Health News and Information

Resting Metabolic Rate (RMR). The term metabolism describes the sum total of the thousands of dynamic chemical reactions that occur in the body to sustain life RMR is the sum total of energy needed to keep the body going at rest. It can be likened to an idling engine. The synthesis of new tissue, for example, during growth and pregnancy have significant metabolic cost. Body size is also related—a bigger person has a generally higher metabolic rate. To extend the analogy of the idling engine, this would be a truck that is required to carry a heavier load. To do this might require a bigger engine which would then burn more fuel while idling. Resting metabolic rate (RMR) can be estimated from equations based on height and weight.

There are two basic factors which determine metabolic rate (MR) at any given moment: the number and size of respiring cells, and the metabolic intensity of those cells as determined by the work being done and how efficiently energy transformation occurs to meet the body’s demands. Resting metabolic rate (RMR) is the energy required to sustain life while an individual is at rest, but still awake. Basal metabolic rate (BMR) is often used synonymously with RMR and the energy required to sustain life at the lowest level, which is during sleep, is called the sleeping metabolic rate (SMR). The main determinants of metabolic rate are fat-free mass (FFM), fat mass (FM), age and sex. A ‘determinant’ is a factor which explains differences in metabolic rate between individuals.

RMR accounts for 60-70 per cent of daily energy expenditure. Excess consumption of energy or overfeeding causes an increase in RMR, while underfeeding, such as very-low-calorie diets (VLCDs) and fasting result in a decreased RMR. Most of these changes are due to changes in fat-free mass (FFM) and the thermic effect of food (which is dependent on the calorie load). There may also be some ‘adaptive’ changes which result in a metabolic rate (MR) which is greater (for overfeeding), or less (for underfeeding) than predicted.

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This is a disease affecting infants and children. It may start to produce symptoms soon after weaning when the infant is introduced to solids. It affects one in 4000, and often there is a family tendency.

The disease affects the small bowel. Frequent and loose bowel actions, general debility, a failure to thrive and a pot belly in children are the usual symptoms. Many become irritable and peevish for no obvious reasons.

The cause is an allergy to the gliadin fraction of gluten. Gluten is the protein part of wheat and certain other grains. In this disease the cells of the jejunum, the first part of the small bowel, are sensitive to gluten and simply cease to function normally. Diagnosis is often overlooked for many years. The fact that the infant does not thrive as well as other members of the family may be accepted without proper medical investigation. A diagnosis is firmly established when a biopsy of the jujenum is performed and the diseased cells examined under the microscope. In 1977 a simple test was invented which consists of a simple injection of the skin. This is much quicker, but it has not yet become generally available.

Treatment

Once an accurate diagnosis has been made, treatment is usually dramatic in its beneficial effects. The patient is placed on a gluten-free diet. Symptoms vanish like magic, often within a few days. A feeling of well-being commences almost immediately. But it may take many months, even up to a year, for the full benefits to become evident. As symptoms have often been present for a long time, reversal and a total cure may be time-consuming. Between 80 and 90 per cent of patients improve dramatically on this simple routine.

Today, Coeliac Societies exist in many countries, and membership is an excellent idea. Recipes for making gluten-free products are made available, and helpful advice offered. Also, lists of commercially available items are regularly mailed to members, allowing them wider selection in foods if they wish to purchase them. In Australia, the address is: The Coeliac Society, P.O. Box 73, Cronulla, N.S.W. 2230.

Parents soon become proficient at making gluten-free bread and other food items. Often this may be conveniently made on a weekly basis, and deep frozen until needed. Once the routine has been commenced, it is usually no great domestic burden, and most parents are only too happy to have discovered a way of helping their child, and seeing the symptoms disappear. The stress and anxiety of caring for a perpetually ill and undernourished child far outweighs any extra work in preparing a gluten-free diet.

Symptoms suggesting coeliac disease should never be dismissed or neglected. Referral to a paediatric physician is usually necessary, so that adequate investigation and treatment can be carried out.

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This is all worth remembering. I’ve been telling parents for the past thirty years: ‘There are no delinquent children, only delinquent parents.’ Children mimic. They will reflect, with astounding mirror-image accuracy. The way your baby, infant, child develops and subsequently reacts depends to a large extent on you, and your personal reactions to the vagaries of life.

This is not a criticism. It is a statement of fact. Parents may benefit from it—for just as tensions and stresses breed psychosomatic symptoms, so reactions of calmness, happiness, joy and brightness may similarly yield these results in one’s offspring.

That is why many children do not necessarily require drug therapy for every symptom. Certainly organic disease must be looked for first, and that is why so much of this book is devoted to recognition and treatment of actual, organic illness. It must never be overlooked. A parent should never screech at little Harry and tell him he is a bad-tempered brat, when in fact he may have a true organic illness that needs the doctor, or medication at least’

But parents should also keep the emotional factors well in mind. If little Harry’s symptoms are recurring ones that follow a similar pattern each time they happen, do they reflect a recurring stress situation in the family? Do these symptoms follow on from an emotional problem in which the child has been involved? From infancy through to old age, but more frequently in the younger age levels, reactions of this nature will occur and they will keep on recurring.

Ideally, efforts should be made to discover causes. If causes are found, then answers are usually possible. Helping children cope is one of the major responsibilities of parents; and other, older members of the family circle can help too. In fact, everybody can be involved, and the closer this co-operation, the more successful and happy everybody will be. Not only little Harry, but every member of the home.

This is where those who follow the Christian ethic often have it over those who do not. The Christian principle of ‘Do to the other person what you would like him to do to you’ may work wonders for all. If you have any doubts, simply read Christ’s Sermon on the Mount (Matthew 5). Filling the mind with thoughts of happiness and confidence, and without anxiety and tension, is beneficial. You do not have to be a religionist to derive benefit from this. It works on a short-term as well as long-term basis. It is excellent psychology, and a very successful method.

Endeavouring to secure co-operation, happiness, freedom from anxiety and tension, understanding of each other, playing down life’s hardships, forgiving grievances (most of which are minor anyway), being honest and sharing, can only yield benefits.

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Mumps is an infectious viral disease which is spread by droplets which are released into the air during coughing or sneezing. It occurs in epidemics, mainly affecting children over two years old, but can infect people of any age. After a two to three week incubation period visible symptoms appear, the most obvious being the swelling of the saliva-producing parotid glands on one or both sides of the face. This is accompanied by fever, swelling in the sub-maxillary salivary glands, swollen glands in other parts of the body and muscular pain in the jaw, ear and abdomen. The pancreas may be inflamed, causing vomiting. In some adult men mumps can cause swelling and inflammation of the testicles, sometimes leading to sterility. There are some rare but serious complications which can result, including encephalitis and meningitis in which the brain or its surrounding membranes become inflamed.

Vaccines against mumps are available and many doctors recommend immunisation for all babies aged between 12 and 15 months. The vaccine has a life of five years, following which boosters are required. Pregnant women should not receive these vaccines since they contain live viruses which can affect the foetus. Normally, once a person has had mumps, they develop an immunity to the disease. However, there are some cases where people have been re-infected.

Treatment of mumps includes isolation to prevent the spread of infection. Rest is recommended until the swollen glands subside, and mild painkillers may be used. Medical treatment may be required if there are complications such as painful or swollen testicles, severe earaches or headaches or a stiff neck. Natural practitioners prescribe a range of treatments. These include herbal medicines such as infusions of yarrow, elderflower and marigold, supplements to boost the immune system, homeopathic medicines or tissue salts and cold compresses to reduce swelling.

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Anxiety frequently produces pain in the left side of the chest which we immediately suspect to be due to some disease of the heart. However, the pain of anxiety is usually situated well to the left side in the area where we can normally feel the heart beat. On the other hand the pain from organic disease of the heart is situated more centrally, under the breast bone. Furthermore, we experience heart pain due to anxiety at any time, even lying down and resting, while organic cardiac pain is typically brought on by physical effort and stops when we rest. Organic cardiac pain also tends to radiate down the left arm in a way which does not usually occur when the pain is of functional origin.

Only a few days ago a doctor brought his twenty-two-year-old son to me. He was a big lad of fine physique and was a successful athlete. In a pleasant extrovert manner he told me that for the past five months he had had continuous pain over his heart and down his left arm. The pain had come on when he was under a lot of stress studying for exams at a time when his girl friend was also demanding his attention, and he felt he could not cope with both. He had recently seen a cardiologist who found him normal and who had suggested a visit to me.

I have mentioned that pain over the heart due to anxiety rarely extends down the left arm. This lad was convinced that there was something wrong with his heart. He is the son of a doctor; and when I questioned him, he said that he knew quite well that pain from heart disease goes down the left arm. This serves to illustrate the way in which the symptoms of anxiety can be modified by our knowledge of our body and its functions.

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People vary in the time they take to learn to relax. But like everything else the more you practise the better you become. By the time you reach this stage you should have discovered a lot about your tensions and how to cope with them. There is one last, very important area of your body that you can learn to relax or contract whenever you want to. These are the muscles in the part of your body known as the pelvic floor.

Three sets of muscles-There are the muscles which control the exit from the bladder, those which control the exit from the bowels, and those which control the walls of your vagina (the front passage or birth canal). Possibly these are muscles you never knew you had. If you imagine that you desperately need to spend a penny and there isn’t a loo for miles, so you have to hold on to it, then the muscles you are pulling in are the muscles of your pelvic floor. You are keeping the muscles all round the exit from your bladder very tight. At the same time you are also tightening the muscles in your vagina. Do this several times so you can recognize where they are and actually feel them tightening.

Once you have felt where they are, breathe in and deliberately tighten them, pulling them in and up as though you were going up in a lift, to the third and then the fourth floor. Can you get up to the fifth? Now blow out those three candles and let the lift fall gradually down into the basement. However, if you have had a baby it’s a good idea to move back up to the ground floor! A little tone in these muscles is a good antidote to the condition known as prolapse (the womb dropping into a lower position than is comfortable).

Some women learn such control over these muscles that they can sit astride a bath of water and ‘suck’ the water into their bodies simply by contracting their muscles and then let it fall back into the bath again simply by relaxing them. It’s more fun to use these muscles when you’re making love. It can have an electrifying effect on the man in your life, particularly if you choose your moment well.

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People who are sensitive, or susceptible, to chemicals are often unable to eat cabbage, broccoli, cauliflower, celery, lettuce, spinach, beet greens, and certain other leafy vegetables. Often such people will simply think such vegetables “do not agree with them.” This may be the case—that is, they may be suffering from allergies to one or more of these foods.

Some patients, however, are susceptible to the effects of sprayed vegetables but not to the same vegetables when they are unsprayed. The worst culprits in this respect seem to be the various members of the cabbage family (including cabbage, broccoli, and cauliflower). They are among the most heavily contaminated vegetables. One sign of this may be that until about 1950, all cooks were warned to look out for cabbage worms on broccoli. Since that time, however, no one of my acquaintance has found one of these insects on commercial broccoli. This certainly represents progress for the cook—but progress at what price?

Another practice which has contributed to the contamination of foods is the indiscriminate spraying of fruit and vegetable counters in stores and supermarkets. This is done to control bugs, molds, and especially flies, which can be unsanitary. The almost complete absence of fruit flies, even in summer, is a testimony to the effectiveness of this spraying program. Susceptible persons, however, may start to cough, wheeze, or show other signs of a reaction when they enter the fruit and vegetable section of a store. Often, of course, this reaction cannot be distinguished from a reaction to the many other chemicals one is likely to encounter in a supermarket.

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Convulsions that occur when a child has no fever may be caused by many conditions. Epilepsy is the best-known cause. Epilepsy is a disorder of the brain that causes repeated attacks or seizures. There are several forms of epilepsy, which are identified by the type of seizure experienced. Some forms of epilepsy cause convulsions (jerking movements or spasms of the muscles). Other types, however, do not cause convulsions. Therefore the term “seizure” is more properly used to describe an attack of epilepsy. The cause of most types of epilepsy is not known.

Signs and Symptoms

Epilepsy must be diagnosed by a doctor. However, signs of possible epilepsy can be seen in the typical behavior that occurs in different types of seizures.

In a generalized convulsive seizure, the child suddenly loses consciousness and may cry out as the seizure starts. The body stiffens, and the child may fall. Muscle spasms cause jerking or wild thrashing movements. The child may lose control of the bladder and bowels. When spasms end, the child may fall into a deep sleep and will usually be confused and sleepy upon awakening. Sometimes there is a warning sensation (aura) before this type of seizure begins, including sleepiness, headache, yawning, or tingling in the arms and legs.

Generalized non-convulsive or absence seizures are so different from major convulsive seizures that they are often not recognized as epilepsy – or may not even be noticed. The child may simply stare into space. There may be rapid blinking or fluttering of the eyes. The child remains conscious yet may be totally unaware that the seizure is occurring. If it is not recognized as a seizure, it may be mistaken for a learning disability, not paying attention, or simple daydreaming.

In complex partial seizures the child remains conscious, but may sit motionless or may make repeated or unusual movements.

In simple partial seizures the child is conscious and may simply feel tingling in the hands and feet. The child may also perceive bad odors, see flashing lights, or speak unintelligibly.

Home Care

Call your doctor any time a child has convulsions.

Of course, you must immediately care for the child during the convulsions. The most important home care is to prevent your child from injury during the thrashing phase of convulsions. Do not put your fingers in the child’s mouth.

If epilepsy is diagnosed, the doctor will give instructions for caring for the child at home. Until the seizures are controlled, discourage the child from climbing high ladders or tall trees. Do not allow the child to swim alone. Otherwise, your child can and should live a normal life with only minor changes in activities.

Precaution

• If you find your child unconscious, do not assume that your child has been made unconscious by a fall. Do consider the possibility that epilepsy has led to a fall and unconsciousness.

Medical Treatment

Your doctor will perform physical and neurological (nervous system) examinations. The doctor may order a variety of laboratory or diagnostic tests. A number of prescription medications that control seizures are available. The doctor may order blood tests to determine the amount and type of drug to be used. In difficult cases, your doctor may recommend consultation with a neurologist (a specialist in diseases of the nervous system).

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When you haven’t been off the couch since high school, starting a lifelong fitness program can seem a daunting task. Take it one step at a time, says Douglas Lentz, a certified strength and conditioning specialist and director of fitness and wellness at Results Therapy and Fitness in Chambersburg, Pennsylvania. The following phases make up one painless approach to getting started. Each phase car last a week or more, depending on your chosen pace.

1. You’re climbing off the couch. “You have to walk before you run,” Lentz says. He means it literally. Start by taking a 10-minute walk, three days a week. Sure, there’s very minimal aerobic effect yet, but you’re introducing your body and brain to a new world. Pick a consistent time for your walk. “If you usually come home and watch television before dinner, walk first and then watch television,” Lentz says. Start stretching right away. For now, do it at the end of your walk, stretching just your hamstrings and calves, some of the muscles you use while walking.

2. You’re mowing away from the couch. Take your walk up to 15 minutes. Add 5 minutes a week until you hit 20 or 30 minutes, says Lentz. Take your stretching up to five days a week. Add a stretch a week to your routine.

3. You’re starting to forget about the couch. Boost your walking pace to “brisk.” You’re on your way to getting your heart rate up to an aerobic-benefiting level. Throw in some strength training, Lentz says. Nothing fancy. Get used to the idea of moving weight around. Do it at home twice a week on the days you don’t walk. There’s a lot you can do without weights-pushups and crunches are just a couple examples. But buy a pair of weight-adjustable dumbbells to expand your options, Lentz suggests.

4. You’ve covered the couch with plastic. Jack up the aerobic pace by doing intervals. “If you’ve been walking briskly for 20 minutes, you may not be able to just start jogging 20 minutes all at once,” says Mark Taranta of the Physical Therapy Practice. “So walk for 3 minutes and jog for 3 minutes, walk, jog, walk, jog.” Move your strength show to a more organized venue. That means joining a gym, or investing in enough home equipment to work all your major body parts. Taranta suggests keeping your start-up routine simple-one set per major body part, 12 to 15 repetitions, two days a week.

5. You gave the couch to Goodwill. You’re at or near exercise commitment. Start cross-training by shifting your aerobic work from jogging to something else, like a little bike work or swimming to keep things interesting. Keep the interval-training idea alive with whatever activity you choose, working your way up to a steady, challenging (but not exhausting) aerobic pace. Include more body parts (that is, biceps, triceps, calves) in your strength routine, adding a little weight to each exercise as it becomes easy, Taranta says.

Welcome to fitness.

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The following three operations are now rarely carried out and are usually reserved for more advanced cancer.

Bilateral oophorectomy

This operation is possible for women who have not reached their menopause. It involves the removal of both ovaries and can lead to regression of tumours in about one-third of cases for between 1 and 3 years. Although a woman who has undergone this operation can no longer conceive, pregnancy should always be avoided by young women with breast cancer as it can cause tumours to recur. The ovaries can be removed surgically or by radiotherapy. Oophorectomy is being considered as an adjuvant to primary treatment for pre-menopausal women who have high-risk disease.

Adrenalectomy

The adrenal glands are two tiny glands, each situated in the fat just above a kidney. They produce many hormones, including adrenalin, Cortisol, and sex hormones. Removal of both these glands – bilateral total adrenalectomy – can lead to regression of recurrent breast cancer in about 50 per cent of cases, which can last for between 15 months and 5 years. Relapse may be due to the tumours becoming hormone independent or to synthesis of the hormone oestrogen (which stimulates tumour growth) being re-started at some unknown site in the body. Metastases in the bones and skin respond better to this treatment than do those in the brain and liver.

Adrenalectomy was carried out together with oophorectomy in women before the menopause. It must be followed by lifelong treatment with cortisone, and it is an obsolete operation nowadays as there are medicines which can achieve the same effect without surgery.

Hypophysectomy

This operation involves the removal of the pituitary gland in the brain and gives slightly better results than adrenalectomy. However, it is a difficult operation for various reasons and is not widely used anymore. Again, following hypophysectomy, women must continue cortisone treatment for the rest of their lives.

Choosing a treatment

All women should have a say in what form of treatment – if any – they receive, and an opportunity to discuss their options with their family before making a decision. They should be aware of all the options available to them, and take account of the advice their specialists give them.

In most areas, some form of counseling is available for women with breast cancer and for their families. Many hospitals now have specially trained breast care nurses who will be able to provide valuable support and information.

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