Early detection of Cancer - Examine larynx sigmoid colon lungs breast uterine cervix

Your regular medical checkup is another important means for early detection of cancer. Your doctor will examine larynx, rectum and sigmoid colon, and usually your lungs. For women, additional preventive measures are important. 

Early breast and uterine cancers is readily curable. Therefore, women should arrange with their doctors to have regular Pap smears of the uterine cervix. This is a simple, painless test which requires only a few minutes and involves only taking a smear through the vagina so cells can be examined under the microscope. 

It should be done regularly, as often as your physician, or the gynecologist to whom he refers you, may suggest. Regarding the breasts, we feel that most women should learn to examine them once each month. If that makes unduly nervous, then they should set up a schedule of regular examinations by the doctor.

Self-examination is a simple process. Immediately after the menstrual period when the breasts are normally soft, look into a mirror and raise both arms over your head so that the sides of the breasts are visible. Study your breasts carefully, noting whether one looks higher than the other or whether one seems larger than it was the previous month. Also, check for any slight depressions or dimpling of the skin over the breast. 

Next, using the right hands on the left breast and vice versa, push the breast back gently against your chest and feel for any small lumps. Then, feel the armpits for any swelling. The best time to make this examination is in the morning. If you decide that something may be wrong, you have all day to reach your doctor, if only to get his reassurance. Not every lump in the breast means cancer. Many lumps are harmless formations due to glandular functioning. Let your doctor decide what they are.

Fortunately, he can now use a special type of x-ray study for breast cancer, a technique called mammography. If cancer should be diagnosed, your doctor will suggest whether surgery or radiation is the best therapy. Most surgeons do cancer surgery. Only a few surgeons restrict themselves to cancer work alone. In our largest cities there are hospitals that specialize in treating cancer patients. 

Let your doctor advice you. Surgery for removal of the cancerous area may be followed by a course of x-ray or other radiation to try to kill any cancer cells that might be lying beyond the area the surgeon has excised.  

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

CHOKING- COUGHING- SNEEZING

CHOKING, COUGHING, SNEEZING

 Large particles of undesirable substances bring, fortunately, an immediate response from the respiratory system. If food accidentally starts down the wrong way, into the lungs rather than the stomach, there are explosive protests from the lungs. 

Normally, swallowing blocks off the glottis, halts breathing briefly, and assures correct division of air and food. It should be noted, however, that this automatic activity may be lacking in an unconscious person, and if a drink is poured through clenched teeth it may proceed straight into the lungs. 

The automatic system is not 100 percent perfect even during consciousness, and many a fruit pit, bite of food, or other object has gone into the windpipe and has had to be coughed up or, in some cases, forcibly retrieved. The protective reflex becomes sluggish after heavy alcohol intake. 

A cough can be a very powerful force. Involved in it are a slight breathing in, closing of the glottis, buildup of pressure, and a sudden release of the trapped air-at speeds of as much as 500 feet per second. A sneeze can be even more explosive. And attempts to muffle a sneeze, to quiet it down, to make it polite, or to avoid it can sometimes lead to nosebleed, ringing in the ears, or sinus trouble. 

MECHANICS OF BREATHING

MECHANICS OF BREATHING

Breathing is accomplished by changes in the size of the chest cavity.

Surrounding-and guarding-the lungs have twelve pairs of ribs. They are joined to the spine at the back and curve around the chest to form a cage. In front, the top seven pairs are connected to the breastbone. The next three pairs are connected to the rib above. 

The last two pairs, unconnected in front, are called floating ribs. The entire cage is flexible and can be expanded readily by special muscles. In addition to the rib cage, which forms the wall of the chest, there is the dome-shaped diaphragm, which forms the floor of the chest cavity. The diaphragm is attached to the breastbone in front, the spinal column in back, and the lower ribs on the sides. The lungs do not suck in air; all the work is done for them by the diaphragm and muscles of the rib cage. When you inhale, muscle fibers of the diaphragm contract and the sheet of tissue is drawn downward; at the same time, rib muscles pull the ribs upward and outward.

This expands the chest cavity and lowers the pressure within it to below that of the atmosphere. This causes the lungs to expand, too; and the tiny air sacs in the lungs also become a little bigger. Air then rushes into the lungs to fill the extra space. When you exhale, just the opposite series of events occurs. Muscles of the diaphragm relax; so do those of the rib cage. The chest becomes smaller; the elastic tissue of the lungs returns to its original shape, making the air sacs smaller; and the air is driven out. 

The rate of breathing varies with age. In a baby the rate is about 45 times a minute; by age 6, it is down to about 25; between ages 15 and 25, it drops to about 18. There is some tendency for it to increase again with advanced age.

The rate of breathing is also influenced by the carbon dioxide content of the blood. If you hold your breath, carbon dioxide accumulates in the blood until, finally, it so strongly stimulates the respiratory control center of the brain that you are forced to breathe again. 

The length of time the breath can be held varies from 25 to 75 seconds. Mothers sometimes become alarmed when children hold their breath during crying spells or temper tantrums. There is no real danger of suffocation; when the child really needs air, he will be forced to inhale. In any condition leading to elevation of body temperature, the respiration rate is always increased. 

Windpipe - Trachea- lungs-

THE WINDPIPE

The windpipe, or trachea, is a tube about four and a half inches long and one inch in diameter. It extends from the bottom of the larynx through the neck and into the chest cavity. At its lower end it divides into two tubes, the right and left bronchi.

The bronchi divide and subdivide many times into smaller branches that penetrate deep into the lungs. The esophagus, which carries food to the stomach, is immediately behind the trachea. Rings of cartilage hold the trachea and bronchi open between breaths. 

The windpipe wall is lined with mucous membrane, and there are many hairslike cilia fanning upward toward the throat, moving dust particles that have been caught in the sticky membrane, thus preventing them from reaching the lungs. Respiratory infections such as colds and sore throats may sometimes extend down into the trachea and bronchi; they are then called tracheitis and bronchitis.

Inflammation of the walls of these passages causes harsh breathing and deep cough.

THE LUNGS 

The two human lungs weigh about two and a half pounds. They have an area forty to fifty times greater than the total surface area of the body's skin-equivalent, some investigators have noted, to the area of a tennis court. Within a lung, the bronchi divide and subdivide, becoming smaller and smaller, until the branches reach a very fine size at which they are called bronchioles. 

Each bronchiole ends in a microscopic air sac, called an alveolus. It has been estimated that human lungs contain more than 750 million alveoli. Filled with air, these tiny sacs give the lungs their characteristic appearance of large sponges.

 A vast network of capillaries penetrates the lungs. Tiny capillaries contact each alveolus. Air in an alveolus is separated from the blood by two thin membranes-the wall of the alveolus and the equally thin wall of a capillary. These thin walls permit ready exchange of gases between blood and air. The lungs ate covered by a double membrane. One, the pleural membrane, lies over the lungs; the other lines the chest cavity. Separating the two is a thin layer of fluid which, during breathing, prevents the two membranes from rubbing against each other. 

Inflammation of the pleura can cause roughness and irritation, the condition called pleurisy. When it is present, the physician, with an ear against the chest, can hear the membranes rubbing each other with each breathing motion. 

THE PHARYNX (THROAT)- THE LARYNX

THE PHARYNX (THROAT)

From the nasal cavity, air moves into the pharynx, or throat, which ranks as one of the most complex parts of the human body. Seven tubes enter the pharynx: the two from the nasal cavity, called the internal nares; the Eustachian tubes which lead to the ears; the mouth cavity; the opening of the esophagus; and the glottis, the opening of the windpipe. Traffic in the pharynx becomes complex during the eating process. Food and water go down one opening; air must pass through another. 

Fortunately, the traffic control is automatic and things usually go where they should. Tonsils, masses of soft tissue, are located on each side of the pharynx, behind the mouth cavity.

There is also tonsil tissue at the base of the tongue. And adenoids are tonsil-like masses of tissue that grow on the back wall of the pharynx behind the internal nares. It appears that the function of tonsil tissue is to trap and destroy disease organisms, helping to guard the body against infections that may develop from germs entering through the nose or mouth. 

Tonsils become infected rather easily. In some cases, the tonsils may become so diseased that tonsillitis, sore throat, and other respiratory infections become frequent. Then a physician may recommend tonsil removal, although such removal, once extremely popular, today is not done on a routine basis, but only where there is strict need. Mere enlargement of tonsils is no reason for removal. Tonsils are normally larger in children than in adults. Only when they interfere with breathing and swallowing may it be necessary to remove them because of size.

 Enlarged adenoids may block the openings of the Eustachian tubes and interfere with normal pressure changes in the middle ears, causing dis- comfort and hearing impairment. When enlarged adenoids happen to block the internal nares, they force mouth breathing. Fortunately, adenoid removal, when necessary, is a simple operation.

THE LARYNX 

The larynx, or voice box, is at the top of the windpipe, or trachea, which takes air to the lungs. But while incoming air passes through the boxlike larynx, it is actually air expelled from the lungs that makes voice sounds. In the front of the larynx, two folds of membranes, the vocal cords, areattached and held by tiny cartilages. Muscles attached to the cartilages move the vocal cords, which are made to vibrate by air exhaled from the lungs. 

The vibrations are carried through the air upward into the pharynx, mouth, nasal cavities, and sinuses, which serve as resonating chambers. The greater the force and amount of air from the lungs, the louder the voice. Pitch differences result from variations in the tension on the cords.

The larger the larynx and the longer the cords, the deeper the voice

 The average man's vocal cords are about three fourths of an inch long. Shorter vocal cords give women higher-pitched voices. 

Respiratory System - Causes and problems

THE RESPIRATORY SYSTEM

 MAN CAN survive for weeks without food, for days without water, but for only a few minutes without air. Air must reach the lungs almost constantly so that oxygen may be extracted there and distributed via the blood to every body cell. Even in a relaxed state, you breathe in and out 10 to 14 times a minute, with each breath lasting 4 to 6 seconds. In the space of a minute, you take in 9 to 12 pints of air. The fact is that the body has small reserves of oxygen, all of it consumed within less than half a minute after the start of vigorous exertion. And with such exertion, the need for air increases many fold so that yours breathing rate may speed up to one second per breath and a total intake of 20 gallons of air a minute. 

You can figure roughly that in a normal day you will breathe in some 3,300 gallons of air-enough to occupy a space about 8 feet by 8 feet by 8 feet-and, in a lifetime, you will consume a prodigious quantity, enough to occupy 13 million cubic feet of space. The respiratory system is one, of course, that you will want to under- stand well. It is a system in particular that you can do much to guard through knowledge of how it functions, what can go wrong, and the preventive techniques available for you to use.

THE NOSE

Respiration begins with the nose, which is specially designed for the purpose, although there will be times when you breathe through the mouth as well. As you read this, you are quietly, with little or no awareness, breathing lightly through your nose. When you race for a bus or train, or perform any vigorous activity, and begin to puff and pant, you are breathing rapidly through the mouth to provide the blood with the extra oxygen needed. The mouth, however, is not designed for breathing. You may have noticed this on cold days when you make a deliberate effort to keep your mouth tightly closed, because if you take air in through the mouth you can feel its coldness.

Cold air passing through the mouth has no chance to become properly warmed. But cold as the air may be, you can breathe comfortably through the nose. The nose, acting somewhat like an air conditioning system, regulates the temperature and humidity of air passing through and filters out foreign particles as well. Air enters, of course, through the nostrils. Hairs around the nostril openings catch dust and other impurities. The nostrils are separated by a partition, the septum, which is made of cartilage-a flexible kind of bone -in the lower part of the nose, and of real bone in the upper part. Thus, while you can pull the bottom part of the nose from side to side, the top part is immovable. 

Smoking problems and healthcare

No HEALTH problem in our time has commanded more attention than smoking. The issuance of the official Surgeon General's Report in 1964 constituted a major scientific and medical event and began a public and medical concern that continues. Despite the concern, however, one third of the women and half the men in the United States still smoke cigarettes. 

Deaths from diseases associated with cigarette smoking continue. A large proportion of health resources and money must be devoted to trying to treat such diseases. But there are encouraging events. As many as 1.5 million people a year recently have been abandoning smoking.

Among them, fortunately, are young and middle-aged men who are at particularly high risk of premature death from lung cancer and coronary heart disease. Also hopeful is evidence from a Public 

Health Service survey indicating that while 29 percent of boys and 15 percent of girls at age 17 are regular smokers, this represents a significant reduction in the proportion of young people taking up smoking. And school systems across the country are emphasizing educational programs on smoking and health in the hope of creating a "smokeless generation."

The evidence about the dangers of cigarette smoking to health is now overwhelming. In the words of the Surgeon General of the U.S. Public Health Service, smoking "is the greatest preventable cause of illness, disability and premature death in this country."

 A conviction shared by medical and health agencies has been expressed by the New York State Commission of Health: "No other single factor kills so many Americans as cigarette smoking .... Bullets, germs and viruses are killers; but for Americans, cigarettes are more deadly than any of them. No single known lethal agent is as deadly as the cigarette." Smoking is a certain irony in the history of tobacco use. American Indians, early explorers discovered, smoked tobacco in pipes for ceremonial silicoses, and believed it had some medicinal values. 

Physical fitness, excercises, health issues- health education-calories

Your exercise program should be balanced, just as diet should be balanced. You need one or more activities to exercise the heart and lungs and to build endurance. Brisk walking, jogging, and swimming relatively long distances are good for this. Other parts of the program should be aimed at improving strength, agility, flexibility, and muscle tone. Suggestions for a home exercise program to achieve these objectives can be found in such publications as these: Adult Physical Fitness. 

President's Council on Physical Fitness

Washing- ton, D.C., Supt, of Documents, U.S. Government Printing Office

Physical Fitness

Department of Health Education, American Medical Association, 535 N. Dearborn, Chicago, Ill. Seven Paths to Fitness.

Department of Health Education, American Medical Association, 535 N. Dearborn, Chicago, Ill Most people understand how. Specific exercises for various muscles and parts of the body can develop strength. These are certainly worthwhile. For some reason, one particular area of relative neglect is the abdominal muscle area. 

Another is the muscles of the back. Both are important in terms of good posture; both are important, too, as aids in avoiding sagging waistlines and backaches. We give exercises for these in this chapter along with another exercise for the muscles of the buttocks; and the four exercises, in addition to their general value, are helpful in restoring muscle tone in these areas in people who are slimming down.

But we think it important to go on at once to emphasize here the activities that exercise the heart and lungs and build endurance. 

When you are at rest, all the muscles in your body use only about one thirtieth of the oxygen they can use during maximum effort. The more oxygen they use, the more the heart will respond, pumping harder to get more oxygen- Physical Activity I 87 carrying blood into circulation. Over a period of time, as a result of this, heart pumping efficiency will increase. 

The heart will become able to pump much more blood with each stroke. At the same time, lung capacity, much of it never used in sedentary living, will increase to absorb and feed more oxygen into the bloodstream. 

Heart problems and Sugar intake - Bodily reactions

SUGAR AND THE HEART 

Can consumption of large amounts of sugar be as much of a factor in coronary heart disease as cholesterol? So British investigators led by Dr. John Yudkin of the University of London maintain. They note that over the past 200 years in Great Britain sugar consumption has gone up almost 25-fold, from an average of 5 pounds per person in 1760 to 25 in 1860 and to 120 pounds in 1960. 

A sizable increase in sugar consumption in the United States also has been noted by American investigators. The British workers note that increasing affluence anywhere is accompanied by increased incidence of heart attacks and by diet changes which include greater consumption not only of fat but of sugar.

They point to studies showing that recent Yemeni immigrants to Israel have little coronary thrombosis but those who have been in Israel 20 years or more become prone to the disease-s-and the major change in their diet is increased sugar consumption. 

Among their own studies, Yudkin and his co-workers report one covering three groups of men, aged 45 to 66. Twenty had recently suffered first heart attacks, 25 had hardening of leg arteries, and 25 others had no health problems. The sugar intake of the first two groups customarily had been roughly twice that of the healthy group. 

Not all doctors agree with Dr. Yudkin. Much work remains to be done to identify the mechanism by which sugar in excess may produce artery disease. And a big question to be answered is whether reduction of sugar intake will reduce risk of artery disease. Still, even the possibility that sugar may be involved in this major disease adds another reason why moderation in its use appears warranted. Ordinary refined sugar is what nutritionists call an "empty calorie" substance. 

It provides energy-but no protein, no vitamins, no minerals. It can add to body weight but does not help the body repair itself. Sugar, as contrasted, say, with cereal, puts the body at a nutritional dis- advantage. 

THE IRON-DEFICIENCY PROBLEM And the Causes in Our Body system

THE IRON-DEFICIENCY PROBLEM

 A deficiency of iron in the diets of young girls and women is a cause of growing concern. Iron deficiency can produce anemia, and the need for iron is universal. Generally, there is no problem in men, who require only 10 milligrams (1/3,000 of an ounce) of iron a day to maintain adequate body stores. 

But menstruating and pregnant women require 18 milligrams a day, and dietary analyses indicate that many adolescent girls and menstruating women have an iron intake of only 10 milligrams a day. Some studies reveal iron-deficiency anemia in as many as 60 percent of pregnant women. The problem centers around the fact, that overall iron content of foods on the market runs around 10 milligrams for every 2,000 calories.

Thus, unless she is paying particular attention to iron, a woman consuming 2,000 calories a day will not be getting adequate amounts of the mineral. The fact is that 50 to 60 percent of iron in the diet comes from cereals and meats, with nearly equal contributions from each, but the proportion of cereals and meats consumed by women varies widely. 

Whenever weight is a problem, too, the tendency is to reduce consumption of cereal products. Most meats provide 2 to 3 milligrams of iron per 3-ounce serving. Dry beans and nuts provide about 5 milligrams per cup. Most leafy green vegetables contain from 1 to 4 milligrams per cup.

Egg yolk, whole grain and enriched bread, potatoes, oysters, dried fruits, and peas are other good sources. There are on the market a number of prepared breakfast foods fortified with high levels of iron; some provide 8 to 10 milligrams per one-ounce serving. The use of iron-fortified food items when necessary to achieve adequate iron intake can be an important aid to health. For some women with high iron requirements-during pregnancy or because of abnormal menstrual losses-physicians may need to prescribe supplemental iron preparations.

Penicillin overdose side effects! How to avoid it?

A Special Word about Medicine Taking of many people that if a little is good, more is better. With potent agents, excessive dosage can produce real trouble. Similarly, under dosage can cause problems. Inadequate antibiotic dos- age, for example, carries its own risk. One common example is the patient with a "strep" throat who takes penicillin, improves, stops treatment, then gets the sore throat back again.

Once more, he takes some penicillin but not the full prescribed amount. Again the sore throat dis- appears only to recur after a short time. And so a disease that can be eradicated by continued administration of penicillin for eight to ten days is converted into one that drags on with repeated remissions and relapses. Physicians have, in fact, long suspected that many failures of anti- biotic treatment stem simply from failure of patients to keep taking medication as prescribed. A recent study uncovered disturbing evidence that many parents may be risking their children's health by failing to make certain they take their medication as long as necessary.

Actually, in acute "strep" infections, penicillin treatment for 10 days is considered essential to prevent rheumatic fever. Yet in a follow-up of 59 children for whom a 10-day course of penicillin had been prescribed, investigators found that 56 percent of the youngsters had stopped taking the drug by the third day, 71 percent by the sixth day, and 82 percent by the ninth day. When a doctor prescribes medication, the first thing to do is to get the prescription filled immediately. The value may be lessened, or even lost completely, if you delay.

Then follow directions of the doctor to the letter. If you are not certain you understand them, ask him for clarification-even for instructions in writing as to exactly what you are to do. Take all the medicine pre- scribed, not some amount you arbitrarily settle on. Don't decide, if you begin to feel better, that you can stop or reduce dosage. Sometimes, illnesses require several prescriptions. Very much worth noting here is an old principle taught to nurses: read every label three times. You can use that principle to advantage at home. 

Persistent Cough may mean Infection, Obstruction, accumulation of fluid, or in lungs

Coughing may indicate only a minor temporary throat irritation. But a persistent cough may mean infection, obstruction, or accumulation of fluid in the air passages or lungs, and so it deserves medical attention.  

 The Promise and Nature of Preventive Medicine 50 does a cough that developed during a respiratory infection but then persists long afterward. 

Urinary changes: We have already noted that blood in the urine re- quires investigation. Frequent urination may be the result of infection or, in some cases, nervous irritability of the bladder. Frequent and voluminous urination may be an indication of a relatively rare type of diabetes, diabetes insipidus. In older men, the need to get up several times a night for urination may indicate an enlarging prostate.

Difficulty in starting urination may indicate sufficient prostate enlargement to require treatment to prevent backup of urine and impairment of kidney function. Actually, any marked change in the urine-in its volume, color, or number of times it must be passed-calls for medical study. 

Nausea may stem, of course, from a gastrointestinal disturbance, but it may also arise from an infection almost anywhere in the body or from disturbance of the balance mechanism in the ear. If the nausea is mild, you can delay a little before consulting a physician, for it may disappear in a short time and not return. But severe and persistent nausea, or nausea that keeps recurring, calls for medical attention.

Jaundice, or yellowing of the skin, may be due to a viralinfection and is especially likely to be seen in younger people. It may signal gallstones, and this is especially likely to be the case for middle-aged women. In older people, it sometimes is due to cancer of the pancreas or to cancer that has spread into the liver from elsewhere. The safe rule is always to regard jaundice as a signal calling for immediate medical attention. In some people with sallow complexion, jaundice may not be readily discernible on the basis of the appearance of the skin; in such cases, look at the whites of the eyes-if they are distinctly yellow, jaundice is present.