An elevated blood pressure level is a hidden signal that can be detected only by actually measuring the blood pressure, preferably by a medical professional who has expertise and experience. In spite of all the high-tech equipment used today, I recommend that it be taken the old-fashioned way with a stethoscope and mercury sphygmomanometer, which employs a cuff and pressure gauge that uses mercury to measure the pressure. Though it’s important to get a blood pressure reading that is as accurate as possible, there are many factors that can give an inaccurate reading, among them a cuff that is applied incorrectly—for instance, over clothes—or one that is too small, which is common in a person who has large arms. The cuff should be the correct size and fit snugly. I’ve also seen cases when the person who is taking the reading doesn’t really know how to interpret the sounds she is hearing through the stethoscope. When in doubt, ask a trained medical professional to take the reading.

The blood pressure reading should be taken while you are sitting or standing and on several different occasions, to correct for inaccuracies as well as for any nervousness on your part. For instance, if you have the well-known “white coat syndrome,” you may suddenly become very nervous in the presence of a doctor or nurse, even if you’ve known the person for years. This anxiety will naturally send your blood pressure level skyrocketing. If you have one elevated reading, don’t be alarmed. This could be due not only to the stress of the office visit but also to other stresses in your life. Likewise, that high-fat fast-food lunch you ate an hour before your appointment can also cause a higher-than-normal blood pressure reading. If you have a high reading during the first few visits, your doctor may decide to take separate readings on both arms.

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Description and Possible Medical Problems

If you feel mote tired and look paler than you usually do, there are a number of causes your doctor will look for, but it’s likely that the first one he will check will prove to be the cause. Fortunately, it is also the easiest to treat.

Anemia is a medical condition in which the red blood cells contain less hemoglobin than is normal for a healthy, well-functioning circulatory system. Hemoglobin is composed mostly of iron, which is why all the commercials for dietary iron supplements stress that without their products you’ll be more prone to developing anemia.

On the surface this is true, but in actuality it’s not that simple. While anemia is frequently caused by a lack of iron in the diet, it can also be due to a defect within the digestive system. Anemia can also be the result of a deficiency of another nutrient, including vitamin or folic acid.

Because the symptoms of the different causes of anemia are similar, your doctor may want to conduct further blood tests to determine the kind of anemia you have in addition to testing for other possible reasons for your fatigue and pallor.

The first test your doctor will conduct is called a complete blood cell count. This will provide the doctor with a clear picture of the composition of your blood by counting the number of each type of blood cell— red, white, and platelets—and comparing it to that of nonanemic blood. Red blood cells should make up 40% to 45% of the blood’s composition in women and 45% to 50% in men. If the numbers from your blood test fall below these figures, you probably have anemia.

In addition to a reduced blood cell count, the test will also reveal an elevated blood cell count, typically when the body is producing a surplus of white blood cells, the condition known as leukemia. Interestingly, the symptoms for anemia and leukemia are similar.

Treatment

Whether the results of an abnormal complete blood cell count show reduced or elevated blood counts, your doctor is the best person to recommend the proper course of treatment. If you have anemia, your doctor will suggest you take iron supplements as well as increase the amount of iron-rich foods in your diet. Though leukemia is the mote serious disease, it can be treated successfully with customized chemotherapy regimens, especially if it’s caught early.

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Al and Betty have now (as of this writing) been sober for sixteen years, and both have been pursuing careers in publishing. Because of their abusive family backgrounds, they chose not to have children. “I was afraid that if I had a kid, I’d abuse it,” Betty says. Al adds, “You never know what kinds of feelings will be drawn out of you by children. Unless you’re really ready for it, you shouldn’t do it.” For the most part, their intimacy with one another has sustained them—particularly the sexual bond. There were times when she would get into what she called her “paranoid mood,” begin to see him as a “man on the take,” and withdraw from him, snap at him, and question everything he did and said. But he was secure enough not to fight back, and the moods passed. During other times, he would get into his attitude that “Women are all teases,” and withdraw from her or get angry at her and accuse her of deliberately frustrating him. Fortunately, because both had worked through their transference feelings in therapy, they had strong enough observing egos to understand what was going on and not act out on that too severely. Always, in the end, their sexual bond brought them back in touch with their core feelings, away from their defensive postures.

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“Dear Lady, I have been watching you from afar for a long time now. I feel strangely attracted to you, but I’m sad because I feel that your own deepest passion is dormant. I wish I could draw out this passion so that you could be your true, best self. I know that sounds corny, but I really mean it. I don’t know the way yet, but maybe I’ll find the way. I know that you’re married, and I will respect that. Anyway, I’m too shy to reveal myself to you. But know you are loved and admired.—Your Mystery Lover.”

This letter should be followed, a week or so later, by a gift—perhaps a dozen roses delivered by hand, with a note:

“Always thinking about you.—Your Mystery Lover.”

When the husband sees the flowers, he might ask, “Who are these flowers from?”—to throw her off. Then, a week later, there might be a short poem. It should be simple and not overly sentimental:

“I think of you and wish/That you and I—/I think of you and wonder/What would be if we—/I think of your beautiful, intelligent eyes/And how it would be/if they looked at me/with love/Or surprise./I think of you. . . .”

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Players: Husband and wife. Activist: Husband. Setting: Home.

Aim: In an exaggerated fashion, to mirror the wife’s need for politically correct sex so as to point up its absurdity.

Game Plan: One evening or weekend the husband approaches the wife and asks how she would feel about having sex. If she says she would like to, he continues to question her.

“Are you sure you want to have sex?” “Yes, I’m sure. Why do you ask?”

“Because Robin Morgan, the editor of Ms., says that even when a woman consents to having sex with a man, it’s still rape—since all men are in a position of dominance in our society, and hence even when a woman agrees to sex it constitutes giving in to the specter of male dominance and is a kind of psychological rape.”

“Yes, I can see the point of that statement.”

“So, how do I know you really want to have sex? How do I know you aren’t simply giving in to my male dominance now? How do I know it won’t be a form of rape?”

“You don’t know.”

“Then maybe we shouldn’t have sex.” “Maybe not. Unless I ask you.”

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In this game the husband and wife undress, go to bed, and begin making love. When they are lying in one another’s arms, either before or during intercourse, they should take turns telling each other all the ways in which they hate one other. Each should begin with the phrase, “How do I hate thee? Let me count the ways.” For example, the wife might say, “I hate you because you never pay attention to me. I hate you because you talk to your mother more than you talk to me. I hate you because you are a selfish bastard.” And the husband might say, “I hate you because you’re a castrating bitch. I hate you because you pay more attention to our son than you do to me. I hate you because you always get headaches every time I want to have sex with you.”

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Players: Playboy (husband), playgirl (wife), and authority (perhaps).

Activists: Both spouses. Setting: Hotel.

Aim: Play out a primary fantasy of impulsive couples, but with a twist: Instead of writhing and running, writhe and review.

Game Plan: This game can be played with or without an actual authority figure—a therapist or a nonprofessional friend. (This book may serve as the authority if no other is available.) The authority instructs the couple to go to a hotel or motel and play out their impulse to have a one-night stand—with each other. However, this time they are to end the sham affair different than usual. Usually, the morning after such an event is awkward as each partner finds the quickest way to the exit. This happens because in a one-night stand a couple quickly achieves a false intimacy based on their impetuous sexuality— but they have not really communicated and bonded so that they can sustain a relationship, and they are reluctant to do so. Hence, the next morning they find themselves having been sexually intimate but thinking all kinds of thoughts about one another that they do not want to talk about. Indeed, they fear that talking about these things would be harmful. (In reality, in many cases talking about these things would lead to a deeper, more realistic relationship.)

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“Hypoglycemia” means that the concentration of sugar in the blood has fallen to less than 45 mg per 100 cc. Blood sugar levels this low adversely affect the brain, causing jitteriness, weakness, lightheadedness, bizarre behavior, episodes of memory loss, and if the hypoglycemia is sufficiently severe and long-lasting, convulsions, brain damage, coma, and even death.

Since we are all occasionally tired and forgetful, hypoglycemia tends to be diagnosed too often in people who do not really have low blood sugar concentrations, the Mayo Clinic Proceedings (60:844) reports. This is potentially very dangerous because overdiagnosing hypoglycemia may result in some other more serious condition being overlooked. Thus, in order to be certain of the diagnosis, the doctor must obtain a sample of blood from the patient and demonstrate that the blood sugar is low at a time when there are appropriate symptoms. He must also be able to abolish the symptoms by giving the patient sugar.

Hypoglycemia has many possible causes. “Mild” cases, which can be quickly corrected with a sugary drink, occur an hour or so after alcoholic drinks or certain medications (especially sulfa-containing ones), or in some people, even after food. “Severe” cases, which are not so easy to correct, may be due to tumors of the liver or pancreas, diabetes, or other serious illness. It is therefore important for the doctor to find out the exact cause in every case. Only in this way can he make sure that a serious disease (e.g., cancer) that needs treatment without delay is not being overlooked.

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Because the delicate skin of the eyelids is only about one quarter as thick as the skin elsewhere, it is unusually sensitive to irritants. Accordingly, it is not uncommon for the eyelids to become itchy, red, and swollen in response to an ingredient of a cosmetic that has been applied to some other part of the body. This can occur even when the primary site to which the offending substance has been applied remains entirely normal.

Thus, eyelid dermatitis is not uncommon in response to nail polish or nail varnish, face creams, makeup, hair dye, hair spray, etc. The reaction can be either an allergic one or an irritant response to traces of a substance carried to the eyelids by the fingers, the journal Cutis (34#216) reports. Without realizing it, most of us touch our eyelids many times a day, even if they are not causing the slightest discomfort. Determining the cause can be difficult since the skin on the part of the body used for testing may not be sufficiently sensitive. To enhance its sensitivity, “closed” testing is employed in which the potential allergen or irritant is applied to the skin under a plastic cover. This seems to be an effective way to determine what is causing the eyelid dermatitis.

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Ready-to-eat breakfast cereals are tasty and convenient, but a lot of them are far from “healthy,” according to Consumer Reports (CR) (51#10:628). Although their basic ingredients, such as corn, wheat, oats, raisins, and nuts are nutritious, many breakfast cereals contain excessive and potentially harmful amounts of saturated fat (i.e., in the form of coconut oil) and salt, which the manufacturers have added to make them more tasty and appealing.

Now, CR reports that the popular Quaker 100% Natural Cereal, because of its coconut content, provides an astonishing amount of saturated fat (the sort than can be responsible for high blood cholesterol levels, heart attacks, and strokes). The CR article also points out that most fiber and bran-containing ready-to-eat cereals provide salt or sugar (or both) in large amounts.

Fiber and bran products have become very popular since they have been shown to help fight constipation and cholesterol and to reduce the chance of our getting colon cancer. It is a pity, therefore, that these products should contain added salt, sugar, or fat in such large amounts.

With very little effort, however, we can prepare a high fiber cereal for ourselves that contains the most desirable water-soluble kind fiber, but no additives. Just boil water and stir in some powdered oat bran. This hot cereal will be free of sugar, salt, and fat, unless you add them to it yourself.

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