Preventive measures for the Degenerative Joint Diseases- Rheumatoid arthritis

Secondary preventive measures are directed at reducing the strain on affected joints by weight reduction, use of back braces, abdominal support for sagging abdomen (to take strain off the back), neck braces, and adequate rest. Pain-relieving medication and local heat applications are useful. Steroid injections of affected joints may be used in some cases. Usually these measures work very well. In cases not adequately helped by them, the arthritis may cause distortion of joint structure and may necessitate such tertiary measures as replacement of a joint by a metal pros- thesis or surgical removal of restricting diseased tissue.

 In some cases of DJD, bony over- growths may cause pressure on nerves. When this happens in the neck region -a common site for DJD-it may cause pain and weakness in the hands and fingers. Surgical removal of the bony spurs is the only effective treatment. Gout is a disease thought lightly of by all except those who suffer from it. Books are replete with cartoons of obese aristocrats suffering from painful gouty toe, and the implication is that "high living"-overindulgence in food and drink and lack of gainful work-is responsible for the disease. In reality, gout is an inherited ailment related to abnormal metabolism of certain important compounds, called purines, in foods.

As a result of the abnormal metabolism, an in- creased level of a purine breakdown product, uric acid, builds up in blood and body tissues. When excess uric acid is deposited in joints it may lead to inflammatory reaction by the joint tissues. This produces severe pain, swelling, and stiffness. The joints usually affected are those of the lower extremities, particularly the great toe, but any other joint in the body can be involved. The arthritis of gout can be severe and disabling if untreated and may lead to permanent deformity.

 Also, changes leading to impairment of vital organs such as the kidney may occur. Not everyone with gout develops the chief clinical symptom of arthritis; by far the great majority of cases are without symptoms. People in sedentary work are more likely than manual laborers to have clinical gout. 

The physician suspects gout particularly when a middle-aged man-goutyarthritis is predominantly a disease of men- complains of pain and swelling in one or occasionally two joints which are extremely sensitive to the slightest pressure. He will confirm the suspicion by a test which measures the amount of uric acid in the blood. The outlook is for recurrent arthritic attacks involving great pain and leading to joint deformity unless adequate treatment is instituted, in which case the patient can be free of all symptoms of the disease.

The physician will perform tests to evaluate the function of the kidneys, because uric acid can cause kidney stones and in other ways can damage the kidneys. Kidney failure is a dreaded complication of gout and fortunately an uncommon one that can be prevented. The physician also will be alert for high blood pressure and heart disease, since, for unknown reasons, many people with gout also have these ailments. Finally, he may ask blood relatives to have their uric acid levels checked, since gout is an inherited disorder. Because it is well known that stress or injury to joints can precipitate an attack of gouty arthritis, the obese patient will be advised to reduce weight. 

Primary preventive care for Rheumatoid arthritis

Among the most effective for RA is aspirin, because in addition to its effect on pain it has a valuable anti-inflammatory effect. Frequently, large doses of aspirin are needed around the clock. In an occasional patient, aspirin will cause bleeding in the stomach or intestine or may even help produce a peptic ulcer. 

Such patients may obtain relief of pain from a medicine such as Tylenol. Indocin and Butazolidin are other anti inflammatory pain relievers that may be used along with, or in place of, aspirin. These agents may some- times produce peptic ulcers so, as a precaution against this, the physician will advise that they be taken with meals or with liquid antacids.

Narcotics should be avoided because of the risk of addiction. Gold salts and certain compounds for malaria are occasionally of value in RA. Their side effects, however, may be drawbacks to their use. Steroid compounds provide the most dramatic relief because their potent anti-inflammatory properties lead to rapid suppression of joint pain and swelling. They may be used for acute disabling attacks or when all other medicines fail to produce adequate results. Steroids, however, do not cure RA. They have such side effects as bone brittleness, weight gain, ulcer formation, diabetes, and others.   Arthritis associated with "wear and tear" in the joints.

 It does not usually develop before middle age except when a joint has been injured or when joints have been subjected to much stress and overuse, as in the finger joints of some pianists.

Degenerative joint disease (DJD) is an uncomfortable but not very severe disease. Unlike RA, it produces no constitutional symptoms such as fever and weight loss. In some cases, how- ever, it may cause joint disability. The joints usually affected are the weight-bearing ones such as hips, spine, knees, and ankles. Frequently swellings of small finger joints are seen. 

Affected joints may "creak" and grate on movement. Typically, and in contrast to RA, pain is increased by exercise and relieved by rest. An essential element of primary prevention is the avoidance of excessive weight gain, which adds to the burden and wear and tear of weight- bearing joints. 

Rheumatoid Arthritis - preventive care and treatment

The joints may be stiffer and sorer in the morning than after exercise. In some cases, small hard nodules may appear under the skin, especially in pressure areas. In many instances, the hand affected by RA begins to deviate outward (toward the little finger). To confirm the diagnosis, x-ray studies may reveal characteristic changes of bones and joints. Blood tests may be used, including one for an unusual protein that appears in the blood of patients with RA, although it may sometimes be related to other diseases. 

Once RA is diagnosed, the physician can envision two possible scenarios for the disease. In one form of RA, there is severe joint inflammation, with pain, swelling, fairly rapidly developing deformities. Fever and prostration often accompany this type of RA; and if the disease is untreated, not only may there be rapid development of deformities, but the deformities may become crippling. In the second and more common type, the arthritic pains and swelling are not as severe and disabling, and there may be intervals during which few, if any, symptoms are experienced.

However, gradually over many years and often after several attacks of more severe joint pain, the joints may become deformed and impaired. Although medical science is learning more and more about rheumatoid arthritis, much remains to be revealed about the cause. The latest findings seem to indicate that an unusual type of bacterium or virus may cause the disease.

Meanwhile, lacking means of primary prevention, the physician must rely on methods of secondary and tertiary prevention to counter the ill effects of RA-joint deformity and disability. For secondary prevention, a many-pronged approach is used. Bed rest is important for acutely inflamed joints. In severe cases, this may mean hospitalization. In less severe cases, adequate sleep and avoidance not only of excessive fatigue but also of coldness and dampness may serve. It's important; too, that inflamed joints be maintained in non-deforming positions.

Swollen, inflamed joints are most comfortable when slightly bent, but if they freeze in this position they become of limited usefulness. Therefore every effort must be made to keep the joints extended or straight. This may require that splints and braces be worn at night and, in some cases, during the day as well. It may also call for use of a non-sagging mattress with a small pillow under the head to help keep the back straight; chairs with firm seats and straight backs; avoidance of tightly drawn sheets; use of cane or crutch to avoid excess weight on sensitive joints; and proper shoes with straight last. 

Exercise is important as part of the program to keep joints from stiffening. Special exercises may be needed to increase or maintain muscle power or to relieve any deformities that may have begun to develop. Local heat-from heating pad, lamp, etc.-helps relieve muscle spasm and pain. Pain-relieving medications also are essential for the arthritic. 

Appendicitis and preventive care

There are still 15,000 to 20,000 deaths a year in this country from appendicitis and its complications. Naturally, it is of the utmost importance to reduce the possibility that an inflamed appendix will rupture. There- fore, if symptoms are equivocal after 8 to 12 hours of observation, the physician will be inclined to operate rather than risk rupture. 

The patient's role in preventing rupture is important. Delay in diagnosis or improper treatment greatly increases the risk. The guidelines are simple:

1. Do not treat any abdominal pain lasting for 3 to 4 hours with cathartics, enemas or local heat. Laxatives and enemas increase contractions in the large intestine and cause pressure to develop in the appendix, increasing the chance of rupture. With each dose of laxative, the risk of rupture and death increases greatly. Local heat may obscure symptoms and may also hasten rupture.

2. Consult a physician as soon as possible.

3. Do not eat or drink anything. Recurrent attacks of acute appendicitis are uncommon but can occur. Chronic appendicitis-that is, appendicitis causing pain for weeks or months-does not occur; this type of pain is indicative of other medical or surgical problems.  

 It most frequently affects the joints of the fingers, wrists, knees, ankles, and toes, alone or in combination, although all joints may be involved. One hallmark of the disease is that usually both sides of the body are affected; that is, both hands and both ankles, for example, are involved at the same time. 

Appendix and appendicitis

A more complex question is whether a person who plans to be away from civilization for a period of time should have his appendix removed as a prophylactic precaution. With modern means of communication and travel, this is probably not necessary unless the person will be extremely isolated (as on a Pacific island or in an unexplored jungle area). 

The best secondary preventive measure is prompt diagnosis and treatment of an inflamed but still un-ruptured appendix. The problem here is that the initial symptoms of appendicitis may be mimicked by so many other conditions-pneumonia with abdominal pain, gallbladderdisease, ruptured ovarian follicle, tubal pregnancy, or just plain gastroenteritis-that the diagnosis of appendicitis can tax the most astute physician. The symptoms usually are nausea, abdominal pain, and loss of appetite, and sometimes fever, constipation or diarrhea. 

Typically, the pain of appendicitis will become most severe in the lower right side of the abdomen where the appendix is usually located. Since the appendix in some individuals may be located in an unusual position, pain may localize elsewhere. Careful history-taking and physical examination with close attention to where the pain is located are the most useful diagnostic measures. As noted, the pain of appendicitis is typically much localized; to pinpoint it further, a rectal orvaginal examination is of value. Suggestive clues such as in- creased white blood cell count, fever, and failure of symptoms to subside help confirm the diagnosis.

Treatment is surgical removal, and with good anesthesia and modern surgical techniques, the risk of surgery is virtually zero, while problems encountered after an appendix ruptures are formidable. After removal of an intact inflamed appendix, the patient is usually out of bed next day and home from the hospital in five to seven days. 

Further convalescence is ordinarily uneventful. Even those suffering from other ailments such as heart disease usually come through the surgery and anesthesia very well. In contrast, a ruptured appendix calls for intravenous feeding, antibiotics, strict bed rest sometimes for several days before surgery can even be performed. Recovery from surgery may involve several weeks of hospitalization because, even with antibiotics, peritonitis is still a difficult and dangerous medical problem. 

Aplastic anemia

At the first suggestion of aplastic anemia, a physician will stop all medications and search, too, for possible exposure to toxic materials. Diagnosis is made on the basis of changes in blood cells and the appearance of bone marrow in a sample obtained by puncture of the sternum, or breastbone. In some patients with aplastic anemia, a thymoma, or tumor of the thymus gland, is found; removal of the tumor is sometimes done but without guarantee that this will be helpful. Sometimes the spleen is enlarged and removal of the spleen may be considered.

Transfusions may be used. And recently there have been reports of promising results with the use of com- pounds related to the male sex hormone, testosterone. These compounds appear to have a stimulating effect on the bone marrow. What of replacement of diseased bone marrow by transplantation as a tertiary preventive measure? This appears to be a likely future measure as more experience is gained in the whole field of tissue and organ transplantation. Miscellaneous Anemias There is a group of anemias that are secondary to various diseases

.

For them, prevention, either primary or secondary, depends upon diagnosis and successful treatment of the under- lying disease.   Preventive measures aim at removing the appendix before it has a chance to rupture. Primary preven- tion may be considered to be the removal of a normal appendix before it has a chance even to become in- flamed. Secondary prevention involves removal of an inflamed appendix before it can rupture. 

Tertiary prevention is treatment of the complications of a ruptured appendix. Primary prevention is sometimes exercised by a surgeon when he removes the appendix in the course of doing other surgery in the abdomen such as removing the gallbladder or performing a hysterectomy. This adds little time to the operation and virtually none to the postoperative recovery period. The patient should make careful note of whether the surgeon states that he removed the appendix incidental to another operation, for this may be meaningful at a future time when abdominal pain is a diagnostic problem. 

Cooley's anemia and Mediterranean anemia-Thalassemia Symptoms, Causes, Treatment & Cure‎

Thalassemia major is also called Cooley's anemia and Mediterranean anemia. It is found in people with ancestry tracing to northern Africa, southern Europe, and such Asian areas as Iran, Iraq, Indonesia, Thailand, and southern China. It is a serious disease which starts in early life. In addition to the usual symptoms of anemia plus the jaundice of the hemolytic type, there is enlargement of liver and spleen. During the course of it, there may develop leg ulcers, gallstones, and a type of heart failure that is resistant to therapy. In thalassemia minor, the anemia is mild and the outlook very good.

Life span is normal. Usually no treatment is needed except possibly in pregnancy when blood transfusion may be used to keep the blood hemoglobin level at a safe point for the sake of mother and child. There are many other types of anemia, relatively rare, in which some slight abnormality of chemical structure of hemoglobin is the basic fault. Usually, when such anemias are suspected, study by a specialist in blood diseases, a hematologist, is needed. Other types of hemolytic anemia which usually require attention of a blood specialist for diagnosis and follow-up are autoimmune hemolytic anemia, ovalocytosis, paroxysmal nocturnal hemoglobinuria, and prima equine-sensitive hemolytic anemia.

The latter disease, which occurs in 10 to 15 percent of black males and 1 to 2 per- cent of black females, involves an unusual sensitivity to certain medications and chemicals; it usually clears up as soon as the offending substances are eliminated. Plastic Anemia Since blood cells are manufactured in the bone marrow; anemia may result when the marrow is damaged and becomes sluggish or fails to function at all. In this type of anemia, not only are red blood cells reduced in numbers; so, too, are the whitecells. Resistance to infections is thus reduced, too.

Blood platelet count drops as well and thus there may be bleeding. When aplastic anemia is severe, the outlook is grave. The mortality rate may go as high as 50 percent. With good treatment, the remaining 50 per- cent sometimes do quite well and, fortunately, in some cases, the disease clears up spontaneously. Aplastic anemia may be a result of sensitivity or toxic reaction to many medications and chemicals, including chloromycetin, Butazolidin, Mesantoin, benzene, hair dyes, volatile solvents, and insecticides. Irradiation in large doses also may be responsible. 

Hymolytic anemia or thallasemia

The patient feels well. Once blood values return to normal, usually just a single injection of vitamin B12 per month suffices for good health. There is no primary prevention for ordinary pernicious anemia. But there are other conditions that lead to vitamin B12 deficiency and to an anemia that resembles the pernicious type. They include destruction or removal of the stomach, regional ileitis, removal of the ileum (the lower portion of the small intestine), and fish tapeworm disease. When anemia stems from these conditions, primary prevention is possible. Fish tapeworm disease can be avoided by eating only well-cooked fish. 

When the stomach or ileum is destroyed or removed, injections of vitamin B12 can be given regularly to prevent the anemia from developing. Hemolytic Anemia In this type of anemia, red blood cells are destroyed. Hemolytic anemia may be congenital or acquired, acute or chronic. In addition to symptoms common to other anemias such as fatigue and shortness of breath, hemolytic anemia usually produces some degree of jaundice because the destroyed red cells release their hemoglobin which is converted into jaundice pigments. 

Sometimes an acute form of hemolytic anemia appears suddenly, with chills, fever, nausea, and vomiting, abdominal pain. The cause may be a medicine to which the patient is sensitive, bacterial or malarial infection, metastatic cancer, or Hodgkin's disease.

 If the basic cause can be removed (e.g., an offending medicine) or cured (e.g., malaria), the outlook is good. Usually the situation calls for prompt hospitalization. In the, hospital, with injections of fluids, transfusions of packed red cells, and use of corticosteroid medicines, the patient makes a good recovery. Some hemolytic anemias are chronic and may last for years.  . It occurs in 1 of 1,500 American blacks. Many patients live to age o and beyond. 

When complications occurs, they are apt to be infarctions III blood vessels of lungs or spleen, bleeding from the kidney, or eye probe retinal detachment or hemorrhages into the rear fluid compartment of the eye, the vitreous). Hemolytic anemia other than sickle- cell may result from transfusion of mismatched blood, which should be preventable with today's knowledge and techniques for blood grouping. 

It may also result from Rh incompatibility (see page 562). In addition, this type of anemia may be produced by some industrial poisons (such as benzol, aniline, TNT), and sometimes by such substances as sulfonamide medications, quinine, lead, snakevenom, castor and fava beans. Outcome will depend on severity of the anemia and on how quickly the cause can be deter- mined and eliminated, as well as on prompt treatment with fluids, trans- fusions, and corticosteroid medications. Another hereditary type of hemolytic anemia is thalassemia, which is subdivided into major and minor categories. 

Prevention of iron-deficiency anemia unless there is chronic loss of blood

Prevention of iron-deficiency anemia unless there is chronic loss of blood

 There is no need to take advertised remedies to provide extra iron for "tired blood." If there is blood loss which is producing anemia, it's important not only that the anemia be corrected but that the underlying cause be found and corrected. Pernicious Anemia For red blood cell manufacture in the bone marrow, vitamin B12 is needed. 

The vitamin is present in adequate amounts in any balanced diet. But for absorption by the body, B12 requires the presence in the stomach of a substance called "intrinsic factor." In pernicious anemia, intrinsic factor is lacking or operates inadequately. Vitamin B12 absorption is then inadequate, and in such patients the vitamin must be administered by injection. In addition to the common signs for all anemias, pernicious anemia manifests itself in a ted and sore tongue, difficulty in swallowing, a pale lemon skincolor.

In about 10 percent of patients, there are symptoms from spinal cord changes such as numbness and tingling in the lower extremities ("pins and needles" sensations) and unsteady gait. Sometimes the fingers are affected by numbness and tingling. Memory may be affected, and sometimes even psychotic states may be induced. The nervous system changes are referred to as "combined system disease" or "posterolateral sclerosis." It is important that they be recognized for what they are, especially when they occur before anemia becomes manifest.

If treated early, by vitamin B12 injections, the changes may be reversed completely; if neglected and treated too late, complete reversal may not be possible. The diagnosis of pernicious anemia is made through the characteristic appearance of the blood cells, examination of a bone marrow sample obtained by simple needle puncture, a finding of acid deficiency in stomach juice, and by other laboratory tests. It is important that the diagnosis of pernicious anemia be unequivocal because this condition requires lifelong care. If correctly diagnosed and treated, the outlook for pernicious anemia today is excellent. Blood returns to normal. 

Diagnosis of amebiasis

When the diagnosis of amebiasis has been established, the doctor starts treatment to clear up symptoms and also to eradicate the disease completely. He knows that complete cure is necessary to prevent spread into the liver where abscesses may develop and dangerous generalized infection may be triggered. Also, the doctor knows that without complete cure, the patient may be freed of symptoms and yet remain a carrier who is a danger to his family and others. 

Usually, there is very good response to emetine, chloroquine, and other medications used in treatment of this disease. Since emetine may have dangerous effects on the heart, it is generally administered with the patient in bed either at home or in hospital. Sometimes, medications alone do not cure amebic abscesses of the liver, and surgical drainage may be needed to eliminate the pus.

ANEMIAS 

Blood normally contains 5 million red cells per cubic millimeter. These cells are packed with hemoglobin. Hemoglobin has a great affinity for oxygen and combines with it in the lungs and transports it to all tissues of the body. On the average, each 100 cubic centimeters of blood contains 15 grams of hemoglobin, so that, roughly, there is 1/2 ounce of hemoglobin for 3-1/2 ounces of blood. Anemia is present when either the number of red blood cells or the amount of hemoglobin in them is reduced below normal values. 

There are many types of anemia but some symptoms are common to all types.   In both sexes, hemorrhoids (piles) may lead to anemia. There are many other possible causes such as hiatus hernia, large doses of aspirin or other salicylates, tumors of stomach or intestines which may bleed hook- worm infestation. Failure to ingest enough iron in the diet-as when a person lives on coffee and doughnuts or goes on a prolonged fad diet--can produce iron-deficiency anemia. 

Because there is so little iron in the body, it takes only a regular small loss of blood, especially if iron intake in the diet is limited, to produce this type of anemia.

Frequently, gastrointestinal blood loss will not even make the stool appear bloody, black, or tarry and will be detectable only by special chemical tests on the stool. For treatment, the physician may prescribe an iron preparation to be taken by mouth or may inject an iron compound into the muscles. The balanced, nutritious diet we talk about should provide enough iron for primary. 

Infections and preventive methods

All fruits and vegetables should be washed and scrubbed. In suspect areas, travelers should eat only cooked foods and use only milk known to be pasteurized. You may be asking, "Why all this fuss about a disease I have hardly heard about?" Consider this one fact about amebiasis: in some forms, it has a fatality rate of 40 percent. 

Your life, if you become infected, is only as good as a 6 to 4 bet; not very good odds. In addition, if an acute attack is survived, there may be serious, chronic complications. Fortunately, treatment has been improving, and today, when the best available treatment is applied promptly and vigorously, the fatality rate can be reduced to less than 5 percent. How is the disease recognized? In the tropics, it will usually start as full- blown amebic dysentery, with up to 25 bowel movements a day, and with stools often containing blood and bits of mucus.

The patient may feel slightly feverish and will soon be weakened by the abdominal distress and dehydration. In this country and other temperate zone countries, there is rarely such extreme diarrhea; and the combination of abdominal distress, diarrhea alternating with constipation, fatigue, slight fever, and vague aches and pains throughout the body may be passed off as "colitis," "irritable colon," or "upset stomach." In some persons, symptoms are so mild that they do not see a doctor for treatment and unknowingly become carriers of the amebic organisms.

Another problem in diagnosing the disease arises from the increasing numbers of Americans who take short winter vacations in semitropical and tropical countries. If a vacationer develops diarrhea and other intestinal symptoms, he is not eager to consult a doctor in a strange country. He also does not want to interrupt his brief holiday. So he doses himself with Lomotil, paregoric, or anything else he has brought along for "tourists' diarrhea." When he returns home, he plunges into work. Thus, the diagnosis of amebiasis may be missed, and the best time to treat it lost; later, there may be dangerous spread of infection in the body, making for treatment problems.

To be sure, most cases of diarrhea during vacations are the relatively harmless tourists' diarrhea. But we strongly advise anyone who develops diarrhea in a semitropical or tropical country to tell his physician about it promptly upon return home or, if the stay is to be more than the usual brief vacation, to consult a local doctor (you can usually find a competent physician by calling the nearest American consul and asking for the name of his doctor). 

When there are symptoms suggestive of amebiasis, your physician will rarely start treatment until a precise diagnosis is made. That means finding the amebic organisms in the stool. Unfortunately, locating the organisms is not always simple; and some physicians who have devoted themselves to the study of this disease will not exclude the diagnosis of amebiasis until six stools, including one passed after a saline purge, have been judged negative by a competent diagnostic laboratory. 

Insect bites can be dangerous-preventive measures

We are not alarmists and have no wish to frighten people away from enjoying outdoor life. However, insect bites can be dangerous. Fortunately, there are preventive measures. Those who know they are sensitive to bees, etc., should carry cards indicating so, and should also be trained by their family doctor or an allergist in the use of a special kit available for emergencies.

 Also, there is effective desensitization treatment for those allergic to bee, wasp, and other stings. It makes good sense for anyone who is allergic in any way and who receives a bite by a bee, wasp, hornet, or yellow jacket to discuss with his doctor the advisability of carrying an emergency kit on the assumption that since he is allergic to other things, he might become so to these insects from a second sting

.

 In terms of general sanitation and comfort as well as for protection against bites, foods should be covered when camping or cooking outdoors, and patios and other areas should be treated with insect repellent. Sensitive people should consider wearing white clothes which are less likely to attract bees than gay colors.

 Also long sleeves and trousers will reduce danger of contact with stinging insects. If you are ever confronted with a person suffering a severe reaction to an insect sting or bite, and if an emergency kit with adrenaline and anti- histamine is not available, you can do some good by placing a tourniquet between bitten or stung area and the heart, applying ice to the inflamed area, and rushing the victim to the nearest doctor or hospital. Emotions and Allergy You may ask how emotions can have any effect in the reaction between an allergen and an antibody.

Usually, in this country, the source is a food handler who may have no symptoms or only very mild ones, and whose unclean hands transmit the disease. In some countries, water is infected, or human Feces may be allowed to contaminate food-growing areas; in some parts of I he world, human feces are used as optimizer.

Since amebic infection can cause pain and disability from diarrhea and may lead to death if the infection spreads from intestine to other parts of the body-it is important to understand basic facts about its transmission. With this knowledge, primary preventive measures can be used. Where dependable, clean water is not available and the traveler or camper must rely on questionable sup- plies or use wells, streams or lakes, water must be boiled for ten minutes or treated with special chemical disinfectants. 

Nurses may become allergic to penicillin

Nurses may become allergic to penicillin and other antibiotics as well as lotions, creams, and antiseptics. Dentists and their assistants may handle procaine which is noted for producing skin allergy.   Physiotherapists may become sensitized to chemicals in creams and lotions they use. There is virtually no occupation in which some substance capable of producing sensitivity in some people can- not be found. 

Workers should know of the dangers and be taught how to avoid sensitizing contact with notably allergenic materials. Skin creams and other protectants may be helpful. Protective clothing and gloves may be required. For protection against volatile materials and dust, ventilation must be adequate, and in some situations masks may be necessary.

Desensitization in some cases may provide relief. Medications used for skin allergies and hay fever may prove helpful, too. Insect Allergy The sting or bite of many insects -including wasps, bees, hornets, yellow jackets, and ants-can set off allergic reactions, and in some in- stances, these can even be fatal. Allergic reactions also may be produced by various flies, mosquitoes, fleas, bedbugs, and kissing bugs.

Among 2,606 persons who registered with the American Academy of Allergy in its search for people with insect allergies, the type of allergic responses varied from local swellings to generalized reactions involving the whole body. Of the generalized reactions, 630 were life-threatening; many patients experienced unconsciousness, severe breathing difficulty, throat swelling-in effect, anaphylactic shock for which prompt emergency measures were needed to prevent death. 

Occupational Allergy

Occupational Allergy It appears that about one percent of all workers develop an allergy, usually of the skin. When the allergenic substance is volatile and inhaled, asthmatic symptoms may develop. Men seem more susceptible to occupational allergy than women, possibly because women tend to clean their skin more thoroughly. Cuts, abrasions, and rashes may predispose to occupational allergies. There is virtually no end to sub- stances that can produce occupational allergies. Some are natural substances such as wool and foodstuffs; some are highly complex new chemical molecules corning from the expanding chemical industry.

Trunk : Clothing, sanitary belts, dispensary underwear, nightclothes, brushing materials, soaps, perfumes, h.ith salts, massage creams. Anal area: Rectal suppositories, douches, enema substances, ingested foods, topical meticulous, underwear, sanitary napkins, toilet paper, toilet seats. Vaginal area: Douches, contraceptive jellies, suppositories, sanitary napkins, perfumes, deodorants, peccaries. Penis and scrotal area: Condoms, prophylactic agents, fabric finishes and dyes in undergarments, pajamas. Legs: Materials and dyes of clothes; coins and other metallic objects carried in trouser pockets; garters. Feet: Shoes, socks, shoe polishes, galoshes, fur linings, ankle bracelets, medications, rubbers, cements, pastes.  

Laundry workers get sensitized to detergents (as do housewives). Printers are exposed to allergenic dyes, gum arable, and metals. In other occupations dusts from grains, plastics, and wood can afflict nose or lungs; fumes from metals and liquids can do the same. In the textile industry, workers may be exposed to countless dyes to which they may become sensitized. And the fixative for dyes contains chromium, a chemical that is often allergenic.

Wool and other materials may be offenders. The cosmetics industry is a source of many allergenic substances. Not only workers in plants but salespeople who demonstrate cosmetics in stores may develop allergies to them. The health professions have their allergies. Pharmacists may become sensitized to medicines they handle in filling prescriptions. 

ECZEMA- Atopic dermatitis- CONTACT DERMATITIS

ECZEMA

 Eczema, also called atopic dermatitis, is manifested by a rash of "weeping" blisters. Later, the area may become dry and scaly. Eczema occurs most frequently in the bends of elbows and knees and on the face and neck. It is common in children, many of whom also have hay fever and allergic asthma. The condition can be stubborn, especially in adults. Some children benefit when an allergenic food is found and removed from the diet.

 Usual medicines for allergy are not very helpful for eczema. Treatment is directed toward stopping the itching, since scratching aggravates the rash. Two possible complications are of concern: adults may develop cataracts in the eyes after many years; both children and adults with eczema may have severe reactions to smallpox vaccination. The doctor knows how to prevent and handle these complications.

CONTACT DERMATITIS

 In this type of allergy, which occurs upon direct contact with an offending substance, the reaction is almost always localized in the skin. There is usually a rash which clears rapidly when the offend- ing agent is removed. To test for this type of allergy, suspected offending substances are placed on the skin and covered with bandages. After one to three days, the sites are inspected to determine whether any of the substances has produced a small rash typical of the patient's allergic reaction. Poison ivy, poison oak, and poison sumac are well-known contact allergens. 

The reactions produced by their oils can be disabling in particularly sensitive people, especially if the eyes or face are affected. Sometimes the oils can be washed off with strong laundry soap. Antihistamine is helpful, plus application of soothing creams or lotions to affected skin areas.

 In severe cases, steroid medicines are given. As we have noted earlier, hair dyes and hair curling preparations should be tested for allergic sensitivity before use. Dozens upon dozens of substances can cause local allergic reactions when applied to the skin. The best preventive measure is to stop wearing or using an offending item if it can be identified. Often, the patient may suspect what it is; in other cases, the doctor can help identify it. 

Here, according to site, are some common contact allergens: Scalp: Lotions, tonics, pomades, soap, hair dyes and rinses, wave sets, shampoos, patent dandruff removers, hair brush bristles, plastic combs, bathing caps, massage brushes, hair nets, hair pins and curlers, toupees, wigs.

Note: Dermatitis produced by substances used on the scalp may appear predominantly and sometimes even exclusively on eyelids, neck, ears, face, even the hands. Forehead: Hat bands, linings or other hat materials; massage creams; suntan lotions and other cosmetics; hair nets; celluloid visors; helmets; dye. Eyelids: Mascara, eyebrow pencil, eyelash curlers. Also substances used elsewhere such as cosmetics, soaps, hand lotions, face powders, nail polishes and lacquers. The eyelids may be affected, too, by insect sprays, nasal sprays, perfumes, airborne pollens, clothing dust, furs, gloves, fabrics, dyed clothing.   

Allergies - Adverse reactions to medications

Adverse reactions to medications which are considered by some experts to be allergic are un- toward effects on blood platelets leading to hemorrhages into the skin, depression of blood cell production in bone marrow, and liver reactions.   The list includes it agents as aspirin, sulfa com- I'0unds, tetracycline and other antihrotlrs, insulin, antitoxins, local anestheues such as procaine, some of the Iranquilizers, mercury, and arsenic. 

In one case, a person seemingly allergic to a medicine may actually be acting to milk sugar used as a filler for the tablet or a dye used to color I pill. An important preventive measure for anyone with sensitivity to a medicine is to carry a card or bracelet indicating so, and also to announce the fact to every doctor or nurse who has occasion to take care of him. 

And when such a person is in a hospital, there should be a sign on or near his bed or in the room stating sensitivity to a given medicine. A person experiencing a severe allergic or other adverse reaction to a medicine should be promptly treated hy a doctor or go to an emergency loom in a hospital. It is not enough to rely on an antihistamine, which may be useful for a mild reaction.

Skin Allergy HIVES. A hive is a raised, blister- like area containing fluid, white in color but surrounded by a reddened area. It usually itches intensely. An acute attack of hives-also known as urticaria, giant hives, angioedema, angioneurotic edema, and nettle rash-may be caused by allergenic foods, medicines, or serums. 

There are also physical causes such as sunlight, heat, cold, and pressure on the skin. When hives are accompanied by edema or water-logging and swelling of throat and laryngeal tissues, there may be danger to life. Treatment is effective. In addition to the same medicines used for hay fever, the doctor may prescribe soothing creams, lotions, or baths for the itching skin.

Sometimes a strong laxative helps shorten an attack induced by food by hastening its elimination from the intestine. People subject to recurrent severe hives should be prepared to act to prevent an attack from progressing to the point of interfering with breathing. They should learn from their doctors how to handle an emergency and should carry the necessary materials with them at all times. There seems to be a strong emotional component in some cases of recurrent hives. Patient and doctor should discuss life-style and tensions and consider whether a session with a psychotherapist might be helpful. 

Medicines for allergies

As for medicines, those helpful for pollen allergy may be used. Food Allergy some people notice that ingestion of a certain food causes hives nasal congestion and sneezing, or asthma. Others trace to a particular food such symptoms as abdominal discomfort, nausea, cramps, belching, and diarrhea. Some people experience migraine headaches after eating particular foods such as chocolate.

 When there is a clear association between particular foods and symptoms, diagnosis presents no problems. But when the symptoms are those of indigestion, it may be more difficult to be certain that a true food allergy is involved. In such cases, the doctor relies not only on the patient's account but does skin tests with allergens pre- pared from egg, milk, and many other foods.

Also, he has the patient keep a diary of food intake and symptoms. Then, in some cases, the doctor puts the patient on a basic non allergenic diet and adds suspected offending foods one at a time to establish which produces symptoms. Food allergy is rarely a serious disease. When milk is the offender in a child or adolescent, care must be taken to include in the diet other foods which can provide the minerals and protein of this important dietary constituent. The best way to treat food allergy is to avoid the troublesome foodstuff. 

This may sound simple but there are dozens of foods that contain eggs and milk, for example; and the purchaser may not realize this or he may have to eat in restaurants where food preparation is not under his control.

Thus people who are allergic to common foods should learn the long list of dishes that may contain such foods. Complete lists are provided in all about Allergy by M. C. Harris, M.D., and N. Shure, M.D. (Prentice- Hall, Inc., Englewood Cliffs, N.J., Publisher, 1969). This 1000-posts contains much of value to persons whose allergies are not readily controlled or whose doctors want them to read extensively about their ailment. 

Can a person allergic to food be desensitized? The method is not easy. It consists of taking very small amounts of the offending food by mouth until resistance to it is finally built up. Medicine-Induced Allergy Any medicine may have more than just a primary effect. For example, an antihistamine may provide some relief for hay fever; that is its primary action. But it may have a secondary effect, drowsiness. In addition, it may have unexpected bizarre actions, producing varied symptoms, sometimes including hives, skin rashes, hay fever, or asthma.

The most feared reaction from administration of a medicine is the allergic condition known as anaphylaxis or anaphylactic shock, in which the patient develops itching, hives, runny nose, and asthmatic breathing, sometimes followed by pallor, cold sweats, low blood pressure, stupor, or coma, and in some cases, death may occur. In some cases of anaphylaxis, there may be only hives with or without swelling of the throat and larynx; this reaction is called angioedema. Another allergic reaction to medicines and serums is the delayed or serum sickness type. It occurs five to ten days after the sensitizing sub- stance is used and involves itching, hives, and joint pains. In addition to hives, medicines may sometimes pro- duce other skin reactions including eczema. 

Pollen allergies and eye irritations on aging population

 The eyes are irritated and reddened, and tears flow. Some hay-favorites have a daily cycle, awakening with symptoms in the early morning, experiencing relief from late morning until late afternoon, then becoming discomfited again. Some patients notice that symptoms are affected by environmental factors such as humidity, heat or cold, strong sunlight, or wind. One patient, very sensitive to high humidity, noted severe aggravation of symptoms whenever he took a hot bath. He improved greatly by changing to sponge baths. 

Air conditioning helped his attacks, too, by reducing humidity as well as by filtering out pollen and dust. Usually, the symptoms and their seasonal nature are all that are needed for diagnosis. In addition, the doctor tests for sensitivity to a large variety of allergens, by injection or scratching them into the skin.

 These tests help determine the substance or substances to which the patient should be de- sensitized. The outlook for hay fever is varied. At best, there may be only minor symptoms easily controlled by filtering air in the bedroom and perhaps by occasional use of one of the medicines employed for hay fever. At worst, there may be severe symptoms which prevent enjoyable living and working for weeks; danger of sinus blockage with headaches, middle ear pressure, or infection (especially in children); development of nasal polyps; and appearance of asthma. 

Most cases fall between, with several weeks of annoying symptoms during which the victim is uncomfortable and unable to work or live at his usual productive level. With most patients, the end of the season brings an end to all symptoms, and the malady may be forgotten until the next season comes around.

Doctors often warn hay-feverites to avoid, at all times, house dust, fumes, heavy tobacco smoke, etc., because these may set off a hay-feverlike attack between seasons or aggravate attacks during the season, Effective treatment will frequently prevent the formation of the little benign cystic tumors in the nose called polyps. Also, such therapy will help prevent development of asthma. One form of preventive treatment is to avoid the allergen.

 People who can afford it, or whose work is not de- pendent on a special locale, may go to an area in the United States or abroad where the particular sensitizing pollen does not occur. While this is not possible for most people, many can take their two- to four-week vacation at places away from the pollen or where the humidity and other atmospheric factors are pleasant and helpful. Another form of prevention is to remove the pollens.

There are effective filters for ventilating and air conditioning units; also, there is a special device which precipitates out pollen. Your doctor or a specialist in allergy (allergist) will tell you where you can purchase these and what rooms to use them in. For homeowners who can afford it, a central unit that filters out pollens and controls humidity makes life comfortable; sometimes the cost of such a unit is not greater than the loss of time from work or the expense of distant vacations. Those who do not have such methods of removing pollens some- times prevent serious attacks by going to an air conditioned movie, theater, or restaurant when they feel symptoms coming on. Desensitization treatment is often effective. 

For this, the doctor administers small, gradually increasing amounts of the offending allergen by injection before the season starts in order to build up tolerance. Even after the season has started, desensitization treatment may sometimes help symptoms, at least to some extent.  

Sometimes, there is obstruction to breathing because of a deviated nasal septum or the presence of polyps. At present, there is little need for electrical or chemical cautery of the nasal membranes, but occasionally cautery may prove helpful. Other Inhalant Allergies Symptoms similar to those of hay fever may be caused by many allergens other than pollens. Such allergy is called inhalational allergy, perennial hay fever, or perennial allergic rhinitis. 

House dust is a common cause. House dust is not simple dirt or dust or sand but has been described as a mixture of "cotton, bits of wool, Feathers, animal hair, pesticide, powder, insect scales, mites, shreds of kapok, shreds of cellulose, and other foreign material, and colonies of mold (mildew) and bacteria." Other causes of year-round hay fever include hair and dander of pets, horses, goats; wool; feathers; cotton- seed (from mattresses and furniture stuffing); pyrethrum powder; flaxseed; orris root; and such miscellaneous items as gums and resins, soybean, glue, castor bean, flour, jute, hemp, sisal, coffee, and sawdust.

There are still others which doctor and patient may have to track down in individual cases. Desensitization to these allergens is more difficult than to pollens. There- fore, avoidance or removal of an offending substance becomes important and is usually fairly easy if there is clear-cut recognition of a single allergen. For example, the person who sneezes only in the presence of a cat can have another pet. A voidance of house dust is more difficult, but the doctor will discuss various ways to reduce it in the home. 

Pollen and skin allergies on aging people

Allergens hit their body "target organs" in different ways. Airborne or inhalational allergens strike the nose ,IIH.1 bronchi and lungs; food allergens M" absorbed through the intestine and distributed to various parts of the body, frequently showing their effects of the skin; contact allergens affect ski 11, lips, eyes; allergenic medicines also may affect the skin. 

Some persons have physical allergies, developing typical allergic responses to sun lights, heat, cold, or humidity. The symptoms ofallergy depend upon the target or shock organ affected. If it is the nose, there may be congestion, watery discharge, and sneezing, as in hay fever; if the skin is I he target, there may be rash, hives, or eczema; if the bronchial tubes are the target, there is the wheezing of bronchial asthma.  

 Allergies affect both sexes and may appear at any age. There is a strong hereditary factor. One patient with severe hay fever has a son of 21 who had asthma from age 6 to 14 and has had almost no attacks since, as the result of avoiding cats; and a daughter who had hay fever for several years as a child and then "outgrew" it; the remaining child has not been allergic. It is important for any person with allergy, or with even a family history of allergy, to mention the fact to any doctor or nurse who is treating him. 

An allergic or potentially allergic per- son usually will not be given penicillin or certain other medicines known to commonly produce allergic reactions unless the medication is absolutely necessary.

Hay Fever Chief among airborne allergic diseases is hay fever. Curiously, it has nothing to do with hay but is caused by pollens of trees, plants, and weeds. The typical case is seasonal except in a few parts of the South where there may be pollen in the air all year. In the northern United States there is spring hay fever caused by pollens of trees and grasses, and the summer- autumn variety caused usually by ragweed pollen.

The symptoms, which develop, when pollen contacts nose and eyes, include congestion of the nose, watery discharge, tickling and irritation, and sneezing

Aging and Allergies understanding the problem and prevention and treatment

The older person needs a good, understanding physician to help him with the more numerous illnesses and minor annoyances to be expected with aging. Also, as friends and relatives die, the doctor becomes a needed friend. What of so-called rejuvenation operations and other methods purporting to stop or even reverse aging? As far as medical science can determine, there is no validity to the claims for any of these methods: e.g., transplantation of animal glands, injections of Novocain. We are very much in the early in- fancy of biological and medical research into aging. 

It is entirely possible that some "Peter Pan" substance may yet be found to keep us young longer. We have to learn why the white rat rarely lives more than three years, a dog no more than twenty, and man seldom more than one hundred. Possibly out of such research, with animals as well as man, will become new knowledge to provide clues to longer, youthful life. Until then, we can only learn how to prevent the diseases and ravages of the years so we may enjoy to the full a near century of life. 

Note: Problems of the later years- e.g., retirement change of location, hospitalization for surgery, choice of physician-are discussed in additional detail in a book by one of us: The Complete Medical Guide, by Benjamin F. Miller, M.D., published by Simon & Schuster, 630 Fifth Ave., New York, N.Y. 10020. ALLERGY With all the talk about it, one might assume that nearly all Americans are allergic. This is not true, but allergic ailments are common enough if one considers all the people who have hay fever, asthma, hives, and sensitivity reactions to medicines, pets, foods, cosmetics, and industrial substances.

The term allergy means altered reaction. A person with allergy has become sensitive to a specific sub- stance which is perfectly harmless to the non-allergic population. The word specific is a key one because an allergic individual may have a violent attack of asthma, for example, when exposed to cat dander but may be perfectly comfortable with dogs, hamsters, canaries, or other pets. The offending substance is called an allergen and is protein in nature or has the capacity to combine with protein in the body. 

Thus a person may be sensitive to such proteins as those in milk, egg white, or lobster but be able to take fats, such as butter, and starches and cane sugar in any amount without symptoms. When a person becomes allergic to a non-protein substance such as iodine or penicillin, it is believed that the offending substance is itself a partial allergen and becomes. 

Aging and diet, exercise, health, companionship, sex and sugery

DIET

 The aging person should at the well-balanced diet we have advocated in Chapter 6. Many older people feel better when they take a multivitamin tablet or capsule daily. If this produces indigestion, ask your doctor to prescribe a diet that will provide the extra vitamins. Old people do better, whenever possible, taking small meals at frequent intervals rather than depending upon one or two large meals a day.

WEIGHT The older person does best to be on the thin side. This can be achieved by regulating intake of calories and by using regular exercise. (See page 65 on weight reduction.)

EXERCISE

 One of the truly important aids to vigorous healthy old age is regular daily exercise. Brisk walking is one of the best exercises.

Swimming another

 But the choices are limit- Aging less. Simply check your kind of exercise, what you enjoy most, with your doctor to determine that it falls within the capacity of your heart and lungs. And reread Chapter 8 on exercise.

HEALTHY EMOTIONAL LIFE

 Good physical condition is necessary for a good emotional life in old age because it is a rare person who can be happy when constantly bothered by chronic illness or pain. On the other hand, good physical condition does not guarantee emotional health. It is such a pity to find elderly people whose bodies are in good shape but who are mentally depressed, lonely, or dispirited from empty hours. Retirement from work is always a serious change and should be discussed with your doctor. If you are a "doer" and not a "sitter," it may be necessary for you to find a new job, full or part time; or if you prefer not to work or cannot find employment you like, then as a doer you need vigorous activities and work hobbies.

COMPANIONSHIP

 This is very important, and as friends and relatives move away or die, new human contacts should be sought in church groups, clubs, and social groups for older citizens. For those who do not work, the day can still be full if there are friends and relatives to visit, books to read, movies and television to see, radio to listen to-and time for exercise. Each season has its appropriate sports, and there is much enjoyment to be found. in viewing them on television or in person.

SEX

 Part of healthy emotional life of old age is sex. Good medical thinking today recommends that people continue sexual activity until they die. The enjoyments and also the health/Disease Scenarios benefits of an active sex life are set forth in detail and persuasively by Dr. David Reuben in his book, Everything You Always Wanted to Know about Sex (David McKay, Publisher, 750 Third Ave., New York, N.Y. 10017).

SURGERY IN THE AGED

 With the great advances in surgery and anesthesia, even the very elderly today can be operated on safely. There is no need for an older person to be disabled by a hernia for fear of the surgery involved. And the same applies to cataracts and many other conditions that require surgery for correction. 

Aging -disease and treament

AGING

 You may be surprised to find aging included in our list of diseases. Doctors really do not know whether or not aging is a disease or a natural phenomenon. The scientific study of aging (gerontology) and of diseases of the aged (geriatrics) is still in its infancy. It may be many years before scientists learn enough about aging mechanisms to answer the question of whether aging is normal or abnormal. In the meantime, most of us assume that aging is part of the divine or natural scheme of life. In our country, when a person is not afflicted with a grave disease, he still rarely lives be- yond age 100, and usually 110 seems to be the limit, although there are reports from India and Siberia of some people living as long as 150 years. So-called normal aging brings changes in many parts of the body.

The skin becomes less firm and elastic and develops wrinkles; vital organs such as heart, kidneys, and brain lose some of their cells so they have less reserve capacity; bones tend to thin out and lose strength and resilience; the endocrine (including the sex) glands tend to become less active. In women, the ovaries stop functioning, the uterus decreases in size, and the vagina tends to lose its softness and elasticity. In the male, the prostate gland enlarges. Fortunately, the muscles hold up rather well throughout life if exercised adequately. 

Despite the many changes, there still is adequate function left to sustain a good life in almost all aged people. However, the man of 85 should recognize that his heart cannot respond as quickly to sudden demands and the brain is not quite as finely tuned an instrument as it was in younger years. Older people learn to adapt by cutting down physical demands, reading more carefully, paying closer attention to names when being introduced. Few people live to 100 or 110. Atherosclerosis (especially its effect on the heart) and cancer are the deadly enemies of the aged. High blood pres- sure, diabetes, kidney diseases, tuberculosis, emphysema, pneumonia, accidents, and liver disease also claim too many victims. Many of these diseases are preventable or curable, and it is a pity that so many older persons succumb unnecessarily.

This book has been written in the hope that the information it provides, especially the stress on prevention of disease and disability, will bring many more people into the older years free of illness and able to enjoy living. We suggest that everyone read the sections on the ill- nesses just mentioned. There seems little point to living to advanced age if one is chronically disabled or handicapped. Every effort should be made to keep the eyes in good condition, hearing at its best, and to avoid the unpleasantness of hernia, backache, find other nonfatal but annoying and sometimes disabling conditions. 

The skin should be kept in good shape and the hair as lustrous as possible (see our chapter on skin and hair). Some older men feel happier with a hairpiece, some when they dye their hair; many women tint hair, one use wigs to make their hair seem more abundant. If these supplements 10 nature add to happiness, why not use them? There are some medical conditions that make a person age prematurely. Among these are hypothyroidism (low function of the thyroid gland), pernicious anemia, and a vitamin deficiency called pellagra. At your regular medical checkups, your doctor can watch for onset of any of these and correct them if they occur. 

ADDISON'S DISEASE- The adrenal glands

ADDISON'S DISEASE The adrenal glands, small bodies sitting astride the kidneys, are essential to life because of the important hormones-adrenaline, hydrocortisone, aldosterone, and many others-they secrete. Any disease process that attacks the adrenal glands may produce a serious problem-adrenal insufficiency or Addison's disease. Years ago most cases of Addison's disease stemmed from invasion of the adrenals by tuberculosis. Now the majority are due to shrinkage and withering away of the gland (atrophy) with- out known cause.

Tuberculosis still causes some cases. In a very few in- stances, metastatic cancer, syphilis, or fungal infection is the cause. A patient with Addison's disease is weak, tires easily, has nausea and vomiting with generally poor appetite, and usually experiences bouts of diarrhea. The patient is irritable and has fainting spells. The skin turns dark and the dark color is especially prominent in body creases, over the but- tocks, in the nipples, and in any recent scars. Black freckles may appear on the tongue. The doctor finds low blood pressure, small heart, scant hair in armpits and pubic area. Laboratory tests show low blood concentration, reduced concentration of sodium in the blood, and reduced levels of ad- renal corticoid hormones.

Before modern replacement therapy for missing hormones became avail- able, Addison patients had a grim out- look, usually dying within a few years or even months. Now the outlook for them is decidedly favorable. With expert medical treatment and their own wholehearted cooperation, many can lead essentially normal lives. Cortisone or cortisol is the keystone of therapy. The hormone is administered by mouth.

To help raise the abnormally low level of sodium in blood, large amounts of salt may be used or a corticosteroid hormone, DOCA, may be given since it helps regulate salt exchange. Addison patients do well on a diet high in protein and carbohydrate, especially if they take many small meals a day rather than the usual three larger ones. Addison patients must still guard against infections and any unusually severe stresses such as prolonged swimming in cold water.

They need careful attention during pregnancy and surgery. An Addison patient needs to discuss stress hazards thoroughly with his physician just as a diabetic, 514 / Disease Scenarios through discussion with his physician, learns what he needs to know about his disease. For example, an Addison patient who understands his tendency to lose too much salt from the blood will be careful after profuse sweating to replace losses. Since most cases now involve atrophy of the adrenal cortex from unknown cause, primary prevention is not yet possible.

 For the tubercular type of Addison's disease, primary prevention, of course, is the same as for tuberculosis (page 659). Secondary prevention, too, in a case resulting from tuberculosis requires intensive treatment of the tuberculosis. 

Medical replacements for heart, lungs, liver, pancreas

 Medical replacements for heart, lungs, liver, pancreas, and other important organs become routinely feasible. For your convenience, the diseases are arranged in alphabetic sequence and thus the order in which they are presented has nothing to do with I heir frequency or seriousness. In this part of our book we tell you about a number of diseases-some potential killers, others disablers, some just nuisances. You may be puzzled by our approach and by use of some words new to you in discussions about your health. For example, you will find mentioned scenario, also primary, secondary, and even tertiary prevention of disease.

We use the word scenario because it conveys the idea of the dynamic picture the physician can foresee for the course of a disease after he completes his questioning to understand the patient's symptoms, his physical examination, and his study of x-ray and laboratory reports. Sometimes, there can be no valid scenario until the physician sees the patient in several return visits. For example, two patients may have high blood pressure. 

Mr. One has a pressure reading of 164 over 98; so does Mr. Two. But in subsequent measurements of blood pressure, Mr. One's has settled down to 150 over 86 whereas Mr. Two's has gone to 190 over 110. Mr. One has no signs and symptoms, whereas Mr. Two shows a small hemorrhage in his retina and slight enlargement of the heart.

The physician will see very different scenarios or possible future courses for these two patients, and his preventive treatments will be much more active for Mr. Two than for Mr. One. By primary prevention, we mean measures that can be used to prevent a disease completely. A good example would be the use of the Sabin vaccine to keep polio from developing. By secondary prevention, we mean the use of measures to keep a disease that is already present from progressing.

 For example, for a patient with a definite ulcer of the duodenum, the physician can foresee and wants to avoid a scenario in which hemorrhage, perforation, or scarring and obstruction may take place; so he institutes diet and medical therapy as part of a secondary prevention program. We may be the first to employ the word tertiary for preventive medicine.

 Our concept is that when every type of secondary prevention may fail, there is still a chance of providing new health for the patient in a special way-that is, by giving him a new organ to replace the destroyed organ. For that, however, the patient's general health must not become so undermined that the new organ would be of little use. 

For example, suppose every effort has failed to stop the ravages of nephritis (Bright's disease); the kidneys have failed; the patient is in uremic poisoning. If the physician institutes tertiary preventive measures at this time to avoid damage to the heart and brain and eyes, then at a suitable time he can save the patient with a kidney transplant. In the future, this type of tertiary prevention may become very common as transplants or mechanical

IF A POISONING OCCURS - treatment for the childhood poisoning

The formula is simple enough -Poison, child: store one, save the other. There is certainly need for other measures. A federal law requires that hazardous household products bear information to protect users and warn against accidental ingestion by children, and vigorous enforcement and education of the public to its significance can help. Industry can and should develop and use increasingly effective safety closures and containers for medicines and poisonous agents, for while some children may circumvent such measures, there will be many who are unable to get a safety cap off. Any medicines administered to a child should be administered on a serious basis, not as a game, and parents should not themselves take medication in the presence of small children.

 More and more now, physicians and official medical bodies such as the American Academy of Pediatrics advise that every home should always have on hand two items for emergencies. One is a 1-ounce bottle of syrup of ipecac and the other an inexpensive can of activated charcoal. The ipecac efficiently induces vomiting. The charcoal, which is mixed with water to make a soup like substance, absorbs any poison in the stomach after vomiting occurs. With these available, you can immediately call a physician, hospital, or poison control center if poisoning occurs. Even if you are not certain exactly what the child has swallowed, they can give you instructions over the phone which may involve use of one or both of these items. Used immediately and properly, they may avoid fatality, serious illness, and even need for hospitalization, stomach pumping, and other drastic measures.

It seems to be human nature not to like to think of accidents when all is going well. But since we can't immunize against accidents, we have to give some thought to their prevention. Perhaps the easiest way to play safe is to organize a home safety council and make its meetings pleasant occasions and a kind of game for the children. Perhaps once a month, the family can sit down and discuss safety rules, any new hazards that may have developed, any accidents that may have occurred. We suggest that husbands can play a major role in accident prevention in the home.

Men know the technical side of dangerous equipment. They should take major responsibility for checking electrical apparatus, furnace, gas connections, and similar equipment. Their wives could then educate the children in accident prevention. If youngsters are given prizes for observing safety rules, and special prizes for new suggestions, plus a treat, say, of ice cream, when the home "safety council" meets, they will look forward to the meetings. In this way, their interest in obeying good safety rules and in making new ones will be strengthened at an early age. 

THE MENACE OF CHILDHOOD POISONING

THE MENACE OF CHILDHOOD POISONING

 "Beware--poison is some other name" is an apt slogan recently adopted by the National Planning Council. Each year now, more than one million cases of poisoning (85 percent of them among young children) occur in the United States, leading to thousands of deaths and a great deal of sickness and suffering. Actually, the death figure given-which is sometimes put at 3,000 annually-is much too low, many authorities believe. 

Many more children die each year because of accidental ingestion of or exposure to toxic chemicals in household agents and drugs, but the correct diagnosis is not made because incriminating evidence is not detected or recognized. Not infrequently, for example, symptoms from irritation of the central nervous system and obvious convulsions lead to the diagnosis of viral encephalitis. "Poisoning," says Dr. Jay M. Arena, President of the American Association of Poison Control Centers, "is now the most common medical emergency among young children that exists in pediatrics." 

No mother, of course, deliberately goes shopping for poisons, but she buys several every time she goes to market.

She uses them whenever she cleans house, polishes the furniture, washes dishes, paints, cleans spots off clothes. Often she is not aware of the dangers of these products due to failure to pay attention to the labels. Naturally curious children are tempted to investigate the more than 250,000 products and myriad medicines available and often present in the home. In a careful investigation into the precise circumstances surrounding child poisoning tragedies and near-tragedies, the Children's Hospital Medical Center, Boston, made some discoveries which all parents should keep in mind: Most poisonings involve children big enough to walk but not over three years of age. 

The most dangerous time of day is during the hour just before the evening meal. The unpleasant taste of a potential poison has little deterrent value. Toddlers will swallow virtually anything. Parents tempt disaster when they underestimate a young child's ingenuity or overestimate his ability to obey orders. Every day, dozens of children poison themselves by getting medicine out of safety-cap bottles -bottles they are told never to touch but which are left within reach. Reports from the nation's 535 poison control centers indicate that, after aspirin, the products most commonly involved in childhood poisonings are insecticides, bleaches, detergents and cleaning agents, furniture polish, kerosene, vitamin and iron pills and syrups, disinfectants, strong acids and alkalis, and laxatives. 

As Dr. Arena notes, 75 percent of all poisonings in small children are within-sight drugs or household agents, which means that three out of four poisonings are due to carelessness or negligence and could be pre- vented by one very simple action-putting all medicines and chemical agents out of sight and reach of children. 

Home accidents at Cellar, Living Room and Bedroom- how to prevent it and treatment?

CELLAR

 As already noted, have your heating system checked by a competent serviceman before cold weather arrives. The cellar is often a play area, especially in winter. Try to separate heating equipment from children's play space. You can put up a wall inexpensively with a few 2" x 4" wood studs and some pressed board partitions. Until your children are old enough to be trusted alone for an hour or more, never let them go to the cellar alone. Avoid clutter. Clearly defined areas should be set aside for tools, equipment, screens, and other paraphernalia. The cellar, including the stairs, should be as well lighted as any other room. There should be at least one sturdy railing for the cellar stairs.

LIVING ROOM

 As already suggested, have a screen covering the entire fireplace. Fasten window curtains, etc., so they cannot blow near the fire- place. You can use various means, including rubber mason-ear rings sewn on the undersides, to anchor rugs. Make certain, there are no long electric light cords to trip over, any open sockets where young children can get to them.

BEDROOM

 Observe the precautions about fire and electrical hazards already listed. Don't smoke in bed or sleep with a heating pad turned on. If there are young children, have bars or safety catches on windows. Make certain the paint on anything they might chew on is not poisonous. Keep any objects a baby might swallow or hurt him with out of reach. The sides of cribs should have extensions, because standard cribs are not high enough. 

Treatment for electrical burn, bathroom accidents, special hazards on each room analysis

ELECTRICAL BURNS AND SHOCKS

These are becoming more frequent with use of power tools and appliances in profusion. As already noted, promptly replace worn cords, cover exposed wires, and replace faulty equipment. Protect children by shielding electrical outlets. Ground all electrical equipment with ground fault devices. Under no circumstances use electrical products outdoors when grass or earth is damp unless the equipment has been specifically designed and approved for such use.     

SPECIAL HAZARDS-ROOM BY ROOM

 Fires, falls, and electrical burns and shocks are the chief dangers but there are many others to watch for. Each room has its special hazards. For example: KITCHEN. Keep sharp knives, lye, ammonia, acids, insect and rodent poisons, and every other caustic or poisonous substance out of children's reach. All, especially lye, have killed or seriously injured a great many children. Keep the children out of the kitchen except when they are being watched. During food preparation, you need light to prevent accidental cuts. Asbestos pads, tongs, and large holders for hot pots and pans can prevent burns and scalds. Be careful with hot fat or grease.

 If fire occurs, do not pour on water because water will spatter the fire, use sand, dirt or ashes, if available, to put the fire out. Small fires can be extinguished by pouring salt or baking soda on them, or they may be smothered with heavy wet clothes or asbestos pads. If the amount of fat on fire is large and the flames high, pull all inflammable material away and guard against spread of the fire by pouring water over the areas the flames threaten to reach. Have your gas range and electric refrigerator checked once a year. This service is sometimes provided free by a utility company.

BATHROOM

 A rubber mat can prevent slips in the tub. Have good lighting. Soap needs a sturdy holder. Never place electric equipment of any type, especially electric heaters, in the bathroom where they may fall into the tub. The safest rule is to warm the bathroom with the electric heater first, then disconnect the heater while the baby or anyone else is in the tub. Do not touch an electric socket, switch, or appliance while standing in the water; you can be electrocuted, since water helps current flow through the body. Keep all medical supplies where children cannot reach them. 

How to avoid home accidents by heating, fire strikes? - Home fire drills

HEATING

 Between them, heating and cooking accidents are responsible for about 40 percent of home fire deaths. Defective heating equipment can cause death from both fire and carbon monoxide gas poisoning. All flues and chimneys should be inspected on a regular basis, and any cracked or corroded sections should be repaired or replaced. All furnace and heating appliances should be inspected by qualified personnel to make certain they are in proper adjustment and good condition. Proper adjustment assures complete burning of fuel and avoids dangerous amounts of carbon monoxide in the flue gases. A good time to have your heating system inspected and serviced is every fall before cold weather arrives. And if you use your fireplace, make certain there is a spark screen in front of it and that the rug is far enough away for safety.

IF FIRE STRIKES

 Heat and smoke, not fire itself, kill most victims. Air moving through a building can be hot enough in five minutes to ignite floors, doors, walls far from where the flames are. So get everybody out immediately; then call the fire department; and never, no matter how great the temptation or how small the risk may seem to be, go back inside for valuable papers or anything else; you may not get out alive. Make it a habit to sleep with bedroom doors closed; this helps retard fire. And in case of a blaze, do not open the door unless absolutely necessary. Be ready with emergency items such as rope or other means of escape from bedrooms. If yours is a two-story house and a typical one, it has only one stairway, which may be blocked by flames.

HOME FIRE DRILLS

 If your child were to awake tonight to see smoke and flames creeping into his bedroom, what would he do? Unless properly trained, most likely he would hide, as do most children, under the bed or in a closet or rush out into a smoke-filled hallway. Instead, he should have gone out of a window if that were at all possible. Any parent would be distressed if a child's school did not have regular fire drills, yet few parents have ever had a fire drill at home where a fire is 200 times more likely to occur. Fire authorities urge that every family set up a regular home fire drill program. Begin by making everyone understand the danger of home fires and the importance of drills. Explain that the major danger is not the flames but the deadly gases and smoke; that fire can build up toxic gases in minutes which then rise quickly to upper floors. Underscore the absolute need to get to fresh air and out quickly, with every second counting. Emphasize that no one should stop to dress or look for belongings but should be concerned only with saving himself. Plan a fire signal-perhaps a whistle or shout.

Assign family members to assist small children or invalid or elderly members

 Draw a chart of every room, and plan escape routes from each room. Each bedroom should have two planned escape routes-normally a hall or stairway and, if this is blocked, an alternate which probably would be a window leading to a roof or porch or a folding ladder that can be dropped from a window. Fire drills should be conducted from bedrooms.