\198\4*

Are there any other reasons for not taking sleeping pills? Pregnant women run the risk of deformity and other harm to the foetus. The tragedy of Thalidomide is well documented, in which babies born to a mother taking Thalidomide sleeping pills had deformed or non-existent limbs. Women who are breast-feeding should not take sleeping pills either, as most drugs pass through the breast milk to the baby. The elderly who have to wake a few times at night to go to the toilet are also advised not to take them, as they can be very drowsy with sleeping pills and can injure themselves with falls easily.

Sleeping pills in Australia:

1. Chloral hydrate—Noctec, Dormel, Chloralix.

2. Barbiturates—now very few doctors prescribe them.

3. Benzodiazepines: Temazepam—Euhypnos, Normison, Temaze Oxazepam—Serepax, Murelax, Alepam, Benzotran Diazepam—Valium, Pro-pam, Ducene Nitrazepam—Mogadon, Dormicum, Alodorm Flunitrazepam—Rohypnol, Hypnodorm

5. Antihistamines-Phenergan, Avil, Piriton, Polaramine.

*66\174\4*

In general, nervous rashes are distinguished by the way in which the condition of the skin waxes and wanes with our emotional state. Sometimes we are rather blind to this, and only come to realize the relationship between the skin condition and our emotional state when it is pointed out to us by someone else. Then we wonder why we had not realized this before. A great number of chronic skin conditions are influenced in this way, particularly when we become frustrated by some stress and find ourselves in the position of being unable to do anything about it. This state of affairs is helped by the practice of our relaxing mental exercises, as this leads us to a calmer state of mind in which we are less inclined to feel frustrated by the various stresses of our life situation.

If we suffer a recurrence of our skin condition, we use our exercises to reduce our tension. We can also use the visualizing method.

Relaxed.

See my skin as it is, red and blotchy.

Utterly relaxed.

I see it clearly.

It is fading.

Utterly relaxed.

Actually see it fading.

See the skin normal again.

Utterly relaxed, drifting in the relaxation.

Remember that to be effective the visualization needs to be combined with relaxation and regression.

Many doctors, aware of the emotional factor in the causation of chronic skin rashes, keep their patients on sedatives or tranquilizing drugs. When the exercises are practised, it often happens that the rash subsides and the drugs can be withdrawn. In these cases, in order to avoid relapse, it is wise to continue with the exercises for some months after the rash has subsided, and until a more relaxed attitude of mind has been attained in which stress situations do not evoke in us the same degree of nervous frustration.

A rather pompous man had suffered from a generalized skin condition for some years. He felt that he was worthy of a much better job, but lacked the courage to make a change. It would take very little to make him feel slighted, and he was continually feeling humiliated and frustrated at work over matters of little consequence. The severity of his skin condition varied with these emotional upsets.

It did not take me long to find out his pattern of reaction, as at his first I inadvertently kept him waiting about five minutes. He was intensely angry about this, feeling that I was not treating him with due respect.

He learned to relax and his skin condition settled down. When he had become stabilized, I thought 1 would test him out. So I purposely kept him waiting for half an hour. He was quite relaxed about it, and when I reminded him of his anger on his first visit he only laughed.

A married man of forty-seven who held an executive position in an industrial concern was referred to me on account of recurring dermatitis of his hands. He had been tense all his life. He said, “I can’t do anything to break the tension.” However, he learned to relax very well and his dermatitis cleared.

*88\57\2*

There is a general belief that warm climate is good for arthritis and will promote recovery. Arizona has more people afflicted with arthritis than any other state, percentagewise. Thousands of arthritis sufferers come to Arizona, New Mexico, and Southern California in hopes that they will find relief from their agonizing affliction.

Although it is true that hot, dry climate makes arthritics feel more comfortable, it must be emphasized that the change of climate alone is not sufficient to effect a cure and restore health.

I have discussed this question with many prominent doctors in Phoenix, Arizona, who have specialized in treatment of arthritis in that state for a long time. All of them share the opinion that although arthritic patients, who come to Arizona, do feel somewhat better there, they will be quite disappointed if they expect that a change of climate alone will solve their problem.

Dr. C. A. Call, D.C., N.D., has an impressive record of work with arthritic patients. He answered my question thus: “Warm climate and sunbathing are good for people with arthritis, just as they are good for everyone. But they alone cannot cure arthritis. Other treatments, particularly dietetic therapy, must be included.”

Dr. B. P. Watterson, M.D., one of the leading medical authorities on treatment of arthritis in Arizona, said to me:

“The warm Arizona climate is of value in treating arthritis, although it is not a decisive factor in effecting a cure. People are outdoors more here in Arizona; they get more fresh, clean air, more ultraviolet rays; they are engaged in more outdoor sports and exercises and perspire more; even the pollen count is less here. All these are beneficial factors. But the change to a hot climate alone will not accomplish a cure. In my experience, arthritis is the end result of a systemic disturbance—a biochemical suffocation and a metabolic impairment. It can be successfully treated only if the underlying nutritional abuses are corrected and a proper biochemical balance is restored.”

Then, it should not be forgotten that any kind of a change which takes the patient away from the monotony of the set routine of his daily living, is good for him—emotionally and psychologically. Also, people living in Southern California and Arizona have a better supply of fresh, local fruits and vegetables the year round. They can eat a better and more nutritious than average diet. All these factors contribute to a patients recovery.

We should never forget that to enable the healing power of the body to function more efficiently and accomplish a cure, we must support it by establishing and maintaining the most favorable environment and conditions for such healing functions to take place. All the positive factors, such as diet, baths, fasting, vitamin and mineral supplements, etc., are beneficial and welcomed. The warm, dry climate, conducive to vigorous outdoor life and exposure to sunlight and fresh air, is just one of these positive factors.

*45\176\2*

It is not sensible to be a steeple-jack or scaffolder if one has many seizures. But just what restrictions on employment should be applied to those with epilepsy?

First of all, there are the legal restrictions on driving. This may stop employment as a travelling representative, for example, but these Regulations have a wider effect in making travel to a job more difficult, especially in rural areas, however suitable that job may be.

Driving is the most obvious way in which a person with epilepsy can harm others, as well as himself, during a seizure. But there are occupations of heavy personal responsibility to others which those with uncontrolled seizures must not do. Surgery and nursing are obvious examples from our own health professions. The occupations of airline pilot, and bus, train, mass transit and crane driver, railway signalman, and merchant navy sailor, are other examples. The Armed Forces, fire, and ambulance services and Police also exclude those with continuing seizures.

In other jobs, there is no real risk to bystanders during a seizure, but there is a substantial risk of injury or death to the person with continuing epilepsy. The operation of heavy moving machinery, including agricultural machinery, work near conveyor belts, work at heights, particularly in the construction or electric power industries, and work underground or underwater should all be avoided. However keen the subject may be to take his own life in his hands, it is not fair to burden employers if there is a substantial risk of a mutilating or fatal accident.

One of the agonizing questions that people with infrequent seizures must ask themselves is whether to tell a potential employer about them. Obviously it is best if they do because the employer can take into account any remote risks about which the applicant is unaware. Employers can make an occasional allowance for rare but unexpected absences from work, and they can, in an informed way, cope with occasional seizures at work. The truth of the matter is that many employers reject those with seizures which are few and far between, or those who have had no seizures for some years, for jobs which carry virtually no risk to the person with epilepsy or to others.

Surveys of public attitudes towards those with epilepsy are in our view meaningless, insofar as potential employers may well make favourable remarks about the employment of a hypothetical person with epilepsy in response to an interviewer, because this is the polite and modern thing to say. However, it is their actual behaviour in hiring and firing that counts. A truer measure of the amount of prejudice against employing people with epilepsy would be to send round two personable young people with equal qualifications in response to 100 advertisements for a post as a secretary, for example. In half the interviews each applicant would indicate that they suffered from mild, well-controlled epilepsy. The success rate with and without revealing this information would be a fair guide to current prejudice against the employment of those with epilepsy. Unfortunately such a study would be unethical, insofar as it would waste the time and resources of employers. Nevertheless, we would be fascinated to know the answer!

Those with epilepsy intuitively know the likely result from the results of their own interviews. One survey of people with epilepsy in London showed that over half those who had two or more full-time jobs after the onset of epilepsy had never disclosed their epilepsy to an employer, and only one in ten had always revealed it. Furthermore, if seizures were infrequent or nocturnal, so that applicants considered that they had a good chance of getting away with concealment, the employer was virtually never informed. Whilst not condoning or encouraging dishonesty, the relative success of this policy can be judged by the fact that 74 per cent of the men of employable age with epilepsy were employed at the time of the survey, compared with 81 per cent of male workers of the same age group in the UK as a whole.

Whatever the policy about disclosure, applicants for a job will be more successful if they follow the general rules of taking care with their written application, taking trouble to inform themselves about the responsibilities of the post and about the employer, presenting themselves well at interviews, selling their ability to do the job, and convincing the prospective employer that they have an enthusiastic desire to work. What is absolutely disastrous is for frequent rejections to lead to the development of a chip on the shoulder, so that a potential employer is confronted by the attitude ‘I have epilepsy; you haven’t; you have a duty to employ me’. We have helped look after patients with seizures who succeed in presenting themselves and their epilepsy in such an unfavourable light that we feel there can be no strong motivation to obtain work.

Obtaining a job is obviously only the first step. Most of us want promotion up to the limits of our energies and capabilities, and here again epilepsy, even if well controlled, often spoils chances in life. It is difficult to measure the frequency with which those well qualified for promotion are overlooked, but one study found that the rate of dismissal following the onset of epilepsy was increased approximately sixfold.

There is another more subtle way in which epilepsy can hinder employment and promotion. The fear of encountering rejection, or the fear of leaving an established position with a tolerant employer may cause the people with epilepsy to deny themselves chances for betterment. Just as the employer may be prejudiced against ‘epileptics’ so may the epileptic be prejudiced against ‘employers’, believing them all to be lacking in understanding.

There may be an advantage in young people with epilepsy seeking a career in small organizations, where regulations for employment, sick leave, insurance, and pensions are flexible compared with those of, for example, the Civil Service.

As might be expected, if seizures occur frequently, one study showed that it was much more difficult to hold down a job. The study showed that a third of the unemployed were having generalized seizures monthly or more frequently, whilst only 2 per cent of those in work were suffering equivalently. Roughly the same proportions held true for partial seizures. Apart from seizure frequency, the main barrier to employment is lack of any special skill. One survey found, as could have been foretold, that virtually all those with frequent seizures and no special skills were unemployed. It is here that specialist advice from employment agencies should be sought.

In the UK the Employment Service provides a wide range of services to help people with disabilities to get and keep suitable employment. Most disabled people helped by the Employment Service are helped by general services. There is also a network of 71 Placing, Assessment, and Counselling Teams (PACTs) to help those people with disabilities who cannot be helped properly by the general services. This may include some people with epilepsy. People in PACTs are called Disability Employment Advisers (DEAs). The DEA can be contacted at, or through, the local Employment Service Jobcentre. It is not necessary to be registered as disabled to use most of the services provided through the DEA, though they may recommend registration. The Disabled Persons Register is a voluntary register of people who want to work, and are able to do so, but who have difficulty in getting or keeping suitable work because of their long-term health problem or disability. The Register is run by the Employment Service through its DEAs. All employers who have 20 or more workers have a duty, under the Disabled Persons (Employment) Acts 1944 and 1958, to employ a quota of registered disabled people, usually three per cent of their total workforce. Consequently a big firm is keen to employ someone capable of good work if they happen to be on the Register. Before registration, the family doctor or neurologist will, with the person’s consent, fill in a special form which provides basic information about the type and frequency of seizures, and any other associated disability.

The DEA may consider that a person with epilepsy may benefit from a course of vocational training, to equip him or her with a special skill not already possessed. For example, a nurse with frequent seizures might no longer be suitable for nursing, until the seizures were controlled, and the DEA might well advise that she or he take a course to encourage the development of business skills. This could be arranged through, and at the expense of, the local Training and Enterprise Council (TEC) (Local Enterprise Company (LEC) in Scotland). Training allowances may be payable. The DEA could put the client in touch with the TEC (LEC).

For those with frequent seizures, possibly in association with learning disabilities, the DEA may advise a job in Supported Employment, in which severely handicapped people work in a supported environment—either in a Remploy factory, a supported workshop run by a local authority or voluntary body, or in a supported placement in ordinary employment.

The DEA can also advise on the wide range of help which is available, where appropriate, through the new Access to Work Programme. Individuals can get up to £21 000 worth of help, over a five year period, to pay for things such as extra costs of travel to work for those who cannot use public transport because of their disability; vehicle adaptations; special equipment needed at work; adaptations to the employer’s premises; communication support for blind or deaf people at work; or human support. The DEA can also offer a weekly grant to an employer who provides employment on a trial basis to give a disabled person the chance to demonstrate that they can do the job.

There will always be a nucleus of people with epilepsy who are unemployed either temporarily or more or less permanently. The person who is capable of work but unemployed may, as time passes, become progressively more unemployable if not given occupation and support. It is here that local authority social workers DEAs, and epilepsy associations can help.

*82\188\2*