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USING CLOZAPINE FOR TREATMENT OF SCHIZOPHRENIA
In 1973, Gilbert Honigfeld, director of scientific affairs at Sandoz Pharmaceuticals of East Hanover, New Jersey, started researching clozapine. Two years later, reports from Europe told of the drug’s blood problem: it was killing patients. This discovery nearly stymied Sandoz’s introduction of clozapine in the United States. Because a small number of patients had done well with the drug, however, they continued to receive it under a compassionate-need program. Their success eventually led to the resumption in 1987 of full-scale research in the United States.
At that time, with the knowledge of the Food and Drug Administration (FDA), says Mr. Honigfeld, Sandoz developed a weekly blood test to “ensure patient safety.” It also probably afforded protection from lawsuits. Each week, a medical technician visited the patient, took a blood sample, and, if test results were satisfactory, handed out the next week’s pills. Sandoz kept the drug on hold while the FDA studied results of the blood-monitoring program. In 1989, the FDA approved the use of clozapine by schizophrenia patients for whom all other treatments have failed. Cost to the patient: 8,900 dollars a year – probably for a lifetime.
Protests rained down on Sandoz, which markets the drug under the trade name Clozaril. The National Alliance for the Mentally 111 (NAMI), an organization of patients and their families, said the expensive weekly blood-testing program would shut out the poor. State Medicaid officials refused to cover the costs.
In 1991, Sandoz announced that doctors, clinics, and hospitals could arrange for their own blood tests. Patients would be required simply to show their doctor or pharmacist proof of the satisfactory results of the weekly blood test before getting the next supply. The Health Care Financing Administration then ordered all state Medicaid programs to cover the expenses for their patients and said it would pay some of the states’ medical costs.
Roch Thibodeau Jr., of Burlington, Vermont, got his clozapine under Medicaid. Schizophrenia had destroyed his ability to earn a living. When his illness began, Mr. Thibodeau first took older drugs, including Stelazine (trifluoperazine). Stelazine was a major breakthrough in treatment in the 1950s, along with Thorazine (chlorpromazine).
While the medicines kept him going and controlled the symptoms of the disease, young Mr. Thibodeau experienced severe side effects. “He suffered terrible dry mouth, blistering reactions to the sun, slurred speech,” says his father. “He could not sit still. He could not focus.” These side effects led Mr. Thibodeau to stop taking his medications. As a result, his schizophrenia again took hold.
When he started taking Clozaril in 1989, the symptoms all but disappeared. Side effects were not a problem. He began working 20 hours a week at a bus station kiosk, selling newspapers and light snacks. Now he works for a hospital, delivering supplies to various departments.
“Before Clozaril, I could not have done that,” says Mr. Thibodeau. “I had a real struggle. I could not handle stress or function. I have a lot more motivation now.”
Now, more than 60,000 patients have taken clozapine. Laurie Flynn, Shannon’s mother, says, “Clozapine is the closest thing to a miracle that you will ever see. You see an amazing return of a patient’s sense of humor, interest in life, and ability to relate to others.” She adds that the drug probably would help many of the nation’s schizophrenics, “but, for most of the people for whom this medicine would make a remarkable difference, it is unavailable.”
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MEETING ENERGY NEEDS: CLINICAL PROBLEMS
Nutritive adequacy
Many people meet or exceed their energy requirement by selecting excessive amounts of foods rich in sugars and/or fats. Others also consume varying amounts of alcoholic beverages. The sugars, fats, and alcoholic beverages furnish only traces of minerals and vitamins. They are often referred to as “empty-calorie foods,” or “junk foods.” They are low in nutrient density which is another way of saying that the food supplies a high proportion of the person’s caloric need but only a low proportion of the nutrient needs. Unless most of the calories for the diet are selected from a variety of foods in the Four Food Groups, the diet is likely to lack some of the essential nutrients.
Weight control
For the adult the best guide to the calorie requirement is the body weight. If the amount of energy needed by the body is less than the amount of energy supplied by the diet, the extra energy will be stored as fat, and the individual will gain weight. This is the problem that many men and women face. On the other hand, insufficient energy in the diet to meet body needs means that the adipose tissue will be used up, and thus weight is lost.
The adult in good health and who has a desirable body weight should aim to keep his weight constant. If people will weigh themselves regularly and will learn to avoid many hidden calories, to refuse second servings, to select low-calorie snacks, and to engage in a regular program of exercise, the maintenance of weight is not difficult. If a pound is gained, the effort should be made to lose it promptly so that there is no accumulation from month to month and year to year.
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MULTIPLE FUNCTIONS OF THE ORGANS
The digestive, the respiratory, and the urinary or excretory systems have of necessity been taken up separately under the general heading of intake and outgo. You just cannot take any one organ or system, classify it under its chief function, and file away the data without cross-references. The man on the street will tell you that the purpose of the digestive system is to take in our nourishment and handle it. But one of the main concerns of the average man is with the outgo from this same system and he spends large sums of money to “regulate his bowels.” He seems to feel that bowel evacuation is as urgently important as urinary secretion, which is not so.
In considering excretion, we cannot complacently ignore the skin. In our youth we were told a sorrowful tale of a medieval play in which golden angels were to appear. So the producers gilded over the skin of some children and caused their deaths. This experiment has probably not been tried since, but it emphasized that the skin is also important for intake and outgo, collecting Vitamin D from the sunshine and clearing away much waste material in the sweat.
Almost anyone will concede that the kidney is an excretory organ. Yet it does not just dispose of waste and poisonous materials; it works over the plasma of the blood, selects carefully and returns to the body materials as the body needs them.
And again we must list the lungs. I doubt that anybody will be dogmatic as to whether these are more important for intake or outgo. Certainly we will die in a few minutes if the lungs do not deliver oxygen to us. But we will die almost as quickly if they do not take away carbon dioxide, a poison which we have to have to regulate breathing.
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WONDERS OF HIGH-TECH MEDICINE: A LASER SUN-GUN
Dr. Lawrence Yannuzzi peers into a horizontal microscope. At the other end, a clamp locks Tom Ward’s head so that he cannot move it. His left eye is open.
A flash of red laser light cuts into Mr. Ward’s left eye. In a trillionth of a second, it travels through the cornea, the window of the eye; through the lens; through the eye’s central bowl of clear jelly; through the retina, the living “photo film.”
The beam halts at the back inside wall of the eye. Dr. Yannuzzi sees a white dot appear on the wall. It is smaller than a pinhead. The light beam has burned the back wall.
Dr. Yannuzzi is treating macular degeneration, a disease that blinds more elderly people than any other. No one knows the cause. It had already wiped out the sight of Mr. Ward’s right eye.
At 62, Mr. Ward is a retired banker who has become a painter and etcher. Without vision, his life would crash.
In his microscope, Dr. Yannuzzi detects a tangle of tiny blood vessels clinging to the eye’s back wall. They cluster under the macula, a yellow spot on the retina. As if they were a balloon, the vessels lift the macula. If it’s lifted too far, the living film will go blank.
The laser destroys those dangerous blood vessels by burning them. With pinpoint accuracy, Dr. Yannuzzi burns more and more of the back wall until only a flat scar remains under the macula. Even without anesthesia, Mr. Ward feels nothing.
“I can paint,” Mr. Ward says now. “I can do the fine work of etching. I have a tiny blind spot where the laser hit. But I can drive and do almost anything.”
He is lucky. The laser helps at most 13 percent of macular degeneration victims. Dr. Yannuzzi, director of retinal services at Manhattan Eye, Ear, and Throat Hospital, introduced the krypton laser, which helps even more by burning closer to the center of sight, the centralis. Eye doctors are testing other lasers and surgical techniques.
The National Institutes of Health has approved laser treatment of macular degeneration.
*42/266/5*

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COMMON PROBLEMS IN MULTI-INFARCT DEMENTIA: EMOTIONS AND INCONTINENCE
Emotions
We try to control our emotions and expression of them both consciously (one tries not to laugh at someone in the same room who is wearing a hideous hat) and unconsciously (I always cry during the last few minutes of the film The Color Purple even though I’m trying not to). A stroke can effectively bring one’s emotions nearer the surface, lessening any control so that some sufferers cry or more rarely laugh at inappropriate times. The control system seems to be damaged. This is known as emotional lability and ranges from the person crying when a certain subject is mentioned to bursting into tears whenever they try to speak. In its severe form it is obviously very disabling both in terms of rehabilitation and socially. There is good evidence that one of the anti-depressants – amitryptiline – in a dose too low for it to be having an anti-depressant effect is helpful. I have used it many times with good success.
Incontinence
Incontinence of urine (more rarely of faeces) can occur after a single stroke but is more common as multiple strokes lead to a confused state. The condition is often associated with more marked physical disability, making toileting difficult, and also because the nervous control of the bladder may be damaged making the achievement of continence difficult. Though one tries to avoid them, one may have to use some form of incontinent pad or consider the use of a urinary catheter when both the physical and mental results of multiple strokes are advanced.
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DISC PROBLEMS
Disc Disruption
The outside of an inter vertebral disc is like a leather onion, the inside of an apple core. Persistent bending forward or heavy lifting scrambles this inner core and the scrambling is called disc disruption. Chemicals leak from a disrupted disc causing pain which fairly typically crescendos over 24 hours and then dissipates over the next fortnight. Pain returns every time heavy lifting or bending forward resumes. A year or two after the onset of pain and disability disc disruptions heal.
Home Remedies
Swim a kilometer a day. Swimming relieves both pain and muscle spasm.
Disc Protrusion
People continuing to heavy lift or bend forward in the face of disc disruption, run the risk of herniating the inside of their scrambled discs. Herniation means the centre of an inter vertebral disc pushes backwards through its outer lining into the space of the spinal canal. Within the canal awaits the spinal chord and the vulnerable beginnings of the peripheral nerve roots. Much pain, disability and back surgery are potential outcomes of the preventable occurrence of inter vertebral disc protrusion.
Home Remedies
In time disc protrusions shrink and heal. Swimming and not bending forward or heavy lifting steer the victim of a disc protrusion into less painful territory. According to orthopedic surgeons, after five years, those who adopt conservative approaches find themselves in exactly the same position as those who undertook surgery. With surgery people get better fast; and develop osteoarthritis later. Without surgery people get better slowly; and still develop osteoarthritis later.
*42/131/5*

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NUTRIENTS FOR YOUR BODY: SOME FALLACIES AND FACTS
1. Fallacy. Potatoes, bread, meat, and milk are fattening. Grapefruit is not fattening.
Facts. No single food can be called fattening or nonfattening. A calorie from one food is the same as a calorie from another food. Some foods provide more calories than others. One becomes overweight only if the total calorie intake is greater than the calorie expenditure of the body.
2. Fallacy. Boiled potatoes are more fattening than baked potatoes.
Facts. Potatoes of the same weight will have the same number of calories whether boiled or baked. The hidden calories in the form of butter, or sour cream, would rapidly increase the number of calories.
3. Fallacy. Polyunsaturated fats are lower in calories than saturated fats.
Facts. Gram for gram, all pure fat – polyunsaturated or saturated – contains the same number of calories. One tablespoon of whipped butter or whipped margarine will have fewer calories than 1 tablespoon regular butter or margarine because air has been whipped into it. But gram for gram, or pound for pound, the whipped fats would contain the same number of calories as the regular fats.
4. Fallacy. Toast has fewer calories than bread.
Facts. The caloric content of a slice of bread does not change with toasting. The bread has lost some weight in toasting because it has lost some of its water content.
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Other names: Prinivil

PERMANENT CORRECTION OF NEARSIGHTEDNESS: STORY OF MELONY CARSON
Appearing about twenty years younger than her present age of 46, Melony Carson of New York City does everything possible to remain youthful and beautiful. She is tall and willowy, uses cosmetics like an artist, and has long, naturally platinum-blond hair.
Melony can’t wear contact lenses comfortably because of an acute sensitivity reaction to them, and she disdains using eyeglasses because she believes they make her seem old and ugly. But corrective lenses or other vision aids are a necessity for the woman inasmuch as she is exceedingly nearsighted. If Melony tries to go without help from visual aids, she just can’t make out the details of anything in her surroundings. Her vision in each eye is only 20/400 or less. Despite her not wanting to, spectacles or some other corrective aids are devices she must wear at her job as a legal secretary and receptionist.
Greeting clients and other visitors for her attorney employer has the woman repeatedly removing her eyeglasses. She does this for two reasons: for sight and for vanity. Wearing a correction for myopia is an obstacle to her recognizing anything at close range. The woman can’t make out the features of office visitors’ faces so that she must take off the spectacles. In turn, Melony would never allow someone to check out her looks while she is wearing eyeglasses, especially if that someone is a handsome man, so off come the visual aids as soon as the outside door opens. Of course, she hated even the idea of resorting to bifocals.
In June 1984, Ms. Carson brought her eye problems to her ophthalmologist. Her doctor suggested that the eye surgery known as radial keratotomy (RK), today’s fastest growing advance in eye care since contact lenses, be carried out. It was the ophthalmologist’s concept, tailored to this woman’s visual, psychological, occupational, and social needs, that he performs the surgery on only one of her eyes. In this way, she could have distance vision with lens correction from the operated eye, and still use the unoperated for near work, again without correction.
Of course, the eye surgeon explained, “It will take considerable practice to coordinate your eyes in order to be able to use them alternately, as you desire.” Melony Carson was strongly motivated to give the procedure a try. Radial keratotomy for the left eye was scheduled the next week, and Melony’s eye coordination practice continued for a month, thereafter.
The concept worked quite well. RK for one eye has totally satisfied both her visual and vanity needs. As far as vision is concerned, Melony Carson will remain 26 years old forever.
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EVENING PRIMROSE OIL AND RAYNAUD’S SYNDROME
A study in Glasgow in 1985 showed that patients with Raynaud’s syndrome definitely appeared to benefit from treatment with evening primrose oil.
The study, which was carried out at the Centre for Rheumatic Diseases at Glasgow Royal Infirmary, found that six out of 11 patients felt a definite benefit from evening primrose oil, while two patients felt a moderate benefit, and three no benefit.
The group of 11 patients on the evening primrose oil treatment of 12 capsules a day was being compared against 10 patients on a placebo. As the weather got worse, the group taking the placebo experienced significantly more attacks than the group taking evening primrose oil. The severity of attacks and the coldness of hands improved in the evening primrose oil group.
One interesting result from this study was that if any improvement was going to happen at all, it was noticeable after four weeks of treatment. Sadly, there was a definite fall-off in the benefits by the end of the eighth week. Some improvements that were noted at two weeks or six weeks were not sustained beyond eight weeks. The peak results happened midway through the study.
However, all the results showed an improvement in the group taking evening primrose oil.
The study continued for only two months, and as yet there have been no studies using evening primrose oil for longer in these conditions.
Many of the patients taking evening primrose oil said the course of treatment was like a tonic. Ten out of 11 patients on the evening primrose oil said they felt generally less depressed and had more energy. Seven patients asked to restart the drug two months later, complaining of a relapse in their Raynaud’s symptoms and loss of mood elevation.
The doctors who conducted the study said ‘in a disease such as Raynaud’s phenomenon where the attacks can be precipitated by strong negative emotion, a drug with an antidepressant effect might be useful’.
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EXCRETION: BOWEL MOVEMENTS
I am certain that you expect me, when talking of excretion, to say a good deal about bowel movements. As a matter of fact, these movements are for the purpose of getting rid of the waste products in food and of the bacteria which, having done their work in aiding digestion, actually make the major portion of the bulk of the feces. These play a very minor part in handling the poisons which are taken care of by the kidneys, lungs, and skin. Hence the universal interest in the number and physical appearances of the feces is not justified. I do not mean, however, that the skilled physician may not learn much from them. The presence of blood or parasites, or the absence of bile, may be of great importance to him; but these, I am sure, he would not consider under the heading, excretion.
Forty years ago a chief duty of a physician for children was to scan the stools left in the diapers. This examination for physical characteristics (color, consistency) is of comparatively minor value; and today diapers are usually sent pretty promptly to the diaper service, or the paper ones are thrown away.
The old-fashioned idea of “auto-intoxication” is no longer held by the medical profession. All the useless substances which make up the bowel movements, along with considerable water, have been dumped from the small into the large intestine. In its upper part, water is absorbed through its walls. The lower part is not for absorption; it is designed to act as a cesspool and storage space for the feces. Presumably the bowel material is poisonous, but it is safely placed in the proper receptacle, and it descends into the rectum where it lays inert, awaiting disposal.
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HIGH-TECH MEDICINE: SUPERMAN’S EYES
I was flat on my back in bed, my legs up in the air pedaling a bicycle suspended from the ceiling. A huge white object, like a quarter of a beer barrel, was pressed against my chest.
“Keep pedaling,” the technician called. My breath came hard. I could feel my heart pounding.
“We have a good picture,” announced Dr. Jeffrey Borer, of Manhattan’s New York Hospital.
It was a black-and-white movie of the inside of my wildly beating heart, and it looked like a hunk of putty being squeezed by a fist.
But Dr. Borer pronounced my heart perfect. He helped develop the technique that uses a nuclear camera to detect heart diseases that escape other methods. (Fourteen years later, I did have a problem: narrowed coronary arteries left over from my days of eating huge amounts of animal fat.)
Dr. Borer’s camera works by detecting radioactivity in the heart. Before I did my upside-down exercise, I got an injection of radioactive chemicals.
The nuclear camera is one of a dozen incredible machines that allow doctors to peek inside the human body without cutting it open. It is as if the eyes of Superman had come off the comic strip and into the laboratory.
Besides viewing the heart, they can see inside the brain, stomach, small intestine, liver, kidney, and a mother’s womb to see the unborn infant.
– The sonogram: It sends inaudible, high-pitched sound waves into the body. A detector picks up the waves as they bounce off the internal organs.
On a television screen, you make out the fuzzy outlines of a fetus’s head, arms, legs, and eyes.
– The CAT-scan: This is a super X-ray machine with a computer to interpret 100 X-ray beams as they bore through your body. On a TV, you see all the parts.
– The PET-scan: You swallow or are injected with special radioactive chemicals. The computer locates those chemicals in your body.
So far PET has detected the center of epilepsy, checked blood flow in the brain of a stroke victim, and tracked cancer growths.
– Neutron activation: The scientists shoot neutrons at you. The neutrons – subatomic particles – make some of your atoms radioactive. The scientists can tell whether your bones are growing.
– Nuclear magnetic resonance: Your head is placed between the poles of a giant magnet. The atoms in your head emit radio waves. From the waves, a computer then produces a picture of your brain.
*41/266/5*

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MEETING ENERGY NEEDS: DIETARY GOALS AND ENERGY VALUE OF FOODS
Dietary goals
In the United States about 45 per cent of total calories in the diet come from carbohydrate; 40 per cent or more of calories come from fat; and about I to 15 per cent of calories come from protein. The Dietary Goals recommend that a better distribution would be as follows:
1. About 48 per cent of calories from complex carbohydrates; no more than 10 Per cent of calories from processed and refined sugars.
2. About 30 per cent of calories from fat, with no more than 10 per cent from saturated fats.
These recommendations would mean that Americans would derive more of their calories from foods of the grain group and less from sugars and sweets. They would reduce their consumption of fats, including fatty meats, fat-rich foods of all kinds, as well as visible fats.
Energy value of foods
You can find that you could draw some general conclusions about the caloric value of food groups. Some foods contain much water and some fiber and are low in calories. Vegetables and fruits, as a class, are in this group. The variation in calories between a tomato, for example, and a sweet potato lies in the much greater carbohydrate content of the sweet potato. Fresh fruits are much lower in calories than canned or frozen fruits, which have been packed in syrup.
Many foods contain little water but appreciable amounts of carbohydrate: flour, cereal foods, bread, sugar, candy, jellies, and others. Weight for weight these foods rank much higher in calories than vegetables and fruits.
The highest concentration of calories occurs in foods that contain much fat. Lean meat, poultry, and fish are moderate in calorie content, but fatty meats and fish are high in calories. Oils, butter, margarine, cooking fats, and cream are concentrated sources of calories because of their high fat content. Many cooked foods are higher in calories because of the ingredients used and the method of preparation. Cakes, cookies, pies, and pastries contain much flour, sugar, shortening, eggs, and milk, and are, of course, high in calories. A piece of lean meat may be only moderately high in calories if it is broiled, but if it is dipped in egg, crumbs, and then fried, the caloric value could be twice as high. Deep-fat fried foods are, generally speaking, high in calories.
Alcohol. One gram of pure alcohol furnishes 7 kcal. One can of beer (12 oz) contains 150 kcal, one martini (1 1/2 oz gin) about 120 kcal, and one glass of dessert wine (3 1/2 oz) 140 kcal. Thus, for many people alcoholic beverages supply significant amounts of energy.
Energy value of the Basic Diet. The recommended number of servings from the Four Food Groups supplies almost 60 per cent of the energy needs of the average woman.
*41/234/5*

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DIARRHEA
Diarrhea constitutes loose bowel motions with an increased frequency and the causes of diarrhea range from viruses, through alcohol, anxiety and inflammatory bowel disease to cancer of the bowel. Cancer of the large bowel typically presents with alternating diarrhea and constipation. Given an innocent diagnosis, medical management of diarrhea involves the use of a synthetic narcotic drug with constipating properties. Drugs of this class include Lomotil, Immodium and Codeine.
Home Remedies
High fibre produces a soft motion in constipation and a formed motion in diarrhea. Fine china clay sold over the counter as Kaolin or Kaomagma also binds loose bowels. Fatty foods, fruit and fruit juice aggravate diarrhea. Avoid them until the attack is over.
Children with diarrheal disease pose special management problems. Doctors don’t use narcotic derivatives and Kaolin in childhood diarrhea. The task becomes one of replacing lost fluid and salt until the diarrhea stops. We are fortunate in Australia to have over the counter preparations like Glucolyte and Repalyte. Mixed with water they replace fluid and salt more than adequately.
If fluid and salt do fall behind in the domestic management of childhood diarrhea and a child’s tongue becomes dry or urine output falls off it is time for medical assessment. The doctor must then decide whether oral salt and fluid replacement is to continue, or whether salt and fluid should be administered intravenously in a hospital.
Diarrhea that lasts for more than a week or that does not respond to home remedies is also worth medical assessment. The collection of a faecal sample and laboratory tests might indicate the presence of a treatable variety of infectious disease. A colonoscopy could reveal the presence of Inflammatory Bowel Disease.
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MULTI-INFARCT DEMENTIA
This form of dementia accounts for about 30 per cent of cases. It is due to repeated strokes affecting the brain. Sometimes the strokes are big enough for them to be accompanied by weakness of an arm or leg (or both), or collapse, slurred speech and facial drooping. The strokes can be fairly small, however, and cause brain damage in the form of memory loss, etc., without any of the other features of a major stroke. These multiple insults to the brain are usually due to the fact that the main arteries supplying blood to the brain are furred-up.
This furring-up process in blood vessels is known as atheroma and is more common in men. Multi-infarct dementia is therefore more often seen in men than women. Not only are the blood vessels in the brain furred up but also elsewhere such as the heart and the major blood vessels supplying the legs. It is not uncommon then for the person with this form of dementia also to have a history of previous heart attacks and pains in the legs on walking (claudication).
Following a major stroke about a third of the people recover almost completely but another third have both physical and mental impairment making them reliant on others. This first stroke can affect memory and behaviour but usually these aspects recover and it is the weakness of limbs and problems with speech that are the main handicaps. The situation changes with further strokes however. Not only does the person have to cope with any new physical disability but the brain appears to cope less well with each new insult. Recovery still occurs but a pattern develops where the person never gets back to the level before the last stroke. In this way there is step-wise deterioration.
Memory loss certainly happens and both short and longer term memory can be affected. The damage though is less global, less widespread than with Alzheimer’s disease so that some areas of function in the brain may be lost while others are retained despite severe physical handicap. Because the damage is patchy, many sufferers retain insight into the problem that is they are aware that there are parts of their memory they cannot unlock and this can obviously be extremely upsetting. The realization of the problem can lead to some aggressive behaviour, usually simply out of frustration. As the disease progresses (i.e. as more slight strokes occur) this insight is usually lost. The brain damage can become so severe that many other problems overtake the sufferer.
*41/128/5*

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RAYNAUD’S SYNDROME AND SCLERODERMA
These two conditions are related in that patients with scleroderma (also known as systemic sclerosis) often suffer from Raynaud’s syndrome (or Raynaud’s phenomenon).
Raynaud’s syndrome
In general, Raynaud’s syndrome affects the arteries in the fingers, and sometimes in the toes as well. No one knows exactly what causes it. The arteries contract in spasm, and as a result the fingers go pale and numb. Then they turn blue and red in turn. They feel painful, tingling, and burning.
In severe Raynaud’s syndrome (also commonly called Raynaud’s phenomenon), the hands and feet turn abnormally cold and there may also be symptoms of a disease affecting the circulation such as atherosclerosis, or the connective tissue such as scleroderma (systemic sclerosis) or lupus erythematosus.
This condition can have serious side-effects. These include inflammation of the arteries of the fingers and toes, which could lead to a blood clot. A lack of blood in the extremities can lead to gangrene, or ulceration of the finger tips.
Scleroderma
Scleroderma is a rare disease affecting the body’s connective tissue – the stuff that supports, separates and protects the organs of the body. The connective tissue progressively hardens and contracts. No one knows the cause, but it is thought to be an auto-immune disease, where the body attacks itself.
Strangely, it is three or four times more usual in women than in men. It most commonly strikes people in their thirties.
Scleroderma can affect any part of the body, including the skin, heart, kidney, lung or oesophagus. It can be localized, or it can spread slowly throughout the body.
Raynaud’s syndrome is sometimes the first sign of scleroderma, and the patient may complain of abnormally cold hands and perhaps feet. Later on, other symptoms appear. In time, the fingers begin to swell, look like sausages, and can be difficult to move. As the disease progresses, the skin becomes thickened and taut, and movement becomes difficult. Scleroderma is a very serious condition, which can be fatal.
At the moment, both Raynaud’s syndrome and scleroderma are incurable, and without any ideal treatment.
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KOLFF’S ARTIFICIAL KIDNEY
In recent years a much more elaborate method has been developed to remove impurities from the blood when the kidneys are unable to do it. A Dutchman named Kolff has built a workable artificial kidney. A tube is placed in an artery of the patient. The blood flows from this through the artificial kidney and back to the patient’s vein. He is given a dose of heparin, a modern drug which helps prevent clotting. A big cylinder, carrying the cellophane tube which contains the blood, rotates in a bath of water, salt, potassium chloride, bicarbonate of soda, and glucose. This solution absorbs the poisonous substances from the blood.
It is evident that if the kidney is permanently damaged, this machine is useless. In from five to fourteen hours it may clear the blood of a severely sick patient but often more of the bad substances will form later and this procedure cannot be repeated many times. Certain poisons which do not combine too firmly with the blood – barbiturates, for instance – may be quickly washed out in this way. If you have a pain in your back which “kidney pills,” don’t cure, it will not be worth your while to negotiate for the use of this machine. It requires great judgment as to when it will be efficient and at present the number of these cases is few.
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HIGH-TECH MEDICINE: NEW ORGANS, NEW LIVES
Sixteen years ago, Robert Brown clung to the edge of life. At 40, because disease had destroyed his kidneys, poisons piled up in his body. A lumber salesman with four children and a wife, he was kept alive by having his blood washed.
“I had no life,” he says. “I lived a day-to-day existence. But everything is beautiful now.”
Drs. David Hume and John Merrill at Boston’s Peter Bent Brigham Hospital transplanted a kidney from a dead person who was not related to Mr. Brown.
Mr. Brown knew the risk was high: he had one chance in six of dying on the table, and most kidneys were rejected. White blood cells would surround the alien flesh, attack it and kill it. Often the patient would die too.
Bob Brown became a member of the club: long-lived survivors of a kidney transplant from an unrelated person.
Thanks to new and better drugs, surgery, antibiotics, and new ways to fight rejection, more people today survive with new organs. The current 1-year survival score: 95 percent for kidneys, 80 percent for hearts, and perhaps 75 percent for livers.
“We’ve made tremendous advances in the past couple of years,” says Dr. Merrill. “Kidney transplantation may be the greatest medical advance in the last 25 years.”
Cyclosporin A, a chemical found in a soil fungus, has been the most effective and safest rejection fighter yet. As it holds down the number of white blood cells that kill foreign tissue, the body adjusts to its new organ.
Cyclosporin A has generated new enthusiasm for heart transplants. While thousands of kidneys have been transplanted, only about 300 hearts have made the transfer, most of them at Stanford University.
And for children born with damaged livers or adults with liver disease, new livers for the first time mean new life. Dr. Thomas Starzl, of the University of Pittsburgh, who pioneered in liver transplants, has saved several dozen children and adults.
Dr. Merrill says that the surgery is safer than ever, the death rate dropping by 75 percent. New treatment for rejection could make kidney transplants “take” 100 percent of the time. Many believe that high-tech medicine will make a transplant as safe as a tonsillectomy and will promise, in Bob Brown’s words, a “beautiful” life for thousands.
The big drawback is a shortage of organs. Hearts and livers, which must come from healthy persons who die in accidents, are especially scarce. That’s because most people killed in accidents die before they reach a hospital prepared to take a heart, kidney, or liver. Relatives often refuse to allow organs to be taken from a loved one. The number of hearts taken stood at 2,000 for years, while the need is at least 10,000.
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ENERGY NEEDS OF THE BODY: ENERGY ALLOWANCES
The recommended daily allowances for kilocalories can be only approximate because of individual variations. For persons who are lighter or heavier than the reference individual, the allowances would be decreased or increased. Women who have average physical activity require about 35 kcal per kilogram (16 kcal per pound), and men with average physical activity require about 38 kcal per kilogram (17 kcal per pound). The allowances for persons who are sedentary would be decreased, while those for persons engaged in hard physical labor would be much more.
The allowances for infants and for children are very high in proportion to their body size so that there is ample energy for growth as well as the high level of physical activity. Note, for example, that the 30-kg child between 7 and 10 years requires about 2400 kcal – a level that is more than his mother needs and only 300 kcal less than his father needs.
Ordinarily, no calorie adjustments need to be made for climate. Most Americans live in well-heated buildings in winter and wear warm clothing. Many people now also work in air-conditioned buildings in the summer.
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Other names: Asacol, Pentasa, Asacol

RETIREMENT: THE DECISION TO RETIRE
The most accurate information we have on why people decide to retire early (or late), and the effect of that decision on physical, financial, and emotional well-being, comes from a synthesis of the best retirement studies published by a team of gerontologists at Duke University in 1985. From the hundreds of studies of retirement that have been done over the past quarter-century, the Duke social scientists selected seven to analyze. The studies they chose were comprehensive, exploring retirement in various ethnic and socioeconomic groups. They also were longitudinal, capturing the process of retirement over time. Instead of interviewing people at a single point either before or after leaving work, hundreds (or thousands) of workers nearing retirement age were picked and then questioned repeatedly over the next years.
The Retirement History Survey sponsored by the Social Security Administration is a good example of this ambitious type of research. In 1969 a representative nationwide sample of about twelve thousand male and unmarried female workers aged fifty-eight to sixty-three was selected and then reinter-viewed every two years over the next decade (until 1979) as they gradually retired. Combining the results of this study with those of the others gives us answers to fascinating questions such as these: What motivates American workers to retire early or to go on working after age sixty-five? How does retiring affect people economically, psychologically, and physically?
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Other names: Dicycloverine
DERMATITIS AND REMEDIES
Dermatitis and eczema are terms synonymous with a red, scaly and often itchy skin condition. The whole process begins as an eruption of blisters, just under the surface of the skin and like many other medical conditions the cause of dermatitis is not known.
Treatment consists of the topical action of steroid creams and ointments like Betnovate. Theoretically, the stronger the cream, the more frequent the application, the sooner dermatitis goes away and the longer it stays away.
No treatment guarantees to keep dermatitis away for ever. It nearly always returns sooner or later. Exceptions to this rule include contact dermatitis where known chemical offenders can be avoided or where the dermatitis clearly relates to a group of food stuffs. Dermatitis is associated in many people with asthma, hay fever and perhaps certain food intolerances.
Home Remedies
Dermatitis often occurs in association with dry skin. Where possible use a steroid cream on active dermatitis and moisturizing cream on all areas of dry skin. Plain aqueous cream is appropriate. Many people with dermatitis prefer Sorbolene cream with an emollient.
The use of soap is not necessarily a problem as long as the skin is covered with an emollient after bathing. Alpha Keri lotion and Hamilton’s bath oil are widely used products. Where possible avoid both cold and hot water as they irritate the skin. Luke warm water is preferred.
Woolen clothing as well as synthetic fabrics also irritate the skin of dermatitis sufferers. Go for loose cotton clothes and avoid tight or ill fitting clothing. Children in particular find sand very irritating. Build no sand pits and don’t let them roll around at the beach.
Nickel frequently triggers contact dermatitis in women especially in relation to jewellery. Ear piercing with the introduction of nickel keepers paves the way for a future sensitivity to all nickel jewellery. In many cases the rash occurs in places other than where the nickel is worn, serving to confuse the situation even further. For those women believing that their jewellery is too expensive to contain nickel, think again. Unless gold is 24 karat, nickel is present. The less the karat, the more the nickel.
Diet is more often a problem in children with dermatitis then adults and it is customary to avoid eggs, orange juice and milk products. With adults an exclusion diet best determines if food stuffs aggravate the dermatitis. The offending agent is identified if three consecutive introductions of the substance trigger the dermatitis.
*40/131/5*