Medical science has come a long way. Epileptics are no longer possessed by the devil, the insane are not incarcerated for life in neglected prisons, and epidemics are not popularly believed to be a punishment sent from God. Despite this, ailments which have tormented mankind for centuries continue to do so. The influenza virus so clearly isolated and characterized is still capable of inflicting its misery, leaving us virtually powerless to curb its debilitating effects. Comfort can at least be found in the compassion of fellow sufferers.

The community has come to accept our vulnerability to the influenza virus which invariably leads to sympathy from family, friends and employers. The chronic snorer has few sympathizers. He is mostly regarded as a threat to the nocturnal harmony of the home, but more widely regarded as an object of hilarity. Cartoons and situation comedies have long used the spectacle of the noisy snorer, apparently sleeping soundly, quite oblivious to the disruption caused to those in his immediate vicinity.

Below the thin comic veneer of the stereotypic snorer lies a range of sociological and physiological problems. Snoring is the source of acute social embarrassment and marital disharmony. The heavy snorer may also experience personality changes, daytime drowsiness, loss of memory and cardiac complications.

At what point does snoring become a problem and when is intervention indicated? Snorers are often referred to a local doctor by spouses who are frustrated by the interruption to their own sleep. The doctor has to make an assessment based upon the story of both partners. If, for example, the husband is the snorer, his wife is probably the better judge of its severity and of accompanying symptoms such as frequent choking sounds or excessively long periods of time between respiratory efforts. These symptoms in conjunction with a physical examination will help the physician decide on appropriate intervention and whether further tests are indicated. A small proportion of snorers have complications, which may be life threatening, but the majority do not require medical intervention. They nevertheless require in many instances professional counseling, reassurance and a guide to some of the simple techniques available to minimize snoring.

*1/51/5*

Concepts of preventive medicine as we think of it today started with the Greeks, although undoubtedly there were simple forms of prevention being practiced worldwide before this. In Ancient China the Yellow Emperor spoke about wholism and preventive medicine:

Sages here do not treat those who are already ill; they rather instruct those who are not yet ill. . . The superior physician helps before the early budding of disease. The inferior physician begins to help when the disease has already developed. He helps when the destruction has already set in.

Two thousand years later Huai-nan Tzu wrote:

The good doctor pays constant attention to keeping people well so that there will be no sickness.

Such concepts were adopted by the Greeks-the first western culture to take prevention seriously. From the very beginnings of Greek medicine efforts to preserve health seemed more important than those to cure diseases. Health, they maintained, was a state in which the various elements and forces of the body were in balance. Disease in this way of thinking was a disorder of this equilibrium. It seemed fairly clear that external (environmental) factors were important in causing a poor balance and the Greeks talked a lot about poor nutrition and physical factors. To the Greek the ideal life was one in which nutrition, exercise and rest were properly balanced. Other important factors were the person’s age, sex, type of constitution and the seasons.

This ecological approach to medicine, which seems so modern today, led the Ancient Greeks to strive to balance their diet, exercise and environmental factors to keep the mind and body in good health. Unfortunately, because this meant a change in lifestyle, few could actually afford to go along with such elegant theories and as a result it was only the middle and upper classes who had the incentives, money and leisure to pursue these goals. Even though few Greeks actually lived like this the concepts continued to influence medical thought for centuries.

In the Middle Ages people began to realize that there was another major dimension to health which had to be taken into account in addition to the Greek notions. This realization came about with the appearance of leprosy as a serious health hazard in Europe. The primary need to do something about leprosy led the society of the day to band together to isolate people with the disease and to clean up the environment, not just for the benefit of individuals but for that of society as a whole. Preventive public health could be said to have been born at this time.

The Church led the way with its insistence that spiritual and physical uncleanliness were linked. The Old Testament, and especially the book of Leviticus, puts great stress on processes such as menstruation and urethral discharges as being unclean and holds that people with such afflictions should be isolated from the rest of society until they have been purified. So leprosy was treated by the Church in a very literal Old Testament way and sufferers were isolated from the community to protect the healthy. Because this disease was untreatable the individuals became socially dead as they were cast out from life.

*1/72/5*

Over the course of a year, I’ll see 5,000 or more patients who come to me for treatment. Of all the symptoms my patients tell me they have, malaise, or a general sense that they’re not feeling as well as they could, is one of the most common complaints I hear. Unfortunately, whenever a patient tells me she is feeling weak and unwell, it opens the door to the possibility of every single medical problem on earth. This can be frustrating and overwhelming to the physician as well as to the patient, so if she simply says she doesn’t feel quite right, I ask her to be as specific with her complaints as she can. It’s important to keep in mind that age and activity levels have a lot to do with how people define malaise. For instance, the malaise of a 20-year-old athlete who cannot run 10 miles every day because of an injury is much different from the 50-year-old executive who can’t seem to find the energy to go to work or the 65-year-old grandmother who just feels too tired to do chores around the house.

If you have been feeling weak and out of sorts lately, answering the following questions will help your physician zero in on the possible causes:

1. How long have I been feeling unwell? A week, a month, or longer?

2. Has there been a change in my appetite or thirst? In my urination or bowel habits?

3. Have I gained or lost a significant amount of weight in the last few weeks or months?

4. For women, if I am still menstruating, has my cycle or flow, or both, changed recently?

5. Have I recently had a fever, night sweats, or a physical intolerance to hot or cold temperatures?

6. Have I recently traveled abroad or to a different region of the country?

7. Do I have a symptom such as a rash, arthritic pain, or swollen glands?

8. Do I think I might have been bitten by a tick recently?

9. Have I been undergoing problems in my personal life lately?

10. Do I have a past history of a serious illness that was cured or went into remission? Have I begun to take a new form of medication recently?

11. Has my urine darkened in color recently?

12. Do I have a history of blood transfusion, sharing a hypodermic needle, drug abuse, or even one unsafe sexual encounter?

13. Do I feel a general ache in my bones?

*566\167\8*

A complete medical history and physical exam as well as a series of specific diagnostic tests will help your doctor determine the necessary treatment for your unexplained weight gain.

As with any medical treatment, the risks must be weighed against the benefits when you and your doctor decide about your specific treatment. If your doctor has prescribed steroids to treat another medical condition, you should realize that the short-term use of steroids for a week or even up to a month has not been found to cause any permanent weight or health problems. You’ll lose the extra pounds once you stop taking the steroids.

Water pills, or diuretics, can help reduce a weight gain of a few pounds that comes before menstruation and is caused by water retention—if they’re used judiciously. However, they do not help reduce the body’s stores of fat and are dangerous to use on a reduced-calorie diet since they can cause potassium depletion and dehydration.

Since most cases of weight gain are caused by eating too much and/or moving too little, what I’m going to say next is going to sound boring, but I’m going to say it anyway. If your weight gain is the direct result of too many calories and not enough exercise, you’re going to have to change your lifestyle if you want to lose weight. A sensible weight-reduction plan should include a low-fat, low-calorie diet and regular physical exercise. Your doctor is the best person to advise you about the best course of action for you.

*570\167\8*

In an elderly person, weight loss can have certain causes a doctor would never consider to be a problem in a younger person. For one, your elderly aunt may not be able to obtain nutritious food because she’s unable to make it out of the house to go shopping and there’s no one else around to do it for her. Poorly fitting dentures can make it uncomfortable for her to eat, or she may be experiencing increasing senility due to Alzheimer’s disease, cancer, or an underlying infection and has lost her appetite.

As with younger people, I consider weight loss in an elderly person to be serious if she loses more than 10% of her body weight over the course of a month or two. If this happens, I’ll order a blood test to determine if there is evidence of malnutrition. Lower serum protein levels, albumin levels, and lymphocyte counts ate all signs that the immune system is beginning to deteriorate, making an elderly person more prone to infections, bedsores, falls, and other health problems. These can depress the appetite even mote.

The treatment for your elderly relative will depend on the cause. Using Meals on Wheels, taking food supplements, and getting new dentures, as well as possibly going into a nursing home are some of the steps that might be considered by the doctor and the patient’s family.

*574\167\8*

High-risk groups. Skin protection from ultraviolet light for persons with frequent exposure to sunlight.

Discussion of aspirin therapy for men who have risk factors for myocardial infarction (e.g., high blood cholesterol, smoking, diabetes mellitus, family history of early-onset coronary artery disease) and who lack a family history of gastrointestinal or other bleeding problems or other risk factors for bleeding or cerebral hemorrhage.

Discussion of estrogen replacement therapy for perimenopausal women who have an increased risk for osteoporosis (e.g., Caucasian, low bone mineral content:, bilateral ovary removal before menopause, early menopause, slender build) and who are without known contraindications (e.g., history of undiagnosed vaginal bleeding, active liver disease, thromboembolic disorders, hormone-dependent cancer).

*578\167\8*

Diet and Exercise

Fat (especially saturated fat), cholesterol, complex carbohydrates, fiber, sodium, calcium. Caloric balance. Selection of exercise program.

Substance Use

Tobacco cessation. Alcohol and other drugs. Limiting alcohol consumption.

Driving/other dangerous activities while under the influence. Treatment for abuse.

Injury Prevention

Prevention of falls. Safety belts. Smoke detectors.

Smoking near bedding or upholstery. Hot-water heater temperature. Safety helmets.

High-risk groups. Prevention of childhood injuries for persons with children in the home or automobile.

Dental Health

Regular dental visits, tooth brushing, flossing. Other Primary Preventive Measures

Glaucoma testing by eye specialist.

High-risk groups. Discussion of estrogen replacement therapy for women who have an increased risk for osteoporosis (e.g., Caucasian, low bone mineral content, bilateral ovary removal before menopause, early menopause, slender build) and who are without known contraindications (e.g., history of undiagnosed vaginal bleeding, active liver disease, thromboembolic disorders, hormone-dependent cancer).

Discussion of aspirin therapy for men who have risk factors for myocardial infarction (e.g., high blood cholesterol, smoking, diabetes mellitus, family history of early-onset coronary artery disease) and who lack a family history of gastrointestinal or other bleeding problems or other risk factors for bleeding or cerebral hemorrhage.

Skin protection from ultraviolet light for persons with frequent exposure to sunlight.

*582\167\8*

When coal, wood, or gas is burnt in fireplaces, stoves, or radiators, it consumes oxygen. Oxygen is essential for life. When such heating methods are used, make certain that air is entering the room. If the doors and windows fit so snugly that you do not feel any air coming in when you place your hand near the sills, be sure to open one of them a little. Always be careful to protect a gas flame from draughts that might blow it out and cause gas to pour into the room. This has been the source of many serious accidents. Electric heaters and electric stoves do not use up the oxygen in the air. Care should be taken when standing near heaters in night attire made from synthetic materials. Many of these materials are highly inflammable, and serious burns have resulted when the wearer merely brushed against a hot heating appliance, causing the garment to burst into flames.

Room temperature

There is, or course, a problem when it comes to getting along with people whose standards of comfort differ from your own. The average person seems to prefer a room temperature between 70° and 75° F. If you like to be warmer or colder than your associates, try to take care of this by the clothing you wear. Garments should be loose enough not to restrict the body in any way and should permit the absorption or evaporation of perspiration. They should be chosen for comfort rather than simply for style.

Air-conditioning

Air-conditioning is becoming so common in big cities that few of us could avoid it even if we wanted to.

Air-conditioning is certainly an aid to comfort, but it sometimes is a problem, especially if the control is fixed. An air-conditioner should have a thermostat so that room temperature can be adjusted to your own comfort and health requirements. In the summer, you may go from an air-conditioned flat, in an air-conditioned car, to an air-conditioned office, and back again at the end of the day. This means that the body has had little opportunity to make the healthy adjustment to varying climatic conditions that is so important to maintaining a sturdy constitution.

On the other hand, air-conditioning can be a lifesaver. Hot, humid weather places added strain on the circulatory system. For persons suffering from some heart disease, this added strain may be intolerable. Living in an air-conditioned environment may be advised by your physician if you have a coronary condition; but be sure and get his advice before taking this expensive step.

Humidity and comfort

Besides the freshness and temperature of air, its moisture content (humidity) may influence health. Again, each individual must find his own prescription. Some people feel well in cold winter climates where the indoor air is extremely dry. Other people notice that this dry atmosphere causes irritation of the nose and throat. Some people are relatively comfortable when the air is warm and moist in summer. Others are so oppressed by humidity that they need a fan or an air-conditioner. Because perspiration evaporates more readily in dry air, thus cooling the body, most people mind the heat less when it is not combined with dampness.

*3\68\2*

The two lungs, which, like the heart, are completely encased by the ribs of the thorax (chest cavity), lie on each side of the heart. They supply the body with oxygen. The blood picks up from the lung capillaries the oxygen that the tissues must have, and carries it in its red cells throughout the body. Carbon dioxide, which the tissues give off as a waste product, is carried back to the lungs and expelled through breathing.

What commonsense precautions should you take to care for your lungs? First of all, especially in view of what we know about the effects of smoking on the lungs, you should give up smoking or cut down from high-risk cigarettes to the lower-risk mild cigar or pipe. I discuss this in the entry smoking in the encyclopaedia section.

Next, if you are a worker in any industry where dust, gases, and smoke are inhaled, you must learn the risks involved now, because industrial materials such as silica will have produced their irreversible damage to the lungs by the time symptoms appear. You can do a great deal to protect your lungs against infection if you study the entries pneumonia and tuberculosis in the encyclopaedia section.

*35\68\2*

If I had to answer that question in one word, I would say, ‘Habit.’ Many fortunate individuals never want to eat more or less than they need to maintain their ideal weight. When they exercise a great deal, they eat more heartily than when they spend a quiet day at home; if they have a huge meal at noon, they just are not hungry at dinner time.

Their appetites are regulated by their requirements, and they seldom develop bad eating habits.

The late Dr. Norman Jolliffe, when he was teaching at Columbia University’s School of Public Health, coined the term ‘appestat’ for the mechanism that regulates the appetite. People who keep their desirable weights usually have appestats that are set exactly right.

In many people, however, the appestat is easily influenced or conditioned by habit. A patient of mine who had been visiting relatives and eating the huge meals they set before her, in order to be polite, came home two months later and told me her appetite had increased. On the other hand, people who do not get enough to eat for some time may develop low appestats and poor appetites.

Emotional factors can play an important part in over-eating or under-eating. People who feel lonely and unwanted often eat a great deal because it is one of their few pleasures. Women with small children have frequently told me they overeat simply because of boredom, or because nibbling makes them feel calmer and better able to cope with the children. On the other hand, worry and tension or the desire for attention and sympathy can also keep people from eating. Deep psychological problems naturally call for the help of a specialist. But often I have found that many of my patients who have fallen into bad eating habits can break them by willpower and the type of information given in this chapter.

*27\68\2*

« Older Posts — Newer Posts »

Random Posts

• TALKING ABOUT OUR BODIES. NAMES WE USE: SLANG OR SCIENTIFIC
• AIDS – HOMOSEXUALITY
• GAMES FOR HYSTERICAL COUPLES – GAME 5: TALK DIRTY TO ME (INTRODUCTION)
• A NINE-POINT PROGRAM FOR A BETTER HEART
• Аллергия
• WHY SLEEP?
• CANCER: PLAYING THE PREVENT DEFENSE
• DIABETES AS DIGESTION-RELATED DISORDER
• MEN IN BED: SUCCESSFUL SEX
• DIAPHRAGMS: WHAT IS IT?