Mhinform

Historically, people have been shockingly bad at determining when their fellow human beings were dead. Things got so bad that in 1896 a group fearful of waking up in their final resting place founded the Association for the Prevention of Premature Burial. Earlier in Russia, savvy sales folk were hawking coffins with a system of flags and bells to summon help should you find yourself buried alive.

The truth is that, until relatively recently, the onset of putrefaction was the only truly reliable sign of death. “Otherwise, you’ve been considered dead when the medical folks say you’re dead,” explains Cyril H. Wecht, M.D., forensic pathologist and coroner in Allegheny County, Pennsylvania. “While that hasn’t changed, thankfully, we’ve developed better ways of determining death these days.”

A couple of centuries ago, long before the magic of medical technology, just having fainting spells could send you to your grave, recounts Kenneth V. Iserson, M.D., professor of surgery at the University of Arizona College of Medicine and director of the Arizona bioethics program, both in Tucson, and author of Death to Dust. “Many diseases like syncope (a condition that causes people to faint or suddenly lose consciousness) and typhoid could easily be mistaken for death in those times.”

As recently as 1926, medical texts were advising doctors to look for “signs of life,” using uncertain techniques such as placing an ice-cold mirror close to the person’s mouth to check for breathing, and cutting an artery to see if the person would still bleed.

They eventually discovered more advanced ways to determine death, based largely on the idea that when your heart stopped, you were dead, Dr. Wecht says. “But then CPR (cardiopulmonary resuscitation) began reviving people whose hearts had stopped. And in 1968, a South African doctor further complicated things by performing the first heart transplant,” he says. That’s when the folks at Harvard Medical School declared and promoted the idea of “brain death criteria.” When your brain has stopped working, that’s absolutely the end, explains Dr. Wecht.

Today, doctors have several surefire methods for determining when the brain dies, ranging from the simple (testing the person’s ability to breathe on his own and blinking in response to touching the cornea) to the high-tech (hooking the person to an electroencephalograph machine to monitor brain activity, electrocardiograph to measure the heart’s electrical activity, and nuclear medicine brain scans). “No one has ever failed all these tests and still regained consciousness,” Dr. Iserson says.

*24/36/5*

There is no doubt in any doctor’s mind that stress plays a crucial role in many of today’s illnesses, both physical and mental, though just how big a role stress plays in any particular disease is difficult to assess. Undoubtedly the link between ‘type A’ behaviour (competitive and aggressive) and heart attacks is real enough and the links between stress and high blood pressure, certain bowel disease, asthma, eczema, migraine and many other conditions are all too obvious to many people.

Each of these eight headings points to what the preventive medical world calls ‘risk factors’. If you want to reduce your chances of getting a particular disease, or indeed of being unwell at all, you have to be aware of what you personally are at risk from. Only by knowing what your risk factors are can you understand the causes and set about possible risk-reducing activities.

Risk appraisal generally depends on the study of probability tables. The Robbins-Hall method of risk-factor analysis (probably the best devised so far) looks at the top twelve to fifteen causes of death, because between them they account for about two-thirds of all deaths. By comparing treated and untreated groups of people in any specific disease category a doctor can find out which intervention produces results, and can work out a ‘health appraisal’ age to compare with the patient’s actual chronological age. Let’s look at an example.

Take a 41-year-old man with a blood pressure of 180/94 mmHg and a cholesterol level of 220 mm/dl who is overweight by 15 per cent and is a non-diabetic. He also smokes twenty cigarettes a day, has eighteen drinks a week, drives 15,000 miles a year, wearing a seat-belt 75 per cent of the time, and exercises moderately each week. He has no family history of heart disease and his parents are both over 60 years old. Using the Robbins-Hall method this man’s total personal risk is 9,680. This means his chances of dying during the next 10 years are 9,680 in 100,000.

If he stops smoking, has his mild blood pressure treated and cuts his drinks to six per week, he can reduce his risk from 9,680 to 4,992. This large reduction is possible because by changing his behaviour in this way he can reduce his risk of heart attack considerably. It would also reduce his risk of cirrhosis, lung cancer, stroke and car accidents.

This man’s total personal risk before he starts his personal preventive programme translates to a risk age of 46.5 years compared with his actual age of 41 years. By using personal preventive measures he can reduce his personal risk age to 40. The Robbins-Hall printout would show that this man’s level of high blood pressure elevates his risk of heart attack by 150 per cent, and that his smoking plus his raised blood Pressure increase his stroke risk. His drinking increases his chances of both liver cirrhosis and of having a car accident.

*19/72/5*

At age 31, Pamela Joyce Kimrey had to face facts.

Her father had died of a massive heart attack when he was just 35 years old. Pamela Joyce wondered if the same fate awaited her. After a lifetime of overeating and almost 2 decades of yo-yo dieting, she weighed 274 pounds. And she was scared.

Pamela Joyce, of Warrenville, South Carolina, traced her seemingly endless appetite to her childhood. “When I was born, I weighed a little more than 4 pounds,” she explains. “My parents left the hospital with instructions to feed me as often and as much as they could.” And they did. By the time she was in fourth grade, her weight hovered around 130 pounds.

Through high school, Pamela Joyce continued to gain. She graduated weighing close to 250 pounds, far too much for her 5-foot-2 frame. “I didn’t want to go through college overweight. I wanted to fit in,” she recalls. “So I put myself on what I considered a diet. I ate less, but I ate poorly—mostly deep-fried, sugary, and fatty foods.” Over the next year, she took off 70 pounds. “At 180 pounds, I still weighed too much for my height,” she says. “But I held steady for several years, right through my wedding in March 1987.”

As Pamela Joyce settled into married life, the pounds started | coming back. “Twenty-five pounds stuck around after I gave birth to our only child, Houston,” she says. “The rest of the weight resuited from’too many meals of fried food smothered in gravy plus thousands of calories worth of junk food and soda.” By October 1996, Pamela Joyce had reached her top weight of 1 274 pounds. “One night, I was lying in bed, feeling disgusted with myself. I started thinking about my dad, and I realized that I could die young if I didn’t take better care of myself. It was my wake-up call.”

The very next day, Pamela Joyce went to her local library and took out every nutrition, fitness, and weight-loss book that she could find. When she read them, she found three themes that came up over and over again: a low-fat diet with portion control, regular exercise, and plenty of water.

Based on the information that she had collected, Pamela Joyce put herself on a strict 1,200-calorie-a-day diet. She cut out junk food, whole milk, and butter and began grilling and baking food instead of frying it. She also invested in a kitchen scale to keep tabs on portion sizes.

Because she was accustomed to eating as much as she wanted, Pamela Joyce had to find a way to keep her stomach full throughout the day. One of her favorite tricks was to save a part of each meal for later in the day. “If my breakfast consisted of a cup of raisin bran, a half-cup of skim milk, and a banana, I’d save the banana for a mid-morning snack,” she explains. “Likewise, I’d keep half of my lunch sandwich for an afternoon snack. If I ate out, I’d have half of my entree wrapped to go before I’d even take a bite.”

This strategy helped Pamela Joyce stay within her 1,200-calorie limit without feeling hungry. Between her improved eating habits, her daily workouts (alternating aerobic exercise and

strength training), and her consumption of gallons of water a week, she managed to lose 137 pounds—exactly half of her body J£ weight—in a little more than 2 years. She’s been holding steady “» since November 1998.

“There is absolutely no way to compare the old me with the new me,” Pamela Joyce says. “I could never have imagined how wonderful I feel. I can keep up with my son and not worry about embarrassing him—except maybe when we’re inline skating in the park. Good health has become a way of life for me and my family.”

*13\89\8*

Flavour enhancers, E620-E635. The most important of these is monosodium glutamate, or MSG, and its relatives, E620-623. Eating large amounts of MSG is said to produce a set of symptoms known as ‘Chinese restaurant syndrome’

- the symptoms described for this condition vary considerably: ‘tightness, pain and tingling in the front of the chest, radiating to the arms, often associated with palpitations and faintness’ according to one authority, but ‘flushing, sweating, loss of coordination, headache and hypotension [low blood pressure]‘

according to another. Some studies have failed to confirm the existence of a reaction, but it has been suggested that the source from which the MSG is manufactured is important. There are reports of MSG triggering attacks in some asthmatics.

Flavourings. These do not have to be listed on food labels, unlike the other additives. There are over 3,000 of these, they do not have E-numbers, and most have never been properly tested for safety. However, they are used in extremely small quantities, and are assumed to be non-harmful for this reason. Although this may be true for the majority, there are doubts over some flavourings, particularly a group known as the ally! alcohols which are potent toxins. The average person only receives small amounts of these, but anyone eating large amounts of sweets, crisps and soft drinks would get a much higher dose.

*408\180\8*

Feeling much better, but with one or two lingering symptoms It looks as if you have cut out your main offending foods, but are still eating something that is a problem. If the lingering symptoms are fairly minor, then you can proceed to the reintroduction phase. Test the major foods: milk, eggs, wheat, rice etc, and continue eating those diat cause no problems. This will help to broaden your diet. Having done this, look through the food diary you kept before the diet and try to identify possible causes for your lingering symptoms – is there anything you used to eat quite frequently and have continued eating throughout the diet? Potatoes, onions, tomatoes, shellfish and fish are likely suspects. Cut all these out and then test them.

If your lingering symptoms are fairly troublesome, or very variable from day to day, then it will not be possible to get clear results from the reintroduction phase. In this case, look back through the food diary you kept before the diet for potential culprits. Cut these out immediately. Should your symptoms clear, then go on to the reintroduction phase immediately. If they don’t, then go on to the Stage 3 diet, preferably a rare-food diet.

Before deciding which course of action to take, consider the possibility that

it might be something other than food causing the residual symptoms. If you have candidiasis, for example, the sugar-free, yeast-free diet could have helped considerably but not removed all your symptoms. Or it could be that food was your main problem, but something else is causing the residual symptoms – an airborne allergen or environmental chemical perhaps. If you have not checked out these possibilities, then think about them now.

*361\180\8*

These measures can help to prevent allergies developing in babies born into atopic (allergic) families.

Plan the timing of birth for September-February; avoid March or April. Don’t eat too much of any one food while pregnant. It may also be worthwhile avoiding foods that are potent allergens (listed below), but there is no firm evidence that this is of benefit during pregnancy. Give up smoking before becoming pregnant. Once the child is born, make

sure that no-one smokes in the house. Breast-feed for the first year if possible. Give nothing but breast milk for

the first 4-6 months. If breast-feeding is not possible, discuss with your doctor the possible

alternatives, such as hydrolysate formulas. While breast-feeding, avoid eating foods that are likely to cause allergic reactions: milk, eggs, peanuts, fish, citrus fruits (oranges, lemons etc), wheat, beef and chicken. To this list, add any food to which a previous child is allergic.

After 4-6 months, introduce some solid foods, but withhold those listed

above until 9-12 months. Introduce these foods gradually, one at a time, so that reactions can be

noted. Do not give new foods when the child is ill. For the first year, have no furred pets, keep dust to a minimum and keep the house free of moulds (see p67 for details). If the child has an infection, take special care to keep allergens to a minimum. Where possible, avoid exposing the baby to air pollution. Avoid unnecessary surgery, during the first year of life. As far as possible, avoid exposure to people with throat and chest infections during the first three years of life.

*314\180\8*

Claire’s eight-week-old baby, Jamie, was apparently healthy but cried a lot of the time, and seemed to be in pain. As Claire was breastfeeding, her doctor asked about her diet and found that she was a vegetarian. She explained that she had been eating more cheese and drinking an extra pint of milk a day to make sure she got enough protein during pregnancy and breastfeeding. The doctor suggested that she might avoid milk, cheese and butter for a while, to see if this had any effect, and prescribed some tablets to give her extra calcium. He persuaded her to eat a little fish to make up for the missing protein. A couple of days after starting this diet, Jamie’s crying was noticeably less and it became easier to get him to sleep each evening. Claire was delighted at the improvement. She tried drinking a glass of milk, to see what would happen, and 24 hours later Jamie, following a feed, suffered, a severe attack of colic. After that, Claire stayed on a milk-free diet for six weeks. She then introduced a little milk and butter into her diet and found that Jamie could now tolerate this.

*263\180\8*

Jane could fairly be described as a ‘typical’ case of food allergy. But Susan is not a typical case of food intolerance because there is no such thing. Food intolerance cannot lay claim to any single set of symptoms. Every patient is different, both in the cluster of symptoms they show and in the foods that affect them. Nor is there a single, clear-cut mechanism underlying the symptoms, as there is with food allergy. The available evidence indicates that there may be half-a-dozen or more different factors that contribute to the illness. In other words, food intolerance is a complex subject, and few generalizations can be made.

Nevertheless there are certain features that characterize this type of food sensitivity, and distinguish it from food allergy. Whereas food allergy reactions are usually immediate, food intolerance reactions tend to be much slower. The culprits in food intolerance are foods that are eaten very regularly, especially items such as wheat and milk that are consumed at almost every meal. The slowness of the reaction, combined with the fact that the foods are eaten so often, contributes to the ‘masking’ effect observed by the first doctors to study these reactions – the link between food and symptoms is unlikely to be made when the body is subjected to a constant bombardment with the food.

*15\180\8*

Players: Husband and wife.

Activists: Both.

Setting: Home or hotel.

Aim: Get couple in touch with unconscious narcissism.

Game Plan: This game is best if the couple can put a mirror somewhere near their bed, on the headboard, on the ceiling, at the foot of the bed; or they can check into a hotel that features such mirrors.

The man and woman get undressed and lie across the bed, their arms around each other, and look at themselves in the mirror. Then they ask:

“Mirror, mirror, on the wall, who’s the fairest couple of them all?”

They begin foreplay, fondling one another, and again turn to the mirror.

“Mirror, mirror, on the wall, who’s the fairest couple of them all?”

They begin making love, and in the midst of it turn to the mirror again.

“Mirror, mirror, on the wall, who’s the fairest couple of them all?”

*120/196/1*

They proceed according to the husband’s fantasies. Having been paid for her services, the wife will give herself to the experience with a new zest, and the husband will in turn respond similarly.

If the game goes well, it should not only enliven their relationship, but also serve to play out each of their deeper repressed fantasies. By giving vent to these fantasies, they break through the block that has kept their sexual relationship at a stalemate. These fantasies are attached to repressed feelings of anger having to do with early-childhood sexual traumas, and may therefore include “rough” talk or action. After the sexual part of the game is finished, the couple should talk about how it felt to play the game, and what that says about the way they had related up to that point. They may repeat the game as often as they like—or even try a reversal of the game in which the husband plays the prostitute and stripper.

*95/196/1*