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PREVENTIVE ASTHMA MEDICATION: IMMUNOTHERAPYThis is another area of treatment which excites considerable debate among the medical profession. Despite the fact that immunotherapy is accepted in the general treatment of certain allergies, it is still one of the most controversial areas of asthma therapy. Some of the reasons for this are:•The effects of immunotherapy treatment tend to be are inconsistent from one patient to another;• It is not possible to predict how long immunotherapy treatment will block an allergic response to a particular allergen;•It is possible to have a positive response to an allergen which may not be the cause of asthma;•Immunotherapy can be dangerous if not practised under professional supervision.But regardless of these problems, immunotherapy remains a viable option for carefully selected patients. If asthma triggers are identified as strongly allergic in origin and skin or blood tests support sensitivity to an allergen which responds well to immunotherapy, then it is very likely that immunotherapy will reduce the frequency and severity of asthma attacks.Immunotherapy attempts to neutralize the effects of allergens. The treatment consists of a long-term series of injections containing a gradually increasing amount of allergen extract. If a patient is highly allergic, the doctor increases the allergen doses very slowly over a longer period of time. Some allergic asthmatics report long-lasting improvement after immunotherapy, others report symptoms returning after stopping the treatment.Despite the continuing debate as to its effectiveness, immunotherapy is regarded as a viable preventive measure by a growing number of doctors as well as allergy prone asthmatics. While undergoing immunotherapy courses, it is usual for asthmatics to remain on their standard medication program.*22\148\2*

Romantic love, then, is an exceedingly important factor in the happiness of a life-time. We must, therefore, be all the more watchful lest any element creep in to undermine it. Most people, for example, do not realize that when they admit jealousy into their minds they are doing most to destroy the very thing they hope to preserve. Love cannot be forced. Freedom is of its essence. When one of a pair through jealousy tries to hold the other by strict surveillance, the bond of confidence which is essential to love is broken, usually beyond repair. There are only two logical positions to be taken in marriage regarding love. One is to have infinite confidence in husband or wife, and therefore wish him or her to have unlimited freedom. This not only brings the greatest peace of mind but also increases and intensifies the love of both. The other position is to know that one is no longer loved but to realize that nothing can be done about it, except maybe to wait and hope and keep up a cheerful, uncomplaining front. This may bring about a restoration of the old relationship. Any half-way position of jealous distrust, or any effort to force love, is sure to destroy even a hitherto unimpaired love.
*93\275\8*

A person may go for months or years after infection by HIV before any significant symptoms appear. The incubation time varies greatly from person to person. Children have shorter incubation periods than do adults. Newborns and infants are particularly vulnerable to AIDS because human beings do not become fully immunocompetent (that is, their immune system is not fully developed) until they are 6 to 15 months old. New information suggests that some very young children show the “adult” progression of AIDS. For adults who receive no medical treatment, it takes an average of 8 to 10 years for the virus to cause the slow, degenerative changes in the immune system that are characteristic of AIDS. During this time, the person may experience a large number of opportunistic infections (infections that gain a foothold when the immune system is not functioning effectively). Colds, sore throats, fever, tiredness, nausea, night sweats, and other generally non-life-threatening conditions commonly appear. People who show these combinations of symptoms have been described as having pre-AIDS symptoms.
*6/277/5*

Until now, the mainstay of HIV testing and surveillance efforts has been the testing of patients at increased risk for chronic HIV infection. However, an increasing focus of attention is the recognition and diagnosis of primary HIV infection. Up to 90% of patients experience some symptoms at the time of initial infection with HIV, but the diagnosis is missed in the overwhelming majority of cases. This has important prognostic implications for the patient and the population as a whole, as a diagnosis of primary HIV infection could
• Prompt early antiretroviral treatment, which may
• Delay the onset of symptomatic acquired immune deficiency syndrome
• Decrease future viral load “set point,” or the maximum viral load that a patient may achieve off of antiretroviral therapy
• Preserve, to some extent, native immunity against HIV
• Identify HIV-infected patients up to 10 to 15 years before they would otherwise be diagnosed, which may
• Limit the epidemic spread of the virus
• Allow for retrospective identification of patients likely to have transmitted the infection
Furthermore, recent studies suggest that obtaining an HIV genotype in recently infected patients has a significant yield for discovery of resistant viral populations, which could have an important impact on choice of antiretroviral treatment regimen and chance of success.
One of the major barriers to diagnosis of primary HIV infection is the nonspecific nature of the clinical presentation: it can look like mononucleosis, influenza, or other nonspecific viral illnesses. In many cases, careful scrutiny will reveal symptoms not typical of these illnesses, but in most the provider must have a high index of suspicion in order to offer HIV testing.
The most common presenting symptoms of primary HIV infection are fever, maculopapular rash, and pharyngitis or oral ulcers. Fever is present in approximately 80% of primary HIV infection cases, and rash, oropharyngeal disease, myalgias or arthralgias, and fatigue are present in approximately 60% of cases. These symptoms are common to a number of other illnesses, and providers should consider primary HIV infection in the differential diagnosis of syndromes such as infectious mononucleosis (particularly heterophile-negative) or streptococcal pharyngitis (particularly when rapid streptococcal testing or culture findings are negative).
In high-risk populations, some of the more common symptoms of primary HIV infection (e.g., fever, rash, malaise) have positive predictive values of 25% to 35%. Combining any two of these symptoms (e.g., fever and rash) increases the positive predictive value of the clinical syndrome to 50%. However, these numbers should be applied with caution – they may be applicable in high-risk populations, but in wider use, the positive predictive value of any symptomatic diagnosis alone will fall dramatically as patients at lower risk are included. Nevertheless, given the value of identification of primary HIV infection and the relative infrequency of false-positive HIV test results, providers should strongly consider testing for primary HIV infection when patients have analogous clinical syndromes with no known cause.
*5/348/5*

Just like you. We are told so often and so much about “female problems” and the many ways women’s bodies break down, especially as they age, that sometimes we lose sight of the fact that being healthy should be the norm—in fact, is the norm. The vibrant, dynamic women described above are all at different stages of their lives—early 40s, perimenopausal with no symptoms; early 50s, experiencing menopause with no symptoms; and mid-60s, finished with menopause and none the worse for wear.
Each has strong, healthy bones providing the foundation for strong, healthy lives and can expect to keep them. As health-conscious women and intelligent consumers, they are aware of the dangers of osteoporosis—literally “porous bones” (bones with holes) so brittle they can fracture from the force of nothing more than a sneeze—and the associated conditions of osteomalacia (soft bones) and osteopenia (low bone mass). But they haven’t surrendered to the hype that makes it seem like a coming plague from which there is no escape (except for the salvation of harsh chemicals), nor the complacency that this simply, inevitably, is a part of growing older. Rather, they’ve put their energy into strategies much like the ones recommended in this book and have radiant health to show for it.
None of it is an accident. There may be some benefit from “good genes,” but each of these women is health conscious and aware of her body and its needs, and takes care to do what is good for it and what feels good. But none has taken quite the same approach to wellness, and not all of them follow a specific plan. They’ve each made changes and adjustments, particularly at times of shifting hormones, but mostly they are busy living their lives, enjoying their work and their families, their homes and their friends, playing and resting and juggling many demands.
Just like you. Whatever your current situation, whatever your age, whatever your bones look like right now, if you know the right things to do for your body, you too can have the same healthy, active lifestyle as any of these women—and keep it for the rest of your life. You may need to do something differently from what they have, and you may want to try things they haven’t. Your body may react differently to whatever tack you do take. But you can learn from them, and the people whose stories are told throughout this book, as well as from the facts and figures laid out here, and work out strategies for yourself to get and keep your bones strong for a lifetime.
*2\228\2*

Maria always watches what she eats, but she’s concerned more with nutritional quality than with calories. Until recently, she never had to pay attention to her weight, but ever since she passed 40, it seems to creep up on her if she’s not careful. She’s probably out buying organic baby spinach and portobello mushrooms and free-range chicken for dinner tonight—if she’s done with her three-mile walk—and picking the right wine to go with it. She took a multivitamin this morning that also contains several trace minerals, and before bed tonight she’ll take a calcium and magnesium capsule. Her new doctor helped her cut down on the amount of thyroid hormone she was taking to counteract her underactive gland—and her energy level redoubled. Her colleagues at the university are always saying they would mistake her for a student if they didn’t know better, and although she always dismisses that as pure flattery, inside she feels no different from how she did in her younger days. Last weekend she wallpapered the nursery at her very pregnant younger sister’s house, then went hiking with her old graduate school buddies.
Sheila finally kicked a long-standing fatty-food habit a few years back, after taking a good look at the photos from her surprise 50th-birthday party. She remains a confirmed red-meat eater, but now with smaller servings only a couple of times a week. Just don’t ask her to give up cheese! Once she cut out most of the sugary snacks she used to live on, she no longer felt lethargic after she ate, and she never got the uncomfortable sense of fullness that had taken away some of the pleasure of a nice piece of steak. Petite and “fine boned” (as her mother, who gave her daughter her peaches-and-cream complexion, always said), Sheila certainly stands out among many of the employees (who tend to be male and muscular) at the construction firm she founded. She was a devoted jogger for years when that was all the rage, but these days she prefers her ballet classes or swimming laps, even though some days she just can’t get to either. But it’s not like her company can run itself!
Althea, an African-American accountant—and grandmother of three—recently reached a personal best on the chest press machine at the gym, and was delighted to watch the man following her take the weight down a notch. She became a vegetarian many years ago, partly to keep her large frame healthy despite what the actuarial tables say is a few too many pounds for a woman of her height. These days, she is eating more vegan meals, though she does occasionally eat fish. After she switched from dairy milk to soymilk (calcium fortified)—except in her coffee, where nothing but cream will do—she noticed her on-and-off bouts of indigestion were more off than on. Then she read in a magazine about the heart-healthy and estrogenic effects of soy products, and began to think that maybe all those tofu stir-fries had something to do with her low cholesterol levels and why she never had menopausal symptoms. That’s when she got some of that soy protein powder from the gourmet/organic food store in her neighborhood. She liked that store, even though the produce can’t really compare with what she grows in her own large garden.
*1\228\2*

Up to the mid-19th century, doctors had no tools to deal with epilepsy. In 1857, a British physician reported success in quelling seizures with compounds of bromine. Sixty years later, Phenobarbital also was found to control the spells. Both, however, have unpleasant side effects: drowsiness and coordination difficulties.
Then, in 1938, two American physicians, H. Houston Merritt and Tracy Jackson Putnam, discovered Dilantin, a drug that quieted the spells in most patients without too many side effects. Dilantin freed thousands of patients from mental and epilepsy institutions. Without Dilantin, many would have remained locked up.
Since then, science has created new drugs, and more are on the way. Dilantin controls most seizures. For various types of seizures, doctors also prescribe Zarontin, Klonopin, Depakene, Depakote, Mysoline, Tegretol, and Tranxene.
The drugs do have side effects but less than the old treatments. Dilantin can disrupt coordination, Tegretol can produce blurred vision, and Depakote can cause hair loss. The doctor, ideally, tries to bring the dose to just the point where the side effects and the seizures both disappear.
Marion Clignet of Aspen Hill, Maryland, takes Tegretol to prevent the seizures that began when she was 17. The drug controls her condition so well that Ms. Clignet, a cyclist, puts in 300 to 400 miles a week, plus weight lifting and stair climbing.
“I’m not concerned about having a seizure while riding,” she says. “At first my family was scared for me, but I proved that I could do it.”
*3/266/5*

The exact cause of the different forms of cancer are not fully understood but the rise in obesity-related cancers is directly associated with those changes found in the metabolic syndrome. In fact, it would not be unreasonable to suggest that increased cancer risk should be added to the list of morbidities that comprise the metabolic syndrome.
The fundamental defect in metabolic syndrome is insulin resistance – the sluggish reaction of cells in muscle and adipose tissue to the actions of insulin. This results in increased levels of blood glucose and, to compensate, increased levels of circulating insulin; this condition is known as hyperinsulinaemia.
However, other organs are not resistant to the action of insulin and display a heightened response to the high levels of insulin (and possibly other insulin-like hormones that act as growth factors). The result of this overstimulation is more rapid cell turnover, therefore a greater cancer risk. Adipose tissue also secretes oestrogen, which, combined with insulin, forms a potent carcinogenic mixture.
*3/312/5*

In February 2002, the International Agency for Research on Cancer estimated that overweight and inactivity accounts for one-quarter to one-third of cases of breast cancer, colon cancer, endometrial cancer, kidney cancer and oesophageal cancer. The increased risk varies between the different sorts of cancer. For instance, cancer of the colon has a risk ratio of 2.7 in women and 3.0 in men, and ovarian cancer is 1.7 times more likely in obese women.
Obesity in patients more than 40% overweight carries an overall mortality ratio for cancer of 1.55 in men and 1.33 in women; the same women are 5.4 times as likely to get endometrial cancer.
It is estimated that 10% of all cancer deaths among non-smokers are obesity related.
A Swedish study followed 28 000 obese patients for up to 29 years. The increased incidence of cancer was 33% compared to the general population, with a breakdown of 25% among men and 37% among women. As well as the previously well-documented associations with cancer, this study also suggested a link with cancer of the larynx, small bowel and non-Hodgkin’s lymphoma.
A study published in the New England Journal of Medicine of the records of over 360 000 Swedish men revealed that obese men had almost double the risk of renal cell cancer.
*2/312/5*

Addicts also have to change themselves. They need to change their feelings, their attitudes and their lifestyle. This inward and outward change is what protects them against going back on drugs. It sounds tough. But this is a killer disease, and half measures get you nowhere. You don’t even get half well from half measures. You stay wholly ill.
The golden rule about recovering from chemical dependence is that half measures don’t work.
In the long run, offering an easy answer for chemical dependence is not being kind to addicts. Some people treat addicts by giving them legally prescribed drugs in the place of illegal drugs because they think this is kinder.
It isn’t. Take the example of Mary, a young addict who was trying to get off heroin. The doctor treating her gave her prescriptions for DF118 (dihydrocodeine tartrate) and tranquillisers. For weeks at a time she took these pills instead of illegal drugs. And that way she did not learn to live without drugs. Eventually, weeks later, she had to be weaned off the prescription drugs, and suffered the much more painful withdrawals that occur after tranquilliser dependence. Her recovery was delayed and made more painful.
The only kindness to a suffering addict is to help them get properly well, not to enable them to stay sick.

*48\116\2*