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This form of resuscitation is also known as EAR (expired air resuscitation). It is used in first aid where the subject has stopped breathing. The technique is taught in practical first aid courses such as that which is offered by St John Ambulance Australia. The following description is a guide only. It is recommended that a first aid course be taken to learn techniques such as EAR and CPR (cardiopulmonary resuscitation).

After establishing that the subject is not breathing, turn onto the back and kneel beside the subject, keeping her or his head tilted back. With one hand pinch the nostrils between your fingers. Use the other hands to lift the jaw forward. Open your mouth wide and take a deep breath, then place your mouth firmly over that of the subject, making an airtight seal, and breathe into the subject’s mouth. Remove your mouth and turn your head towards the subjects chest. Listen for exhaled air and observe whether the chest falls. If there is no exhalation make sure the head is tilted back and check for foreign objects in the airway, removing any obstructions if necessary. Breathe into the subject’s mouth again, giving five full breaths in 10 seconds, then check the pulse in the neck for 5 seconds, placing the ends of your fingers (not thumbs or fingertips) in the groove behind the Adam’s apple on one side only. If pulse is present continue EAR at the rate of 15 breaths per minute. If there is no pulse CPR will be required.

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Anxiety may have an effect on stuttering. The right side of the body is controlled by the left side of the brain and vice versa. In the right-handed person the left side of the brain is dominant over the right, and as a result the right hand is given preference over the left. In those who are left-handed the right side of the brain is dominant over the left. It is believed that stuttering often develops when the dominance of the leading side of the brain is incomplete, or when a potentially left-handed child is trained to function as a right-hander. We see then that stuttering results when the messages from the brain to the organ of speech are indecisive. This indecision may be further increased by the presence of anxiety. This is shown very clearly by the fact that many quite normal people show a hesitancy in their speaking or even a mild stutter when confronted with the task of speaking in some formal situation which produces anxiety.

On the other hand, some people stutter without showing or feeling much tension or anxiety at all. As a general rule these people who stutter in the absence of anxiety do not gain much help in their speech difficulty by practising relaxing mental exercises. However, the majority of stutterers experience considerable tension when they are speaking, and with them the reduction of the general level of anxiety by relaxing mental exercises is a great help toward establishing a pattern of easy normal speech.

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Relax the muscles of your chest first. Push your breasts as high into the air as you can. You will find that you tend to arch your back when you do this and you will feel tension along both your sides too. Breathe out and fall back, letting your breasts flop and remembering to drop those shoulders at the same time.

Now imagine that you have an extremely tight, old-fashioned corset on and it’s pulling in your belly even further than you thought possible. As you breathe in, wearing your corset, the tension will spread upwards into your chest and you’ll probably clench your buttocks too. As you breathe out, loosen the corset and let your belly flop and sag. This is a very difficult thing to do, because a lot of clothes are designed to show off a flat stomach- so a full, rounded belly is something most of us try to avoid. In other times and other places it was, and still is, considered to be a mark of great beauty. It may take quite a time to achieve entire relaxation of this part of the body. But it’s the most important bit, because these are the muscles which will clash with the muscles in your womb that are squeezing out the period, and they will squeeze no matter what you do. Don’t give them any opposition and the whole business immediately gets a lot easier. After all, they’re extremely powerful muscles; ten times stronger than any other muscle anywhere in your body.

At this point it’s a good idea to pay some attention to the position of your spine. If you started off supported by a lot of cushions and pillows and now your spine doesn’t feel comfortable, remove them all and start all over again. Many women find that if they imagine they are lying on their backs floating in pleasantly warm water they can curve their spines into a very comfortable position; others need to arch their spines up from the bed and then let them relax; others find that if they relax their necks and shoulders, their spines relax too. It takes time and experience to find the best method and position.

*11\177\2*

We have spoken of the problems of food allergy and chemical susceptibility as the two main components of environmental disease. This is technically correct, but in actuality these two problems are usually found together, tightly interlinked in the history of each chronically ill individual. One of the major ways in which these two elements interlock is in the chemical pollution of our food supply.

It is no secret that our food is now treated with synthetic chemicals of every sort. Some of these chemicals have been deliberately added, to impart color, flavor, or longer shelf life. These deliberately added substances are called additives. In addition, numerous chemicals accidentally enter the food supply as residues of pesticides, fertilizers, or environmental pollutants. These are called food contaminants.

Together, food additives and food contaminants have become a major source of the problem of chemical susceptibility in most Western countries, since everyone must eat, and most food now comes from the giant agribusiness conglomerates. These giant corporations are mainly concerned with maximizing profit, even if the health consequences for the population are negative. What is more, these companies are often closely linked to chemical companies and thus have a built-in bias in favor of synthetic pesticides and fertilizers.1

For any person who wants to avoid environmentally induced illness, it is necessary to understand the sources of such chemical contamination of the food supply. These chemicals can either cause, or help perpetuate, chronic illnesses of all sorts. However, their presence can be detected, and they themselves can be avoided, by methods which are explained later in this book.

I have already described how the role of chemical pesticides was discovered in the case of William Petersen, the man who found that he could eat unsprayed apples from an abandoned orchard, while commercial apples from a store gave him a headache. The principles discovered in this case were soon extended to many other food-allergy patients. It was determined that in some cases they were actually reacting only to chemical contaminants. Usually, however, patients with the chemical susceptibility problem also had the food allergy problem, and vice versa. Some patients appeared to react to commercial food in the winter, but to a much lesser degree in the warmer months. This was because in the cold months they were often cooped up in their houses and exposed to the cumulative effects of indoor air pollution (Chap. 6). The combination of food allergies, contaminated food, and such indoor pollutants greatly heightened their symptoms and made their winters miserable. Not infrequently their winter maladies, environmental in origin, masqueraded as colds or flus. In other cases, they did have genuine infections, but these were accentuated by allergic problems.

The variety of problems is endless, since environmental disease is above all things an individual problem. There is no single cause for all people, nor a single solution. Usually the disease is a result of the interaction between an individual, with his particular bodily makeup, and his environment. Certain exposures, however, stand out as most troublesome for the greatest number of patients. Of the food additives and contaminants, some of the most troublesome are residues of pesticide sprays which find their way into almost everything the average person eats.

*12\110\2*

Constipation is a condition in which the bowel movements are too hard. The frequency of bowel movements is not a factor of constipation. Passage of six too-firm bowel movements a day is considered constipation. Passage of one normal or soft bowel movement every third or fourth day is not constipation. Many normal, healthy children have a bowel movement only every few days and are not constipated. The hardness of a stool is judged by appearance and by diameter. A stool greater than twice the usual diameter is probably too hard.

Over 95 percent of constipation cases involve no physical abnormality. This form of constipation can always be cured by changes in the diet or by using medications that soften the stools.

Constipation occurs in the large bowel (colon). The function of the colon is to store unabsorbed food waste and to absorb and hold water from the liquid material received from the small intestine. If the colon absorbs too much water, the stools become hard.

In children, there are two common reasons for constipation. The first reason is that the diet does not include enough roughage, which holds water in the stools. Foods that prevent constipation are all fruit juices and all fruits – particularly those eaten with their skin on – except bananas and apples; all vegetables, especially if eaten raw, except peeled potatoes; unrefined grains (whole-grain cereals and breads); and unrefined sugars (brown sugar, molasses, honey). All other foods, including milk and milk products, promote constipation.

A second common reason for constipation in children is that the child resists the normal impulse to move the bowels. This allows the colon to continue absorbing water out of the retained stools; it results in stools that are too hard. A common reason why children resist the normal impulse to move the bowels is that the parents are putting too much pressure on the child during toilet training. Once the stools become too hard, bowel movements become painful. Fear of such pain makes the child even more determined to postpone bowel movements. Constipation enlarges the colon, causing a loss of muscle tone, and the physical impulse to empty the bowel becomes weaker. This cycle can lead to chronic constipation.

Signs and symptoms

The major sign of constipation is stools that are too hard, too dry, and larger in diameter than usual. Constipation can cause pain in the anus during bowel movements. Red blood may appear on and around the stools. Other symptoms are cramps in the abdomen and an eventual loss of appetite.

If constipation continues for days and weeks, paradoxical diarrhea may develop. In this condition, loose, watery stools seep around the hard stool in the colon and are passed as diarrhea. When this happens, it can be difficult to tell whether the child has constipation or diarrhea.

Home care

For immediate temporary relief, use a glycerin suppository or disposable commercial enema. For a long-term cure, increase the amount of roughage and decrease the amount of constipating foods in your child’s diet. If constipation occurs during toilet training, stop training efforts.

Precautions

• Check with your doctor before using laxatives in children. Laxatives may force passage of a hard stool and cause pain that leads to further holding back by the child.

• Enemas, suppositories, and laxatives are habit-forming. They should never be used on a regular basis.

• Do not assume that a child is constipated simply because bowel movements do not occur every day.

Medical treatment

Your doctor will perform a rectal examination and a careful examination of the child’s abdomen. X ray studies of the bowel may be taken to look for possible physical abnormalities. Directions and follow-up by your doctor may be needed.

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Troublesome symptoms of varying severity that affect most women at least to some extent around the time of the menopause (about the age of 50 in most women today). Throughout a woman’s reproductive life she produces female sex hormones, but from the menopause onwards these are produced in reduced amounts. The first sign of the onset of the menopause is usually irregular periods. Although a woman’s female sex-hormone levels may fall to below those found in most men, her male sex-hormone level can remain high and could account for the facial hairiness seen in some women at this time.

The most common symptoms around the menopause are hot flushes, vaginal dryness, pain on intercourse, headaches, night sweats, weight gain, light-headedness, muscle and joint aches and pains, dry skin, depression, excitability and a loss of confidence. There are, of course, many others too. The vast majority of these signs and symptoms can be reversed by giving female sex hormones, so clearly they are hormone-linked. However, such replacement therapy has fallen under a cloud since research has found an increased level of breast cancers in women taking oestrogens in this way. It also increases the risk of gall-stones and high blood pressure.

Once over the age of 50 or so ischemic heart disease (which leads to heart attacks) becomes more common in women than before and a few women lose their pubic hair and armpit hair and have degeneration of their vulva and vagina. Women also start to lose calcium from their bones and are more liable to fractures when they fall than are men. Some women welcome the onset of the menopause because it means they can now enjoy sex without worrying about contraception, but others mourn the passing of their fertile years and are miserable.

The menopause also often coincides with the departure of children from the home and the woman’s husband may be at the stage of life in which he is becoming interested in younger women, perhaps to sow the oats he never did when he was young. This is now the second peak time for divorces (the first is during the first five years of marriage).

Having said this, the menopause is used somewhat as a catch-all and any problems a woman encounters at around this time of life tend to be attributed to it-often erroneously. About 10-20 per cent of women suffer no symptoms at all at the menopause.

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The concepts of “health” and “Grateful Dead concerts” don’t often appear in the same sentence. But those enthusiastic souls who used to shake their whatevers nonstop while the Dead played 1 1/2 hours straight (without tuning up once) were faithfully, if unwittingly, engaged in a noble health pursuit-aerobic exercise.

Jane Fonda-style aerobic dance classes may have publicly appropriated the word, but the truth is that any activity that jacks your heart rate up for an extended period of time is aerobic exercise. That means running, cycling, swimming, rowing, skiing, inline skating, or anything else that gets you huffing and puffing enough to feel it but not so much that you can’t keep it up.

All those good things that exercise does to help you avoid heart disease come mostly from aerobic work. That’s eminently logical when you bear in mind that what aerobic exercise essentially does is strengthen your heart (hey, it’s a muscle, too) and improve your lung capacity, thus helping the flow of oxygen through your bloodstream.

Aerobic exercise is also the principal player in diabetes prevention. “Regular aerobic-type exercise will allow you to metabolize your blood sugar without requiring as much insulin,” says Ben Hurley, Ph.D., director of the Exercise Science Laboratory at the University of Maryland’s College of Health and Human Performance in College Park. “That’s important for both heart disease and diabetes prevention. And the research is very consistent.” If you want to take advantage of aerobic exercise’s health benefits, here’s all you need to do.

Do as you please. The kind of aerobic exercise that works best is whatever kind you’ll do. So your wisest choice, according to physical therapist Mark Taranta, director of the Physical Therapy Practice in Philadelphia, is to go with what you like. “Do something you’re familiar with or enjoyed doing in the past,” he advises. “Don’t go out and buy a big piece of equipment like a treadmill if you’ve never tried it before. You might hate it.”

Get that heart rate up. Any exercise expert will tell you that to reap the full benefits of aerobic exercise, you have to do it hard enough. Sorry, golf won’t cut it. (No, not even if you carry your clubs and take 130 strokes to finish.) The aerobic effect doesn’t kick in until your heart’s beating at 70 percent of its maximum rate.

Your maximum rate per minute, by the way, is 220 minus your age. So if you’re 40, you want to have your heart beating at 70 percent of 180 beats per minute while you’re exercising. (We’ll do the math for you, this time only-it’s 126 beats per minute.) Check your pulse by putting two fingers to the side of your neck and counting the beats for 10 seconds; multiply that by six, Taranta says.

And keep it up. Once you get your pulse up to 70 percent of your maximum, keep it there for at least 20 minutes. While you’re working your way up to that magic 20-minute mark, remember that accumulating the time over a 24-hour period (say, three seven-minute sessions on the stationary bike) will provide almost the same benefits.

Stick with it. If you get your aerobic workout three to five times a week, you’ll be amazed at how quickly the positive changes kick in. But you’ll be just as amazed at how fast they fade if you start backsliding. “If you don’t keep at it, you lose it,” Dr. Bortz warns. “The gains and losses are very transient. If you want to translate them into genuine health benefits, you have to do it regularly.”

Be reasonable. Assuming that your fitness goal is achieving overall health rather than medaling in the Olympics, it makes more sense to enjoy your exercise sessions than to turn them into torture tests. Yes, there are the minimum requirements we’ve mentioned, but you don’t have to go much beyond them. “It doesn’t take a whole lot to maintain your cardiovascular fitness,” says Tom Baechle, Ed. D., chairman of the exercise science department at Creighton University in Omaha, Nebraska. “We’ve gotten away from the killing-yourself mode. You can get it done in 20 minutes a day, three times a week, at a reasonable intensity.”

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Partial mastectomy/segmentectomy

A variation of lumpectomy, this operation is done for a larger tumour and involves the removal of a larger wedge of normal tissue. Auxiliary lymph nodes may also be removed.

The advantage of this operation for women with larger breasts is that most of the breast tissue is preserved. There is also unlikely to be much swelling of the arm as most of the auxiliary lymph nodes remain intact. However, the breast may be left flattened or distorted, particularly the nipple.

Radiotherapy is likely to be necessary after a partial mastectomy in case any cancer remains in the breast tissue left behind. Again, radiotherapy must be avoided if all the auxiliary lymph nodes have been removed.

Mastectomy

In simple or total mastectomy, the entire breast is removed, usually together with some or all of the auxiliary lymph nodes. Breast reconstruction should be possible following this operation. Its advantages include the retention of the muscles of the chest wall, which are removed in a radical mastectomy. The risk of arm swelling is increased if the auxiliary lymph nodes are completely excised, or if some of them are removed for staging and then radiotherapy is given.

There is controversy about how many of the auxiliary lymph nodes should be removed. Some surgeons claim that complete removal leads to a very low recurrence rate and makes radiotherapy unnecessary. Others prefer to perform a wide lump excision (removing the lump itself as well as a wedge of the normal tissue surrounding it), with sampling of the auxiliary nodes for prognostication, and follow it up with radiotherapy to a large area around the breast and armpit. This is a quicker operation, involving less risk of damage to the nerves responsible for sensation in the arms.

For pre-menopausal women whose auxiliary nodes are involved, surgery may be followed by adjuvant chemotherapy for 6 to 12 months.

Radical mastectomy

This operation is now uncommon. It involves the removal of the entire breast, the auxiliary lymph nodes, fat, and the pectoral muscles of the chest wall. If metastasis has not already occurred, radical mastectomy can completely remove the malignant cells. However, it does leave a long scar, a hollow chest, restricted movement of the shoulder, and loss of arm strength due to the removal of the muscles which normally allow arm movement.

Modified radical mastectomy (Patey)

In this operation the entire breast, all the lymph nodes in the armpit and the smaller of the two chest muscles are removed.

As all the auxiliary lymph nodes are removed, swelling may occur in the arm, but muscle strength is retained.

Super-radical mastectomy

Another uncommon operation, this involves radical mastectomy as well as removal of further lymph nodes known as the internal mammary and supraclavicular nodes. However, there is no evidence to prove that this operation is more effective than radical mastectomy alone.

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These include things such as stopping smoking, wearing seat-belts reducing alcohol consumption and so on. They are often extremely cheap to implement. A cost-benefit analysis on smoking and alcohol produces dramatic results. The cost of alcohol abuse and smoking accounts for one fifth of all health expenditure. When indirect costs are added the cost of smoking and alcohol abuse accounts for one quart of all the economic costs of illness. These figures would increase even more if the costs of fire losses, ca accidents and crime due to smoking and alcohol were added.

According to Dr John H. Knowles, President of the Rockefeller Foundation:

Over 99 per cent of us are born healthy am suffer premature death and disability only ñ result of personal misbehaviour and environmental conditions. . . . the individual has the ðîã indeed the moral responsibility to maintain own health by observance of simple prudent rules of behaviour. . . life is meant to be enjoyed . . . but the cost of individual responsibility health care now becomes prohibitive. The choice is individual responsibility or social failure. Responsibility and duty must gain some degree of parity with right and freedom.

So much for the costs of alcohol and smoking. The benefits are harder to quantify. The benefit could be the amount people are prepared to pay to indulge in these activities but this is probably an underestimate because presumably people prevented from smoking and drinking would need to do other things to answer the need; they have in the first place. Perhaps the cost of the drug bill would rise proportionately. A prevention plan to reduce smoking and alcohol use would, of course, cost money and there would be transitional costs as the two industries lost profits and put people out of work. Governments could, of course, compensate these industries temporarily in the interests of the nation’s health.

Even allowing for all these costs economists still think the financial advantages could be considerable. To see just how cost-effective a reduction in tobacco and alcohol use would be one need look no further than the Mormons and Seventh Day Adventists in the US who live without these drugs and have provably lower death rates and longer lives. Their healthy eating habits also give them a cancer mortality of between 50 and 65 per cent that of other Americans.

*38/72/5*

It wasn’t until Susan Ledford discovered the power of a fresh, sweet orange that she was able to pass up her biggest indulgence and lose 43 pounds.

A member of a big Southern family that loves food, Susan is no stranger to temptation. When special occasions call for family celebrations, “it’s like a race to see who can make the most disgustingly rich casserole,” says the 36-year-old newspaper designer from Tallahassee, Florida.

Such decadent dishes were standard fare while Susan was growing up. But they weren’t kind to her waistline. She gained weight throughout her teenage years, and by her twenties, she was trying all sorts of diets in an effort to slim down. “I’d go on one diet and lose a few pounds only to watch them return when I went back to my normal eating habits,” she recalls. By age 34, she topped out at 168 pounds.

Knowing that Susan was unhappy with her figure, a friend suggested that she join Weight Watchers. The program taught Susan how to make healthy food choices and control her portion sizes. Within a year, she took off 43 pounds.

Thrilled to have finally reached her goal weight of 125 pounds, Susan was determined to stay there. But she had one dietary hurdle to overcome. Susan loved to bake cookies for her family and friends, especially around the Christmas holidays. She especially enjoyed licking the bowl and sampling each batch fresh from the oven.

Realizing that her taste-testing ways would do nothing for her hard-earned figure, Susan decided to have a healthy snack before baking. Her food of choice: a fresh, juicy orange. She found that the intense flavor of the fruit quashed her cravings for cookies. She was i able to bake to her heart’s content without eating a thing.

Thanks to her ingenious strategy, Susan had an easier time sticking with her healthy eating habits. Her weight has held steady at 125 pounds since 1998.

WINNING ACTION

Feed your sweet tooth an orange. Susan’s strategy has real scientific merit. According to Marilyn C. Majchrzak, R.D., food-development manager at the Canyon Ranch Spa/Health Resort in Tucson, Arizona, intensely flavored foods such as oranges tend to be more satisfying than bland foods. So snacking on something sweet and juicy will help reduce temptation. Keep lots of oranges, fresh pineapple, strawberries, or your favorite tastebud-shocking fruit in your fridge.

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