Calcium is the mainstay of treatment but, used alone, it only slows the rate of bone resorption.

One way of improving its effect is to combine calcium with fluoride in large doses and this treatment seems to lead to active bone replacement.

The calcium and fluoride can be given by mouth and injections are not necessary.

One way of determining the extent of the thinning and also of measuring the response to treatment, is to X-ray the head of the femur and to note the crossing lines of bone known as trabeculae. These decrease in number as the bone thins.

The degree of osteoporosis can be measured by taking X-rays of the bones.

Osteomalacia is a similar disorder of bone, where the protein matrix is laid down as normal but there is a reduction in the deposition of calcium salts.

This leads to softening of the bone, so that it may bend and show deformities.

Osteomalacia is the adult form of rickets.

*523/71/1*

Colds and, indeed, most respiratory infections are highly contagious, spreading easily from person to person.

The incubation period is short, from one to three days. The symptoms are so well known as hardly to need describing, but for those few readers who are fortunate enough to escape colds I will outline the most important ones:

A slight fever, mild headache and aches and pains are associated with a blocked or runny nose.

The throat becomes thick or ‘scratchy’.

Initially the discharge from the nose is clear, but then becomes thickened with pus due to a secondary bacterial infection.

The infection may spread to the sinuses or to the middle-ear.

It may spread down to the lower respiratory tract and involve the trachea or windpipe and the bronchial tubes.

Despite the marvels of modern medicine, the only effective treatment for a cold is the same advice your grandmother may offer.

Go to bed for a day or two, keep warm, have a hot lemon drink and a couple of aspirin or paracetamol. Whisky or rum is an optional extra, and although I don’t believe in alcohol’s medicinal benefit, it might make you feel better in your misery.

A cough suppressant is helpful at night if coughing keeps you or others awake.

*267/71/1*

These are frightening to parents when they first experience it.

They may happen at any time from about six months to four years. They tend to develop as a result of frustration or anger in the child or they may follow a period of denial by the parent, or a fall or when the child can’t get his own way with other children.

In an attack the child breathes right out. Then comes a period when he doesn’t breathe at all. During this period his face may become congested and take on the bluish red tinge of cyanosis. Twitching of the muscles may occur and then he usually loses consciousness. There could be loss of control of the bladder at this time.

After loss of consciousness, the child starts to breathe again and quickly returns to normal. At that stage the parents are left in great panic.

Treatment consists mainly in counselling the parents, who must understand that this is an attention seeking device and that the way to overcome it is to ignore the child.

It is, of course, not easy to tell parents to walk away from the child when he is going blue in the face and losing consciousness.

Children usually grow out of this habit, but by this time a poor parent-child relationship may have developed with the child able to manipulate his parents.

The parents need counselling so that they can fulfil properly the emotional needs of the child and help him overcome his anxiety.

*15/71/1*

Say you are considering having a ‘breast’ reconstructed after a mastectomy (removal of the breast). Ask to be referred to a plastic surgeon who has done a lot of these operations. Only someone with plenty of experience is in a position to explain beforehand exactly what result you can expect, and then to actually produce the promised result.

All of these are just examples. If you are in doubt about the experience of your doctor, ask directly how often he or she has done the procedure in question. Ask whether there are doctors who specialise in the procedure and, if there are, ask to be referred to them.

A word of warning: specialists have advantages when it comes to knowledge, experience and technical skill. However, they also tend to have a major disadvantage — they are less likely to see you as a whole person. Specialists do not take a broad view, on the contrary, they tend to take a very narrow view. Specialists tend to see their patients as caricatures, with the particular aspect they are interested in blown up out of all proportion to everything else. They may even act as though other aspects of their patients don’t exist.

Try to think of your specialists as resource people who have a lot of very specialised knowledge, some of which they can share with you. They also have special expertise which you can take advantage of, if you choose. However, even if, for example, someone knows everything there is to know about chemotherapy and is very experienced at giving it, this still does not make them the best person to decide whether you should have chemotherapy. The best person to decide is someone who knows a bit about your cancer and what you can expect from chemotherapy, and a lot about you—your values, priorities, expectations, strengths and weaknesses. That person is you.

*24/40/1*

The answer to these questions is, ‘It depends on your symptoms’. If you are not bothered by menopausal symptoms, nor at risk of developing osteoporosis or arterial disease, then don’t feel pressured by your friends, family or the media to take it. You do not need it, and to take it would be an unnecessary medical intervention. Despite what the papers say, it will not keep you ‘young and sexy forever’, and if this is why you want to take it perhaps you should look carefully at yourself, your relationships and your underlying fears.

If, however, you are being bothered by hot flushes, night sweats, and the various early signs of the menopause, then you might want to start HRT as soon as these signs start having a negative effect on your life. This may well be while you are still having periods, but you can still start HRT, although it may be difficult to get the level of treatment exactly right.

Although you may accept all this, some women find the higher rate of side-effects and the irregular bleeds put them off HRT completely and they are then reluctant to consider it again in a few years’ time when different symptoms occur.

If you have been put off HRT for this reason, you may find that, in the meantime, new forms of HRT have become available that would reduce the problem. Again, talk to your doctor about this.

*33\42\4*

Any woman on the Pill should come off it a month before surgery, substituting a non-hormonal method of contraception, such as a condom or diaphragm in the meantime. Women who smoke should stop at least a week before a hysterectomy. They should also consider a permanent break from smoking as their risk of heart disease and osteoporosis is likely to increase as a result of the surgery, and smoking will increase this risk still further.

A GnRH agonist may be prescribed prior to surgery in a bid to reduce the size of any fibroids a woman may have. When this approach was systematically studied in 142 women, only half of whom received a GnRH agonist, the results were encouraging. The surgery was less likely to be difficult in the treated women who also experienced significantly less blood loss on average. It has been suggested that the beneficial effect of GnRH agonists is due partly to their ability to shrink fibroids and partly to their reduction of uterine blood flow.

*48\198\4*

Have you noticed that, even without looking at a watch, we usually wake up at about the same time every morning and feel sleepy and go to bed nearly the same time each night? We do not need to know the time to do all these things. Somehow our body knows the time, as if we have a clock inside. This internal clock is called the biological clock.

Jet lag is a similar example. The traveller who flies from one side of a continent to another is unable to reset his biological clock immediately. The clock is still running at the same time back home; hence there is a feeling of disharmony. Sleeping and eating at a new time disrupt the jet traveller’s old pattern. It may take a few days to get used to the new time. There is one way to reduce the effect of jet lag and that is to reset your biological clock closer to the local time of your destination a few days before travelling. For people travelling westward, you should stay up later and later each night for a few nights before departure. For people travelling eastward, you should go to bed earlier and earlier each night instead. By doing so you may reduce the gap between your biological clock and the new local time of your destination.

Jet lag can become a problem for someone who has to make frequent trips overseas, especially if he has to make important decisions immediately on arrival. The inadequacy of performance after travelling across different time zones has led the military and many large corporations to forbid high level decision-making after a long flight until after a proper resting time. The ‘rest formula’ now used by the International Civil Aviation Organization, developed by Dr L. E. Buley, takes into account the hours of the day the traveller departed and arrived, the number of time zones flown through, and the number of hours travelled:

Rest time (days) – [ 7/2 + (Z - 4) +Cd + Ca ]/10

T is the travel times in hours, Z is the number of time zones, Cd and Ca are coefficients of departure and arrival which introduce gains and losses of time.

If one flies from Melbourne to London, departing Melbourne at 1300 hours (Eastern Standard Time) and arriving London at 0555 (Greenwich Mean Time), the rest period is calculated as follows:

Rest time =[26/2 + (10-4) + 1 + 3]/10 = 2.3 days.

An overseas trip is one of the very few instances in which sleeping pills are to be recommended. A drug that is short acting is preferred so as not to cause drowsiness on arrival.

*46\174\4*

Do not be alarmed at the thought of regression. Remember that it is a completely normal phenomenon which all normal people experience in moments of reverie. In fact, it would seem that periods of reverie, like sleep, are necessary for the normal healthy functioning of our mind. In moments of reverie we are no longer concerned with our immediate surroundings, and our mind is left to wander from topic to topic. These moments are extremely relaxing, and the relaxation of the mind remains with us for some time after we have abandoned our reverie, and have returned to our normal way of alert thinking. It seems that in reverie,, just as in sleep, there is an integration of nervous impulses so that we lose some of our tension and anxiety, and as a result feel calmer and more relaxed. In this respect it is interesting to note that the person who suffers from severe tension and anxiety no longer has this normal tendency to moments of reverie. He is alert and on the lookout all the time. He cannot relax and let himself go off guard into a state of reverie. As a result he is without this normal mechanism which helps to save us from anxiety, so his tension is still further increased. The exercises with their consciously induced regression help to make up for the loss of spontaneous reverie, and so work to relieve tension and anxiety.

The common difficulty in allowing ourselves to regress concerns the letting go which is such an important part of it. There is a biological reason for this. Over countless generations we have been conditioned to be on guard. Those that were not on guard fell by the wayside and did not survive. True, we have some reverie, but reverie is characteristically a momentary affair. Now, to regress we have to let go and let ourselves be off guard. But now we can do it because we are safe. We know that we are safe and that nothing will befall us.

We are really rather afraid to let go. This applies to all of us, but especially to those who are tense and anxious. When we suffer from tension we are all the time holding ourselves in, as it were. We keep a hold on ourselves. We keep ourselves in check. We feel that if we did not do this our tension would somehow get out of control, and anything might happen. The difficulty is that the anxious person is continually holding himself in, while in the exercises he is asked to let himself go.

There are two things which help us to overcome this difficulty. The first is that we know that we are completely safe. This simple idea is of the utmost importance. You are safe. It is perfectly safe for you to let yourself relax and go off guard, so that your mind can wander where it will. It is safe because it is the normal thing that all healthy people do in reverie. We must feel safe and secure, because if we feel unsafe and insecure we are automatically on guard, which is the exact opposite of what we are aiming to achieve.

The other way that we get help in allowing ourselves to drift into regression is to become more and more familiar with the sensation of letting go.

I feel the muscles of my legs let go.—The thighs and the calves, they really let go.—My arms let go so that they are just flopped on the sides of the chair.—And the muscles of my face, they let go.—My jaw has let go, I feel it loose.—And my face lets go so that I can feel it smooth out.—I let go my whole body.—I let myself go.—I just drift with it.

Some people experience difficulty in that they remain too alert to everything that is going on around them. Their eyes are closed, but they are still conscious of the furniture and the things around them. If someone in the next room moves, they think that is so-and-so getting ready to prepare the meal. This is not what we want. We aim to let ourselves be oblivious of our immediate surroundings, and if we hear a noise from the next room, it is just a noise, and it has no particular significance for us. We can help ourselves like this:

I am just sitting here relaxing.—While I am doing it nothing else matters, nothing else matters.—I am just here, easy, comfortable, relaxed.—There is just me relaxing.—Me relaxing, that is all that there is.

Occasionally sleep may be a difficulty. Some people, as they start to relax, go straight to sleep. This is to be avoided. Sleep is some help in relieving tension, but it is very, very much less help than this relaxed state of mind. If you have a tendency to fall asleep when you start your exercises, use a more uncomfortable posture, and concentrate on keeping awake. Then when you have finished the exercises, just let yourself drift off to sleep to have a rest.

*72\57\2*

The latest scientific research shows that the single most important health and longevity factor is a scanty diet or underfeeding. Statistics collected from the several thousands of centenarians in Russia show that one common characteristic of all people who lived 100 years or longer is that throughout their lives they were all moderate eaters. Extensive animal studies reveal that moderate underfeeding increases longevity and decreases incidence of degenerative diseases.2 The eminent scientist, Dr. C. M. McCays of Cornell University, has shown by his research that overeating is the major cause of premature aging in civilized countries. To prolong life and assure good health he recommends a scanty diet of nutritionally superior natural foods.

As Benjamin Franklin said, “A full belly is the mother of all evil.” Obesity is, perhaps, the biggest American health problem and a contributing cause in the contraction of many diseases, including arthritis. As Thomas Edison suggested, “People gorge themselves with rich foods, use their time, ruin their digestion, and poison themselves…”

Food eaten in excess of the actual bodily need acts in the system as a poison; interferes with digestion; causes internal sluggishness, gas, incomplete assimilation, and other metabolic disturbances. It causes fermentation and putrefaction and actually poisons your system.

Leave your table when the food tastes its best. Several smaller meals or snacks are better than a few huge meals. Train yourself to systematically undereat and you will give yourself the best—and the cheapest—health insurance possible.

*29\176\2*

The surgical treatment of epilepsy is becoming increasingly useful, particularly when the seizures are not controlled by anti-epileptic drugs. However, surgery must only be undertaken after a careful detailed assessment of the patient. This, and the operation, should only be carried out in recognized specialist centres. This is because both the assessment of the patient, and the operation itself involve expert and sophisticated procedures—and clearly surgery is an irreversible treatment.

Surgical treatment depends on two main principles or ideas. The first is that a local abnormal area of brain can be entirely removed, leaving behind only healthy, normal brain. The second is that the spread of the seizure discharge, can be prevented by cutting the nerve fibres which cause the discharge. Penfield and Rasmussen, two Canadian neurosurgeons, were the pioneers of surgery for epilepsy and much of the surgical assessment and treatment of patients today is based on their early work. One of the most important questions that must be answered before surgery can be considered is from where

precisely within the brain do the seizures originate. When the cause is a tumour or cyst, then this is relatively easy, but frequently the cause is an area of brain that developed abnormally in fetal life. The identification of the abnormal part of the brain relies upon magnetic resonance imaging, and the use of special electrodes to try and record or ‘capture’ the epileptic discharge. The scalp electrodes (used in a routine EEG) are not usually sensitive enough for this task, and so other electrodes, called depth electrodes, are frequently used. They are also called ‘sphenoidal’ or ‘foramen ovale, electrodes because this describes how they are placed close to the brain. Electrodes may even have to be placed directly on the surface of the brain, or, as fine silver needles, within its substance. Because these special electrodes are in very close contact with the brain, there is a much greater chance that they will pick up the epileptic discharge.

As well as these assessments, people being considered for surgery may also need detailed psychological evaluation, specifically to try and identify which side of the brain is responsible for language and memory, so that these areas are not damaged during the operation. Consideration must also be given to avoid operating in those parts of the brain responsible for movement—it would be unacceptable to stop the seizures at the expense of causing a paralysis on one side of the body (hemiplegia), which might result in losing the ability to walk or write.

Before a patient is considered for surgical treatment of their epilepsy, it must have been shown that the patient’s seizures could not be adequately controlled using anti-epileptic drugs. For how long a patient should not have been controlled is dependent on individual circumstances. It is unwise to operate too early, as the epilepsy might remit (stop) spontaneously, although this is unlikely in the difficult epilepsies. However, if surgery is delayed for too long, then this may limit the potential success of the operation, either because the patient has suffered irreversible educational and social consequences of repeated seizures, or because other parts of the brain which were previously normal may have developed abnormal foci of electrical activity as a result of the continuing activity of the primary focus. Generally speaking most patients with difficult, drug-resistant epilepsy are being considered for surgery too late; surgery can safely be undertaken in children—even young infants. Most specialists would now consider that if acceptable seizure control has not been achieved using optimal doses of anti-epileptic drugs after one to two years, then surgery should be considered as the next step in a patient’s treatment. It has been estimated that many patients in the UK might currently benefit from surgery, but only about 200 operations per year are at present being performed.

There are four types of surgical procedure that are currently undertaken:

• removing a large, identifiable lesion such as a tumour or cyst.

• removing an entire cerebral hemisphere. This is done when the whole of one side of the brain is abnormal, this being associated with a hemiplegia (weakness down one side of the body). The operation sounds dramatic, but is often successful leading to a complete resolution of seizures and, frequently, an improvement in the hemiplegia. Hemispherectomy is particularly useful in children with the Sturge-Weber syndrome.

• removing a small or large lesion which has been identified on the basis of detailed specialized EEG recording and imaging. This procedure is the one frequently used in temporal lobe epilepsy, where different parts and amounts of the temporal lobe are removed. Advances in imaging have led to the identification of subtle structural abnormalities in the temporal lobes, which are responsible for seizures.

• carrying out a disconnection procedure; this is to try and separate the focus (site of abnormal electrical activity) of origin of the seizure from other parts of the brain, by cutting the nerve fibres which allow the epileptic discharge to spread. Operations attempted have included division (cutting) of the corpus callosum. This is a large band of fibres which transmits electrical information from one hemisphere to another. A more sophisticated, technically difficult procedure (called subpial transection) appears to be more successful.

Overall, the results of epilepsy surgery are encouraging, as many as 60-70 per cent of people who have operations for epilepsy have no further seizures, whilst another 10-20 per cent are much improved. Patients undergoing a hemispherectomy or temporal lobectomy do better than patients who have a corpus callosotomy. For some patients who have had to live with uncontrolled seizures for many years, a cure of their epilepsy following surgery may come as something of a ‘shock’, requiring a major adjustment in their lives. These patients need careful and expert support and counselling.

It must be emphasized again that patients must be assessed carefully in specialist centres before undergoing surgical treatment of their epilepsy. No one person can have a guarantee that their seizures will stop.

*66\188\2*