Description and Possible Medical Problems

Since the primary function of the liver is to detoxify the blood, if the livet fails to do its job properly, the problem will immediately become evident through a routine blood test. An abnormal liver function test can be caused by many diseases, including hepatitis, viral inflammation of the liver, an injury to the liver, such as cancer or alcohol abuse, gallbladder disease, and certain medications, such as Cognex and Mevacor.

Treatment

Since each specific liver disease requires its own individual treatment, if your doctor discovers a problem with your liver, he will immediately order a regimen for you. This may include medication such as corticosteroids to reduce inflammation, a diet that’s restricted in protein, fat, and alcohol, and rest. Some liver diseases, such as viral hepatitis, can be highly contagious, so your doctor may recommend that your family members receive immune globulins against hepatitis.

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Description and Possible Medical Problems

The triglyceride level is nothing more than the amount of fat that is found in the bloodstream. A test to determine your triglyceride level will be included as part of a cholesterol test; triglycerides alone pose very little risk to your health. I feel the value should be 150 or less. Currently, there is a lot of controversy in the medical establishment over whether an elevated triglyceride level alone increases the risk of heart disease. Even though I believe that for good health the triglyceride level should be at 150 or less, an elevated triglyceride level will be treated only if it is extremely high, in excess of 800 milligrams/100cc, which is an indication of a pancreatic problem or advancing arteriosclerosis. Elevated triglycerides are often caused by heredity, but, like the HDL and LDL cholesterol levels, more often than not they’re a result of a high-fat diet, uncontrolled diabetes, and heavy smoking—particularly in women.

Treatment

The primary treatment for a high triglyceride level is medication, but again, only if the level is above 800. Your doctor will also prescribe a low-fat diet and moderate exercise program for you to follow. However, an underlying condition, such as diabetes, must also be treated in order to bring the triglycerides down to a normal level. I’ve found that in some rare cases a triglyceride level above 200 is caused by taking a medication such as Accutane, which is used to treat acne. In this case, discontinuing the medication will lower the triglyceride level to its previous state.

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Since, like many Americans, you may have been fighting excess body weight for most of your life, you may be heartened to discover that weight loss is a common part of the aging process. However, this weight loss begins when people reach their mid to late 60s, and it usually amounts to only a few pounds a year, if that. Even though your scale says you weigh less, any pounds that are lost due to the aging process are mostly lean body mass or muscle mass, not fat. This leaves most people with less strength than they had just a few years before. Since the process is usually slow, the weight loss usually goes unnoticed except for when they are weighed in at their annual checkup or observe a change in their physical stature.

The time you and your doctor should become concerned about weight loss, however, is when both your weight and your general health rapidly deteriorate over a short period of time. If you have lost 10% of your weight over a period of a month or two, I usually become quite concerned, and the younger my patient, the more concerned I become.

If a person who is quite overweight loses a couple of pounds without trying, the loss might not initially seem serious, but this too can be the sign of a medical problem.

As with the case of malaise, weight loss can occur because of either the normal physiological changes of aging or a more serious illness.

That’s why a complete medical history and physical exam with the necessary diagnostic tests are extremely important in any instance of unexplained weight loss. Thyroid problems may cause you to feel overheated, while cancer or a hidden infection may be responsible for a fever or night sweats. If you are coughing or feel short of breath, you may have emphysema ot lung cancer. There is also the possibility that if weight loss is accompanied by a cough, swollen glands, a fever, and/or a general feeling of malaise, you might have been exposed to the HIV virus, which can lead to the development of AIDS.

If you have tecently lost weight without trying, either a few pounds or 10 or more, you should ask yourself the following questions:

1. Over how long a time has the weight loss occurred?

2. Have I also experienced a change in my appetite or bowel habits?

3. Do I suffer from heat intolerance, nervousness, or heart palpitations?

4. Do I have night sweats, occasional fevers, or newly enlarged glands?

5. Am I coughing a lot lately? Do I suffer from shortness of breath?

6. Do I have a prior history of a serious illness?

7. Do I regularly use alcohol or tobacco?

8. Have I ever had an unsafe sexual encounter, shared a hypodermic needle, or had a blood transfusions?

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Laboratory/Diagnostic Procedures

High-risk groups. Fasting plasma glucose for the markedly obese, persons with a family history of diabetes, or women with a history of gestational diabetes.

Syphillis test VDRL or RPR for prostitutes, persons who engage in sex with multiple partners in areas in which syphilis is prevalent, or have contacts with persons with active syphilis.

Urinalysis for bacteriuria for persons with diabetes.

Chlamydial testing for persons who attend clinics for sexually transmitted diseases, attend other high-risk health care facilities (e.g., adolescent and family planning clinics), or have other risk factors for chlamydial infection (e.g., multiple sexual partners or a sexual partner with multiple sexual contacts).

Gonorrhea culture for prostitutes, persons who have multiple sexual partners or a sexual partner who has multiple contacts, sexual contacts of persons with culture-proven gonorrhea, or persons who have a history of repeated episodes of gonorrhea.

Counseling and testing for HIV for persons seeking treatment for sexually transmitted diseases; homosexual and bisexual men; past or present intravenous drug users; persons with a history of prostitution or multiple sexual contact; women whose past or present sexual partners were HIV-infected, bisexual or IV drug users; persons with long-term residence or birth in an area with a high prevalence of HIV infection; or persons who had a blood transfusion between 1978 and 1985.

Tuberculin skin test (PPD) for household members of persons with tuberculosis or others at risk for close contact with the disease (e.g., staff of tuberculosis clinics, shelters for the homeless, nursing homes, substance abuse treatment clinics, dialysis units, correctional institutions); recent immigrants or refugees from countries in which tuberculosis is common (e.g., Asia, Africa, Central and South America, Pacific Islands); migrant workers; residents of nursing homes, correctional institutions, or homeless shelters; or persons with certain underlying medical disorders (e.g., HIV infection).

Electrocardiogram for men with two or more cardiac risk factors (high blood cholesterol, hypertension, cigarette smoking, diabetes mellitus, family history of coronary artery disease); people who would endanger public safety were they to experience a sudden cardiac event (e.g., commercial airline pilots); or sedentary or high-risk males planning to begin a vigorous exercise program.

Hearing test for persons frequently exposed to excessive noise.

Fecal occult blood sigmoidoscopy for persons aged 50 and older who have first-degree relatives with colorectal cancer; a personal history of endometrial, ovarian, or breast cancer; or a previous diagnosis of inflammatory bowel disease, adenomatous polyps, or colorectal cancer.

Fecal occult blood colonoscopy for persons who have a family history of familial polyposis coli or cancer-family syndrome.

Bone mineral content for perimenopausal women who have an increased risk for osteoporosis (e.g., Caucasian race, bilateral ovary removal before menopause, slender build) and for whom estrogen replacement therapy is not recommended.

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Tetanus-diphtheria (TD) booster.

High-risk groups. Hepatitis B vaccine for homosexually active men, intravenous drug users, recipients of some blood products, or people in health-related jobs who are frequently exposed to blood or blood products.

Pneumococcal vaccine for persons who have medical conditions that increase the risk of pneumococcal infection (e.g., chronic cardiac or pulmonary disease, sickle-cell disease, nephrotic syndrome, Hodgkin’s disease, asplenia, diabetes mellitus, alcoholism, cirrhosis, multiple myeloma, renal disease, conditions associated with immunosuppression).

Influenza vaccine for residents of chronic care facilities and persons suffering from chronic cardiopulmonary disorders, metabolic diseases (including diabetes mellitus), hemoglobinopathies, immunosuppression, or renal dysfunction.

This list of preventive measures is not exhaustive. It reflects only those topics reviewed by the U.S. Preventive Services Task Force. Your doctor may wish to add other preventive measures on a routine basis, after considering your medical history and other individual circumstances. Examples of conditions not specifically examined by the Task Force include:

Chronic obstructive pulmonary disease.

Hepatobility disease.

Bladder cancer.

Endometrial disease.

Travel-related illness.

Prescription drug abuse.

Occupational illness and injuries.

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Back to the ovary. Here there is a sudden gap left when the ovum escapes. There are about 100-200,000 other primitive eggs still left behind, and one by one a certain number of these will be released. But for the moment, egg production ceases. The hole left by the escapee is filled with blood. In a short time special cells grow into the space, to produce an organ called the corpus luteum. This rapidly starts to manufacture chemicals or hormones, which have a dramatic effect on the inner part of the tube and the endometrium, the lining of the womb.

Each month the lining is prepared to receive a fertilized ovum. If this takes place, then other changes quickly occur. But if pregnancy does not ensue, this is gradually shed in the form of a normal, regular menstrual bleed or “period.”

In the lifetime of any one woman, the number of times pregnancy will take place is extremely small. But fortunately the ovary and womb are not aware of this, for they would otherwise soon despair! But they tenaciously carry out their appointed duties with unfailing regularity, month in and month out. However, if the ovum is fertilized, then there must be great rejoicing. But the chances are not high. Unless fertilized within about thirty-six hours of its release, the egg disintegrates and dies. A sperm can live for only about forty-eight hours outside the male. Therefore, there is a period of about thirty-six to forty-eight hours in any given menstrual month when pregnancy can possibly occur.

Considering the number of allegedly unwanted babies in this hard, cold world, it is amazing how frequently intercourse must take place at the crucial moment. But nature is really artful, as has already been pointed out.

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In recent years great changes have taken place in the attitude towards therapeutic abortion. This means that abortion is carried out by a doctor as a method of treating his patient, and for her welfare.

Prior to this, abortion was considered a criminal offence, both for the person carrying out the operation as well as for the participant-patient. Only under very unusual circumstances was the action legally condoned.

However, world-wide attitudes are changing. As the population explosion becomes an increasing problem in many countries, the laws have been reshaped or indeed changed completely. Now, in many Scandinavian countries, Eastern lands and Japan, abortion is freely available and indeed actively encouraged for social and economic reasons.

In quite a few places it is readily available completely free of charge, and carried out in government hospitals under their care and at their expense. Certain safeguards are present, but many consider it an attempt by such countries to survive the pressing urgency of population problems.

The Western world has been a little slower and more cautious. However, Britain has led the way, and in April 1968, the “Abortion Act of 1967″ came into force. Basically, this removed many of the previous barriers to the legal termination of pregnancy for therapeutic reasons. Abortion became legally permissible, provided a set of clear-cut regulations were followed. However, the actual interpretation of some of these requirements seemed open to wide variation. The result has been an enormous increase in the rate of legal terminations being carried out.

From the low point in 1968 the figures rapidly climbed to a peak of well over 160,000 in 1974. After this they started to decline slightly, probably because abortion reform became available in certain other European countries, and women who travelled to the U.K. for treatment now found this was no longer necessary.

However, these figures pale into insignificance when compared with figures for Japan where, as far back as 1955, an estimated 1.7 million terminations were carried out. This has now settled down to a fairly constant figure of around 750,000 a year – still a vast number, nevertheless.

In America various states have undertaken “reform,” and termination of pregnancy is now more readily available.

The Australian scene has taken a major change in recent years. South Australia introduced variation to its state laws early in the 1970s, making it more readily available under a closely scrutinized set of rules. New South Wales left the law intact, but judicial decisions later opened the way with the existing legislation for a much wider interpretation to be given.

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What should the pregnant mother eat?

Much has been written and spoken about this. A tremendous volume of ridiculous advice has been offered, and no doubt will continue to be offered. For some strange reason, the pregnant woman has always been the target of all kinds of well-meant advice given her by everyone who thinks that their information is “special.”

Of course, as so many mothers-to-be are young, and without yardsticks with which to compare, they are vulnerable to the verbal missiles of every so-called expert in the land.

Pregnant women are a fine target for commerce, too. Not only is their own health involved, but they are responsible for that of their developing offspring. For this reason, many feel a moral obligation to seek out the very best, and cost what it may, give this to baby-to-be. So the advertising experts aim their propaganda at the unfortunate expectant mother.

Give baby this; take that; eat something else; regularly imbibe this vitamin compound, or else you are depriving your poor little baby of the ‘ ‘best.” So the story goes on and on. Every day mothers across the land are bombarded with slick advertising and dubious promotion, essentially in the name of commerce, but dished up so that it appears to be in the name of better health, life and vitality for mother and baby.

As a general rule, pregnant women would be far better off completely ignoring this barrage of “advice.” It is far better to stick to simple, well-established principles as far as dietetic intake is concerned. Ignore the fad routine so often advised. Ignore the smart advertising and glossy folders from pharmaceutical houses.

Many of these firms certainly give advice, much of which is reasonable, but they are essentially out to separate you from your money.

The baby business is big business in every country in the Western world. So, read the mass of material that is thrown your way. But treat it all with a rather critical eye.

Your doctor will outline the general principles that matter. Use these as the basis for your food patterns. Don’t be duped into spending a fortune on fancy products. Neither you nor your baby will measurably benefit.

In general terms, a pregnant woman will eat much the same type of food she ate before she became pregnant. It will not change much. The old notion that she ”must eat for two” is an idea of a bygone era. There is quite sufficient in her normal daily food intake to take care of herself plus the needs of her growing infant, provided she is careful and sensible in her food selection.

A person’s normal food intake varies. It will depend on the country in which she lives, and the local cultural habits. It is related to her normal routine, and this in turn is related to her socio-economic standard.

When money is no object, families tend to consume more protein products, as they are usually more expensive, and perhaps more desirable. Poorer people tend to eat more carbohydrate (starchy) products.

Recently a well-known obstetrician succinctly summed it up this way: ”In affluent societies the advice should be, Buy all you can afford from the butcher, the greengrocer and the dairy, and spend only little at the confectioner’s, the grocer’s and the chemist’s.”

This is an excellent precise of what is best for the pregnant woman. It may be used as a constant guide throughout the full term of her prenatal months.

These days, there is an increasing emphasis on the value of a vegetarian dietetic routine, not only for pregnant women, but for the community in general. It is now well established that meat substitutes are perfectly safe, and quite adequate. So, women desiring to follow a vegetarian diet can certainly omit meat products. However, it is essential that this be replaced by adequate amounts of protein replacement items.

Many protein replacement foods are easy to make, and frequently involve the use of soy beans, soy products, gluten flour and the many items that are readily prepared from these, and many other bean products. These include Lima, broad, butter, navy and other bean varieties. Most nuts are high in protein values, and these include cashews, almonds, peanuts, etc.

Today, many of these items are available ready for use, and precooked in commercial form (tinned). As a flow-on from this, a wide range of “health food” products incorporating the use of most of these products is now widely available commercially. So, for those desiring this excellent form of protein intake, there is no shortage of products from which to choose.

For women not conversant with vegetarian eating and cooking, today there are plenty of recipe books which clearly set out methods of preparing nutritious and attractive meals, using these non-meat products.

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Many reports have been issued on the relationship between drug medication taken by patients under regular treatment for epilepsy, and congenital birth defects.

The treatment of epilepsy is a continual, ongoing process. But from studies carried out in many countries, including one at the Royal Women’s Hospital in Melbourne, it now seems there is a definite and fairly high risk in becoming pregnant while on this form of therapy.

This naturally raises a problem of some magnitude in the minds of younger women recently married who are desirous of having a family. Should they cease their medication, reproduce and run the risk of epileptic attacks? Or should they run another risk of producing abnormal offspring, and remain attack-free?

It is a question of major importance in their lives. At present there is no simple answer. With the passage of time, the question will become more difficult to answer. They must discuss the whole situation with their obstetrician before ceasing medication or embarking on a course that will result in pregnancy.

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Some years ago an Australian eye surgeon named Norman Gregg noticed an apparent relationship between women who had suffered from the common and relatively innocuous viral infection called rubella (German measles) and certain eye abnormalities in their babies.

This prompted him to study the situation much more closely, and this was the beginning of one of the most important discoveries of recent times on the maternity scene. Gregg’s early studies have had world-wide repercussions of major magnitude since they were first enunciated.

Little did he realize when he published his original report in an Australian eye magazine that he was touching the tip of a giant iceberg. In fact, the results are still being felt, as the general principle is still being investigated in many allied fields.

Gregg’s basic discovery was this: The mother became infected with rubella, an innocuous disease in itself, producing a mild rash, a few swollen glands in the neck, and maybe symptoms of a mild cold. But, the mother’s system harboured the germs in profusion. Some of the viruses crossed over the “placental barrier” and gained access to the developing embryo in the maternal womb.

Occurring during the vital first weeks of development, they were able to interfere dramatically with the cell division and organ development of the embryo. As time passed, it became very evident that the eyes were not the only organs to be adversely affected. The ears and heart were also prime targets.

It did not take long before Gregg’s work received world-wide acknowledgment. In fact, major epidemics of rubella are now followed by an unfortunate wake of blind or deaf children or those with heart defects. Indeed, se serious has the situation become that a mother in the early stages of pregnancy who contracts rubella is considered to be a suitable candidate for a legal termination of her pregnancy. This is now a very widely held principle in many countries of the world.

Of course, many women still refuse to undergo this operation, and are often left with a deformed baby to rear. It is a sad event, but one which still occurs in large numbers of cases throughout the world.

It has been calculated from major epidemics in many parts of the world that a woman who is pregnant and becomes infected with rubella will produce a congenitally deformed infant, or will spontaneously abort in 40 per cent of cases. If the infection occurs in the first six weeks of pregnancy, there is a 50 per cent chance of a major congenital abnormality taking place.

The lens of the eye and the major parts of the ear develop in the embryo between the fourth and twelfth weeks. The chief chambers of the heart develop between the fifth and seventh weeks. Therefore, the importance of infections during these vital times may be appreciated.

In the light of these discoveries, it can now be stated with a fair amount of accuracy what abnormalities may be expected. For example, rubella occurring during the fifth and seventh weeks may produce cataracts in the eye. (This means the lens of the eye becomes opaque and the child is virtually unable to see.) Deafness will take place with rubella infection during the eighth to ninth weeks. Heart abnormalities occur with infections during the fifth and tenth weeks. It is now as clear-cut as this.

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