After she fought so hard against breast cancer, Rosemary wasn’t about to just sign up for HRT as she went into menopause. She simply tolerated the menopausal symptoms she had as best she could, until they subsided after a couple years and she figured her hormonal troubles were over.

But when I sent her for a bone scan when she was in her mid-SOs, it showed she had osteoporosis. Fortunately, her NTX was 37, within the normal range, so her fracture risk was still manageably low. I prescribed Miacalcin and she started taking nutritional supplements, including calcium. After a year, however, her NTX levels were up to 57, putting her at higher risk for fracture and indicating an increasing rate of progression of bone loss. For Rosemary, Miacalcin wasn’t doing enough.

I had her hormone levels analyzed, and found her estrogen levels were very low. Because of her fear of a breast cancer relapse, Rosemary decided to add the estriol and ipriflavone to the Miacalcin. She felt comfortable with the natural estrogen since it does not increase the risk of breast cancer while still providing some of the benefits of synthetic estrogen. Since estriol has been less studied than other forms of estrogen, and it remains unproven that the bone benefits equal those of synthetic estrogen, Rosemary uses the ipriflavone—with its proven bone benefits—to ensure her bones are covered.

Rosemary pays attention to her diet, and is generally active. She considers herself a spiritual person, and copes with the many stresses in her life with regular meditation. But with her hormones finally in balance, she feels better than she has in a long time, and she now encourages her friends facing menopause to look carefully into alternatives for HRT. If a breast cancer survivor could find a regimen that suited her, she figures, anybody can.

*151\228\2*

Inadequate amounts of even one mineral can have serious consequences. That’s why, for individuals with eating disorders, a complete nutritional workup is vital to address mineral needs. Treatment programs should always include concentrated sources of minerals, such as those found in sea vegetables, including dulse, kelp, sea palm, and nori. Such foods are excellent aids for overcoming malnutrition. For people not yet able to eat solid food, pieces of seaweed can be added to soup. Other sources of condensed minerals are the so-called superfoods, such as spirulina, blue-green algae, barley grass, and alfalfa. Just a small amount added to water or juice will replenish missing nutrients. These foods are easy for people with eating disorders to digest, and when taken with liquids they help to rehydrate the person, which is important because people with eating disorders often are dehydrated without realizing it. In addition, the superfoods are low in calories and therefore nonthreatening to the recovering individual.

*66\233\8*

Skeletal muscle-Pain due to muscle spasm usually responds to diazepam or other benzodiazepine, although sedation may be troublesome. Non-benzodiazepine skeletal muscle relaxants may also be effective in relieving pain secondary to muscle spasm, although the relief of spasm may lead to reduced function. Baclofen (Lioresal) acts at a spinal level and often causes sedation. Dantrolene (Dantrium) which acts directly on muscle, causes less sedation but may be hepatotoxic.

Smooth muscle-Nifedipine, a calcium channel blocker, is reported to be effective in the treatment of rectal tenesmoid pain and pain due to oesophageal spasm.

Other drugs for bone pain-Bisphosphonates-The bisphosphonates are chemical analogues of pyrophosphate and inhibit bone resorption. They are used for the treatment of hypercalcaemia and metastatic bone disease. Following treatment with pamidronate (Aredia, APD) some patients with metastatic bone disease have less pain.

Radioisotopes-The systemic administration of strontium (89Sr) is effective in relieving pain due to bone metastases which show osteoblastic activity, although response takes two to four weeks. The side effects relate to bone marrow suppression.

*65\55\2*

ELM remedy is very uncommon remedy, as it usually caters to very uncommon people—people who hold very responsible positions in life: Presidents, Ministers, Mayors, Principals of educational institutions, General Managers and Chief Engineers of big factories, Managing Directors of big houses and institutions, secretaries of labour unions etc. whose decisions affect thousands of persons. They are very capable people, always ready to shoulder the great responsibilities attached to their office, and work ceaselessly to do their best.

Occasionally, even the most indefatiguable and over-ambitious person is led to identify so strongly with the current role of his personality that he ignores the guidance of his higher self that is calling for moderation. That is the time of weak moments of the Elm person. That is the time when he feels overwhelmed and a fear assails him “How is it humanly possible to do this job alone. No, I am finished. I am dead tired. I won’t be able to do it”.

It is a temporary phase, though. The ELM person is self-reliant and has inner conviction that he is quite capable of discharging his responsibilities.

But till the weak moments last, he feels despondent and exhausted. At that time ELM helps him to overcome the feeling of inadequacy and despondency quickly.

*102\308\8*

Surgery

Kneecap alignment problems can be diagnosed by X ray, which will clearly show a patella that is off track. Depending on the cause of the problem, the following types of surgery may be performed.

Lateral Release. In some cases, the patella is being pulled off track by tight lateral bands, or retinaculum, which the physician can feel when she palpates the area. In a lateral release, which is done arthroscopically, the surgeon simply cuts the lateral bands, reducing the lateral pull on the patella, thus the patella moves back into place.

As with any arthroscopic procedure, possible risks include a small chance of developing an infection (under 1 percent), nerve damage, skin numbness, and other problems that are described on your patient consent form, which all patients should read carefully.

Patellar Realignment. There are two types of surgical procedures for patellar realignment: proximal realignment or distal realignment.

In a proximal realignment, an open-knee procedure, the surgeon must first perform a lateral release. After the lateral release, he cuts a piece of the quadriceps tendon (all the way down around the medial side of the patella to the medial border of the patellar tendon) and resutures the quadriceps tendon to a more medial position.

In a distal realignment (which may also include a proximal realignment), the surgeon moves the patellar tendon insertion at the tibia tubercle over to a more medial position and sometimes distal and elevated.

Exercise

Rehabilitation is crucial after patellar surgery. Keep in mind that surgery is not a cure-all. Even after surgery, it is imperative that you continue with a good strengthening program tailored your particular problem.

Bracing

Some people may find that a functional brace worn during activity may offer some relief for patellar problems. Frankly, there is no specific evidence that it does; however, it may have a subtle effect on the tracking of the kneecap, which could relieve discomfort. A patellar femoral workout brace is primarily a sleeve made of cloth or neoprene (rubber). This brace has a hole or pad around the kneecap to stress-relieve the area. A different variety of the patella brace has single straps around the distal (lower) part of the extensor mechanism around the patellar tendon. Either brace is fine if it works for you. Avoid braces that are too tight around the kneecap or an Ace bandage that compresses the knee too tightly—both can cause further discomfort. Braces can be purchased at surgical supply stores and some sporting good stores.

*31\185\2*

In the 1930s, people with diabetes could only measure the amount of sugar spilled from the bloodstream through the kidneys and into the urine. To do this measurement they had of use a Bunsen burner and liquid chemicals that made them appear to be laboratory scientists.

In the 1940s, a tablet test for sugar in the urine became the standard for diabetes self-monitoring. The procedure uses a urine sample, a test tube and a tablet that reacts with the urine sample by changing the colour of the solution, depending on the concentration of sugar.

Throughout the world, many people with diabetes still use this test as their sole means of monitoring. Although it has some value in detecting above-normal blood glucose levels during the past few hours, it does not provide information about current levels, nor can it disclose low blood glucose levels.

By the 1950s, urine sugar tests were available on “dip and read” strips and tapes. These, too, were widely used. Improved versions of the strips provided reasonably accurate readings of glucose in the urine. These more precise and convenient strip tests provided information about glucose levels and still are used by persons who are unwilling or unable to do blood glucose tests.

The technology used to produce urine tests for glucose also was used to develop urine tests for ketones. These tests, in tablet or “dip and read” strip form, are widely used by people with diabetes who are at risk for developing the conditions called ketosis and ketoacidosis.

Most people with Type II diabetes are not prone to develop these complications, although some are. If you are at risk, your doctor will advise you to test for ketones in your urine, using a tablet or strip test, when your blood glucose levels are above normal or when you have an illness or are under stress.

There is another monitoring procedure valuable for people with diabetes. It’s called the glycosylated hemoglobin test and is done primarily at the physician’s office or in a laboratory (although an at-home test may be available in the near future). The glycosylated hemoglobin test, also called the hemoglobin A1C test, tells where your glucose levels have been, on the average, for up to eight weeks preceding the measurement.

The results of this test give you and your doctor a much more accurate view of how your overall efforts at good control have been working. Your self-measurements provide daily information. The glycosylated hemoglobin test shows the overall degree of control by averaging out the occasional highs and lows.

The goal of your diabetes management programme is to bring your blood glucose level down into the normal range and to keep them there. The glycosylated hemoglobin test shows how well you’re doing. Your self-monitoring records provide data on specific events – a heavy meal, a skipped exercise session – in relation to a single measurement. Your self-monitoring and your glycosylated hemoglobin test work as partners in helping you gain the best possible control of your diabetes.

To help you keep track of when to monitor, we’ve prepared the following chart. If you have complications, such as high blood pressure, you will want to check that more frequently. Be sure to ask your own doctor about how often you should have checkups and what other things you might be doing to maintain optimal health.

Monitoring schedule

Daily

Blood glucose

Feet

Weekly

Weight

Every three months

Glycosylated hemoglobin A1C

Blood pressure (more often if you have high blood pressure)

Yearly

Eye examination

Kidney function tests

Dental checkup

Liver function tests

*37/210/5*

The earlier a person is diagnosed as having cancer, the better the prospect for survival. Various high-tech diagnostic techniques exist to detect cancer, including the following:

- New high-technology diagnostic imaging techniques have replaced exploratory surgery for some cancer patients. Magnetic resonance imaging (MRI) is one example of such technology. In MRI, a huge electromagnet is used to detect hidden tumors by mapping the vibrations of the various atoms in the body on a computer screen. Computerized axial tomography scanning (CAT scan) uses x-rays to examine parts of the body. In both of these painless, noninvasive procedures, cross-section pictures can show a tumors shape and location more accurately than can conventional x-rays.

- Prostatic ultrasound (a rectal probe using ultrasonic waves to produce an image of the prostate) is currently being investigated as a potential means to increase the early detection of prostate cancer. Recently, prostatic ultrasound has been combined with a blood test for prostate-specific antigen (PSA), an antigen found in prostate cancer patients. Although the reliability of PSA tests for screening has been questioned, it appears to show promise.

Such medical techniques, along with regular self-examinations and checkups, play an important role in the early detection and secondary prevention of cancer.

Most of the sites that pose the highest risk for cancer have screening tests available for early detection. Other common forms of cancer present with symptoms that are often readily identifiable. The key seems to be whether or not the individual has the financial resources (insurance) to seek medical diagnosis and early treatment. A health care reform package that focuses on payment for regular checkups and preventive services would help many poor and middle-class Americans seek medical care earlier when the chances of curing their disease are better.

Regardless of insurance status, individuals must be actively involved in their own cancer detection. If you notice any of these signals, and they don’t appear to be related to anything else, you should see a doctor immediately. For example, difficulty swallowing may be due to a cold or flu. But if you are otherwise symptomless and the difficulty continues, you should see a doctor.

Make sure that appropriate diagnostic tests are completed whenever any warning signals appear. Also make a realistic assessment of your individual risk factors and try to avoid those you have some control over. Even if there is a history of cancer in your immediate family, for instance, you can reduce your risk for cancer by changing your dietary patterns and avoiding known carcinogens and other environmental hazards. Heeding the suggestions for primary prevention n significantly decrease your chances of getting cancer.

*30/277/5*

Substitute fish, seafood, skinless chicken, and turkey for red meats, and choose lean cuts (beef flank or round steak, pork tenderloin) when you do eat meat. Limit meat and fish portions to 6 ounces a day, and limit eggs to three or four a week. Use egg substitutes freely, and, suggests dietitian and writer Gail Levey, for baking, try using two egg whites instead of one whole egg. Also, she mixes 3 tablespoons of cocoa and one tablespoon of oil to substitute for one square of baking chocolate. Instead of ice cream, Ms. Levey says to try low-and no-fat yogurts, regular or frozen. Plain popcorn also makes a healthful treat, she advises.

Replace the calories lost by the elimination of animal foods with complex carbohydrates – starches like bread (preferably whole-grain), cereal, pasta, rice, dried peas, and beans. Let half or more of your calories come from starches.

Eat more vegetables and fruits to raise the amount of vitamins and fiber in your diet. You also will get fiber from breads and other starches. Fiber, especially the water-soluble kind found in oat bran, helps lower your blood cholesterol.

Use vegetable oils – such as corn, safflower, and olive. They contain unsaturated fats that lower cholesterol. Says Dr. James Cleeman, head of the National Cholesterol Education Program in Bethesda, Maryland, “Exercise is very important in lowering cholesterol. Vigorous exercise may raise levels of good cholesterol.”

The Education Program, comprised of panels of experts, was convened by the National Heart, Lung, and Blood Institute. It helps spread the word about cholesterol, and the number of patients going to doctors has increased by nearly five times since the program began in 1985.

First, one panel suggested that all adults be tested for total blood cholesterol. Levels below 200 mg/dl need only sensible dieting.

Borderline scores between 200 and 239 mg/dl may require action, depending on other risks you may have, such as heart disease, smoking, high blood pressure, a family history of early heart disease, diabetes, or severe obesity (more than 30 percent overweight). Being male also raises your risk.

If you have heart disease or two of the other risks, you’re in the high-risk group. If you have none of these, you’re in the low-risk category.

If your cholesterol level is borderline, doctors will urge you to keep your diet below 30 percent fat. Have your level checked yearly. If you’re at high risk with the middling score, your doctor will warn you to lower your cholesterol.

The first thing to be checked is your level of LDL, the bad cholesterol. If you have less than 130 mg/dl in your blood, your diet should be kept healthful. If your LDL is between 130 and 159, barring other risks, you may not have to do anything more than watch your diet and moderate your intake of saturated fats. If your LDL level puts you in the high-risk group, you’re certainly going to have to enlist in a strong diet program.

Your goal is to push your blood LDL down to under 130 if you have heart disease, or under 160 if you do not. If you don’t succeed in 6 months, your doctor may consider prescribing drugs.

Fortunately, there are many, including nicotinic acid, Questran, or Colestid. The last two are resins that trap bile in the digestive tract and carry it out of the body. Normally, your intestines reabsorb unused bile and reprocess the cholesterol it contains. When the resins remove the bile, they remove its cholesterol, too. Because it needs cholesterol to make more bile, the liver will remove new cholesterol (especially LDL) from the blood.

Doctors prescribe resins because, although they cause occasional constipation and heartburn, they are known to be safe and can lower the LDL count quickly. With a resin drug, my cholesterol level fell from 270 to 180, my LDL dropping along with it. And it definitely cut my risk of heart disease.

*10/266/5*

Sometimes DIMS may arise from some kind of ingrained disturbance in the sleep pattern. For example, you may experience awakening during your first nightly REM sleep period, then continue to awaken during as much as 75 to 100 percent of the remaining REM time throughout the night, finding it difficult or impossible to return to sleep. If so, you may be losing as much as four to six hours of rest a night. REM-interruption insomnia is more common in men, especially after the age of thirty-five, and has been linked to emotional disturbance and, as we have seen, to depression.

EEG tracings indicate that the REM-period awakenings follow a burst of intense eye movement, perhaps caused by the onset of a dream. It might seem logical to conclude that the dream itself prompts the awakening, but research does not really support this idea. Actually, you may find you experience REM interruptions if at some point in the past, perhaps a time of emotional / trouble, you have suffered a nightmare or even a series of nightmares. As a result your intrinsic sleep control mechanism may have become programmed to awaken you before or as dreams occur, in a well-meaning but ultimately harmful effort to avoid nightmares by preventing the onset of REM sleep. It is harmful because, as we have seen, REM deprivation may aggravate other psychotic symptoms. In a sense, then, REM interruptions are a kind of conditioned-response DIMS.

Another sleep-pattern disturbance is identified on EEG tracings as the presence of alpha waves during the NREM phases of the cycle, which indicates that the brain experiences waking activity even while it is supposedly asleep. Alpha waves are not usually recorded during REM sleep. Not surprisingly, sleep that is riddled with alpha waves is interrupted and nonrestorative. Victims will awaken feeling tired and unrested and will often underestimate the amount of sleep they actually obtained; they describe their nights as marked by a “sense of continued vigilance.” Withdrawal from alcohol and some drugs may result in the superimposition of alpha waves onto the normal sleep pattern.

*126\226\8*

The fever and its pattern may be helpful in the diagnostic work-up. A fever above 38.1 °C must be observed on at least three occasions over 3 weeks. In elderly patients, because of a blunted febrile response, it is suggested that the temperature criterion should be any increase of 1. 3°C from the baseline temperature or a persistent rectal temperature greater than 37.5°C.

The fever pattern may occasionally point to the diagnosis, and a number of fever patterns have been described. Cyclical fevers due to malaria can occur at 48-hour intervals (tertian fevers) in the case of Plasmodium vivax or Plasmodium ovale infection and at 72-hour intervals (quartan fevers) in the case of Plasmodium malariae infection. The Pel-Ebstein fever pattern of Hodgkin’s disease is characterized by 3 to 10 days of fever followed by 3 to 10 afebrile days. The relapsing fever pattern due to Borrelia species is characterized by 2 to 3 days of fever followed by a 7- to 9-day afebrile interval before symptoms recur.

The duration of the fever may also be helpful. Although a prolonged fever (occurring over months to years) without other concomitant symptoms is less suggestive of infection or malignancy, chronic “smoldering” osteomyelitis, an occult abscess, parasitic infections, or Whipple’s disease can have indolent courses and should be considered. Still’s disease, Crohn’s disease, hereditary fever syndromes, and Behget’s disease may also have long recurrent courses of fever interspersed with afebrile periods.

*149/348/5*