Health News and Information

Pain in the head from any cause. Migraine is a very specific type of headache and is relatively uncommon, whereas headaches are extremely common-one of the most familiar of everyday pains.

Migraine is characteristically a one-sided headache and more than half of all sufferers have their first attack before the age of 20. Most people who have true migraine know when it is about to start. Often sufferers say that they feel exceptionally well a day or two before the attack. The senses are often generally sharpened at this time. Shortly before the headache itself begins there may be a sensation called an aura. This often takes the form of difficulty with or changes in vision. You might see flashing lights and you might even go blind for a while. There may also be peculiar smells, a feeling of nausea and you might even vomit. Some people lose their voice and have altered sensations of touch. The aura lasts for up to half an hour and then fades.

Next comes the headache, which can last from an hour up to a few days. It starts above or behind one eye and spreads to the back of the head on the same side. Many people feel nauseated and may even vomit. For many, sleep cures the headache but others wake with the headache still there.

Cluster headaches are not at all uncommon and are a sort of face-headache migraine. They come in bouts (clusters) with an attack every day for weeks and then nothing for months. This complaint is much less common than ordinary migraine and men have it more often than women. The individual attack starts at the same time each day (or more often, night) often in the spring or autumn. When an attack is at its peak it is very painful, usually being worst in the eye and the cheek. The eye on the affected side becomes red and watery and the nostril on that side blocked. Anti-migraine drugs can be useful but often the condition persists.

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Bypass surgery

When bypass surgery was first started, it was usual to take a vein from the leg (we have plenty to spare!) and insert it around the narrowed site in the coronary artery. The blood then flows through the vein, around the stenosis, to reach the myocardium beyond it. The immediate result is a much better flow of blood to the heart muscle, carrying much more oxygen and glucose to the starved area.

There has been a more recent trend to use a small segment of artery from inside the chest wall—the internal mammary artery—instead of the vein. Among the reasons for the change is that the artery is more readily available than a leg vein, and that an arterial graft is probably more appropriate than a vein graft for what, after all, is another artery. There have been reports that the internal mammary graft is more effective in the long term, but other comparisons between the two seem to suggest that there is little difference in the merits of the two types of graft.

Bypass grafts are, of course, done under general anaesthetic, and patients must stay in the hospital for several days afterwards. I was astonished to be called to a patient’s home on a Friday to see him, to be told that he had had his bypass just four days before, on the Monday! The pressure to remove patients from hospital care in today’s fast-paced health care climate is surely immense!

Bypass surgery appears to work best for those who have left-main or severe three-vessel blockages.

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That guidance may be based not just on the work of Professor Williams and Dr. Beevers, but also on the most recent results of the many studies of the possible links between alcohol and heart disease. Unfortunately, the results are far from clear, and many different conclusions have been drawn from them.

Probably the most reliable conclusions were drawn by Professor A. G. Shaper, of the British Regional Heart Study mentioned in the introduction/in 1994. This showed that moderate drinkers (sixteen to forty-two units a week) suffered 34 percent fewer deaths from heart attack, and 13 percent fewer deaths from other circulation disorders (mainly stroke) than nondrinkers.

This would seem to be encouraging for drinkers, but Professor Shaper stressed that it was not. First, the actual overall numbers of such deaths were so small that the differences could not be considered as reliable or statistically significant. Worse, there was no reduction in overall death rate among the moderate drinkers, so that they were more likely to die from other diseases at the same time.

Professor Shaper showed that the extra heart deaths among the teetotalers included several in people who had been diagnosed as having heart disease when they entered the study. They may well have been drinkers who had turned teetotal because they were already feeling ill, and this could account for the difference in death rates. He concluded that if moderate drinking does protect against heart attacks, the effect is relatively small, and is not accompanied by a reduction in deaths from all types of circulation disorders, or by a reduction in deaths over all.

He compared his results with those of studies in other countries. In Trinidad, the lowest mortality for all causes was in men labeled as abstemious, who did not usually drink, and had no history of drinking problems. In the large Kaiser Permanente Study, which used lifelong abstainers as a comparison, none of the drinking groups— ranging from occasional, through mild, moderate, and heavy—showed any benefit from their alcohol consumption, and those drinking more than six units a day were decidedly worse off.

In a study carried out by the American Cancer Society, in the data on deaths from all causes, only occasional drinkers and those taking one or two drinks a day had a significantly lower risk than nondrinkers. Here, too, the figures may be distorted by some people who gave up drinking because they were already unwell before they entered the study. Above the lowest alcohol intake level, death rates rose progressively with each step up in alcohol consumption.

In this same study, at the level of alcohol intake associated with the lowest risk of coronary heart disease death (four drinks per day), there was an increased risk for all-cause deaths, particularly from accidents and violence, cancer and stroke, which more than outweighed the apparent savings in heart deaths. This bleak statistic does not take into account the increased rates of illness that may stem from consuming much lower amounts of alcohol than four drinks a day.

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Start off by making the right decision. Don’t listen to that voice inside you that says “I’ll start next week,” or “I’ve tried to before and couldn’t keep it up,” or “I can’t make the change just now.” You can make the change, even if it is just with a first small step. There are a few rules for beginning exercise:

• If you have a health problem, such as angina, discuss with your doctor the best type and amount of exercise for you.

• Choose a type of exercise you will enjoy, one that feels right for you.

• Do exercise that involves the large muscles in your legs, such as in brisk walking, cycling, and swimming.

• Start easily and gently, and build up your activity slowly and gradually.

• Be sensible about starting and stopping. Listen to your body, and don’t overdo things.

• Do not exercise if you are unwell—for example, if you have a throat infection or flu.

• Do not exercise if you have a muscle strain or injury. Wait until it is pain-free before you start again, and do so slowly.

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Among the early studies was the Los Angeles Veterans Administration Study, which took place between 1959 and 1967. This followed 846 men aged between fifty-four and eighty-eight years, of whom a quarter initially had evidence of coronary heart disease (mainly angina). Half were allocated to a diet in which the ratio of polyunsaturated fats to saturated fats was two to one. Vegetable and fish oils were used instead of animal fats. Half were left as the control group. After eight years, fewer deaths from heart disease and nonfatal heart attacks had occurred in the treatment group (85 in 424) than in the control group (119 in 422). The benefit of cholesterol lowering was greatest in the men under sixty-five years old.

Diet also seemed to work in seven hundred men and six hundred women in the Finnish Mental Hospitals Study, which was undertaken from 1959 to 1971. For six years, those in one hospital were on the same polyunsaturated/saturated two-to-one diet as in the Los Angeles study, whereas those in the other hospital were left alone. After six years, the positions were reversed. Although the patient populations changed greatly during the twelve years, and there were many problems with the data analysis, the diet was linked with a moderate benefit in reduction of heart attack and stroke for both men and women (though less so for women).

The North Karelia Study described in chapter 4, which targeted a whole community, produced a similar benefit, in that heart attacks became fewer after the low cholesterol educational project started.

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The answer is that it can be, (and it will take the rest of this book to explain how) with a combination of sensible eating, exercise, a different lifestyle, drugs, and perhaps surgery. Yet it is important, in understanding how this can be done, to look at all the other contributors to angina, for cholesterol is not the only danger to angina sufferers.

Atheroma is the necessary background to most kinds of angina, but it is hardly ever the sole cause of the symptoms. In most angina sufferers, it is the combination of underlying atheroma with many other changes in the blood that causes the illness. For example, the blood may be more viscous (sticky) than normal, slowing the flow through the narrowed areas. It can be more likely than normal to clot. It can carry too little oxygen due to lung disease or anemia, or perhaps because the oxygen-carrying red cells are full of carbon monoxide instead. All of these possibilities can reduce the supply side of the equation.

Or there may be high blood pressure, which, by increasing the force of the heartbeat even at rest, increases the heart’s demand for oxygen and glucose, causing further imbalance to the supply-demand equation.

How all these changes can combine together to create angina, and how they can all be reversed, is explained later, but in order to understand them, it is first necessary to outline the components of healthy blood.

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Before you make a decision regarding hormone replacement therapy, you should consider carefully all the known risks and benefits. Get as many competent opinions and as much professional advice as is possible. Discuss the options with your doctor and seek a second or third opinion. In the end, the decision is an individual choice, so you should get as much information as possible and make sure you understand the entire process and its effects.

Known Benefits

1) Very effective for treatment and prevention in the short-term of menopausal symptoms such as hot flashes, sweating and vaginal dryness.

2) May reduce episodes of depression and enhance sleep patterns. The therapy may also provide an overall sense of well-being.

3) Studies suggest that if taken for several years, this therapy slows down the rate of bone reduction. Other research indicates that if taken for at least five years, the incidence of hip fractures is reduced.

4) Some studies show that if the therapy continues long-term, it can help to maintain quality of skin and breast tissue.

5) If the therapy involves estrogen alone, it may help to protect against heart disease or reduce heart disease by 50 percent. However, the addition of progesterone appears to neutralize some of those benefits.

Known Risks

1) The therapy may cause minor side effects, such as headaches, nausea, bloating, weight gain, breast tenderness, and jaundice. Your doctor can lower your dose to alleviate the side effects.

2) Taking estrogen alone may increase the risk of endometrial cancer. However, that risk is apparently eliminated with the addition of progesterone.

3) While not conclusive, some studies suggest that estrogen may increase the risk of cancer. Also not conclusive, is evidence suggesting that the addition of progesterone gives protection.

4) Although rare with the dosage levels currently in use, the therapy may increase blood pressure.

5) Newer regimens attempt to eliminate monthly periods, but many women report regular spotting with this treatment.

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1) Fever— a recent study of persistent, unexplained fevers in children discovered that doctors who used an assortment of imaging tests, such as X- rays or Catscans, failed to make a diagnosis 66 percent of the time. The finding suggests that doctors should pay more attention to the symptoms, rely on basic laboratory findings and observe the child over time, in order to properly diagnose fevers.

2) Parkinson’s disease— a degeneration of the nerve cells in the brain, the symptoms of this disease may include tremors, rigidity, and a shuffling gait. It can be hard to diagnose because the symptoms in the early stages can appear similar to those of other afflictions, including stroke.

3) Clinical depression— this is a disorder which is caused by a biochemical imbalance in the brain. It involves serious mood disturbances which impair the person’s ability to function.

There are many possible symptoms of clinical depression including persistent sadness, emptiness or anxiety; loss of interest or pleasure in ordinary activities including sex; fatigue; changes in sleeping patterns; sudden fluctuations in weight; to concentrate or make decisions; forgetfulness; apathy; and thoughts of death or suicide.

The problems in diagnosing clinical depression arise from doctors who are not trained to detect a major depressive disorder. Such doctors are apt to misdiagnose the condition about half of the time. In many cases it is diagnosed as a “low” mood brought about by a stressful situation. Other times it is attributed to physical problems. Among elderly people, the symptoms of clinical depression are often misdiagnosed as the early stages of senility.

4) Multiple sclerosis— a progressive central nervous system disease which is thought to result from the breakdown of the myelin sheaths which protect and insulate nerve fibers in the brain and spinal cord.

The most common initial symptom of multiple sclerosis is numbness or tingling in the hands or feet. Other symptoms may include visual disturbances, muscle weaknesses, poor bladder control, balance problems or dizziness, or tremors.

The main problems involved with diagnosing this disease are that the early symptoms can easily be mistaken for other disorders, and the symptoms often disappear after a few weeks and then return months or years later.

5) Hypoglycemia— this is a condition in which the sugar content of the blood is abnormally low. The condition, which is common among diabetics can also be due to an underactive thyroid, improper diet or allergies, or emotional problems.

Two to five hours after each meal, a person with hypoglycemia may experience weakness, trembling, dizziness, sweating, fatigue, hunger, craving for sweets, and anxiety.

Current tests for hypoglycemia are not always conclusive. Some doctors may also be skeptical that such a condition exists at all, causing the illness to go undetected and unchecked.

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If your cholesterol level is abnormally high, your doctor may choose to put you on medication. While it is advisable to follow your doctor’s recommendations exactly, there are some people who may be able to lower their cholesterol naturally, without having to go on medication. Here are five ways you may be able to lower your cholesterol naturally:

1) Follow a strict low-cholesterol diet. Most doctors agree that many people may be able to lower their cholesterol levels by making prescribed dietary changes. Some people have experienced as much as a 30 percent improvement after following a strict diet for slightly less than one month, and ultimately experience a cholesterol reduction of up to 50%.

2) Practice weight control. It is important that you maintain your proper weight.

3) Be sure to get regular checkups. This is the only way to keep track of your cholesterol level and other matters related to your health.

4) Maintain a regular program of exercise.

5) If you smoke, quit.

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Severe burns may be caused by dry heat, such as fire; by moist heat, such as hot liquids and steam; or by electricity; corrosive chemicals; or friction. Burns that are critical and require prompt professional attention include third degree burns which leave a charred area after destroying skin and underlying structures; blistering burns on a child or on an elderly person; all burns to the head, face, neck, hands, feet, or genitals; inhalation burns; electrical burns; chemical burns; and burns covering large areas of the body.

The treatment of burns and scalds depends on the severity of the injury. In general, the first treatment involves reducing the temperature of the burned area. This will help prevent further injury to the skin and underlying tissues as well as to stop the burning and reduce pain. The initial cooling of the burned area can be done by immediately flushing the area with cold water. The injury should then be covered with a dry, clean cloth. Do not put any pressure on the burned surface.

Never apply ointments, sprays, antiseptics, or home remedies such as butter to a burn. And don’t break blisters.

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