Everybody has had the experience of walking into a smoke-filled room. The coughing and smarting of the eyes that can result is leading many people to ask whether this kind of ‘passive’ smoking may produce the same sort of serious diseases as those seen in smokers themselves. This possibility has been examined in a number of ways. The most obvious method was to look at the occurrence of smoking-related diseases in the husbands or wives of smokers. Studies of this kind were done in the early 1980s and some involved tens of thousands of people. All of these studies were brought together in 1986 by Professor Nicholas Wald and his colleagues in an influential paper published in the British Medical Journal. They added together the results of thirteen epidemiological studies and concluded that there was sufficient agreement between them to conclude that there was significant increased risk of lung cancer for someone married to a smoker. The average effect of a married man or woman smoking would be to increase the risk to the non-smoking partner by about 35 per cent. Much controversy remains, because others have suggested that there might have been biases in these studies. It has for example, been suggested that a non-smoker, when married to a smoker, it more likely to have been given the occasional cigarette during married life and that the explanation of the increased risk might lie in this. This possibility is difficult to reject.

Another approach comes from the laboratory; where work has been done to measure the products of smoking in the urine of non-smokers. These studies show only a few things with any certainty. Products of smoking are to be found in the urine of non-smokers who are married to smokers. Whether there is enough of them to be responsible for an increased risk of lung cancer is not proven.

This controversy is likely to continue and complete resolution is unlikely. We would agree with Sir Richard Doll’s view that ‘the one conclusion that can be drawn with certainty is that reached by the International Agency for Research on Cancer (in 1986): namely, that the presence of several known laboratory carcinogens in environmental smoke, combined with the knowledge that tobacco actively smoked causes lung cancer in humans must lead to the presumption that environmental smoke causes some risk of the disease.

It is worth setting this risk in perspective. A non-smoking woman has about one chance in 10,000 of getting lung cancer in any year. If she is married to a smoker her chance increases to about one and a half in 10,000 in each year. It might be argued that the consequences for her of her husband’s possible lung cancer, which might be as high as 20 in 10,000 in every year, is even worse than the risk to herself. She should try to stop him smoking, but rather more for his sake than for hers.

Risks to children in households where parents smoke are real. The Royal College of Physicians in its recent book Smoking and the Young reported that children who have smoking parents receive the same amount of nicotine as if they smoked 60-150 cigarettes each year. This is damaging: the children of parents who smoke arc shorter, have twice as much asthma, twice as many chest infections, have more time off school, get more chronic bronchitis and are more likely to die than the children of non-smokers.

There are many reasons, apart from the cancer risk, for not smoking in the home.

*41\194\4*

The whole body in both sexes, especially in women, is sensitive and sensuous to touch. But certain touch spots stimulate greater desire than others and are termed EROGENIC or EROGENOUS ZONES. They are located mainly around the body openings—the lips, the mouth, the outer side of the eye sockets, the ears, the vulva in the female, the penis in the male and the area around the anus, are all highly sensitive as they are richly supplied with nerves.

‘EACH Kiss A HEART QUAKE’: Kissing with lip-to-lip contact brings into play the senses of touch, smell and taste. Erotic kissing is basically a Western form of love-play. Orientals have the nasal kiss. There are different types of kisses—the kiss of love, kiss of affection, and parting kiss between friends. The first is mouth to mouth while the other two are usually on the cheek or forehead. Kissing is not a common form of foreplay in our culture. Shashi, hero of many conquests, once told me, ‘It is much easier to get at the breasts than at the lips in our culture. If I tried anything like that in the West, I would instantly be slapped!’

*109\262\8*

Another way of looking at it is that lack of exercise, or a sedentary life-style, is a risk factor for coronary artery disease, just like smoking, a poor lipid profile, high blood pressure, a family history of coronary artery disease, and diabetes.

Most of the population of the United States is sedentary. Sedentary people have nearly twice the risk of having a fatal heart attack as active people of the same age when other factors— such as smoking and high cholesterol—are equal. The umber of persons with coronary disease would decline dramatically if sedentary people would become moderately active.

Without physical activity, you will experience a gradual decline in your ability to perform activities that require physical effort. You will lose strength, endurance, and flexibility, and day-today activities will become harder. However, if you remain active, you can maintain or improve your fitness level. A personal exercise program is the best way to make sure that you include adequate physical activity in your daily life.

*271\252\8*

Mr. K. S. was ailing from a long time past. The trouble started from ordinary cold which was suppressed by strong allopathic antibiotics resulting in stomach upset. Took some medicine from a chemist shop. Therefore started one implication after another. He was a Cerato type person, never believing his own judgement and changing many doctors and mode of treatment on the advice of others.

Finally an ulcer in the stomach put a stop to his normal eating. He became weak and dis-spirited, and lost all hope of ever regaining his health.

“Doctor Sahib, for the past 15 years, I have been under the treatment of many doctors and specialists, and got no relief. Frankly speaking, I do not entertain any hope of being relieved now. In fact I was reluctant to try any new treatment, but my young daughter-in-law literally forced me to come to you”.

GORSE for his hopelessness, and Cerato for his distrust in his own judgement was given T.D.S for 1 month. A steady improvement in his health started after 1 week of the treatment. After one month there was no trouble, his appetite became normal, and he felt alright. He had shed off his hopelessness fully. Thereafter Cerato alone was continued for another 2 months to change his negative Cerato temperament.

*110\308\8*

In pregnancy, if you’re not taking in enough calcium, some will be withdrawn from your bones to nourish the growing baby. Bearing a large number of children multiplies your risk, as does carrying a single multiple pregnancy (eating for three—or more—is even more difficult than eating for two). Pregnancy later in life may pose more of a problem, since you’ll have less time (and lower ability) to make up for any loss. The key to protecting yourself will be to take supplements, particularly calcium and vitamin D, in addition to a prenatal vitamin, during pregnancy, and eat a variety of foods rich in those nutrients to guarantee adequate intake for both (or all) of you.

Never having borne a child also increases your risk of low bone density, though the reasons are not well understood.

BREAST-FEEDING

The benefits of nursing your baby are well documented, but you will need to take precautions to make sure it doesn’t leave you with softer bones. In order to make sure your breast milk has sufficient calcium for your child, nature has arranged it so that calcium from your bones will be added to it if enough isn’t otherwise available. Some studies show that mothers breastfeeding their infants may drop up to 5 percent of their bone mass (although there is disagreement on this point). Bone density seems to be regained quickly once the children are weaned, but the moral of the story is that taking calcium and vitamin D supplements (in addition to continuing the “prenatal” vitamin your doctor prescribed) to ensure you get as much calcium as your body needs is a wise move, in addition to including in your diet many foods rich in these nutrients. Mothers young enough to still be building up to their peak bone mass should be extra careful, as should mothers old enough to be closing in on menopause (which is no longer particularly uncommon).

*33\228\2*

a) Patient with diabetic peripheral Neuropathy – proper foot wear is essential.

b) Polyester or Blend, Cotton polyester socks to prevent blister.

c) Hydration : Proper hydration is essential as dehydration affects blood glucose levels and heart function adversely.

TIME OF EXERCISE

a) Ideal time is morning, if not possible then evening or both.

b) Empty stomach or small snacks before exercise to prevent hypoglycaemia.

c) Exercise after meals to be avoided.

CHOICE OF EXERCISE

Choose an exercise that one enjoys and that suits the need of an individual patient. For old aged diabetics brisk walking is safe & easy to perform. For youngster according to their choice jogging, cycling or outdoor games are much preferred. Take precautions to prevent hypoglycaemia.

TYPES OF EXERCISE

i) Aerobic exercise: It is beneficial for diabetes patients. In this energy utilization is gradual. Blood circulation in various organs including lungs, heart improves. Consult your doctor for type of suitable exercises eg. walking, brisk walking, cycling, swimming, running, outdoor games etc.

ii) Anaerobic exercise : In anaerobic exercise, muscles are not dependent on 02 for energy eg. Weight lifting, hand grip exercise etc.

*38\329\8*

Psychological stress or tension is now recognized as the most important risk factor of coronary heart disease. With more and more scientific research results pouring in over the last 2 decades we have come to know that excessive stress can lead to the following:

1.   Increase in blood pressure.

2. Increase in the heart rate.

3. Increased concentration of fat in blood.

4. Increased blood sugar.

5. Increased cholesterol in blood.

6. Spasm of coronary and other arteries.

7. Increased blood clotting.

8. Increased deposition of fat and cholesterol in the arteries.

This means that stress is such an influential risk factor that even in the absence of other risk factors it can by itself become responsible for coronary heart disease. I have seen many people without high cholesterol, overweight and family history, having normal blood pressure developing angina only because of excessive stress.

The problem with stress is that there are no means of measuring it even with the latest scientific gadgets. There is no unit, such as ml, mm, kg, etc., to define it. Because of this reason modern science and cardiologists have specifically abstained from talking about stress in heart disease. It is now known that city dwellers have 3 times more chances of getting heart disease than those in small villages, the major reason being excessive stress in city life.

Research has also revealed that a particular type of people (Type-A behaviour) who are aggressive, always short of time, short-tempered and stressful are much more prone to develop heart disease. Most young heart patients of modern day have Type-A behaviour.

It is obvious that without controlling stress we cannot stop the advancement of heart disease. Sudden stress or anger leads to the spasm of coronary arteries which precipitates sudden angina and heart attacks. This is the reason why many people develop heart attack when they are excessively strained or hear bad news.

*11/283/5*

Sometimes life changes that precede an illness are what might normally be identified as positive changes. Bob Gilley, thirty-nine years old when he received his cancer diagnosis, is a good example of how individual the nature of a person’s response to stress is. When Stephanie first began working with Bob to explore his own emotional participation in his illness, she concluded at the end of his first interview that perhaps our theories did not pertain to him.

On first examination, Bob’s life seemed to be a model of the dynamic and successful young executive. He owned his own corporation and attained national recognition within his profession, receiving an award for maintaining the highest standards of production in his industry for over ten years. Even though in the past Bob had experienced many business difficulties with previous partners, he had formed a new partnership a few years before which seemed ideal.

Bob reported that early in their marriage he and his wife had had considerable difficulties, particularly when he was struggling to become a success. As his career became more and more successful, however, his marriage, on the surface, seemed to improve. Additionally, Bob and his wife had made the decision to adopt children some years before. Just prior to his diagnosis, they had completed the adoption of their second child. For all outward appearances, Bob seemed to have reached the top of the ladder and should have been enjoying the rewards of his years of struggle.

One of the first clues indicating that all was not as it seemed with Bob was a remark he made in his initial interview. He said that one of the few things he could remember in the year prior to his illness was a generalized feeling that was best characterized by the Peggy Lee song, “Is That All There Is?” To a man who had learned that the proof of his attainment and manhood rested in conquering difficulties, the attainment by age thirty-nine of most of his life’s goals and ambitions left him adrift. For someone who had not learned to enjoy the peaceful times in life, the absence of turmoil and struggle was experienced as a loss.

Within a year, Bob was diagnosed as having an advanced cancer and was once again faced with a challenge and a battle to be won. In the months and years after Bob’s diagnosis, much of his own emotional work and exploration has been in learning to enjoy the rewards of his struggles and to accept himself for who he is, rather than constantly needing to prove his worth by overcoming an obstacle or meeting a challenge head-on.

*32\347\2*

One of the most frequent cause of hypersomnia is narcolepsy. Victims of this strange disorder do not necessarily feel tired during the day; however, they are frequently overwhelmed by sudden, uncontrollable attacks of sleepiness. One of the most prominent—and troubling—features of narcolepsy is cataplexy, or muscle paralysis, a symptom that distinguishes this condition from other forms of hypersomnia. Narcolepsy accounts for roughly one-fourth of all DOES diagnoses. In fact, seven out of ten patients who are seen by sleep laboratories are diagnosed as having either sleep apnea or narcolepsy.

Less frequently, DOES may be the result of nocturnal myoclonus if the leg jerks are powerful enough to cause partial arousal during sleep. Like apneics, victims of myoclonus may be unaware their sleep has been disrupted, noticing only that they are still tired the following the day. Other sources of daytime sleepiness include psychiatric disorders such as depression, use and abuse of drugs or alcohol, and a whole range of metabolic, endocrine, and central nervous system disorders. When we are unable to identify a specific cause for hypersomnia, we classify it as “idiopathic,” which means “caused by itself” or “of unknown origin.” Nearly one out of ten cases of DOES fits this vague but convenient category. I will also devote part of this chapter to a discussion of another variety of sleep problem, disorders of the sleep-wake schedule (DSWS) which, though of a different nature from DOES, can also produce the symptom of daytime sleepiness.

As we will see, diagnosis of DOES can be tricky. Daytime tiredness can mask a number of other problems, including drug use, poor nutrition, emotion frustration, dissatisfaction, or poor motivation. Many forms of psychological disruption can sap our energy, disturb our rest, and exhaust us even more than strenuous physical activity. Lifestyle can contribute as well: if you lead a sedentary life, for example, you omit the exercise that gives the body the chance to purge itself of waste products and restore energy to the muscles.

*131\226\8*

The diagnosis of neurosyphilis often poses a challenge, since there is no one test that is both sensitive and specific. The diagnosis is usually made based on a combination of reactive serologies, abnormalities of

CSF cell count and protein, or a reactive VDRL-CSF. The VDRL-CSF is the standard serologic test for CSF and is diagnostic of neurosyphilis when reactive (except in cases of gross contamination of CSF with blood). However, it is an insensitive test, so a negative result does not rule out the diagnosis. An FTA-ABS test on CSF appears to be more sensitive than the VDRL but may lead to more false-positive results and currently still has investigational status. The high sensitivity of the FTA-ABS CSF test may make it most useful in ruling out the diagnosis of neurosyphilis.

Typical abnormalities in the CSF profile in the setting of neurosyphilis include a mild mononuclear pleocytosis or an elevated protein level, or both, and these findings should be considered indicative of neurosyphilis in a patient with reactive serologic tests with or without clinical evidence of neurosyphilis.

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