MORE COMMON IMMUNE-SYSTEM DISEASES: SARCOIDOSIS AND SCLERODERMA

SARCOIDOSIS: we don’t know what causes it; possibly a virus.

Signs and Symptoms: may be fever; pains in joints; generalized body aches; cough; weight loss. Can have shortness of breath, lumps on the skin; enlarged liver; inflammation of a portion of the eye, which can lead to glaucoma and loss of vision. May get into heart and cause chest pain. Usually gets into lungs, causing shortness of breath. Many times I have made the diagnosis of sarcoidosis from the characteristic appearance of the X-ray, which shows enlarged lymph glands in the chest.

SCLERODERMA (progressive systemic sclerosis): chronic disease with generalized fibrosis (thickening) of the skin, joints and many internal organs.

Signs and Symptoms: joint pains; stomach upsets; heartburn; weight loss; malaise; difficulty in swallowing; shortness of breath. Skin of fingers and face becomes thick. Normal creases on the fingers and face disappear. Fingers become purple and hurt when exposed to cold. Face become thick, like a mask, and blood vessels on face, lips and tongue become prominent. Other symptoms may be esophogitis; (inflamations of the esophagus); pleurisy; pericarditis (inflammation of the sac surrounding the heart); heart irregularities; muscle weakness. Death from pneumonia often occurs.

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MORE COMMON IMMUNE-SYSTEM DISEASES: ANKYLOSING SPONDYLITIS AND BACTEREMIA

ANKYLOSING SPONDYLITIS: a progressive, inflammatory arthritis characterized by fusion of various joints, especially of the spine, that leads to years of suffering. Norman Cousins described his experience with ankylosing spondylitis in his bestselling book, Anatomy of an Illness.

Signs and Symptoms: fatigue; malaise; weight loss; low back pains; sacroiliac pains; sometimes pain down the back of the legs; stiffness of the back, especially in the morning; stiffness and pain spreading up to involve the rest of the back; hips and shoulders ache and feel stiff; in advanced stages there is forward flexion of the spine, forcing the person to walk with his head facing the ground (almost like an exaggerated Groucho Marx walk).

BACTEREMIA: a condition in which bacteria invade the circulating blood. The bacteria can come from a small abcess on the skin, dental drilling or manipulations, infections in the urinary tract or female organs, lung infections, intravenous drug use, indwelling intravenous catheters, urinary catheters, surgical procedures, and almost any other way bacteria can get into your blood.

Signs and Symptoms: fever; fatigue; rapid heart rate; rapid breathing; cool, pale extremities; can lead to confusion or disorientation; shortness of breath.

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WHAT CAUSES CHEMICAL SENSITIVITY?THE ALLERGIC EXPLANATION

This assumes that the affected person makes IgE antibodies to the synthetic chemical concerned (see p25), or responds with some other inappropriate and damaging immune reaction. Since the chemicals concerned are too small to act as antigens in their own right, they would have to combine with body proteins and act as haptens.

It has been suggested that this can happen with some food additives, particularly preservatives and synthetic colours. These cause chronic urticaria (nettle-rash) in some people, and urticaria is sometimes due to an allergic reaction. There are also isolated cases of tartrazine (a synthetic colouring) causing acute asthma attacks, or a severe reaction that resembles anaphylactic shock in some very susceptible people. Other food colourings, particularly the synthetic ones, have been known to cause allergic dermatitis, mainly in food workers exposed to large amounts. The preservative, sorbic acid, has occasionally caused allergic dermatitis when used in medicinal creams.

In most of these cases, the tests to show that the reaction really is an allergic one have not been carried out. And when a group of patients who were apparently allergic to tartrazine were tested for IgE antibodies, none were found. So it looks as if these are not allergic reactions at all, even though they produce allergy-like symptoms. Doctors suspect that tartrazine produces symptoms in these people by directly affecting the immune response in some way – perhaps by stopping the synthesis of immune regulators called prostaglandins, or by triggering mast cells directly. In the case of synthetic chemicals apparently causing asthma, the effect may be due to irritation rather than an allergic reaction. This is well known for metabisulphites and sulphur dioxide.

These are cases where the symptoms provoked by chemicals at least looked like allergic symptoms. In the majority of chemical-sensitive people, the symptoms are not those commonly associated with allergy. So it seems unlikely that chemical sensitivity is allergic in origin. It is possible, however, that synthetic chemicals might affect the immune response in some way. This has indeed been shown for some chemicals, but the usual effect is to lower resistance to disease, rather than to make allergies more likely.

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KNEE, PAIN IN, ESPECIALLY AFTER SPORTS ACTIVITY: TREATMENT

Once a diagnosis is made regarding the knee’s status, treatment can take one of many forms. Since the knee is an easily damaged joint, you should see your doctor, who will probably take an X ray of the knee and manually examine the knee as well as the way you’re walking. She will tell you to test the knee and take aspirin or Advil to ease the pain and inflammation.

If, however, your doctor determines that your X rays reveal a torn meniscus that requires surgery to remove, you will undergo arthroscopic surgery, which involves inserting a stainless steel surgical tube through a tiny incision at the side of the kneecap and suctioning the torn cartilage out. This popular operation has enabled people to indulge in their chosen sport within a week after surgery, if not the next day.

Tips and Precautions

Preventing knee injury consists of two components: warm-up and conditioning. Walking rapidly for five minutes will serve as a warm-up before your regular exercise session, and being in shape will give you sufficient strength to get through your workout. Injury occurs most often when you’re tired or when you push past your energy reserves.

Stretching the hamstrings and other joints that surround the knee will also lessen the chance of injury to the knee. And if you strengthen the inside of the quadriceps, or thigh muscle, with a combination of stretching and walking, it’ll pave the way for smoothing the movement of the femur within the groove of the kneecap.

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BODY SIGNAL ALERT PAIN ON URINATION, FOUL-SMELLING AND CLOUDY URINE, PRE- AND POSTMENOPAUSAL: DESCRIPTION AND POSSIBLE MEDICAL PROBLEMS

For some reason, Mother Nature had it in for women when she designed their external genitalia. I once heard someone compare the urethra, vagina, and rectum to a highway where the exit tamps are all too close together.

A fourth physical flaw can be added: the woman’s urethra, or the tube that leads from the bladder to the outside of the body, is very short compared to a man’s. This shortness is what helps create urinary tract infections, since the bacteria don’t have very far to travel before they start to cause an infection in the urethra. The major symptoms of a urinary tract infection are a burning pain during urination and foul-smelling urine. A urinary tract infection can occur in different parts of the urinary tract. An infection of the urethra is called urethritis; if it spreads to the bladder, a bladder infection can occur. An infection of either the bladder or the urethra can be quite painful. Because urethrtis is often caused by intercourse, when bacteria are pushed up into the urethra, it is often called honeymoon cystitis.

Rarely, the infection will proceed to the kidney; this condition is called pyelonephritis. This can cause permanent kidney damage, so it’s important to treat urethritis in the early stages before it has a chance to spread.

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NIPPLE, RETRACTION OF

Description and Possible Medical Problems

A health columnist at a popular women’s magazine has said that two of the most commonly asked questions from readers are (1) Why do I have hairs growing around my nipples? and (2) What can I do about my inverted nipples?

Although she could answer the same two questions in her column every month, making her readers happy, she limits the appearance of each question to once a year. Her answers: (1) They’re perfectly normal—pull them out with tweezers and (2) They’re perfectly normal— ignore them.

Inverted or retracted nipples are perfectly normal if you’ve had them since puberty. Only if the inverted nipples have developed recently could they be a sign of trouble—that is, cancer.

Treatment

If your nipples have recently turned inward, see your doctor right away. Any change in the skin of the nipple—whether a color change or an inversion—could be a sign of cancer. She will do a routine breast exam and a mammogram if she suspects you have a tumor.

Otherwise, if you’ve had them all your life, you have nothing to worry about.

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BELCHING, SWEATING, SHORTNESS OF BREATH: DESCRIPTION AND POSSIBLE MEDICAL PROBLEMS

When I first began my medical practice, one of the first patients I saw was an elderly gentleman who came into my office off the street because he couldn’t stop belching; he was also mildly short of breath. He thought all he had was a severe case of indigestion. However, I admitted him to the emergency room because he was actually having a heart attack, though he didn’t believe me. At times a person may have heart attack symptoms—such as belching—without any significant chest pain.

In fact, if you have been diagnosed with heart disease and show some of the risk factors for a heart attack, if you start belching and can’t stop, go to the hospital immediately!

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BODY SIGNAL ALERT THROAT, SORE: TREATMENT

Because there are so many reasons why your throat may be sore, the treatment will depend on the cause. If you think pollution is causing your sore throat, your only remedy is to stay inside more and to venture outside only in the early morning and on days when the air pollution index is low.

If you have a sinus infection, antihistamines can help alleviate a sore throat by stopping the postnasal drip. If your mouth is dry because of the sinus infection, sipping water frequently during the day will help keep your throat moist and more comfortable.

If I think a patient has strep throat, I’ll take a throat culture. It’s important to seek treatment for strep throat right away, since it can lead to scarlet fever or rheumatic fever if left untreated. If the culture comes back positive, I’ll treat it with penicillin or erythromycin for a 10-day period. Although strep throat occurs more frequently in children than adults, you should know that if you have strep throat, you can easily pass it to your children.

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GAMES TO RESTORE TENDERNESS – GAME 5: EXPRESSING RESPECT (PART 1)

Husband and wife repeat the following sentences: “It’s difficult for me to say that I respect you.” “And it’s difficult for me to say that I respect you.” “If I say I respect you, I’ll …” (Say whatever comes to mind next.)

“And if I say I respect you, I’ll …” (Say whatever comes to mind next.)

“I feel I’m giving something away if I say I respect you.”

“And I feel I’m giving something away if I say I respect you.”

“My mother had contempt for my father.” “My father had scorn for my mother.” “My brothers teased my sisters.” “And my sisters degraded my brothers.” “It’s difficult for me to accept your respect or admiration.” “And it’s very hard for me to accept your respect or admiration.”

“If you say you respect me, I’ll …” (Say whatever comes to mind next.)

“And if you say you respect me, I’ll …” (Say whatever comes to mind next.)

“I don’t feel worthy of your respect because …” (Say whatever comes to mind next.)

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GAMES FOR POLITICALLY OR MORALLY CORRECT COUPLES – GAME 4: EROTIC CARDS (PART 2)

The eighteen cards (sixteen high cards and two jokers) are placed face down on the middle of the table. Then the husband and wife take turns drawing one card from the deck. Each time one draws a card, the other asks, “Play or pass?” If the card holder wants to play, he or she must do whatever is written on the card. If he or she says “Pass,” that player may keep that card and draw again. Each partner is allowed three passes per draw. However, he or she must put $50 in the jackpot for each pass. After three passes, should a partner refuse to play, he or she loses the game and forfeits the jackpot. (The jackpot includes the sum of money that is begun with—perhaps $100, contributed to equally.) If each performs what the cards dictate, the winner is the one with the fewest passes. If the game is still tied at the end, the jackpot is divided—and each partner becomes a winner in more ways than one.

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