RECOMMENDATIONS FOR TREATING BDD WITH AN SRI: SRIS USUALLY BEGIN TO WORK GRADUALLY AND YOU NEED TO TAKE THE MEDICINE EVERY DAY AS PRESCRIBEDSRIs usually begin to work gradually: Occasionally, the medication begins to work in a dramatic fashion. Sometimes people can pinpoint the day, or even the hour, that it starts working. But typically it starts working gradually. People say things like “I felt a little better three days ago and today, but not for very long, so I don’t know if it’s really working.” Don’t get discouraged if this happens, because it’s expected. These ups and downs—what I call a “sawtooth pattern” of improvement—gradually give way to more sustained periods of feeling better. Good hours gradually turn into good days, and good days transform into good weeks. With time, you’ll notice more and more improvement in many, if not all, of your symptoms.You need to take the medicine every day as prescribed: It’s very important to take the medication every day, exactly as prescribed. It usually takes a while to work, so you need to take it every day even if it doesn’t seem to be helping. If you take less than prescribed, or you take it sporadically, it may not work as well or at all. If you have trouble remembering to take it, try a pill box, which you can buy at a pharmacy. This can help you stay on track. If you don’t want to take the medicine as prescribed because of side effects or because you have concerns about it, it’s better to discuss your concerns with your doctor than to stop the medicine or not take it as prescribed. The whole point of taking it is to feel better, and you’re more likely to feel better if you actually take it and don’t miss any doses.*259\204\8*

SOCIOCULTURAL THEORIES ABOUT BDD CAUSE – TRIGGERS: COMMENTS, STRESS, AND OTHER POSSIBLE PRECIPITANTS”I started worrying about my skin when one of my friends in high school called me ‘pizza face,’ ” Patrick told me. “I know he was only kidding, but it stuck in my mind. I started feeling very self-conscious about my skin.” Scott started parents split up unexpectedly,” he said. “It was especially rough on me, because my father blamed me for the breakup. I remember in the middle of their divorce, when he was really angry about something, he said to me ‘You’re no longer my son.’ I looked in the mirror and I thought I looked different. My whole face seemed to be sagging. I’ve never looked the same since.”In some cases it seems that a chance remark about appearance may acutely trigger the onset of BDD symptoms. Examples in published case reports include “You certainly resemble your father,” “You look very nice but you have got a small mouth,” or “Why is your face half red and half white?” G. G. Hay, who wrote about BDD in the 1970s, reported that such a remark was at least partly responsible for the onset of BDD symptoms in” 9 of his 17 patients. Several other published case descriptions note the sudden onset of symptoms soon after a distressing event, such as a spouse’s affair or abandonment by a boyfriend.Negative comments about appearance or stressful life events seem to sometimes play a role in BDD’s onset. Eight percent of the people in my studies reported that a negative comment about their appearance triggered the onset of symptoms. In most of these cases, symptoms began abruptly and acutely, soon after the comment or stress occurred, as opposed to more gradually. However, such events probably act as a trigger or contributing factor, but not the only cause of BDD. In other words, they seem to have the potential to precipitate the onset of BDD in someone who is biologically and psychologically vulnerable to developing the disorder. This is sometimes referred to as the vulnerability-stress hypothesis. A high school teacher’s comment reflected this view: “My concern about my nose was triggered by a comment about it, in a context of extreme sensitivity and low self-esteem.”One reason to think that comments or stress may act as a precipitant, as opposed to the major or only cause of BDD, is that negative comments about appearance and stress are very common. Virtually everyone has experienced significant stress. Most of us have heard something negative about how we look. But most of us don’t develop BDD. In addition, most people with BDD can’t identify a trigger of their symptoms, so a trigger doesn’t appear necessary for BDD to occur.*197\204\8*

STRATEGIES FOR LIVELIER LIVING WITH ARTHRITISThere are many forms and causes of arthritis, which is basically an inflammation of a joint or joints. It can strike persons of any age, be caused by injury as well as by a complication of another disease (e.g. rubella), exist as a symptom accompanying a systemic infection, and even occur as a side effect of certain medications – particularly contraceptives, anticonvulsants, and major tranquillizers.Arthritis can strike at any age . . . and even occur as a side effect of certain medications!Osteoarthritis and rheumatoid arthritis are only two of approximately one hundred conditions known as rheumatic diseases, which encompass tendinitis, hepatitis, gout, syphilis, diabetes mellitus, and more.But diet and exercise can help! Though conclusive evidence is not yet in, there have been enough established correlations between arthritis diseases and nutrition to convince me and thousands of former arthritis sufferers that knowing what and what not to eat (as well as how and when to exercise) can mean the difference between being housebound and fitness bound.*1/137/5*

EPISODES OFTEN MISTAKEN FOR SEIZURES: THE PHYSICIAN’S EVALUATIONThe child who clearly has had a seizure needs an appropriate evaluation. Tests that will help determine the cause of the seizure may be necessary (see Chapter 3). If the seizure has been provoked by an acute disturbance of the brain, such as infection or trauma, extensive evaluation may not be needed.The child who clearly has not had a seizure may not need those tests.When the physician is uncertain, multiple tests may still be unnecessary since no test will tell you definitely if the event was a seizure or not. Careful observation, watching, and waiting— “Tincture of Time”—is often the best approach.• Almost 10 percent of all individuals will have a single seizure at some time in their lives.• 50 to 75 percent of those who have one seizure will never have a second seizure.For such reasons, it is not necessary for you or your physician to be overly concerned about the future just because your child has had one episode, even if that episode was a seizure.*29\208\8*

YOUTH NUTRIENTS: ANTIOXIDANT DOSAGES: A COMPARISONANTIOXIDANT DOSAGES: A COMPARISON                                   RDA                                      Longevity DosesVitamin C                      60 mg                                     800 to 1,000 mgBeta-carotene            50IU                                       10,000 IUVitamin E                   10 mg                                     400 to 800 IUCalcium                     800 mg                                   1,000 to 1,500 mgIf you get the longevity amount of antioxidants from food you can’t really go wrong. However, it is very difficult to get enough vitamin E from food alone without adding massive amounts of calories to your diet. So this is one antioxidant that you may have to take in supplement form. In fact, recent Harvard studies have found that vitamin E supplements can decrease heart disease by as much as 37 per cent.THE REST OF THE STORYAntioxidants are true biological miracles. All we have to do is reach and have that apple, drink that glass of fresh orange juice, have that salad, and in so doing, turn back the clock and reset the scale for a life that takes us to the max. Simple, isn’t it? Wait, it gets better. Read on.American scientists estimate that just three antioxidants—vitamins C, E and beta-carotene—if used optimally could reduce breast cancer by 16 per cent, lung cancer by 21 per cent, stomach cancer by 30 per cent, heart disease by 25 per cent and cataracts by 50 per cent. Monetary savings of the cost of hospital care would be $1 billion for breast cancer, $3 billion for lung cancer, $30 billion for heart disease, 1\2 billion for stomach cancer and $100 million for cataracts.*65\323\8*

DEALING WITH UNPREDICTABLE PERIODS: COULD A FIBROID TUMOR GIVE ME HEAVY PERIODS?My doctor says that my fibroid tumor is making me bleed heavily and giving me pain each month. He wants me to submit to surgery, but I don’t like hospitals. Could you please tell me if there are any other alternatives?—L.B.Dugway, UtahFibroid tumors can grow in the middle of the uterine wall (intramural), outside the uterus (subserous), or in a position in the uterine wall just below the surface of the endometrium, the uterine lining (submucous). This last type of fibroid, which is called a submucous fibroid, comprises only 5 percent of the tumors, but more than the others, the submucous is the one that brings on the serious problems. If it enlarges, it can break through the uterine lining and cause very heavy periods. AD&C does not change the situation because it will not remove the fibroid tumor, which continues to be an irritant inside the uterus. The uterus cannot contract as it should to stop the bleeding because the tumor gets in the way.Some very recent preliminary studies have indicated that women with heavy bleeding could possibly cut down their blood loss by taking a prostaglandin-blocking drug such as Motrin or Anaprox. Either of these medications will lower prostaglandin levels and, in turn, will ease uterine contractions and lessen the bleeding. Progesterone tablets prescribed alone or in combination with an antiprostaglandin drug might also help relax the uterus.If Ms. B. were prescribed the antiprostaglandin/progesterone combination she might reduce her bleeding and discomfort and avoid surgery. However, if the medications do not bring relief to her, she may require a myomectomy, an operation to remove fibroid tumors only. Once her tumor is removed, the bleeding should diminish. There is no reason to assume from her letter that she needs a hysterectomy. In fact, I would venture to say that a hysterectomy should not be performed except as a last resort.*49\333\2*

HEART ATTACK: SYMPTOMS CONFUSED WITH HEART PAINOne of the problems that may cause symptoms confused with heart pain is gallbladder disease. The gallbladder is an organ in the abdomen that lies below the liver in the right upper part of the abdomen. The gallbladder is prone to form stones and to become infected, conditions that can cause pain. Pain from diseases of the gallbladder may occur more often after meals, which gives some clue to its origin. More important in this respect is that it usually causes pain in the right upper abdomen. In fact, the upper abdomen is often tender. Vomiting is a frequent, associated symptom. Pains originating in the heart usually do not cause abdominal pain or tenderness.Ulcers in the stomach and duodenum or gastritis (an inflammation of the stomach) might produce symptoms that some people would term indigestion. Actually, these conditions usually cause a burning pain in the uppermost part of the abdomen. The pain is usually relieved by eating, drinking milk, or taking some form of antacid. Another frequent finding in ulcer patients is that they may awaken in the middle of the night with this pain and are then able to relieve it with milk or an antacid.An episode of food poisoning might cause indigestion for some people. The prominent symptom here, again, is abdominal discomfort, pain, or cramps that are usually associated with or followed by vomiting or diarrhea.These are not the symptoms that people have when they call their heart pain indigestion. Cardiac pain is usually felt in the chest and may also be felt in the shoulders, arms, neck, or jaws. Although a person with a heart attack may feel slightly nauseated and may on rare occasions vomit, these symptoms are minimal. The pain of a heart attack is located in the chest or uppermost part of the abdomen, and may gradually increase, but when it reaches its peak, it persists relentlessly. Abdominal pain from many causes is usually cyclic. The pain comes and goes; it builds up to a crescendo and then eases away.*2/309/5*

COMBATTING ASTHMA IN CHILDREN: ANTI-INFLAMMATORY DRUGS – STEROIDS: THE CORTISONE DRUGSGlucocorticosteroids is one of the three distinct classes of steroids produced by the adrenal gland. It is related to Cortisol, the hormone that is produced by the cortex or the outer part of the adrenal gland. This steroid controls the levels of sugar, fat, and protein, in the body. Cortisone also controls inflammation in the body, and is a group of steroid drugs used to treat asthma. It has no anabolic effect i.e. it does not increase hair growth or muscle mass, and has little effect on the body’s salt balance. A number of closely-related synthetic compounds are available and used. These include hydrocortisone, prednisone, prednisolone, betamethasone, triamcinolone and dexamethasone and are known by a variety of brand names. These steroids are strong anti-asthma drugs. They affect macrophages, T-lymphocytes and eosinophils and reduce allergic inflammation and airway hyperresponsiveness.Cortisone drugs work by reducing the secretions in the lungs, and by reversing swelling and inflammation in the bronchial tubes.Steroids are available as tablets, injectables and inhalers. However, it is inhaled steroids that have become quite important in the treatment of asthma.*57\260\8*

DIETS AND ASTHMA: VITAMIN B12 (CYANOCOBALAMIN)This nutrient is in a class of its own, because it has been given in massive doses by injection for many decades now. Especially in Europe, doctors often give B12 shots when someone is tired or depressed. In more recent years it has been used to treat blood disorders such as histapenia and endogenous depression. Low B12 levels predispose humans to the development of psychiatric problems during periods of depression and low levels of this vitamin have been noted in patients with psychotic depression.I have lost count of how many B12 shots we have arranged for our patients, but they must number in the thousands by now, and I can report that they are very effective in the majority of cases. More recently B12 injections have been used in the treatment of asthma, together with magnesium sulphate shots. This seems to be even more effective, especially in children. The great news is that special B12 shots for asthmatics are now available (through Biological Therapies in Melbourne) in 2-millilitre bottles of 20 milligrams each. The possibility of allergic reaction to this form of injectable B12 is much, much lower than to the B12 shots once used. Dr Jonathan Wright, an American physician who is considered one of the world’s foremost experts on B12 and asthma, has been using B12 shots for many years, especially in the treatment of children. He claims it is one of the safest vitamin injections available. The reason why it is more effective when given as an injection is that B12 absorption is dependent on a good supply of acid factors in the digestive tract. These are often low in asthmatics and so they tend to absorb less B12 from their diets. For this reason, Dr Wright also recommends digestive enzymes and hydrochloric acid supplements in many of his asthmatic patients. There are three forms of injectable B12: cyanocobalamin, methylcobalamin and the water-soluble form, hydroxicobalamin. Orthomolecular psychiatrists preferred hydroxicobalamin for many years because of its superior absorbability, but unfortunately this also renders it more likely to cause an allergic reaction. Such reactions are very rare, however. Allergy to cyanocobalamin is also very rare but the possibility always exists, as it does with almost any injection.Generally speaking, methylcobalamin seems more effective in cases of multiple sclerosis and other auto-immune disorders, while cyanocobalamin is better for asthmatics and people suffering from anxiety and depression. Methylcobalamin is inadvisable in many types of mental illness. Oral B12 reduces the risk of an allergic reaction to sulphites, especially metabisulphite.*47\145\2*