Archive for the ‘General Health’ Category


Friday, October 29th, 2010

Sorry, this entry is only available in Russian.


Tuesday, September 14th, 2010
I mention this quite rare condition because it can present with a chronic confusional state, and if diagnosed early it can be treated by neurosurgery. In this condition the chambers inside the brain enlarge. The consequences are threefold: the person develops difficulty in walking (ataxia), becomes incontinent of faeces (but can also be incontinent of urine as well) and develops confusion (usually described initially as loss of short-term memory, i.e. memory for recent events). These three problems are often present in people with advanced dementia, hence the importance of recognizing the problem early. The diagnosis is made on the history, examination and findings on the CT scan, as well as other complicated tests.
If discovered early the potential for recovery is good. A shunt (a long tube) is passed from the chambers in the brain (ventricles) to the blood stream or a body cavity. In this way the excess CSF (cerebrospinal fluid) is diverted and the chambers revert to their normal size. In the past the diagnosis has been made late and the results of surgery have not been good, with very little recovery in mental function and the complications of the surgery to contend with. Early intervention can produce dramatic improvement and full reversal of all symptoms.

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Tuesday, September 14th, 2010
A  clue  to  the  cause  of  night  blindness  is  rhodopsin, or visual purple,  the  pigment the eye uses for night  vision.
One  of  the  components  of  visual  purple,   Vitamin A,   is  not found   in  the  other  three  pigments  used  to  distinguish colors  for  daytime   vision.  A   deficiency  of  Vitamin  A, therefore, appears  to inhibit the proper  functioning of visual purple  and  prompting night blindness,  without affecting one’s vision during the day-Recent studies  seem  to confirm  Vitamin  A’s legendary reputation  as  the  ”eye  vitamin.”  The symptoms  of night blindness  are  greatly  alleviated  when  treated  with  large doses of the  Vitamin A  and  the  vegetable  most commonly associated  with  it,  the  carrot.  Carrots are the single most important natural source of beta-carotene, which the body uses to manufacture Vitamin A.
Deep orange fruits and vegetables such as broccoli, squash, apricots and peaches, also provide the body with beta-carotene, and are most beneficial when eaten fresh.
Many case histories are on record of people, plagued by night blindness, reporting dramatic improvements in their condition after adding carrots and beta-carotene to their diets. One of the easiest ways of getting more Vitamin A is by drinking carrot juice.
A typical example of the power of carrot juice is illustrated by the experience of a young mother suffering from night blindness. She avoided driving at night until her son’s sudden illness. With her husband out of town on business, she was forced to drive her child to the hospital in the middle of the night. While she reached the hospital safely, and received the proper treatment for her son, the slow speed of her travel-an average of 15 miles per hour-disturbed her.
She vowed that she would never allow herself to be put in that position again. She began a regimen of drinking a quart of Carrot Juice a day, as well as feeding it to her family every morning. Her night vision improved dramatically in less than a month.
Vitamin supplements are a useful way of boosting one’s intake of Vitamin A. Health food stores carry a potent European formula blended with Vitamin A. It is a rare, special blend of powerful natural ingredients, proven successful in guarding against night blindness, eye fatigue, impaired vision and sensitivity to television, reading, or driving. This European formulation has been used on that continent with great success for many years. Each capsule contains 5,850 I.U. (International Units) of Vitamin A and Beta-Carotene in an oil solution to maximize its conversion to Vitamin A that the body can use.

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Tuesday, June 1st, 2010
“Hardening of the arteries” is the way people have described the vascular (blood vessel) problem called multi-infarct dementia. In the past, this colloquial description was a good one, because experts thought that “hardened” and partially clogged arteries produced this particular form of dementia. Today we know that this vascular type of dementia is caused not by partially blocked arteries, but by completely blocked ones. A series of small strokes (or in medical terminology, multi-infarcts) is what produces the changes in memory and thinking.
A stroke occurs when a blood vessel feeding the brain becomes blocked, the blood supply is cut off, and the part of the brain nourished by that vessel either is damaged or dies. A large stroke produces symptoms that are impossible to miss-paralysis, loss of speech, perhaps death. With multi-infarct dementia, strokes are so minor that individually they may cause only transient symptoms or no distinct symptoms at all. But as their number increases and more and more brain tissue dies, intellectual processes gradually get worse.
If you have had a large stroke you are not predestined to suffer from multi-infarct dementia, though you may run a greater risk of developing this disease. Many people who have a large stroke never have multi-infarct dementia, and many people who suffer from multi-infarct dementia never have a large stroke.
The best treatment for multi-infarct dementia is prevention – reducing the risk factors for any type of stroke: control your blood pressure, your weight, your cholesterol; stop smoking.10 Although there is no way of reversing damage that has already been done, making these changes may help slow the illness’s downward course.


Tuesday, June 1st, 2010
Barry Gurland, director of geriatric psychiatry at Columbia University and an expert on dementia’s clinical course, thinks the intellectual losses that occur as this dreadful condition advances are like peeling an onion. As time goes by, each cognitive milestone is stripped away in the reverse of the order in which it was attained. So first a person loses the mental skills acquired in adolescence – complicated abstract thought – then what was learned in elementary school – reading, the ability to add and subtract. Finally, the milestones reached at ages two and one are gone – dressing, forming sentences, going to the toilet.
Another expert on dementia’s clinical course, Penn State psychologist Steve Zarit, believes this analogy is misleading.  In his experience, not everyone changes in this lockstep way. Some people never become incontinent. Others, while unable to control their bladder or bowels, may retain even complex skills if they were passionate pursuits before the disease struck. A gourmet cook might still prepare meals even though she can no longer remember her husband’s name. A concert pianist may continue to play even though he needs help getting dressed. Zarit’s research shows that the disease often has an emotional course too. In the middle stages of the illness, very difficult behavior such as aimless wandering, or night waking or intense hostility toward loved ones tends to erupt. As more abilities are lost, people tend to quiet down. Ironically, in interviewing spouses caring for Alzheimer’s patients, Zarit and his colleagues found that as the illness reached its final stages, caregivers paradoxically found it easier to cope, largely because when the deterioration became profound the disruptive behavior abated.
Not everyone develops these difficult symptoms when the disease is in its middle stages. For instance, in tracking people with Alzheimer’s disease, University of Washington researchers found that only about 10 to 15 percent of their subjects ever became severely agitated or abusive. When people do lash out at loved ones – accusing a husband or wife of poisoning them, disowning a caring daughter or son – the reason is physical, not personal. The disease is destroying areas of the brain involved in modulating the emotions. It is not laying bare the true self or real feelings. Out real self is the one we have when out faculties are intact.
Perhaps the most heartbreaking aspect of this illness, however, is that we cannot predict how rapidly it will progress. Some people get worse very quickly, becoming unable to understand the basics of life within a few months after they are diagnosed, others may stay at about the same mental level for years. On average, people live a few years from the time they are diagnosed. But some die within six months and, with excellent care, others can live twenty years. So planning for the future becomes difficult, as a family either prays that the loved one will not get worse or yearns for the death that will end the pain.
Though dementia is a leading cause of death, the brain impairment itself is not what directly kills. In fact, at the 1986 annual meeting of the Gerontological Society of America, doctors from the Jewish Institute for Geriatric Care in New York reported that the Alzheimer’s patients were healthier than the average older person their health center served. As the illness Progresses, physical problems related to the mental losses arise that do cause death. A man may forget to swallow and choke on a piece of food; a woman may develop pneumonia from months of being in bed.


Thursday, May 21st, 2009

Starting school

The child should be prepared well in advance so that he anticipates it in a positive way. The parents can take him to school beforehand, showing him around and perhaps meeting the teachers. He should be involved in purchasing any requirements for school, such as a schoolbag, books or clothes. Sometimes it is beneficial for him to meet other children of the same age, who are starting school at the same time.

Starting creche or kindergarten

Starting kindergarten or daycare is just as stressful as starting school, though the child is younger and it is often more difficult to prepare him for it. During the first couple of days, it may be helpful for a parent to stay a little while, rather than leave immediately. Each kindergarten will have its own way of handling a child’s stress, and the preschool teacher will be experienced in handling separation anxiety in young children. Parents need to make sure that their own feelings of anxiety are not transmitted to the child — this will only serve to make things worse.



Monday, May 18th, 2009

Extreme cold from carbon dioxide, snow or liquid nitrogen will also result in death of the warty tissue, which sloughs away and the underlying skin heals usually without a scar.

Warts near the nailbed are prone to come back.

Plantar warts are often called papillomas and these are warts on the soles of the feet.

They are the same as warts elsewhere but because of the pressure of the foot against the ground or the shoe, the warty tissue is forced inwards and this presses on the sensitive nerve endings in the skin and causes pain.

These warts may be treated like those elsewhere but cutting them out or burning them with the electric diathermy may produce a tender scar.

The warts can be softened by using a local application and the base curetted away.

They do respond well to freezing with liquid nitrogen.

Plantar warts are usually multiple. Venereal warts or condyloma acuminata are the same as the others.

Their difference being that the warm moist conditions of the genital or anal areas produces a different type of wart.



Friday, May 15th, 2009

Metatarsalgia involves a breakdown in the horizontal arch of the foot. This arch is formed by the heads of the metatarsals, the long bones of the foot.

When this arch is weak, the ball of the foot flattens when weight is put on it. Pressure of the heads of the metatarsals pushing into the pad on the ball of the foot causes a painful callus.

This is a mechanical problem and requires a mechanical solution. A pad of sponge rubber or plastic foam inside the shoe may cushion the effect as the foot presses down. A metatarsal bar on the sole of the shoe will give relief. This shifts the weight behind the metatarsal heads and eases the pressure.

A Plantar wart may be mistaken for a callus. They occur on the soles of the feet, are often called papillomas and are like warts elsewhere on the body being caused by a virus.

Because of pressure when walking and standing, the wart tends to grow inwards. It is painful because the warty tissue presses on the sensitive nerve endings in the skin.



Friday, May 15th, 2009

Most women with symptoms of bladder irritation will lose these symptoms within a few days, whether treated or not. Those that have been given treatment for their nerves will get better and both they and the doctor may believe the problem is therefore of nervous origin.

In those cases where the urine shows no bacteria, the true cause of the symptoms lies in the urethra or at the base of the bladder where the ureters enter. This is called the trigone.

Often, the first attack of urinary infection may be that embarrassing condition known as “honeymoon cystitis”.

This is due to irritation and pressure on the urethra from regular and frequent intercourse in a woman unused to it.

Many a honeymoon has been spoilt for the bride and groom by such an experience, and many women have lost interest in sex because of the discomfort and embarrassment. A few doses of Citralka from the chemist will usually relieve the symptoms. Most doctors will prescribe antibiotics.



Friday, May 8th, 2009

The Russian Minister of Health told the story of a Russian centenarian from Caucasus who lived to the respectable age of 146 years. When asked for the reasons for his enviable longevity, the man said:

“I have never had a boss over me—I have never been envious of what others have—and I have periodically rejuvenated myself by marrying three times!”

Vibrant health, long life and sexual virility go hand in hand. All vital functions of the body should collaborate in perfect harmony, including the functions of the vital reproductive system. The health of the reproductive system is closely tied to the general state of health, which is, as we have already seen, dependent on vital nutrition.

In the last ten years many studies have been made which indicate that man’s sexuality is not an isolated phenomenon, but is an inseparable part of his total health entity. Doctors have found that man’s sexual capacity is directly related to his health and his mental and physical well-being. Furthermore, they have found that there is a direct relationship between man’s sexual health and the foods he cats. Recognizing that psychological causes are behind many cases of impotency and other sexual disturbances, the fact remains that nutrition is the most important single factor affecting one’s health, including the health of the reproductive system. Malnutrition and nutritional deficiencies may affect every aspect of man’s physical well-being. His sexual functions are no exception.

Just how does nutrition affect man’s sex life?

Man’s sexual life is directed by his glandular system, particularly by the so-called endocrine glands. The hormones produced by these glands, and by the ovaries and testes, hold the secret of your sexual power. Estrogen plays a vital part in the sexual life and reproductive functions of women; testosterone, the male sex hormone, plays an equally important part in man’s sexual life. These hormones and other secretions of the endocrine glands are your spark plugs, which provide sex stimulus and drive to your body as well as to your mind. The decreased function of the endocrine glands and diminished secretion of sex hormones will slow down all vital life processes and lead to premature aging. The healthy function of the endocrine glands is imperative not only for sexual virility and libido, but is also absolutely essential for your general health and for your feeling and looking younger far into advanced age. In other words, you are as old as your glands!

What can you do to keep your endocrine and sex glands in good working condition so that you will remain vital and virile as long as you live?

You can feed your glands! Your glands need certain nutrients in order to function properly. If the food you eat does not supply these essential nutrients, the normal function of the glands will be impaired, and hormone production diminished. Lost interest in sex and diminished or totally lost physical capacity for love will be the ultimate result.

Since the beginning of time man had certain remedies and foods for prolonging or increasing his sexual power. Every nation and every race had their favorites: honey, sesame seeds, oysters, nuts, eggs, etc. Modern medical science laughed at the notion that there is a relationship between food and man’s physical capacity for love. But in the last decade or two we have seen profound changes taking place in the attitudes of scientists toward sex. Doctors stopped laughing and began a serious inquiry into the mysteries of sex life. Now it is not only an old wives’ tale, but a well-established scientific fact that your libido and capacity for physical love are directly related to your nutrition.

It would take a book to relate to you all the exciting facts the scientists are coming up with with regard to the relationship between nutrition and sex. Much research is being done in Russia, France, and Germany in this field. There is also corroborative research being done in the United States. Here are a few revealing facts discovered by scientists.



Friday, May 8th, 2009

The most successful of all attempts to treat multiple sclerosis are the two dietary methods used extensively in Europe, particularly in Germany—the Evers therapy and the Waerland therapy.

Joseph Evers, M.D., is the founder of the only clinic in the world which specializes in the treatment of multiple sclerosis. He has treated well over 10,000 multiple sclerosis cases in his clinic and has achieved very dramatic results. Patients come from all over the world to Dr. Evers* clinic and in most cases they leave his clinic healed and restored to health. Naturally, advanced cases cannot be helped. If a major portion of the central nervous system is damaged and most of the vital organs affected, nothing can help the patient.

In his excellent books, The Changed Aspects of Diseases and Directions for Treatment of Multiple Sclerosis, Dr. Evers points out that multiple sclerosis is a metabolic disease caused by faulty nutrition. In the past, man has lived for thousands of years on pure unadulterated natural foods without poisons and toxic chemical substances. Today our foods, because of wrong agricultural methods, processing and chemical additives, contain over 2,000 substances to which man is not adapted and which his system is not able to handle. Dr. Evers specifically points out a replacement of wholesome sourdough whole-meal bread by devitilized white bread, and raw milk by pasteurized and homogenized milk, as some of the most serious assaults on man’s natural foods. Thus, denatured foods cause metabolic disorder and are responsible for the many degenerative metabolic diseases, such as obesity, arthritis, diabetes, and a host of other diseases, including multiple sclerosis.

Dr. Evers’ program

First, all manufactured, canned, processed, refined, frozen, and denatured foods are omitted. Anything made from white flour and white sugar is specifically prohibited, as such foods are lacking in the vital nutrients of vitamins and mineral salts. Coffee, tea, chocolate, salt, sugar, mustard, pepper, and vinegar are also prohibited.

Dr. Evers’ patients receive a diet of raw fruits, root vegetables, raw milk, raw eggs, raw rolled oats (freshly prepared and not steamed), honey and water. In addition, the patients receive sprouted seeds* and raw fermented foods, such as sauerkraut, fermented wheat and fermented dairy products. In less severe cases, and when the patients are well on their way to recovery (and also in the case of older patients), raw meat is added to their diet. Dr. Evers specifically uses raw ham and raw bacon. He permits an occasional glass of pure wine. As you can see, the emphasis is on raw foods.

Dr. Evers also treats with his diets other metabolic diseases, such as leukemia, rheumatoid arthritis, lymphogranulomatosis, and plasmocytoma. He has achieved especially good results in hundreds of cases of infantile muscular dystrophy.



Wednesday, April 29th, 2009


The third major zone is also divided into two zones—the fifth and sixth minor zones. The fifth minor zone is called the Skeletal zone. Further iris research may eventually require many minor modifications to this schema.

When a condition of the skeletal system is presented the sign should never begin in the

iris-wreath. It may project well into the muscle zone, just as it may also extend into the sixth zone—the skin zone. It is, however, a sign which is always localised precisely in the middle of the ciliary zone. On the other hand, a heart sign, for example is always found conjoined to the iris-wreath, as also are the pancreas, kidney and adrenal signs. But the leg area never begins in the iris-wreath. These facts should be especially noted.

The junction of the fifth and sixth zones—bones/skin—refers to the whole of the mucous membranes. This large and important organ system is found for the most part within the skeletal system, as for example with the pleura in the thorax, and the peritoneum in the abdomen. Therefore the condition of this system is to be seen in the iris at the junction of the fifth and sixth minor zones. There are also special signs which appear in affections of the mucous membranes.

In the sixth minor zone, the degree of skin activity can be seen. All body openings also have their places in this zone.

However, I would like to draw attention to the position in this zone of a few particularly important organs. The liver is placed in the right iris between 37′ and 40′ at the outer margin of the iris. In the left iris the spleen occupies a corresponding position—from 20′-23′.

The thyroid gland may also be mentioned—at 14′-17′ in the right iris, and 43′-46′ in the left iris. The cerebellum is indicated when disturbed or diseased in the right iris at 54′-56′ and in the left iris at 4′-6′.

The lung areas extend from the blood zone to the skin zone and are shown in the right iris from 45′-50′ and in the left iris from 10′-15′.



Tuesday, April 28th, 2009


An emetic is used to induce vomiting in certain cases of swallowed poison. Every medicine chest should contain an emetic, and syrup of ipecac is recommended. It’s convenient to have two small bottles, each containing a single dose of two to three teaspoonfuls for immediate use. Note, however, that vomiting should not be induced automatically in a case of poisoning. If the poison is an item not normally edible – such as petrol, turpentine, cleaning fluid – you should not make the child vomit because the poison may do more harm on the way back.

Nose drops, nasal aspirator, and decongestant

Along with aspirin and paracetamol, these items are useful in treating the symptoms of common colds. Ask your doctor to recommend types and uses.

Thermometer and lubricant

A multipurpose, stubby-bulb thermometer, which can be used rectally, is most practical. Any lubricating ointment will serve to grease a thermometer for rectal use, but a water-soluble gel is superior because it readily washes off in cold water.


The following are useful for treating minor accidents: antiseptic solution, antibiotic ointment, sterile gauze pads (50 x 50 and 76 x 76 mm), rolls of knitted bandage (50 mm and 76 mm wide), adhesive tape (6 mm wide), steristrips, and adhesive bandages of assorted sizes.



Tuesday, April 28th, 2009

Anorexia nervosa means literally “nervous loss of appetite.” Actually, however, persons with this condition-almost always female from upper- and upper-middle-class homes-do not lose their appetites. Rather, they willfully suppress the urge to eat in an unhealthy desire to lose more and more weight. In short, they starve themselves because they mistakenly believe that they are fat and need to diet.

After a certain point, anorexia nervosa leads to the cessation of menstruation. It also causes the destruction of healthy muscle and organ tissue that the body must use as an energy source in the absence of food. Ultimately, anorexic patients may starve themselves to death.

Anorexia nervosa is considered to be principally caused by serious psychological problems. Anorexic youngsters are usually obedient, successful children who try to do everything expected of them by parents, teachers, and friends. As a result, the anorexic’s strenuous dieting and exercising may represent a desire to gain absolute control over at least one part of her life.

Anorexics may also try to deny the onset of adulthood by dieting away all the signs of mature femininity: breasts, curved hips, and rounded thighs. The lack of menstrual periods, too, is a reminder of childhood. In addition, the current preoccupation with thinness as the ideal of attractiveness fuels the anorexic’s desire to starve herself to the “perfect” weight. Frequently, the condition arises after a casual remark that the girl is slightly overweight.

The anorexic’s fear of becoming fat is accompanied by a distorted body image that makes it impossible for her to realize how unattractively thin she has become. Often when an anorexic looks in the mirror, she perceives herself as fat when in reality she is exceedingly thin.

The anorexic develops an aversion to eating which cannot be overcome by threats or appeals to reason. The dieting is accompanied by overly vigorous exercise to burn off the few calories that she does consume. Although she refuses to eat more than tiny amounts of certain foods, she is often obsessed with the subject of food and will prepare elaborate meals for others.

Often the anorexic may go on an eating binge after which she forces herself to vomit. Excessive use of laxatives is also common.

After a certain percentage of body fat is lost, menstruation will automatically cease. Fine, downy hair may begin to grow all over the patient’s body.



Thursday, April 23rd, 2009

It’s not that skeptical scientists don’t believe that hundreds of thousands of people will be celebrating their 100th birthdays in the years to come. But the buck pretty much stops there, they say.

“It’s true that we’re living about 30 years longer than we did at the beginning of the century,” says Dr. Olshansky. “But if you look at the data, those advances are due to how much we’ve been able to lower infant and child mortality. Now that we’re trying to extend life expectancy on the back end of life, those improvements have slowed dramatically.”

In 1993, there was actually a small dip in life expectancy, followed by a stagnant period in 1994. Since then, we’ve made some gains. Life expectancy is expected to pick up some steam again, but the U.S. Census Bureau has conservative estimates. By 2050, they predict, the average man will add about 7 years to his life, living to about 79-7 years. If they’re right, plenty of men would reach the century mark, but not much longer than that.

“Though people like to talk about how much we understand the aging process, that doesn’t mean that we’ll be able to do anything about it,” says Dr. Siegfried Hekimi of McGill University. “We can mutate certain genes in worms so that they live five times longer, but that’s by slowing them down metabolically so that they live five times slower. You have to stop living to stop aging, and I doubt that people want to do that.”



Thursday, April 23rd, 2009

A discussion of snoring would be incomplete without acknowledging the fact that snoring in children can be as socially disruptive and as medically demanding as that of adults. One of the problems arising from any discussion of children is the tendency to make generalizations about a group which undergoes complex changes from infancy to adolescence. Size of airways, breathing rate and shape of the chest wall are just some of the variables which change significantly in the first few years of life, highlighting the need to specify the age group in question. Another problem relating to the investigation of young children is the inability of parents to give an adequate description of the child’s symptoms. Difficult breathing during sleep, whether it be described as wheezing, coughing or choking can be symptomatic of any number of disorders, the doctor’s task being made all the more challenging if these symptoms only occur at night.

The first priority is to identify these nocturnal events either by having the child observed during a hospital admission or by making a sound recording of the events on a portable tape recorder. Any abnormal breathing associated with sleep should be investigated but for the purpose of this discussion it will be assumed that nocturnal snoring has been confirmed. Data on the incidence of snoring in healthy children is unreliable, ranging between 10% and 25%, a variation possibly arising from different age groups and populations selected from one study to another. It is therefore not an uncommon occurrence and parents should not be alarmed by the observation of occasional snoring.

The common factor in both adult and childhood snoring is a comparatively narrow upper airway compromised by a lack of muscle tone during sleep. Whilst accepting that obstructed airways of different age groups have something in common, there are differences in the incidence of underlying causes. Enlarged tonsils and adenoids remains one of the most common findings in snoring children and, although there has been some reticence in recent years to remove tonsils and/or adenoids, surgery is certainly warranted in cases of persistent heavy snoring which is accompanied by complete and repetitive airway closure. Upper respiratory tract infections and nasal congestion are more likely to cause problems in newborns and young children, given the narrow diameter of their airways and susceptibility to collapse. In the absence of other predisposing factors, a return to normal breathing would follow the successful treatment of such infections or allergies.

Children born with structural abnormalities of the head and face (or craniofacial abnormalities) will be prone to snore if the structure results in compression or narrowing of the upper airway. There are several well described syndromes, each with characteristic facial and anatomic features which interfere with normal breathing. Children with Down’s Syndrome, for example, with the characteristic flattened face and nose, short neck, small jaw and mouth, and general lack of muscle tone, may have symptoms of obstructive sleep apnoea (OSA) depending on the severity of the syndrome. Other anatomical factors common to both young and older snorers include a large or poorly positioned tongue, abnormal jaw alignment, an excessively fleshy soft palate and obesity.

As with adults, the differentiation between mild snoring and OSA in children ultimately depends on the results of overnight studies in hospital. However, a clue to the need for further investigation is provided by the observation of certain behavioural changes. Snoring accompanied by laboured breathing and frequent arousals is suggestive of OSA. Sleep disruption then manifests itself as lethargy, sleepiness, irritability and possible learning difficulties and behavioural problems at home and at school. The weight and stature of these children often falls behind that of their peers, commonly referred to as a “failure to thrive”.

Hospital or sleep unit admission screens for the same physiological changes seen in adults with OSA, with blood oxygen saturation being the most important measure of airway obstruction. The options available for treatment of heavy snoring or OSA in children are not as diverse as those available for adults. Middle-aged, overweight adults with the problem show considerable improvement with weight loss and alcohol avoidance, conditions which may be difficult to enforce or which simply do not apply to young children. Continuous Positive Airway Pressure (CPAP) applied through a nose mask has been used successfully on infants and older children, but in general cooperation by younger people who are unaware of its benefits remains a problem.

In summary, snoring in children is fairly common. Parents should not be alarmed by mild snoring but should consult their doctor if sleep disruption or difficult breathing becomes a regular feature at night.



Thursday, April 23rd, 2009

However we define health, illness and prevention, it has to be said that health and disease are very unevenly spread throughout society. Put bluntly, people lower down the socio-economic scale have more disease and illness, and die younger, than those higher up. Analyses show that since 1910 those at the top of the social scale have consistently lived longer and are healthier, both mentally and physically. Not every disease is less common or causes less mortality among those better-off in socio-economic terms but this is generally so.

One of the best illustrations of health differences between socioeconomic groups is the infant mortality rate. In 1975-7 the infant mortality rate in the world was 99 per thousand live babies, ranging from 11-20 per thousand in advanced countries to 100-200 per thousand in less developed countries. Within advanced countries, though, the variation between the figures for different socio-economic groups is remarkable, with those lower down the scale having three times the infant mortality of those higher up. Whilst British and US statistics show a consistent overall fall in infant mortality the differences according to position on the socio-economic scale

still persist.

In the US socio-economic group is clearly related to racial composition since a large proportion of the non-white population lives in poverty. This is less true of the UK but there are close parallels. Infant mortality rates amongst the US black population are still double those amongst the white population-in fact the gap has widened over the last thirty

The crucial questions when thinking about prevention are to do with trying to understand why these discrepancies occur. Factors such as the mother’s age, nutrition, literacy and use of the health services greatly influence the risks for her baby. ‘High-risk’ mothers are more likely to be at the extremes of reproductive age, to be unmarried, to have had several babies, and to have had miscarriages and still-births. There is also a higher incidence of prematurity and low-birth-weight babies in the less advantaged socio-economic groups. These two conditions carry an increased risk of infant mortality and of physical and intellectual handicap in the baby. Women from these groups also have two behavioural factors that act against the best interests of their babies – they are more likely to smoke, and to have below-normal weight-gain during pregnancy.

I have used infant mortality as an example, but there are many other sets of statistics that show how much more commonly diseases occur in the jess advantaged sections of society. Infectious diseases are more common, possibly because the poor may be living in conditions which make infections more likely and lower their resistance to them. As recently as 1972 the mortality rate for ÒÂ among British men was ten times as great lower down the social scale as it was at the top. Better environmental conditions do not always act in favour of the rich though. People living in poor sanitary conditions acquire antibodies against poliomyelitis and hepatitis A virus early in life, whereas those living in clean conditions are vulnerable unless they are immunized.

When we look at chronic illnesses such as heart disease and cancer-the two biggest killers in the western world-the story is more confusing. The relationship between socioeconomic group and heart disease, for example, has changed with time. A position towards the bottom of the scale seemed to ‘protect’ men from heart attacks in 1960 but today this advantage has largely disappeared. One UK study found that the direct relationship between socio-economic status and heart disease (those at the top of the scale having more heart disease) disappeared when each category was analyzed for physical activity. Once, the kind of work a person did was what determined his or her level of physical activity, but with the coming of jogging, squash and other leisure-time sports this is no longer so.

There is also a relationship between socio-economic group and psychological well-being, whether one is rating subjective happiness, psychiatric symptoms, or first admissions to mental hospital. Studies show that certain neurotic conditions are commoner among those lower down the socio-economic scale. These groups are less likely to feel well in themselves, physically and psychologically. In a major US survey, groups lower down the socioeconomic scale (mostly members of racial minorities) were consistently (60 per cent) more likely than those higher up the scale to report their health to be ‘fair’ or ‘poor’. Reports of ‘excellent’ health increased with income-and people in the highest income group were more than twice as likely as those with the lowest incomes to report ‘excellent’ health. The factors influencing these differences are very complex and far from completely understood. It is clear, though, that the influences determining an individual’s health are many and varied, and are not always within his or her own control.



Thursday, April 2nd, 2009

Much of what has been said about nursing homes is relevant also to residential home care. Many people with dementia who live on their own may well need to go into residential care when they can no longer be maintained in their own home, despite the fullest use of community services. This will often happen well before the stage at which they need nursing care, and the choice will usually be between the social services welfare home, or ‘Part III accommodation’, and a private residential home. The local authority will levy a charge on the demented person’s estate, after applying a means-test, if he or she has any financial resources. Private residential home charges are often higher than those in local authority homes, but there are many statutory grants that will help cover the cost. These arrangements may change after the new regulations, based on the Griffiths Report, come into effect, but a local social worker will be able to advise.

Most residential homes cannot cope with a heavy, physical nursing load nor with markedly impaired behaviour unless the home is specifically designed for this type of resident. It is very likely therefore that the time will come when a demented person in a residential home will have to move to alternative accommodation, most usually a nursing home or a hospital continuing-care bed. This of course is where the benefits of dual registered homes come in. The criteria for choosing an appropriate residential home are very similar to those for choosing a nursing home. Private residential homes are often smaller and more homely than local authority homes, but this is by no means always the case. Staffing levels may vary considerably between homes and although it is not so important to have trained nursing staff to hand, it is essential to inquire about the staffing ratios and the qualifications of those employed.

Arranging for a confused relative to be admitted to a home can seem a major problem. The person to help you most is the social worker. He or she should get to know your relative, provide you with a list of homes, point out the sorts of things you ought to be taking into consideration, beyond those mentioned in this book, and help you with the financial arrangements. The social worker should also be able to assist you with any worries and reservations you may have about placing your relative in a home, and may be prepared to keep in touch with you for a while afterwards, as the guilt and other emotions that are sometimes aroused by such a move can be very distressing for the carers who have arranged it.

It may be more difficult to persuade a person early on in the course of his or her illness to enter a residential home, than to persuade a more demented elderly person to accept a move to a nursing home. It is important that you, and if necessary also the social worker concerned, try to involve your relative in making this decision. Again, gradual habituation to the new environment by occasional day attendance may make it easier. Because many residential homes are unhappy about taking on very confused people, occasional attendance of this sort will give them the opportunity of assessing whether or not they can cope. It will also give you the opportunity to assess how they react to your relative and to assist in making the decision as to whether or not placement in a nursing home may be more appropriate.



Thursday, April 2nd, 2009

For many people, guilt is the most destructive of all the emotions aroused by caring for a person with dementia. It can undermine the carer’s self-esteem and can arise, initially, as a consequence of choosing a course of action deemed best for the sufferer. On the one hand the family may decide to have an elderly parent living with them, so that they can care for him or her; on the other they may decide that the sufferer would be best looked after in a hospital or a home. In each situation the carers will believe that the path they have chosen is best for their relative, either because they are preventing them from having to live in an institution or because they are avoiding the need for them to live at home where everybody else in the house may be out at work or school, for example.

So often, both approaches result in considerable guilt. The family that have decided to entrust the care of their relative with dementia to an institution feel guilty about not looking after him or her themselves, while the family who have elected to keep their relative at home may worry that by providing such a high standard of care they have prolonged a life that is causing distress to the sufferer and may also have introduced all sorts of stresses and strains into the family that they never dreamed would occur. Whatever you do is likely to appear to be wrong at some time. There are very few situations to which there is only one correct answer — in most you have to accept the best compromise, and this will vary very much from family to family. It has to be remembered that by the very nature of compromise, there are bound to be disadvantages to the chosen course of action.

Many of the other problems that are mentioned in this chapter – anger, changing family responsibilities, the possibility of your own physical illness, sexual relationships, and so on – may well make you feel guilty and undermine your self-confidence. As with so many other similar positions it is impossible to come to terms with such a problem and live with it until you realize what is happening and can accept it. In these circumstances you also have to accept that you are in a no-win situation and as long as you know that you are doing the best that you can, that is all that anyone can expect of you. It is essential that you break free from your own particular circle of guilt as much as you possibly can and don’t allow it to stop you thinking positively about the future.

Guilt that is festering inside can be very damaging. You may not wish to talk to other people about it, either because you are too ashamed to admit that you feel guilty because of something that has happened or because you feel they won’t understand your own emotional responses. This is where counselling can be very helpful, whether in the form of attending a support group or on a more individual basis, and discussing the problem with others who have either faced the same problems themselves or worked very closely with families in a similar situation in the past.

You may at times be embarrassed by the behaviour of your relative with dementia, whether this involves something dramatic like screaming in public or forgetting to pay for things in a shop, or more minor problems like poor table manners which are apparent to other people. Incontinence and changing sexuality also cause embarrassment. Many carers feel guilty about their own embarrassment, but this is a situation that you should be able to tackle. Explaining the situation to others involved and asking them to make allowances would be much more helpful than trying to pretend that nothing is happening or that you don’t know what is going on. Sharing the problem, where this is possible, will often relieve the tension and sense of embarrassment. This in itself will help alleviate the degree of guilt that may be felt. So it should be possible in some but not all situations that are potentially embarrassing to reduce the feeling of guilt by reducing the extent of the embarrassment.

Arranging for a relative with dementia to be admitted to a home or a hospital, even for a short period, is one of the situations that often arouses the greatest feelings of guilt. Even if a break is desperately needed or you have been caring for your relative for years and really have got to the end of the road, the feeling of relief is so often mingled with one of shame at having apparently abandoned him or her to the care of others. If the admission is a short-term one, to allow you to recharge your batteries, being advised to stay away or to go away on holiday so that you have a complete break, may make this feeling worse. It is important, however, to put each of these situations in the correct context. As far as a short-term admission is concerned, this is the sufferer’s side of the contract. In return for being unable to continue living at home the sufferer has to accept, albeit unknowingly, some of the consequences of the unsatisfactory nature of the compromise that has been forced upon all involved. A short-term admission to allow the carer some relief is after all in the sufferer’s best interest. It will usually result in being able to stay at home for longer and even if he or she is distressed while away from home, and disturbed for a while afterwards, the memory will soon fade.

When institutional care has had to be arranged on a permanent basis, whether in a hospital or in a private home, there is no need to feel a sense of abandoning the sufferer. The need usually arises after the carers have done all they can to cope for as long as possible and when, because of their own particular circumstances, and possibly others relating to the sufferer, they can no longer provide the necessary level of care. At this point, the sufferer is usually best looked after by people with professional skills. The fact that some families manage to continue caring at home until the end of the illness should not make others feel guilty if they are unable to do the same. Circumstances are never the same and we are all made differently; some people can cope more effectively with particular situations than others and some dementia sufferers are much more difficult to cope with than others.

There is also no need to feel that you are abandoning the sufferer if you continue to visit him or her on a regular basis while it still seems to you that you are eliciting some kind of response. For many dementia sufferers, however, the time will come when it is no longer important who looks after them, but essential that they are looked after in the best way possible. Social interaction is eventually reduced for many, although not all, dementia sufferers and there will come a time when regular visiting may seem less important. If this situation does arise, it is still important to visit from time to time for the sake of the professional carers who have taken over. It will also enable you to keep in touch with what is going on and to be happy that as much as can be done, is being done.



Thursday, April 2nd, 2009

It can be very difficult to choose a new general practitioner, either because you have moved into a new area or decided to part company with the practice with which you are currently registered. Ask friends and neighbours who their doctor is and where the surgery is located. Ask them how they get on with their doctor and what they see as the strengths and weaknesses of the doctors they know. If possible, try to make contact with other people caring for a person with dementia and see whether their doctor has the qualities that you think are important.

Make a shortlist of practices – there will probably only be three or four at most within easy reach of your home, fewer in rural areas – and visit them. You can tell a lot from the atmosphere that you pick up as you enter the surgery and from the attitude of the reception staff. Make a list of questions to ask such as are the doctors taking on new patients, are you in their area, how do you register with them, do they have any particular interests, and do they visit the elderly house-bound. Ask if you can make an appointment to talk to one of the doctors before registering with them. The way in which your questions are treated, and more importantly whether they make you feel welcome, should help you to decide if this is the practice with which you wish to register.



Thursday, April 2nd, 2009

Loss of brain tissue — atrophy of the brain substance – leads to a progressive shrinkage of the brain as the disease advances. Viewed externally, the brain therefore looks smaller and the spaces or sulci between the ridges, gyri, become bigger. Internally, the hollow spaces within the brain enlarge; the brain from a person with Alzheimer’s disease weighs less than normal. The degree of wasting is most marked in younger patients; in many older people with the disease the brain can appear very similar to that of a non-demented elderly person. The shape and degree of wasting of the brain can be seen on modern brain scans.

Although there is no particular diagnostic feature of Alzheimer’s disease when the brain changes are observed in this way, the absence of any other abnormality, a cerebral tumour or stroke-damage for example, makes the diagnosis of Alzheimer’s disease more likely. The similarity, however, between the degree of brain wasting in normal old people and elderly subjects with Alzheimer’s makes this observation of less value than in younger people, for whom any significant degree of atrophy is quite clearly abnormal. The most marked loss of brain substance usually occurs in the temporal lobes, particularly in the structure known as the hippocampus. As this part of the brain is particularly important for memory function, this fits in well with our knowledge that memory loss is one of the major symptoms of the disease.

At a microscopic level there are two main changes, both of which have already been briefly mentioned. One of these is the formation of disc-like plaques of abnormal tissue, found especially in the grey matter of the cortex; the other is the collection inside nerve cells of bundles of an abnormal fibril-like substance, called neurofibrillary tangles. Both of these occur to a lesser extent in the normal ageing brain. In Alzheimer’s disease the changes are more widespread and greater in number.

Further changes that are found in the brain of a person suffering from Alzheimer’s disease include abnormalities within the cells and the formation, within the walls of some of the small blood vessels, of an abnormal substance called amyloid. This amyloid is very similar to the material that is found in the centre of the plaques. It is found in significant amounts in many cases of Alzheimer’s disease and is also sometimes discovered in apparently normal, older people.

Amyloid is found in other parts of the body in other medical conditions. Some researchers have looked for a connection between the amyloid of other conditions and that of Alzheimer’s disease. The amyloid of Alzheimer’s is very different to that found in, say, the liver or the heart in other unrelated illnesses. At the moment it seems unlikely that there is any specific link.

The abnormalities that affect the brain cells would seem to lead to the death of many of them. Therefore when the cerebral cortex is examined under the microscope it becomes apparent that there are, in many areas, fewer cells than there should be and that a significant proportion of those that remain are affected by abnormal changes such as neurofibrillary tangle formation. In addition, some of the supporting glial cells increase in number. The general pattern of these changes, however, varies considerably from case to case and the largest number of nerve cells appears to be lost from the temporal lobe and the hippocampus. The actual degree of cell loss is still a matter of dispute because measurement of cell numbers in the brain is technically very difficult. It is, however, generally agreed that the greatest cell loss occurs in younger subjects.

There are also changes in the pattern and extent of branching of the nerve fibres in the brain. Although these are difficult to understand, they are probably one of the more important changes as nerve cells interact with each other via the connections, or synapses, made between their nerve fibres and the nerve fibres of other cells. The disruption of this system of communication leads to neurological disorders.

The plaques, commonly called senile plaques, and neurofibrillary tangles are the best-researched of the abnormalities and probably the most important.

Senile Plaque

Senile plaque can be shown to consist of granular material in the centre of which is a substance loosely referred to as the core. The granular material on the rim of the plaque consists largely of nerve cell fibres, their contents, and a collection of glial cell fibres. In other words, this rim consists largely of components that are normally part of brain cells. The centre of the plaque is made out of amyloid, now known to be similar to the amyloid protein found in some of the blood vessels.

These plaques multiply in the cerebral cortex in normal people as they age and are occasionally discerned in the brains of intellectually normal people in their thirties and forties. More usually, however, they begin to build up from the age of fifty. In a person with Alzheimer’s disease they are present in considerably increased numbers and in some cases it is difficult to find an area where you can see the normal structure of the cortex because there are so many plaques crowded into the grey matter. Although they look like flat structures, this is because they are normally observed in cross-section. In fact, they are spherical or oval and seeing them on a microscope slide is rather like taking a hard-boiled egg, cutting a thin slice out of it, laying it down, and looking at it. The yolk would be the equivalent of the amyloid core and the white around it the equivalent of the granular rim of the plaque.

In Alzheimer’s disease these plaques particularly affect those parts of the brain that are associated with memory function. They spread to involve heavily all the grey matter, but not the white matter — that part of the brain that is predominantly made up of nerve fibres.

It seems very much as if the plaques are composed of nerve cells that have begun to degenerate, glial cells that may have been attracted towards the degenerating nerve cell structures, and the amyloid substance in the centre. How they are formed is a matter of conjecture. One theory is that the protein that makes up the amyloid core leaks out of damaged blood vessels; another is that abnormal processes within nerve cells lead to the death of some of their branches and that this somehow leads to the formation of plaques.

Neurofibrillary Tangles

Neurofibrillary tangles occur inside brain cells, particularly the larger neurones. Again, they are especially seen in those parts of the brain that are involved in memory function and like plaques are present in small numbers, in circumscribed areas of the brain, in people who are old but intellectually normal. Eventually the cells containing them die and all one can see is the neurofibrillary tangle material lying free in the brain substance – usually cortical grey matter. Each of these tangles is made up of many smaller filaments arranged in a helix or spiral. They are mainly situated in the cell body, but may extend into some of the nerve cell processes.

Many people feel that neurofibrillary tangles are a better indicator of the presence of Alzheimer’s disease than are plaques. The number of tangles, rather like the number of plaques, relates well to the severity of the dementia; people with more severe Alzheimer’s disease usually have greater numbers of both.

The cause of neurofibrillary tangle formation is, like so many aspects of Alzheimer’s disease, still a matter of speculation. It has been thought that aluminium may be responsible, but for reasons discussed in a later chapter this seems unlikely. It may be that there is a genetic cause or that some infectious agent is responsible. At the moment we really don’t know, but a better understanding of the processes that lead to the formation of tangles may well help us in the fight against the disease.



Thursday, April 2nd, 2009

As has been mentioned already, nerve fibres connect with parts of other nerve cells. The message travels down the nerve fibre using a process that is often likened to an electrical current flowing down a wire. This is a convenient way of thinking about it, and although it isn’t quite right, for our purposes it is a useful analogy. When it gets to the end of the nerve fibre the message has to ‘switch on’ the next nerve cell or one of its dendrites, and there is a special system to make this possible.

Although it looks as if the connecting parts of two nerve cells are actually in contact with each other when they are viewed through an ordinary microscope, we know from the electron microscope, which can produce an even higher magnification, that there is in fact a gap between the axon that is bringing the message and the part of the cell that is going to receive it. This gap is extremely narrow and the way the first nerve cell activates the second is by releasing a special chemical into this gap. The chemical travels across the gap until it hits a specialized area on the cell which is receiving the message, and the interaction between the chemical and the receiving area, which is called a receptor, switches on the second cell. This neurone then either transmits the message to further cells by a similar process, or reacts to the messages received in some other way.

These chemical messengers are known as neurotransmitters, and if they were to stay in the gap, which is in fact called a synapse, they would continue to stimulate the second nerve cell, which in many cases would result in its death as it would be over-stimulated. The body has, therefore, very cleverly arranged for other chemicals to be present at many of these synapses so that they can break down the neurotransmitter after it has done its job. In many of the illnesses that cause dementia, such as Alzheimer’s disease, there is a gross disturbance of the chemical neurotransmitter system. Developing medicines to try to put this right is one of the approaches to treatment that is still being experimented with, as is described in a later chapter.