Coming home

When you come home from the hospital with a new baby, a brand-new period of your life begins. It may take several weeks, or even several months, for the mother to recover from the physical stress of labor and delivery. At the same time, the new baby is completely dependent on the parents for food, shelter, and comfort. To accommodate the mother’s physical tiredness and the baby’s constant needs, you may have to review what is most important to you as a family. For example, keeping the house spotless may have to take second place to caring for the baby and allowing the mother to get the extra rest she needs. Household jobs may have to be reassigned so that the mother can devote more time to the baby. Your social schedule may have to change as well. You may find that your preferences have changed, and you would rather stay home with the baby than go to a party or a movie. This certainly does not mean you must—or should—give up going out or never do the things you enjoy. It only means that your priorities will probably change when you have an infant in your household.

Feeding

In the first months of life, eating is a major concern of your baby. This activity will take up a lot of your time and a lot of your energy. But whether you breast-feed or bottle-feed your baby, feeding time is a time of closeness. You are giving the baby nourishment and thus meeting the child’s most basic need. At the same time you are holding and cuddling the baby, and he or she is getting to know your touch and your voice.

Burping the baby

As the baby nurses, from the bottle or the breast, air is swallowed along with the milk. Burping the baby helps to expel excess air and prevent discomfort. Interrupt the feeding once in the middle for a burp, and also burp the baby after a feeding. Expelling extra air in the middle of the meal ensures that the baby’s stomach will fill up with food, not air.

To burp an infant, put the baby over your shoulder, sit the baby up on your lap, or place face down across your lap. Pat or rub the baby’s back gently until you hear a good, solid burp. Some babies prefer one position while others need to be moved around until they burp. If burping is difficult, experiment with different positions and combinations of patting and rubbing. Some babies will protest the interruption of the meal, but burp them anyway at mid-meal. They will get more nourishment and your life will be easier.

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Why did I get diabetes?

Nobody can really tell why you get diabetes. We know that you probably were born with a tendency or chance to get diabetes and you got this tendency through nobody’s fault. Being born with a tendency to diabetes is like being born with a tendency to be tall or short, to have a particular hair colour or eye colour or a particular shaped nose or a tendency to go bald when you are a young man. We all of us inherit things from our parents as they did from their parents. A tendency to get diabetes is just one of those things. Why it should have come out when you are a child rather than when you become an adult nobody can tell at present. Possibly it was just bad luck. Certainly there is no reason to suppose it was anything that you did or your parents did or did not do, that brought it on. Sometimes people who do not know anything about it claim that a child gets diabetes from eating too much sugar. This is not so: perhaps if it were, almost everybody that you know would have diabetes.

Can you ‘catch’ diabetes like you ‘catch’ chickenpox?

No. It is quite impossible to ‘give’ diabetes to anybody else. It is not infectious and we do not think of it as a disease.

I was told I got diabetes from a shock. Could this be so?

Nobody can get diabetes just from a shock. It may be possible for someone who has a tendency to diabetes, and who was going to get it sooner or later, to develop it after some stress or strain like a shock. In this case perhaps the shock has brought the diabetes on.

Can the pancreas start functioning properly again?

Yes, for a short time. After a child first gets diabetes and has been stabilized it is common for the pancreas to function again, and that is why the dose of insulin may be quite small in the early stages. Children in general, however, require steadily increasing doses of insulin, and after a few years it is usual for the pancreas to stop working altogether. When this happens, the pancreas does not function again. It seems that the pancreas has a better chance of functioning again in older teenagers and young adults than young children. The reason for this is not yet clear.

In what way is diabetes in childhood and adults different from that of older people?

Adults, particularly young adults, may develop the same kind of diabetes as children. Older adults are more likely to develop a different type of diabetes, one that does not depend on insulin treatment and therefore is called Non-Insulin Dependent Diabetes.

Although there are many ways in which diabetes is similar in children and adults there are also many differences. When a young person first gets ill with diabetes, he may lose weight and become extremely thirsty. This sort of illness is not so common in older people, many of whom are overweight when they develop diabetes.

Children are also more likely to develop ketones when they are ill, and although some adults do not require insulin for treatment, almost all children do. One of the major differences appears to be that when a young person develops diabetes his pancreas fails to produce enough insulin and eventually produces none at all, whereas in an old person the pancreas may produce insulin, but there is something wrong with the way in which it is produced or the way in which the body can use it. This explains why a child has to have insulin injections to replace the insulin which the pancreas should be making. On the other hand, an adult may be able to take tablets which can affect the way in which the body uses its own insulin or which may stimulate the pancreas to produce insulin more effectively.

What is meant by the term ‘honeymoon period’?

There is usually a time after diabetes is first stabilized when the pancreas makes a partial recovery. At this time it makes some of the insulin needed by the body, so the dose of insulin you inject can be quite small. When this happens, diabetes is usually fairly easy to control (provided you are not given too much insulin) because the body’s own insulin does a lot of the work for you.

This is a phase of partial recovery, and is sometimes called the honeymoon period. It is not a bad term, as it is like the holiday after a marriage and at the start of a lifetime of marital adjustment. Like all honeymoons, it eventually comes to an end – weeks, months or sometimes even years later. Then you have to work at a comfortable relationship with your diabetes.

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Listen to your mom. Mama put it this way: “You eat your vegetables now, young man.” The National Cancer Institute puts it this way: “Populations consuming diets high in fruits and vegetables tend to have a lower cancer risk.” They both mean the same thing, so do what Mama said. The National Cancer Institute suggests eating five or more servings of fruits and vegetables a day. More is better, according to Dr. Giovannucci, and variety is also important. He suggests that you eat, among other things, leafy green vegetables, deeply colored orange vegetables like carrots, tomatoes, garlic and onions, broccoli, and citrus fruits.

Listen to Neil Young. Excuse the apparent redundancy, but there’s another reason for pinching your overall calorie count besides losing weight. It has to do with the damages of oxidation. “It’s the ‘Rust Never Sleeps’ theory of cancer,” Dr. Wurzelmann says. “We’re under a lot of oxidative stress. The more we eat, the more the furnace burns and the more likely it is we’re going to create something that causes cancer. We can reduce that oxidative stress by reducing our total caloric intake.”

Hide the beef. Studies consistently show that colon cancer is low wherever meat consumption is low. There is some suggestion that increased meat consumption could also increase the risk for prostate cancer. Vegetarians, even in the United States, have a lower risk of cancer than their carnivorous compatriots. “Try to stay as close to a vegetarian diet as you can,” advises William J. Catalona, M.D., chief of urologic surgery at Washington University School of Medicine in St. Louis. “If you do want to eat meat, try to emphasize fish and chicken and limit the amount of red meat that you eat-ideally, not more than one serving per week.”

Iron out your risk. Dr. Wurzelmann led a study that showed a connection between high levels of iron and cancer. For the most part, he says, the link is a corollary of the red meat problem. “If you eat beef, you eat iron,” Dr. Wurzelmann says. But, he adds, there does seem to be a clear connection between iron overload itself and liver cancer. “People who are supplementing with iron might not be doing themselves a favor,” he says. “I think this medical practice deserves serious reappraisal.”

Get enough selenium. Research has pointed to a “very promising” role for the trace mineral selenium in reducing the risk of several cancers, including prostate and colorectal.

“There’s more work to do,” Dr. Giovannucci says. “But at this point it might be a reasonable thing to take selenium supplements given our current knowledge. More research is necessary to make firm recommendations, though.” The Daily Value for selenium is 70 micrograms.

Go for the grape. The revered grape has long been a folk cure, but a 1997 study by University of Illinois at Chicago researchers has put some scientific muscle behind the idea. The preliminary evidence in test tubes and animals is that resveratrol, a compound found in grapes and other plants, may slow down tumor growth, block the action of cancer-causing agents, and even clean up precancerous cells.

Yes, there’s resveratrol in wine, but Varro E. Tyler, Ph.D., dean emeritus of Purdue University School of Pharmacy and Pharmacal Sciences in West Lafayette, Indiana, and distinguished professor emeritus of pharmacognosy (natural pharmaceuticals), suggests taking advantage of the potential benefits by adding some real grapes or a glass of grape juice to your diet.

Smother it with onions. If you’re in the habit of saying “hold the onions,” you might reconsider. Dutch researchers found that volunteers who ate half an onion a day had half the risk of stomach cancer that their sweeter-breath co-subjects did. The heroes in onions are allylic sulfides, which help enzymes neutralize cancer-causing substances.

Get enough vitamin C. It’s always a controversial topic, but when researchers look into the health role of vitamin C, they usually find that it protects against certain cancers, according to the National Cancer Institute. The best evidence is that it fights cancers of the esophagus, mouth, and stomach. But it also helps fend off pancreas and rectum cancers.

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Dr. Scanes Spicer (Welbeck Street) writes:

In reply to “Stertor’s” query, I would suggest that the condition of the nose and naso-pharynx be thoroughly explored by anterior and posterior rhinoscopy, to ascertain whether there is an obstruction, structural or erectile. In my experience, most snorers have some obstruction of the nose, which increases from erectile conditions of the mucous membrane on assuming the horizontal position; and most cases of snoring will yield when the physiological path of the breath is permanently restored, together with many of the symptoms so often accompanying snoring, such as nightmare, restless nights, dryness of mouth, and unpleasant taste of mouth in the morning, necessity for placing the water-bottle by the bedside to allay the parched throat, post-nasal catarrh, and throat irritation and cough. Over-indulgence in food, alcohol, and tobacco undoubtedly increases the erectile condition of the obstruction.

Thereafter, some discussion could always be found on the causes of snoring and methods to minimize it, but it was not until the 1960s that the diverse branches of medical science began to focus their attention on the subject, paving the way for significant developments into our understanding of snoring and its consequences. Research into the nature of sleep was accelerated after the late 1930s when it was discovered that sleep, rather than being a steady state, was characterized by a series of discrete and measurable stages. However, it was not until the late 1950s and the following decade that these stages were accurately described to an extent where they could be applied with some confidence in a clinical setting. An unfortunate fact of medical practice and research has been the need for some sort of invasive monitoring, a good example being the collection of blood samples. After years of observation and speculation about the effects of snoring, medical scientists had accumulated enough evidence to suspect that the airway obstruction of severe snoring impaired the normal oxygenation of blood. The most direct way to measure blood oxygen levels was, and still is, to take a sample of blood with a needle and syringe and have it analyzed, but this presents very real problems if one proposes to take samples from sleeping, snoring patients. Many patients are so intimidated by the thought of multiple blood collections that they would find it impossible to sleep, and it would also be necessary to take a large number of samples during the period of sleep to give a true indication of oxygenation throughout the night.

In the 1940s a non-invasive technique for estimating blood oxygen levels was developed which, to put very simply, relied on the absorbance of light by oxygenated blood. The device was called an ear oximeter, and by placing a light source and detector on the earlobe it was possible to measure blood oxygen levels continuously with minimal trauma to the patient. The first commercially viable oximeters became available in the 1970s, a decade which established their usefulness in a variety of clinical situations, particularly in the management of respiratory and sleep disorders. Oximeters have since been substantially modified. They are readily portable and suitable for bedside use, are attached with reasonable comfort to either ear or finger and are probably the most important diagnostic tools in those laboratories which have been set up to investigate snoring and other sleep disorders.

An understanding of snoring has resulted from the contributions of several medical specialties. Mention has been made of advances in sleep staging and oxygen monitoring technology but we owe just as much to the physiologists who told us about the mechanisms which control breathing, to the radiologists who filmed the collapse of the upper airway during snoring, to the cardiologists who verified the dramatic response of the heart to the suffocating effects of severe snoring and finally to the band of dedicated researchers who would spend months observing the snoring patient from one night to another while the rest of the community slept.

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There are various investigations which can be carried out at a hospital or special clinic if any disease of the breast is suspected. The more common ones will be described here, before the actual process of diagnosis is explained. All doctors and all hospitals and clinics have their own way of doing things, although there are plans to standardize this care.

Mammography

Mammography involves taking X-rays of the soft tissues of the breast and armpit. It is used for routine breast screening and as a tool in the diagnosis of breast diseases.

The natural contrast due to the breast’s fat content is exploited in mammography. Most breast cancers occur in women over the age of 45, and it is around this age that glandular tissue within the breast begins to be replaced by fat. The appearances of different types of growth vary, allowing quite accurate distinction between some benign and malignant lumps.

Young women, who are concerned about breast cancer, perhaps because they have a family history of this disease, may find that their request for a mammogram is refused; some then arrange for mammography at a private clinic. However, mammograms are not normally helpful in women under the age of 35 as their breast tissue is too dense for most abnormalities to be visible.

Seen on an X-ray, benign breast tumours and cysts tend to have a smooth outline, sometimes surrounded by a ‘halo’ of fat. Malignant tumours, on the other hand, are usually poorly defined, more diffuse masses with diagnostically important tendrils extending randomly into the surrounding tissue. Both types of tumour can contain calcium deposits, but these are more numerous, irregular and less coarse in a malignant growth. If mammography reveals a lump in the breast, it may be followed by further investigations such as a biopsy.

When is mammography necessary?

Apart from its use as a screening tool for women over the age of 50 in the UK, and for those who are particularly at risk of developing breast cancer, mammography is important in the diagnosis of various breast diseases. The following are some signs and symptoms which may need to be investigated by X-ray mammography.

* A lump of unknown origin.

* Several small lumps which can be felt within the breast.

* Unexplained discharge from the nipple.

* Unexplained inversion of the nipple.

When malignant disease is suspected, mammography is also used to:

* confirm the clinical diagnosis,

* determine the extent of the disease – there may be more than one cancer in the breast,

* look for disease which cannot be felt but which may be apparent on a mammogram as areas

of calcification,

* look for cancer in the other breast.

Mammography can also help in the planning of surgical treatment as a lumpectomy will not be suitable for all women. It may also be used to look for signs of recurrent disease or further breast lumps following cancer treatment.

Some small benign lumps, and occasionally cancers, within the central ducts of the breast near the nipple are difficult to detect by mammography, and X-ray following the injection into the duct of a radio-opaque substance may be required if these are suspected.

The process of mammography

You will be asked to remove your clothing down to your waist, and a radiographer will then help to position you for the X-ray. Each breast in turn will be placed on a shelf-like plate on the mammography machine, and another plate will then be lowered onto the breast to compress it. You will be asked to keep very still while the X-ray is taken.

The pressure on the breast as it is compressed between the two plates can be quite uncomfortable, but lasts only a few seconds. Many women are anxious about having a mammogram and so are more than usually sensitive to any discomfort it causes. Some do find the process painful – particularly just before a period – and, rarely, it can cause bruising of the breast and in some cases pain that can last for several days or weeks. However, the pressure of the plates is unlikely to cause any harm, and the radiation level from the X-ray is very low, although higher radiation doses are required to take X-rays of the breasts of young women, who therefore should not have more mammograms than necessary. The benefits of mammography as a diagnostic tool and for breast screening do outweigh any discomfort it may cause.

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The significant step forward in preventive medicine came with the alarming realization that health was not just a middle-class luxury. In other words the middle and upper classes began to realize that whether they liked it or not their own health and wealth was deeply involved with the health of the ordinary working people. It is perhaps surprising that industrialists did not see the economic link between the poor and unhealthy working classes and low productivity earlier, but they did not and in 1848 when parliament was debating the first Public Health Bill even the Economist magazine did not see the connection between the two. As we have seen, Petty had been talking about exactly this link over a century beforehand but an Austrian, Johann Peter Frank, was the first to make the assertion that governments were strengthened by healthy, happy workers. His thinking produced the world’s first government medical system, in Germany in 1883.

The growth of preventive and public health measures in any industrialized country appears to follow a fairly predictable pattern as the country becomes industrialized. First, there is a rush for power, then an increase in exploitation which is difficult to control. Along with this, rural people and even those from outside the country migrate to the major cities, become separated from their own food supply and depend on cash as wages. At the same time death rates rise dramatically and the value placed on individual life is low. But such a system, whether it occurs in nineteenth-century England or twentieth-century Third World countries, produces wealth and makes money available for those who want to spread it around. Historically, individual philanthropists started creating better conditions for their workers and indeed for whole communities and this, combined with the new egalitarianism born as a result of the French and American Revolutions, made the upper classes more aware of the value of keeping the masses healthy.

At the turn of this century another truth began to dawn. About 60 per cent of all the men who volunteered for the British army’s fight in the Boer War were unfit for service. This appeared to shake people’s long-held attitudes almost more than any other single factor and led Sidney Webb to write:

We have become aware, almost in a flash, that we are not merely individuals but members of a community, nay and citizens of the world. . . . In short, the opening of the twentieth century finds us all, to the dismay of the old-fashioned, individualist, thinking in communities!

Slowly, the notion that society was a collection of communities began to develop-rather more slowly in the US than in the UK, partly because of the individualistic frontiersman thinking in the former. But things were on the move and the time was ripe for the second phase in the development of preventive medicine -the scientific approach.

Until this time facts and figures about health were poor, so few lessons could be learned. Simple ‘Bills of Mortality’ had been collected in London since 1603 but it was not until the establishment of the office of the Registrar General in 1837 that guesswork was replaced by real statistics. The availability of verifiable facts now made it possible to enact regulations to prevent frankly harmful behaviour and to promote healthy behaviour and practices. Ordinances to abate noise, control sewage and dispose of decayed matter, dead bodies, filth and stagnant waters go back as far as 1388 and in colonial times several American communities enacted laws to quarantine ships and isolate smallpox. Baltimore organized America’s first board of health in 1793. But effective public health administration was impossible in either country because local parishes and communities overruled national goals. As so often occurs in history, the activities of one man changed all this.

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Pastor Kneipp combined hydro treatment with the old culture of bathing in aromatics and healing bath oils. ” Herbal bathing” is especially healthy because the healing power of herbs affects the body on different levels. The active ingredients of the medicinal herbs are absorbed through the skin and therefore directly into the blood. Up to 30 times more active ingredients are taken through the blood during a bath. The body will absorb so many etheric oils, that these are often enough for the treatment but without having any negative side affects on the digestive organs. Parts of the etheric oils are absorbed through the lungs when breathing. The herbal steam affects the limbic part of the brain through the sense of smell, which is regarded as the connection between body and soul. In Kneipp’s day, it was common for everyone to collect their own herbs in nearby forests, on field edges and in meadows.

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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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