REATMENT OF ALCOHOL PROBLEMS: ALCOHOL ABUSEAlcohol abuse is similar to alcohol dependence (alcoholism) except for the absence of physical dependence, that is withdrawal and/or tolerance. Practically speaking, alcohol abuse can be considered to be present when there is a pattern of alcohol problems and the sense that alcoholism is “just around the corner.” Alcohol abuse may be present in an individual even if loss of control is unclear because there may have been no efforts to control or moderate alcohol use. If physical dependence and loss of control have not occurred, then moderation of drinking practices from a physiological standpoint is possible. However, depending upon the person’s social situation and life circumstances, this may still represent a monumental feat. Consider the college student who is heavily into the partying and drinking set. Changing drinking patterns will require marked changes in the student’s circle of friends, daily routine, and choices of recreational activities. To achieve this magnitude of change will require the client be engaged in more than a Dutch uncle talk!To do this, to our minds, requires that the individual be engaged in some formal alcohol treatment, which involves alcohol education, individual counseling, and participation in a group with others in the same situation. Monitoring the individual’s efforts to moderate alcohol use and avoid future problems is imperative. Through this process, in a number of cases, evidence may mount that there is loss of control, or preoccupation with drinking. Therefore abstinence and alcoholism treatment is now needed. In essence, if efforts to address alcohol abuse are unsuccessful, the diagnosis of alcoholism can now be made.*95\331\2*

ASTHMA: TRAPS FOR THE UNWARYNow for the moment you’ve been waiting for, when you can start playing detective to your own body: innocent heir to generations of genes and perhaps not-so-innocent victim of assaults dating back to childhood.The Pulse TestAlthough it has some shortcomings, the pulse test is a simple screening procedure that may at least provide some insight into the problem to the alert patient and therapist. Unfortunately, some people regard it as a conclusive test rather than a pointer in the right direction.Muscle and Kinesiology TestsThese can be very useful and accurate, provided the relevant measurements are taken very carefully. The muscle test consists simply of asking someone to hold their arm out and resist any pressure you apply to the arm to force it down. After noting how difficult or easy (if you are much bigger and stronger) it is for you to do this, you place a small amount of the substance to be tested under the patient’s tongue and wait a few seconds. Then you repeat the exercise. If the patient is allergic to the substance, he or she will notice immediately that it is much harder to resist the pressure applied to the arm. Unfortunately the test has some pitfalls and requires very careful administration.Elimination Testing: Avoidance-Challenge Tests Avoidance-challenge tests are probably the simplest to perform and, if carried out accurately and with the proper preparation, can give a great deal of information. The biggest point in their favour, of course, is that they can be performed by anyone at home without outside assistance.The Provocative Fasting-Challenge TestsIn the fasting-challenge test, the patient is asked to go home and fast totally for four days. Once again, care must be taken to drink only distilled or purified water and avoid exposure to chemicals such as perfumes, aerosol sprays, gas heaters, tobacco smoke, car-exhaust fumes, polishes and so on, and air-borne inhalants such as dust and mould spores. By this method, your body gets into a pristine state in which its response to an offending substance will be swift and dramatic.On the fifth day you start to eat, carefully re-introducing, one at a time, each member of the avoided food family until some or all of the original symptoms return.The Cytotoxic TestThe name ‘cytotoxic’ is taken from the Greek word for cell (cytol), and the test is designed to find if a food may be toxic to the cells in your body. Most experts in allergies and environmental medicine have stopped using this test in all but a few special cases, because the cost is not often justified by the results. Since the procedure is very convenient we still use it occasionally with children or people who are unable to try any sort of diet.A little blood is collected and parts of it are placed on a slide which is coated with a specific food. Well over 100 different foods, as well as some chemicals, can thus be tested from a single sitting by the patient. A technician then examines the way in which cells are damaged by contact with various foods and the reaction is graded with plus signs (+). One plus signifies a borderline likelihood that the food is toxic, two plusses indicate a slight probability, three a moderate one and four a stronger probability.This is where the problem begins. First, the results depend heavily on the skills, experience and even the enthusiasm of the technician. The bias of the laboratory promoting the test may also influence the eventual outcome. Here is what a world expert on cytotoxic tests, Dr Robert Pottenger Jr, has to say:… It is important to choose a reliable, unbiased lab with good, responsible technicians, because if he or she only gives a quick glance to the test preparation, there is a risk in making false positive readings. A careful, time-consuming study is required in equivocal preparations.The ALCAT Test (Antigen Leucocyte Cellular Antibody Test)This is the latest and most accurate cytotoxic test, but in my experience it is still not accurate enough to be used as the sole means of identifying food allergies or intolerances without corroborating evidence from challenges.ConclusionSo, cytotoxic tests are not very useful tools for a definitive diagnosis and even less useful for the implementation of any therapeutic regimen. While the original cytotoxic test is quite unreliable even as a screening method, the ALCAT test appears to be a much more useful screening procedure, especially for children or adults whose time constraints do not permit other, more involved, methods.Fortunately there are other techniques by which food sensitivities, allergies and intolerances can be measured, and they also provide the method to either desensitise the patient or neutralise the allergy.The Radio Allergo Sorbent (RAST) Test for Food AllergiesAnother blood test sometimes used for food allergies (although it is much more accurate for Candida, inhalants and some chemicals) is the RAST test which measures specific (IgE) antibodies’ responses to food fragments. There is very little chance of this test giving a false positive, although the patient may not be aware of any symptoms associated with ingestion of that particular food.The Intradermal or Sublingual Challenge Test This is the most accurate of all food and chemical allergies tests. It consists of asking the patient to grade the severity of his or her symptoms. These estimates are then used as a benchmark. Then a concentrated solution of the suspected substance is applied under the tongue. Various physiological responses, such as the pulse rate, can then be measured and, of course, one notes the onset or aggravation of symptoms.The Cell-Mediated Immunity (CMI) TestProbably one of the most important tests, the CMI is also known as the ‘Multitest’. It allows the doctor to know if a patient is ‘anergic’ — that is, unable to mount a response/defence against some organism or factor. This is a clear indication that the immune system is in trouble and often most other allergy tests will be negative, in spite of the patient being affected, sometimes dramatically, by ingestion or exposure to the substance in question. It is a negative correlation test; in other words, it is significant when there is a negative or low score.*41\145\2*

BASIC FORMS OF DIABETES MELLITUSIn general, two basic forms of diabetes mellitus exist. One form occurs mostly in adolescents, and the second later in life. The first is called juvenile, or growth-onset, diabetes mellitus, and the second form is called maturity-onset, or adult, diabetes mellitus. The difference between these two types is very interesting. The adult form of the disease is usually characterized by a gradual onset, and studies of the blood and pancreas in these persons typically demonstrate the presence of insulin, but in decreased amounts. These findings are compatible with the long-held theory about the origin of diabetes mellitus in that the disease is due to a premature wearing out of the pancreas with its resultant decrease in insulin production.In the case of juvenile onset diabetes, examiners were surprised to find that some patients with this disease, shortly after its onset, had a normal amount of insulin circulating in their blood and that their pancreas also contained normal, or greater than normal, amounts of insulin. In a period of months, however, insulin completely disappeared from their blood and from their pancreas. This finding led to the postulation that there might be something present in these young people that was using up an abnormal amount of insulin, with the result that the pancreas becomes exhausted from over-stimulation and finally is unable to produce any insulin at all. This unknown agent could be a substance in the body that combines with insulin to prevent it from acting in a normal manner, or perhaps another organ in the body, such as the liver, might remove the insulin from the blood before it has a chance to function.Another characteristic of this disease is its tendency to occur in relatives of persons who have the disease, or to be inherited. Relatives of diabetics have a chance of developing diabetes two and a half times greater than that of the general population. This inherited disease may first show symptoms at any age. A grandparent may have the disease, and then diabetes may occur in a grandchild during early adolescence. Finally, the child’s parent may develop the disease several years after it appeared in the child.*2/309/5*

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*

CERTAIN IMPLICATIONS OF AMERICAN PSYCHIATRY: IATROGENIC DISEASESIatrogenic diseases are disorders caused by the medical profession itself. Today the medicines for many diseases create symptoms which are frequently only slightly preferable to those of the original disease. It is in fact common practice to accept drugs which ameliorate syndromes but which create new symptoms themselves.One such occasionally occurring disorder, tardive dyskenisia (TD), may be mentioned. TD is a disorder arising in conjunction with many neuroleptic drugs which sometimes produce only marginal improvement of psychotic states. TD is potentially irreversible, involuntary or choreathoid movements which develop even after short term treatments (Kessler and Waletzky, 1981). Forty percent of elderly chronic patients now get it.Even medical practitioners see some hallucinations as tolerable relative to the TD side effects (Janson et al., 1985). A recent report in Psychiatric News (May 17, 1986), lists several dozen drugs which carry TD side effects. These are Serentil, Moban, Innovar, Inapsine, Iositane, Haldol, Triovil, Taractarn, Navane, Mellarille, Thorazine, Sparine, etc.*7\227\8*

HYPERACUTE BACTERIAL CONJUNCTIVITISHyperacute bacterial conjunctivitis is a severe sight-threatening ocular infection primarily caused by Neisseria gonorrhoeae. Gonococcal ocular infection may present in neonates (a cause of ophthalmia neonatorum) or in sexually active young adults. Transmission of the organism to infants occurs during vaginal delivery, and affected infants develop ocular discharge 3 to 5 days after birth. In adults, the organism is usually transmitted from the genitalia to the hands and then the eyes.Hyperacute bacterial conjunctivitis has an abrupt onset and is characterized by purulent discharge that re-accumulates rapidly after being wiped away. The discharge often accumulates in the lashes and runs down the patient’s cheek. The conjunctiva is bright red, tender, and edematous (called chemosis), and an inflammatory membrane of leukocytes and fibrin may develop on the palpebral conjunctival surface. Preauricular lymphadenopathy is often present. One eye is usually involved first, but within several days, the second eye becomes involved through autoinoculation. As the conjunctival swelling and reaction increases, a peripheral corneal ring ulcer can develop because of compression of the corneal vessels.Gram-negative intracellular diplococci can be identified on Gram stain of the discharge. Patients with hyperacute bacterial conjunctivitis require immediate ophthalmologic referral. If a gonococcal ocular infection is left untreated, rapid progression to corneal perforation and permanent loss of vision can occur. Since gonococcal conjunctivitis is a sexually transmitted disease, clinicians should inquire about concomitant urethritis or vaginitis and ask about sexual partners who might be infected.*28/348/5*

THROAT: LARYNGITISInflammation of the vocal cords may follow overuse of the voice, irritation by chemical substances, or infection. Men, who are more frequently subjected to exposure to irritant substances in their occupations and who indulge more than women in deleterious habits, suffer more from laryngitis than do women. Contributing causes to inflammation of the larynx include the swallowing of hot or spicy foods, the abuse of alcohol and tobacco and similar irritants. Occasionally the larynx becomes inflamed because there is an infection in the throat or the lungs. In fact, any condition that blocks breathing through the nose helps to cause laryngitis, because large amounts of air then pass directly to the larynx without having been modified, as is usual, in passing through the nasal tract.In serious cases of laryngitis it is customary to go to bed and keep quiet. Nothing helps the vocal cords under such circumstances as much as continuous rest, speaking only in a whisper. The application of an ice bag or ice collar or moist compresses to the throat is soothing. Some people prefer warmth, which seems to be equally effective in its soothing action. A measure which comes down from ancient history is the inhaling of steam to which various aromatic oils can be added. Apparently the chief benefit is derived, however, not from the aromatic oils but from the moisture and the warmth. Nowadays many special devices have been developed that use electrical heat in order to produce such steam for inhaling. These devices are usually much safer than the old-fashioned dish or kettle of hot water. Many instances have been known of severe burns from accidents with open kettles of exceedingly hot water used in this way.For serious laryngitis, particularly that complicated by inflammation or infection, the physician may prescribe many drugs that are helpful in securing rest and in soothing the area concerned.*22/318/5*