KEEPING GYNAECOLOGICALLY FIT
SEVERE HYPERGLYCEMIA: KETOACIDOSIS
SEVERE HYPERGLYCEMIA: KETOACIDOSIS
Hyperglycemia and dehydration If someone with diabetes is seriously insulin-deficient, various major biochemical changes occur. Without insulin, glucose cannot enter your body cells to be stored or to produce energy. Your body therefore behaves as if you were starving. While a starving man has no glucose available because he has not eaten any, the diabetic has plenty of glucose available but it cannot get into the cells without the help of insulin. The lack of insulin causes the liver to release glucose from its stores, but of course this cannot be used any better than the glucose derived from the carbohydrates you have eaten. Your blood glucose levels rise, sometimes to 50 mmol/1 (900 mg/dl) or more. Glucose starts pouring out into your urine and the thick syrupy fluid draws water out of your body with it. You become more and more dehydrated and however much you drink you cannot keep up with the fluid loss. If you have severe diabetic ketoacidosis you may be short of as much as ten liters (18 pints) of salty water! Potassium starts leaking out of your cells and is passed out in the urine.
Ketones Because your cells are now starving, your body turns to other sources of energy such as proteins and fats. You start to lose weight. Fats are broken down into fatty acids which are, in turn, broken down into ketone bodies. Ketones give the breath a characteristic smell of pear drops and are also passed out in the urine where they can be detected by simple tests (Ketostix, Acetest and Keturtest). As the ketones build up in the blood stream, your blood gradually becomes acid. The build up of acid stimulates the lungs to breathe too hard to blow off acid as carbon dioxide. Gradually your breathing becomes deeper and longer with a sighing quality and a pungent smell of ketones. This deep sighing breathing is called acidotic or Kussmaul breathing and is a classical sign of diabetic ketoacidosis. As the blood becomes increasingly more acid, more biochemical processes fail because they cannot work in an acid environment.
Slow deterioration This takes several hours or days. By now you are feeling very ill. You are vomiting, desperately thirsty, breathing deeply and becoming confused or even semiconscious. You are also very silly to have let your condition get this far without seeking help! Dial for an ambulance and get yourself to a hospital immediately. Surveys in Britain and North America showed that ketoacidosis was the cause of about one in every six deaths among diabetics who were under fifty years old when they died.
*26/102/5*
TREATMENT OF RHEUMATOID ARTHRITIS: CONSERVATIVE APPROACH
TREATMENT OF RHEUMATOID ARTHRITIS: CONSERVATIVE APPROACHTraditionally, medical therapy for RA was outlined according to a pyramid approach. Treatment options started at the base of the pyramid. Doctors would begin conservatively, by prescribing what was thought to be the safest medication. From the 1940s through the 1960s this first-line therapy took the form of large doses of aspirin. In the 1970s and 1980s many new non-steroidal anti-inflammatory drugs (NSAIDs) became available. Because they are convenient and often well tolerated (patients notice few side effects), NSAIDs have gradually replaced aspirin as the first line of therapy.Also located on the base of the pyramid were other conservative forms of treatment such as rest, physical therapy, and diet. Because early RA was thought to be a purely inflammatory and reversible condition, doctors believed that anti-inflammatory therapy alone was justified. Before doctors moved up to the next tier of treatment and prescribed second-line therapy, actual damage would need to be apparent by physical examination or x-ray. This was consistent with the theory of the time which held that the early phase, the inflammatory phase, of RA was only infrequently followed by a more damaging proliferative phase. In this later phase, the synovium would become thicker and more destructive. Doctors often waited one to three years for evidence of this damaging phase before prescribing disease-modifying drugs (drugs that attempt to induce a remission by stopping the proliferative phase). These disease-modifying anti-rheumatic drugs (DMARDs), or remittive (causing remission) drugs, were thought to be unnecessary and too dangerous for early use.*84/209/5*
GENERAL URINARY TRACT INFECTIONS
GENERAL URINARY TRACT INFECTIONSAlthough general urinary tract infections (UTIs) can be caused by various factors, particularly the insertion of catheters and other devices during hospitalization, some forms of the problem are sexually transmitted. Any time invading organisms enter the genital area, there is a risk that they may travel up the urethra and enter the bladder. Similarly, organisms normally living in the rectum, urethra, or bladder may travel to the sexual organs and eventually be transmitted to another person.You can also get a UTI through autoinoculation (transmission to yourself by yourself). This frequently occurs during the simple task of wiping yourself after defecating. Wiping from the anus forward may transmit organisms found in feces to the vaginal opening or to the urethra. Contact between the hands and the urethra and between the urethra and other objects are also common means of autoinoculation of bacterial and viral pathogens. Women, with their shorter urethras, are more likely to contract UTIs. Hand washing with soap and water prior to sexual intimacy, foreplay, and so on, is recommended.Treatment depends on the nature and type of pathogen. For minor infections, some practitioners recommend drinking 8 to 10 glasses of fluids per day, particularly those high in acid, such as cranberry juice, to alter the acidity of the vagina in order to kill the pathogen. This treatment is considered worthless by some authorities, however, since it has been estimated that a person would have to drink over 4 quarts of cranberry juice a day over a period of several days to even begin to alter vaginal acidity. Considering the caloric intake, cost of the juice, and minimal effectiveness of this home treatment, you would probably be better off visiting a doctor and obtaining proven medications from a pharmacy.*27/277/5*
THE BONE DENSITY PROGRAM: EVELYN’S STORY
THE BONE DENSITY PROGRAM: EVELYN’S STORYWhen a bone scan showed I had bone loss that was serious, but not yet osteoporosis, my family physician referred me to a menopause clinic with a whole team of care providers. I saw an endocrinologist, a pharmacologist, a breast health nurse, and a nutritionist. Everyone was very knowledgeable and supportive, and wanted to help me take steps that would fit in with my life. If you don’t like the idea of one pill, they have ten other options to tell you about. The information I got was very individualized, and by the time I went back to my regular doctor, I felt confident in the plan I had in place. For me, that meant weight lifting, aerobic walking, calcium supplements, and Fosamax. HRT hadn’t agreed with me, so I was surprised and relieved at how many other ways I could protect my bones.Women have big choices to make about how to care for their bones, and I can’t say enough about what it meant to me to have a network of people pulling together on my behalf, knowing I had the best information in each area available to help me decide what was right for me.*8\228\2*
RELAXATION TRAINING FOR WAYWARD NERVES: CREATIVE VISUALIZATION – IMAGES WHICH QUIETEN THE MIND
RELAXATION TRAINING FOR WAYWARD NERVES: CREATIVE VISUALIZATION – IMAGES WHICH QUIETEN THE MINDThese images which follow are only suggestions; if they don’t work for you, make up your own scene where there is cheerful noise and movement which becomes more and more tranquil. Here are some examples:• Imagine a tree filled with song birds. The birds fly away from the top branches, then the next branches, and so on until there is just one bird left. Concentrate on this bird until it flies off, then look at the branch it was sitting on and focus on just one lovely pale green leaf.• Think of a fairground, full of laughter and music; it is closing down for the night. The people go home, the lights go out, and all becomes quiet.• Imagine a playground of noisy, tumbling children. It’s supper time; they gradually go home. Watch as the last child goes off with his mother; see how sleepy he looks.If you have trouble stilling your mind with images, try concentrating on the feeling in your nostrils as your breath enters and leaves, or simply by repeatedly counting to ten.*109\326\8*
NON-EPILEPTIC SEIZURES: CONFUSION ABOUT DIAGNOSIS
NON-EPILEPTIC SEIZURES: CONFUSION ABOUT DIAGNOSISSometimes, as in Carol’s case, the diagnosis of non-epileptic seizures is easily made. But often diagnosis is not so easy, and occasionally it presents a real problem for both the doctor and the patient, who may be given anticonvulsants unnecessarily over many years.Someone who has non-epileptic seizures usually has a model on which to base them. Sometimes someone else in the family has epilepsy, or the person has had some similar experience such as a faint. In Carol’s case she had had expert, though unintentional, tutoring by the people on her ward who experienced genuine seizures.A few people have both non-epileptic seizures and epileptic seizures. It is important that both should be diagnosed because both need to be treated, and treatment is different.Diagnosis of non-epileptic seizures is particularly difficult in people who have both epilepsy and non-epileptic seizures, and who therefore have a very good model of epilepsy on which to build their non-epileptic attacks. Indeed, the person experiencing both kinds of attacks often finds it difficult to distinguish between the two for him or herself. They will usually say, for example, that their non-epileptic attacks seem to come out of the blue just like real epilepsy. It does not seem to them that they are feigning attacks. Nevertheless, these non-epileptic attacks can nearly always be distinguished from an epileptic seizure.When someone who has epilepsy also develops non-epileptic seizures there is a problem in treatment as well as diagnosis. Even if the frequency of the person’s epileptic seizures is actually being reduced, their doctor may not realize that this is the case because the person continues to have non-epileptic seizures. They may be given even higher doses of anticonvulsant drugs which they do not need.Why should someone who has genuine epilepsy develop non-epileptic seizures too? Quite often the real epileptic seizures have been more or less brought under control, but the patient still ‘needs’ their seizures, perhaps for the attention they bring, or because they allow him or her to remain dependent. It may take time for someone to learn to do without their seizures.Not surprisingly, then, the patient with non-epileptic seizures is often given different diagnoses. Some doctors diagnose epilepsy, others non-epileptic seizures. No wonder the patients themselves are often confused about what they do have, or that they often reject medical help if the advice they are given is conflicting. Even more important, a prolonged non-epileptic seizure may be mistaken for status epilepticus and the patient rushed to the nearest intensive care unit and given treatment which is entirely appropriate for someone who is in status epilepticus, but highly dangerous for anyone else. So although non-epileptic seizures are not dangerous in themselves, they should never be taken lightly.*52\193\2*
PILLS FOR TREATMENT OF DIABETES MELLITUS
PILLS FOR TREATMENT OF DIABETES MELLITUSThe pills used are technically termed oral hypoglycemic agents. Hypoglycemic means acting to lower blood sugar. These agents are NOT insulin. No form of insulin can be taken orally. This point is emphasized because we have found patients who had so little knowledge of their diabetes and the oral drugs they were taking that they were doing dangerous things with the medicine. They thought the pills were a direct substitute for insulin, and instead of taking the prescribed number of tablets a day, they were taking extra pills whenever they cheated on their diet. They thought that the extra pill would take care of the dessert or other sweet that they ate. This is not the case, and they were risking developing a low blood sugar hours after they took the pills.There are two categories of oral hypoglycemic drugs. The first category is comprised of tolbutamide (Orinase), chlorpropamide (Diabinase), and acetohexamide (Dymelor). This group of drugs apparently acts primarily by stimulating the pancreas to produce more insulin. The reason that these drugs usually are not effective in the juvenile-onset type of diabetic is that shortly after this type of diabetes develops, the pancreas is completely emptied of insulin and stops producing it. The dosage used varies between patients, and some individuals may take one tablet a day, while others may take the medicine several times a day. It is important to emphasize that these drugs stimulate the pancreas during many hours of the day, and low blood sugar reactions can occur just as they do in persons who are taking insulin injections. It is therefore important not to skip meals when these drugs are used. The temptation to skip meals occurs more often when persons go on sporadic diets to lose weight.The diet is just as important here as it is for the diabetic using insulin. Obesity must be controlled. The penalty for cheating on the diet when oral hypoglycemic drugs are used is the possibility of eventually requiring a shift over to insulin injections. Between 20 and 30 percent of patients whose diabetes is initially controlled with the oral drugs will gradually fail to respond to the drugs over a period of months to years. The failure rate is probably higher among those persons who continue to overtax their pancreas by excess ingestion of carbohydrates (sugars).The second group of oral hypoglycemic drugs contains only one agent. This drug is phenformin (DBI). This drug has a different mechanism of action, one that is not well understood. It does not stimulate the pancreas to produce more insulin, a fact we know because this drug will work in some diabetics who have had their pancreas removed surgically. The drug probably has some direct action on the body cells to assist them in utilizing glucose (sugar). The drug is somewhat limited in its usefulness because of its side effects. Phenformin is frequently used in conjunction with one of the other oral hypoglycemic drugs or injected insulin to help achieve smoother control of the diabetes.*7/309/5*
ARTHRITIS: ACIDS IN FOOD LEAD TO SENSITIVITY
ARTHRITIS: ACIDS IN FOOD LEAD TO SENSITIVITYNext to water (when you drink it at the wrong times), the most dangerous element in our food is acid. Almost everything we eat has some form of acid in it. Unless we carefully watch our “acid intake” at every meal, we can become victims of “gassy stomachs,” ulcers, nausea or many other bad reactions by our sensitive bodies.Therefore, now that we have examined foods to learn their water content it is equally important to learn the “acid content.” If water can harm lubricating oils needed by every arthritic, imagine how much more damage acids can do to those oils!Before we show how acids in foods actually injure the sensitive bodies of an arthritic, let’s see how scientists measure acidity. How they determine whether acid is present in our diet.In scientific laboratories, doctors and research technicians frequently use two types of specially treated paper to make their tests. Material known as litmus and nitrazine paper is used. When a strip of blue litmus is placed in any liquid containing acid, the litmus paper turns red. If the liquid is non-acid, the blue litmus keeps its blue colour.It has been found, for example, that approximately 10,000,000 quarts of water yield one gram of hydrogen ion “acid.” The degree of acidity depends upon the number of hydrogen ions in the solution. In mathematics, the logarithm of 10,000,000 is seven. For the purposes of simplicity, then, water is referred to as having a pH of 7. This figure “7″ is the basis for measuring acids in foods. Anything above 7 is alkaline, anything below 7 is acid.After litmus paper has shown there is some acid present, then the scientists use nitrazine paper to measure how much acid is there and how strong or caustic it is. Nitrazine paper in the presence of water, with a value of 7, does not turn a different colour, but remains a dusty greenish colour. Acid content in foods and liquids decline from 7 down through 4*0, and lower.Milk, when tested in this way, turns out to be slightly acid. It has a pH of 6’6. If milk were 7, it would have no acid at all. Therefore, we can see how very small the acidity of milk really is. That’s one reason why we recommend milk for arthritics, because of its extremely low acid content.To keep acids away from lubricating oils should be the main goal for anyone who has arthritis. No wonder we condemn fruit juices. Look at this chart and recall what you have learned about the number 7. Remember, the lower the pH, the more acid in the food.THE HIGH ACID CONTENT OF FRUIT JUICESFOOD pH LEVELLemon juice 2-29Grapefruit juice 2-98Grape juice 3-00Apple juice 3-24Orange juice 3-42Pineapple juice 3-42Prune juice 3-70Tomato juice 4-18
The above list speaks for itself … a plain warning to arthritics.Most of the above foods have also been found to etch teeth in experimental animals, and humans.If they can erode tough tooth enamel, no wonder these juices cause reactions in more sensitive organs of your body. Many arthritics give up juices voluntarily, when pains in their joints increase. We maintain that the pain results from oils being dried out by citric, phosphoric, or tannic acid.The Acid Content of Your BloodWe have been discussing the acid content of saliva and other fluids in your body. What about the most vital liquid of all? Is there acid in your blood?The answer is “No.” The pH of blood is always between 7 and 7-4, meaning it is non-acid. If your blood ever fell below 7, death would come immediately. When you eat acid foods, your blood and digestive juices must neutralise the acid. Your body must borrow mineral salts, etc., from your blood and tissues to counteract the increased acidity.Because basic properties are borrowed from the blood and tissues to combat the acids, you have robbed your tissues and they can begin to degenerate. Degeneration leads to dryness of tissues surrounding your joints, for example. Dryness leads to arthritic joints and the very disease we are trying to prevent.To protect the blood—keep it from falling below the fatal level of 7—many organs throughout your body “donate” neutralising salts. They give up their own minerals, even if they injure themselves by doing so. Your tissues make this sacrifice, at the risk of degenerating and becoming dry. The kidneys, lungs and liver all surrender parts of themselves to fight the acids.Our purpose is to save our bodies from this terrible toll. We have warned you about fruit juices and certain liquids. Now, let’s examine solid foods.Fortunately, we can honestly tell you that most meat, fish, cereals and vegetables do not disturb the “acidity level” in your body. All these foods are found in the menus recommended for arthritics later in this book.Briefly, to defeat arthritis, we want to eliminate acids and gain oils.*36\146\2*
DRUG ABUSE: CULTURAL REACTIONS
DRUG ABUSE: CULTURAL REACTIONSThese messages are carried by many young people today and provoke the establishment to be against drugs. The young person on drugs who is supposed to be going out and conquering life is, in the minds of his elders, giving up because he is depressed, hopeless, or angry at the social structure around him. Therefore simply revolting against the junkie by trying to wipe out heroin addiction will not solve the tension and differences of belief between the old and the young.Mao’s solution to the drug problem was to force withdrawal by detainment in a work camp. Clearly Mao is going to have a greater cure rate than any western drug clinic, which at best claims that 30 percent of the addicts successfully withdraw. Though successful, such pressure does not take into consideration the counter-culture aspects of drug taking, the fact that part of the addict’s message is that the world as it is is unacceptable.*111\227\8*