MAKING DIAGNOSIS FOR HYPERTENSIONThere is general agreement that optimal blood pressure is 120/80 or less. However, exactly what blood pressure constitutes hypertension is subject to some interpretation. In the past a diagnosis of hypertension was often based exclusively on diastolic blood pressure (the bottom number in the blood pressure reading). If your diastolic pressure was over 90, you had high blood pressure. It was felt that because the heart takes longer to rest than it does to beat, the diastolic measurement was more significant. However, more recent research has made it clear that an elevated diastolic pressure is no more hazardous than a high systolic reading – and the latter appears to be an even more accurate predictor of cardiovascular risk. The current consensus is that elevations in either systolic or diastolic blood pressure readings should be taken seriously. This is particularly true among older people, who may have dangerously high systolic readings while maintaining virtually normal diastolic blood pressure.According to current American Heart Association guidelines, hypertension is clinically defined as a systolic blood pressure greater than 140 or a diastolic pressure greater than 90. This echoes the recommendations of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC), a widely respected National Institutes of Health task force of physicians who are experts in hypertension and whose recommendations are approved by most major organizations. The JNC, which updates its recommendations periodically, published its sixth and latest report of guidelines in November 1997. The committee devised an updated system of diagnosis using both systolic and diastolic blood pressures to assess a patient’s health risk. The guidelines also recommend that clinicians specify other known risk factors, including smoking, immoderate drinking, and routine overeating. All of this information is then combined to determine the stage of risk for a specific patient. The higher the stage, the greater the patient’s risk of a heart attack or stroke.However, more recent research suggests that blood pressure readings for a diagnosis of hypertension might need to be adjusted downward. In June 1998, results of the Hypertension Optimal Treatment (HOT) trial, a five-year study involving almost 19,000 patients from26 countries, were published in The Lancet, one of the world’s leading medical journals. Researchers found that patients who were able to lower their systolic blood pressure to an average of 138.5 mm Hg and their diastolic blood pressure to an average of 82.6 had major reductions in heart attack and stroke risk. In early 1999, the World Health Organization and the International Society of Hypertension recommended that the upper limit for high normal blood pressure be lower, 130/85 (down from the JNC’s upper limit of 139/89). They based this on findings of the HOT trial and other studies showing that stroke and heart attack risk are dramatically reduced when diastolic blood pressure is less than 85.You may be thinking, “Why quibble over such small numbers? What’s the difference between 85 and 89?” According to an article published in the Journal of the American Medical Association in March 1999, a decrease in diastolic blood pressure of only 5 to 6 points lowers your risk for stroke 42 percent.*5/313/5*

TREATMENT OF CANCER: MEANS TO ELIMINATE DISEASEModern medicine has four chief means for eliminating cancer from the body. These are surgical operation, radium, X-ray and new specific drugs. By surgical operations the entire cancerous structure is removed and usually with it the organ that contains the cancer, if that is not a vital organ. Some cases of tumor are especially susceptible to radioactivity. They are called “radiosensitive.” Other types are resistant to the radioactive rays. The X-ray, particularly the modern type of high-voltage, deep-penetrating X-ray, can be used in areas in which radium cannot be implanted and to which radium cannot extend.This does not mean that every case of cancer can be treated by just one method. Every cancer is different from every other cancer. The doctor must decide in each instance the forms of treatment that will be most helpful. In some instances not only surgery, X-ray, and radium are employed but also other techniques. The female sex hormone or estrogens are used in the control of cancer of the prostate. All over the United States studies were made under the direction of the Therapeutic Trials Committee of the Council on Pharmacy and Chemistry of the American Medical Association to determine whether or not testosterone, the male sex hormone, is valuable in treating cancer of the breast. Apparently it is helpful in preventing spread from cancer of the breast to other portions of the body.With cancer of the breast early attention is vital. If a cancer of the breast comes to proper medical attention within the first few months the woman can have practically her normal life expectancy. If she delays to the time when the cancer has extended to the glands under the arm her life expectancy may be greatly reduced. Studies made of thousands of cases of cancer of the breast prove with certainty that early attention prolongs life. Delay is likely to be fatal.Not so many years ago a cancer of the lung was invariably fatal. In 1933 a surgeon for the first time removed an entire lung by operation, because of the presence of cancer. The patient was another doctor. That patient is still alive. Today there are hundreds of people throughout the United States who have had all or part of a lung removed and who have survived the operation successfully. Thus what was an invariably fatal condition now yields in a considerable percentage of cases to modern methods of treatment, and patients recover. Similarly, cancer of the stomach was formerly considered invariably fatal. The percentage of recoveries in cases that are diagnosed early and that submit to proper surgical treatment is considerable. Unfortunately, far too many wait too long. The prolongation of life includes years which are exceedingly valuable, because these conditions do not generally occur in extremely young people but usually in men and women at the top of their productive periods.Drugs called nitrogen mustards and other drags that stop cell growth are now available for use against cancer. All are powerful and can be used only as prescribed by the doctor. A drug called methatrexate is specific and saves lives in cases of choriocarcinoma, a cancer of tissues involved in childbirth. Sarcolycin and actinomycin D have been used against other forms of cancer.The death rate for cancer is still high. The new knowledge that may come through research may even serve to prevent the appearance of cancer among great numbers of people whose fathers or mothers or ancestors may have had cancer and died of it and who therefore form something resembling a stock or type in which cancer is more likely to occur than among the population generally.*5/318/5*

RHEUMATOID ARTHRITIS AFFECTING THE BODY: SPINAL CORD, BLOOD AND MOREWhat happens to the spinal cord in the neck in RA?This is one of our biggest worries. When the cervical, or the neck, bones have arthritis and inflammation, there is the risk of the spine becoming unstable. A simple X-ray will confirm whether the spine is at risk for damage. Damage to the neck spine results in weakness of the extremities, or even paralysis. Destruction of the spine nerves bears no relation to the amount of pain felt by the patient, so damage can ensue without any warning. Suddenly, subtle signs and symptoms of damage, including weakness or loss of feeling in the arms or legs, just appear.
What is amyloidosis?Amyloid is a form of protein with a small bit of sugar attached. This material deposits in organs and tissues in people with chronic disease, particularly rheumatoid arthritis, causing problems. It can infiltrate organs, resulting in dysfunction.
What does RA do to my blood?Patients with RA have anemia, or low red-blood-cell count. This is not due to blood loss, but rather because the bone marrow, where red blood cells are produced, is affected by the disease, and thus the cells are not made efficiently. This is called anemia of chronic disease. There is no amount of vitamin or iron that will successfully raise the blood count to normal in a rheumatoid patient.
What is Felty’s syndrome?This is a serious and little understood disorder that can occur as a result of RA. Patients with severe nodule-forming RA generally get this syndrome. The white cell count drops, the spleen enlarges, and some patients get leg ulcers. Sometimes lymph nodes enlarge, and the patient’s platelet count drops precipitously. Fortunately, aggressive therapy with disease-modifying anti-rheumatic drugs (DMARDs) often causes complete resolution of this syndrome.*16/141/5*