CEREBRAL PALSY - symptoms-treatment-medicines- signs, preventive care and cure

CEREBRAL PALSY

Cerebral palsy (CP) ranks as the most common cause of crippling of children in the United States. Almost one quarter of a million persons are afflicted. Too often people associate the abnormalities of movement and muscular control, which are the outstanding features of CP, with mental retardation and lifelong dependency on others. But the majority of CP victims is not mentally retarded and is capable, with special training, of becoming self-sufficient. Cerebral palsy is not an inherited disorder, or a contagious one, or a progressive one.

 Cerebral refers to the brain, and palsy to muscularweakness. So the name implies that it is a condition of muscular weakness or disability resulting from brain dam- age. The brain damage may occur before, during, or shortly after birth for many different reasons. (Brain damage in adulthood leading to disability is not considered CP.)

The nature and extent of disability will, of course, depend on the amount of brain damage. There are three ways in which the muscles may be affected: in the spastic variety of CP, muscles are stiff and tight, and weakness is profound; in the athetoid form, muscles contract without apparent reason, leading to uncontrolled grimaces and limb movements; in the ataxic form, talking and other movements are poorly coordinated. 

Along with these difficulties there may be hearing and sight impairment, speech disturbance, poor ability to learn, convulsions, emotional problems, and sometimes, unfortunately, mental retardation. Despite these handicaps, however, modern training methods offer more hope than ever before for even the most severe form of CPO Primary prevention of CP begins with good antenatal (prenatal) care.

German measles and other infections early in pregnancy may damage the brain of the developing child. Vaccination against German measles- before a girl reaches childbearing age or, in the case of an adult woman, when there is little likelihood of immediate pregnancy-is an important preventive measure. Other infections during pregnancy are often hard to detect, and the physician cannot al- ways predict whether or not they will harm the baby. 

The preventive approach is limited to recommending adequate protection against diseases for which vaccines are available and avoiding unnecessary exposure to others. Another known, and now preventable, cause of potential brain damage to children is Rh incompatibility.

Detecting this blood problem is now part of routine antenatalcare. The use of special techniques-such as intra- uterine blood transfusion for the fetus and delivery by cesarean section if necessary before severe damage occurs can prevent brain and other organ harm. A recent development promises to eliminate the hazard of Rh incompatibility. 

It is well known that the first child does not suffer harmful effects from Rh incompatibility; the succeeding children are at risk. This is because it takes time for the mother to become sensitized to the Rh factor.

A new medication, called Rhogram, when given to the mother within 48 hours after birth of the first child, prevents development of sensitization to the Rh factor and eliminates risk for succeeding children. To prevent sensitization from ever developing, the medication must be given after each subsequent pregnancy. 

Premature infants are more likely than others to be afflicted with CPo Among factors in the mother which predispose toward premature birth are cigarette smoking, infection of the kidney and bladder, and a history of having borne previous premature infants. 

Cancer prevention - ENDOCRINE GLAND SURGERY- symptoms signs - treatment

ENDOCRINE GLAND SURGERY FOR SECONDARY PREVENTION

 The growth of some cancers is influenced by certain of the endocrine glands. For example, in the spread of prostate cancer, hormones of the testicles play a role. It has been found that the painful metastases of prostate cancer to bone can be relieved for long periods by removal of the testicles. This is not as drastic as it sounds, since prostate cancer patients have reached an age when the eunuchizing effects of testicle removal will be minimal.

When breast cancer gets out of control and spreads to bones and other parts of the body, an endocrine gland operation may help to extend life for months and even years. The operation may be on the ovaries, adrenal glands, or pituitary gland in the brain. The age of the patient, the duration of the cancer, and the location of the metastases will be considered before the decision as to which operation to use is made. 

Tertiary Prevention Perhaps not too far distant is the day when organ transplantation be- comes fully practical. Then cancers that are destroying such vital organs as the liver and the pancreas may be removed entirely, and the missing organ will be replaced by a transplant from a cadaver. Cancer Phobia Cancer is such a dreaded disease that, understandably, many people have an irrational fear of it. 

The realistic fear that everyone has of this disease should be allayed by the sensible, scientific approach to prevention presented in this book. If strong fear of cancer persists, the phobia should be discussed with your doctor.

He can help you overcome it. If not, then he may wish you to have a talk with a psychotherapist.  

Types of Cancer- detection -symptoms- prevention- treatment- Medications

Cancers are of several types. Carcinoma is a cancer of the outer part of the body (such as skin, lip, breast, tongue) or of the innermost part of the body (such as stomach or colon). Sarcoma is a cancer of in-between tissues (such as muscles and bones). A teratoma is a mixture of these types. A hamartoma is an overgrowth of cells in an organ which does not progress and is now considered more a congenital abnormality than a tumor or cancer. 

Because cancer starts in a single organ rather than diffusely, there have been some daring suggestions about primary prevention. Quite seriously, some distinguished surgeons have discussed the possibility of prophylactically removing organs that are common cancer sites. Why not, they suggest, remove the uterus after child- bearing when it is no longer needed, Cancer of the breasts, or the prostate? From a straight surgical viewpoint, the decision would rest on the dangers and disability of operation versus the danger of the cancer. But surely other considerations enter in. Removal of the breasts is a great emotional shock for a woman.

The danger of operation, while small, cannot be overlooked. And, too, this danger comes for a relatively young woman, for if prophylactic surgery is to be meaningful it would have to be performed when a woman is entering the time of life when cancer becomes a possibility. Thus, at 40 years, she may be exposed to the danger, discomfort, and psychological hazards of the operation, whereas even if she is destined to get cancer, it may not strike until she is 55 and she has a good chance of getting years of relief or even complete cure from surgery performed at that time. 

Prophylactic removal of the uterus after the childbearing years might seem more desirable if it were not for the Pap test, which makes it possible to detect precancerous lesions in the uterus and thus institute surgery that will be curative. And for men, prostate removal is a major operation with some risk of mortality and danger of impotence, which a younger man would not want to face. At present, then, primary preventive surgery does not seem a practical answer.

There are more practical methods possible for primary prevention of cancer even though we realize from the frequency of the disease that these are far from sufficient. First, as we have noted earlier, cessationof smoking can save thousands of lives otherwise doomed to be lost from cancer. And an appreciable additional number can be saved from cancers of lip, tongue, larynx, and possibly stomach and urinary bladder. Then there are the precancerous lesions which can be removed before they have a chance to become malignant.

 They include leukoplakia (white patches) on tongue and lips; senile changes in the vagina; skin lesions such as moles which begin to enlarge; certain polyps of the colon and rectum. These pre-cancers can be detected by the type of regular checkup we have described earlier in this book. There are cancers that follow heavy exposure of the skin to sun and wind -the so-called sailor's and farmer's cancers-which can be prevented by covering the skin and shading the face. Radiation can lead to cancer. There is much less danger from diagnostic than from therapeutic x-ray or other irradiation. But every exposureto radiation should be entered in your medical record and shown to your doctor and dentist whenever they suggest x-rays. Workers in the radiation industries should know every safety precaution. 

BREAST DISEASES symptoms causes treatment medicines preventive care

BREAST DISEASES 

The breast is an important part of the female reproductive system. And, like internal reproductive organs, it is dependent to an extent on the level of hormone activity. This is exemplified by changes in size and consistency of breast tissue during the menstrual cycle and during pregnancy as hormonal levels change. The breast is made up of glandulartissue arranged in a complicated pattern of lobes. The milk ducts lead into the nipple at the approximate center of the lobes. The breast is subject to a number of disorders that are difficult to differentiate by physical examination alone, since they most commonly take the form of a lump or mass. 

The lump may be a benign growth, a cyst, or a cancer.

Since primary prevention for any of these conditions is limited, early detection of a lump and identification of its nature are an important preventive measure. Self-examination of' the breasts at least once a month, at the end of the menstrual cycle (after the monthly flow) when the breasts are normally soft, is an excellent means of early detection. Women who feel that they cannot adequately perform self-examination can make arrangements with their doctor for a brief monthly examination. The technique of self-examination is described. Of course, examination of the breast is an important part of a regular physical examination. In many cases, when a mass is found, the physician can determine if it is benign through history and examination.

Among other things, he will consider the age of the patient; breast cancer is rare below age 20 and quite uncommon until the 40'S. Any painand fluctuation in size of the lump usually indicate that the cause is benign cystic change of glandular tissue. Some women are prone to recurrent breast cysts, a condition referred to as chronic cystic mastitis or benign cystic disease (see below). Nipple discharge, with or without a lump, is almost always indicative of a benign growth. 

The physician also will consider the consistency of the mass, whether it is well demarcated, and whether there are skin changes over the area. In most cases, when there is any doubt as to the nature of the suspicious mass, the physician will remove it for microscopic examination. This will resolve doubts and fears of both doctor and patient. The surgery is minor even though it is usually done under general anesthesia. 

Chronic Bone Infection - Scoliosis - symptoms causes treatment preventive care

When bone has been severely weakened by chronic infection, it may be necessary to provide support for it with plates and pins or bone grafts in order to avoid repeated fractures and to allow normal function. Scoliosis mean abnormal curvature of the spine. A minor degree of it is present in a large proportion of all people, in whom it is usually barely noticeable and does not interfere with posture and function.

 Two important causes of severe scoliosis in the past-polio and tuberculosis-have been minimized in recent years. Polio may lead to scoliosis if muscles on one side of the body are weakened to a greater extent than on the other side. When this occurs, the stronger muscles pull harder on the spine than the weaker ones, leading to curvature. Tuberculosis may affect the spine, leading to an imbalance of the bony spinal column. Scoliosis may be the result of a congenital defect, such as absence of half of a vertebra. It may develop for unknown reasons, usually between the ages of 5 and 15, and most often in girls. Sometimes, unequal leg length or faulty function of a hip joint can unbalance the spine, leading to curvature. 

Scoliosis can progress rapidly, particularly the type that affects young girls. Therefore, it should be brought to a physician's attention as soon as possible. The physician is most concerned about whether the curvature is progressing, and if so how fast. If the cause of the scoliosis is unequal leg length, treatment may require nothing more than use of a shoe lift for the shorter leg. Most cases of scoliosis are minor and require little if any treatment.

But when treatment is needed, it should be supervised by a specialist in bone problems, an orthopedist. X-ray studies of the spine with careful measurement of the degree of curvature is an important step in evaluation of the scoliosis. If the scoliosis is of the type which, if unchecked, may progress to become a serious deformity, it may not only interfere with normal posture and gait but also lead eventually to compromising of lung function, since the chest wall on one side may be compressed. Treatment should be begun without delay.

 The further the spine is deformed, the longer corrective measure will be needed. Recent advances have made treatment of scoliosis more effective and less inconvenient as well. The Milwaukee brace, a device designed to gradually reposition the curved spine, is particularly effective. It is essential that an experienced technician measure and fit the brace and an orthopedist supervise the wearing. Another method of treatment is to cast the spine so as to gently nudge it into normal position. Most children adapt readily to several months of treatment with brace or cast. Surgery may be avoided in this way. 

With age, the spinal column becomes less pliable and bracing or casting may be insufficient to correct a deformity. Several surgical procedures are of value. One of the most outstanding is the insertion of special rods, called Harrington rods, in the back muscles, one on either side of and connected to the spinal column. One rod pushes up on the shortened side of the spine while the other pulls the longer side.

Once the spine is correctly aligned, surgical fusion ofbones of the spine secures the alignment.   Sometimes, however, as in many fractures of hip, forearm, and upper arm, extra support may be needed to insure that the bone knits together. Such support may be provided by operative placement of plates and screws or nails, or occasionally by bone grafts. Simple fractures can often be treated by a general practitioner. But most fractures should be evaluated and treated by an orthopedist, who will decide on the need for operative or non-operative measures.

Bone requires six or more weeks to heal, and during this time proper alignment is maintained by a plaster cast. Although the fractured bone must be immobilized if it is to heal properly, muscles that normally move the immobilized part must be kept limber and strong. Special exercises achieve this. Doctors also pay close attention to the cast itself, making certain it is neither too snug nor too loose. Too tight a fit can lead to compression of theblood supply to the extremity. 

Fingertips and toes are left uncovered by a cast so the physician can judge the status of blood supply from skin color. Too loose a fit of the cast can allow movement of the fractured bone and misalignment. X-rays after application of the cast can be used to check proper alignment. As mentioned earlier, prolonged immobilization weakens bone andmuscle. Therefore, return to normal functioning as soon as possible is encouraged. 

BONE DISEASES-Osteoporosis and Osteomalacia Causes symptoms treatment remedies

BONE DISEASES 

Osteoporosis and Osteomalacia Beginning at about age 50, it is not unusual for people to note a slight diminution of height every few years. It is well known, too, that bones tend to become more brittle and to be more prone to fracture as we pass from the middle years to the later years. Both the slight height reduction and tendency to bone brittleness result from a process called osteoporosis (literally, softening of the bones) which occurs with aging. 

Bones that are osteoporotic contain the same individual minerals and proteins but they are less dense than younger bones.

Hence, they are more likely to be compressed (resulting in height loss) or broken. While x-rays do not invariably reveal the presence of osteoporosis, it is not uncommon for the condition to be first identified on a routine x-ray film. One rather common x-ray finding in osteoporosis is compression and fracture of a vertebra which may cause mild back pain but does not endanger the spinal cord. Osteoporosis is not limited to the later years. Other causes which a physician must consider include:

1. Steroid medications which may produce osteoporosis changes even in very young patients when administered for prolonged periods.

2. Lack of stress. Bones begin to weaken when they are not subjected to normal stresses such as those exerted by muscles and by the pull of gravity. Astronauts, as the result of exposure to gravity- free environment, have shown early changes of osteoporosis. More commonly, such changes may stem from immobilization because of illness or the casting of a fractured bone. Osteoporosis also may be- come apparent after a stroke when muscles in a limb fall into disuse.

3. A diet low in calcium and protein.

These are the basic building blocks of bone, and a dietdeficient in them will eventually lead to weakening of bones.

Cancer, when it spreads to bone, weakens the intrinsic structure.

Menopause apparently hastens the development of osteoporosis, and many women past the menopause exhibit bone changes (see page 618). What can be done to prevent osteoporosis and to treat it should it occur? Prolonged immobilization should be avoided. If it cannot be, exercises to maintain muscle tone and stress on bone are of value. Almost every hospital today has a physical therapist to administer such exercises as a precaution.

Bone diseases poor blood supply, natural body defenses against infection, which are circulated by the blood, have a more difficult time reaching a trouble area. Bone infection may result from in- jury to a bone, such as a compound fracture, or the entrance of a foreign body, or from spread of infection from elsewhere in the body. If acute bone infection is not treated effectively, the infection may become chronic. 

With chronic osteomyelitis, the bone is weakened and made more subject to fracture, pus may be discharged chronically through the skin, the body's reserves are drained by the constant need to fight the infection, and there may be considerable pain and discomfort.

For these reasons, any attack of severe bone pain and fever-usually it occurs in a child or young adult- needs quick evaluation and therapy. An effort will be made to identify the causative organisms and select an anti- biotic suitable for combating them. In addition, surgery to drain the infected area may be required. Surgery is often an indispensable adjunct to antibiotic treatment in cases of chronic bone infection. 

Dead and dying tissuewhich serves as the nest, for continuing infection must be removed. Occasionally it is difficult to remove all the infected or dead tissue located in and around the bone, and repeated surgery may be required. In some instances, chronic osteomyelitis may be present for years, with alternating periods of quiescence and activity, and intensive therapy is needed to affect a cure. 

Weight Loss and body mechanism

WEIGHT DOES MAKE A DIFFERENCE 

It would be a fallacy to say that obesity is ever the one and only cause of a death. But the association between overweight and excessive death rates is unmistakable. Among overweight men, mortality from all causes is 150 percent that for other men; among overweight women, 147 per- cent that for other women. 

As for individual diseases, insurance statistics show that overweight men and overweight women, respectively, have these excesses of mortality as compared with the general population: 142 and 175 percent for heart attacks; 159 and 162 percent for cerebral hemorrhage; 191 and 212 percent for chronic nephritis (kidney disease); 168 and 211 percent for liver and gallbladder cancer; 383 and 372 per- cent for diabetes; 249 and 147 percent for cirrhosis of the liver; 154 and ) percent for hernia and intestinal obstruction; 152 and 188 percent f or non -cancerous gallbladder diseases. Obvert is associated with many diverse types of health hazards. There are breathing difficulties, since the greater the weight in the chest.

wall, the greater the work involved in breathing. With their increased difficulty in breathing, obese people have less tolerance for exercise. They have a higher rate of respiratory infection than do people of normal weight. They may experience two complications related to their breathing problem: lethargy may develop because of accumulation of carbon dioxide in the blood from decreased ventilation; and as the result of reduced levels of oxygen in the blood, the body, trying to compensate, may produce increased amounts of red blood cells. 

The latter condition, called polycythemia, often is responsible for the ruddy complexion of obese people. It may lead to blood-clotting problems. Heart enlargement and congestive heart failure attributable to obesity have been reported. Many studies have established that more hypertension, or high blood pressure, exists among the obese than among the non-obese, that the obese hypertensive experiences a greater risk of coronary heart disease than the non-obese hypertensive, and that mortality rates for obese hypertensive persons are greater than for others with obesity alone or hypertension alone. Obese people often have impaired carbohydrate tolerance that may be sufficient in degree to be classified as diabetes.

Difficulties during anesthesia and surgery have been associated with obesity. In women with significant degrees of obesity, menstrual abnormalities and abnormal hair growth (hairsutism) have been observed with some frequency. For pregnant women, obesity can be a hazard in several ways: it is associated with a greater incidence of toxemia, of complications during delivery, and of stillbirths. Some skin problems are related to obesity. Thus, the extra surface area of the skin in the obese person may lead to excessive perspiration, and the juxtaposition of moist skin areas in adjacent folds may lead to boils, fungal infections, and other inflammatory conditions.

It has been well established that in many health problems, significant benefits often follow loss of weight. Among such conditions are hyper- tension, angina pectoris, congestive heart failure, varicose veins, rupture of intervertebral disks, osteoarthritis, and many other varieties of bone and joint disease. And certainly not to be omitted from even a partial list, many foot aches and backaches may be relieved to a significant extent, sometimes even completely, by weight loss.

WHAT SCIENCE STILL DOES NOT KNOW ABOUT FOODS? SPECIAL DIETS

SPECIAL DIETS 

Special diets can be of value for certain specific health problems. For example, a protein-free diet may be prescribed in some cases of severe kidney damage; a high-protein diet in some cases of hepatitis; a high- residue diet in cases of atonic constipation; a low-fat diet in certain diseases of the liver and gallbladder; a low-purine diet in gout; a low- sodium diet in high blood pressure, congestive heart failure, and toxemia of pregnancy; a bland diet for ulcer, gastritis, and hiatus hernia; a gluten- free diet for celiac disease and cure. 

Special dietary treatment is also an important part of the overall therapy in many cases of diabetes. Whenever a special diet may be of value, it should, of course, be prescribed by a physician on the basis of the patient's individual needs.

WHAT SCIENCE STILL DOES NOT KNOW ABOUT FOODS 

Every physician and scientist concerned with nutrition knows well that despite all that has been learned, much more remains to be. At any time, some fundamental new finding-of a previously unknown vitamin or other essential nutrient-may be made. 

At the risk of being repetitious, we would like to emphasize again that every advance to date has underscored the one fact: except in special instances, the best and healthiest diet is a balanced and generously varied diet. Nature distributes her largesse. We can be most certain of benefitting from it by making use of many rather than limited numbers of foodstuffs. Almost certainly, if we do this, we will be enjoying the values of still-undiscovered vital elements.

WEIGHT CONTROL 

WHILE THERE are nutritional diseases due to deprivation-rickets, scurvy, and others-by far the most common nutritional disease in this country is one that results from abundance. Overweight, affecting one in every five Americans, is a mammoth, chronic, frustrating problem. 

It can be called, justly, the number-one health hazard of our time. It's a remediable problem-but not, unfortunately, the way most of us choose to go about attacking it. To a much lesser extent, underweight constitutes a health problem. And the correction of both is an important function of preventive medicine. 

Modern Medicines is One of Major Successes, But it Also Includes Disasters

A SPECIAL WORD ABOUT MEDICINE TAKING 

THE HISTORY of modern medicines is one of major successes, but it also includes disasters. Tremendous benefits have followed the discovery of insulin for diabetes, agents for controlling high blood pressure, antibiotics and other anti-bacterial that kill or impede the growth of bacteria, cortisone and other steroid compounds that combat inflammation, tranquilizers and antidepressants for nervous and mentaldisorders, and drugs that slow the wild growth of some cancer cells. But there have been tragedies traceable to indiscriminate use and abuse of such powerful agents and of others. For one thing, no medication yet developed is fool proof-universally useful for even the condition for which it was developed, free of undesirable effects.

Virtually every drug, just as virtually every food, may produce unpleasant effects for at least a few individuals, and so it must be used with care. We hope in this chapter to provide a useful guide to medicine taking, one that will be helpful to you both in more effective treatment of any health problems that arise and also in preventing many problems. 

PRESCRIBING FOR YOURSELF 

A recent survey of a small but typical group of households carried out by a major university research institute found that the number of medications on hand varied from 3 to 88, with a mean of 30. Of the 2,539 medications observed, only 445 were prescription drugs. Each month in the United States, 750 out of every 1,000 adults 16 years of age and over experience a cold, headache, or other illness or  injury for which only 250 will consult a physician.

Thus, people control their own care in terms of whether and when to seek medical aid and when to prescribe for themselves. Virtually everyone on occasion does his own prescribing-and that can be a practical matter. Certainly every minor ache or pain does not require that a doctor be called. Nobody wishes to become a habitual patient. The medicines-variously known as "patent," "proprietary," and "over-the-counter" or "OTC"-which you can purchase in drugstores without a doctor's prescription are generally milder and have fairly broad safety margins. 

Symptoms of Cancer - How to detect Cancer? Answer these questions

CANCER SIGNALS

Some signs and symptoms are commonly associated with cancer. They include: Any lump or thickening in the breast or elsewhere Any sore that does not heal Any persistent change in bowel or bladder habits Persistenthoarseness or coughing Persistent indigestion or difficulty in swallowing Any change in a wart or mole Any sudden weight loss Actually, none of the foregoing constitutes proof of cancer-only that cancer is a possibility which should be investigated without delay.

No sign or symptom-either severe or mild but persistent or recurring -should be neglected, it bears repeating here, on the grounds that it may not mean anything or that the doctor may say it's "just nerves." The preventively minded physician whom you see regularly for your checkups will welcome being consulted about such signals, will not pass them off lightly as "just nerves," will check thoroughly, and, if it should be just a matter of "nerves," will help you do something about the "nerves.

YOUR OWN HEALTH INVENTORY

In addition to regular periodic checkups by your physician and your alertness for danger signals, there is an additional line of defense, an extra safeguard, you can put to use in maintaining health. It consists of a simple inventory of your health, a checklist of statements. Taking the inventory at home will require only a few minutes once a month.

Mark your calendar now to remind you to refer to this chapter and the following statements on some convenient date each month, perhaps the first or fifteenth. If you cannot say "True" to anyone of the statements that follow, you should see your doctor as soon as possible. If you have a perfect "True" score, it is quite likely that your health is being maintained satisfactorily, and you need not see your physician again until your next scheduled examination.

1.            I have noticed no sore on skin, lips, or tongue that doesn't seem to heal.

2.            I am not aware of shortness of breath when walking on level ground or when performing any type of activity that never before made me short of breath.

3.            I am not bothered by indigestion, nausea, appetite loss, abdominal pain or cramps, or the recent sudden appearance of constipation or diarrhea.

4.            I have noticed no blood in bowel movements or urine.

 5.           I am not steadily losing or gaining weight and I am satisfied that my weight is suitable for me.

6.            I do not feel myself becoming nervous, irritable, or depressed. I have had no crying spells and no feelings of overwhelming sadness, worthlessness, mental apathy. I have no persistent feeling that any- body is against me. I do not feel a nervous breakdown coming on.

7.            I do not feel unduly fatigued after little effort, mental or physical. I have no feeling of being rundown.

8.            I have no pallor; my skin color has not changed.  

9.            I have no cough that has persisted longer than a month. I have coughed up no blood.

 10.         I have had no persistent hoarseness.

11.          My hearing remains as good as it has ever been.

12.          My eyesight, too, remains good; I have had no dimming or fogging of vision.

13.          I have no persistent headaches.

14.          I have felt no chest discomfort without obvious cause.

15.          I have had no prolonged aches in back, limbs, or joints.

 16.         There has been no swelling of my feet or ankles.

 17.         I have noticed no urinary changes.

18.          I sleep well. I have no tendency to wake up during the night and have difficulty falling asleep again.

 19.         I have no new persistent pain or any other new symptoms.

20.          I am not worried about the possibility of having a venereal disease. Special for women:

21.          I have noticed no vaginal bleeding at unexpected times.

22.          I have felt no lump in my breast, and I have not been worried about the possibility of cancer or tumor there or in any other part of my body.

23.          I am not troubled with hot flashes. Special for men:

21.          My urination has not been abnormal in any way recently-particularly in terms of difficulty in starting, stopping, dribbling, and pain.

22.          I am not ruptured and have no thoughts that I may be.

23.          I do not believe that I may have picked up some disease overseas during the war which may now be coming to the surface.

Important Note: If you cannot say "True" to one or more of the preceding statements, it does not necessarily mean that you have a serious problem. There may, indeed, be a clue to something serious-and because it is likely to be an early clue, the problem is very likely to be amenable to effective treatment. On the other hand, the problem may be mild, possibly even temporary. But let your physician make the diagnosis for you. He will almost certainly agree that it is good preventive medicine, in the best interests of your continued good health, for him to check up on the lead provided when you cannot say "True" to a statement. –