Неврозы – Neuroses

There are a number of ways in which you can carry out an exclusion diet – that is, a diet in which you leave out foods that you suspect and then reintroduce them to monitor symptoms. Whichever way you go about it, it is important that you do it thoroughly. If you leave a food out of your diet (even if it is only one food), you have to leave it out totally during the testing period to be confident of your results. You may not get clear results if you cheat a bit, or eat ‘just a little’ of something. Only you and your conscience need know what you actually do eat, but be honest with yourself and be prepared to redo the exclusion period if you succumb to temptation.

Be aware also that it can take time to get clear results. You need to leave a food out, wait for a while and then try it again. Even to test one food, it can take up to a few weeks to be absolutely sure about it, and if you are sensitive to a number of foods it can take longer. So be patient and do not be in too much of a hurry – it is better to get good results eventually, than to get confusing results straightaway.

If you are testing for an adult, do not worry overmuch about nutritional balance for the period of exclusion dieting, unless you continue with it for a period of more than a few weeks, or unless you are already in poor health. Providing you are eating a variety of different foods and are in generally good health, leaving out a few foods that are important to general nutrition will not do you permanent harm. Seek advice from a doctor if you are worried.

If you are pregnant, breastfeeding, or thinking of conceiving within the next year, you should not go on an exclusion diet unless a doctor advises.

Working out a diet for a baby or young child should always be done with a doctor’s advice.

*99\117\8*

Some people also find, when unravelling multiple sensitivity, that they become unusually sensitive and react very intensely to things around them, as if their systems have been stressed or de-stabilised. It is common to appear to be sensitive to many things while eliminating and unmasking, but your system will eventually settle down and tolerate things again, once you have sorted out the true troublemakers and are avoiding them.

If this happens to you while in the process of sorting yourself out, take a deep breath and do not panic. Some of the things you are reacting to (especially foods and chemicals) may well be temporary intolerances and could go away with time. Concentrate on avoiding the things that upset you particularly badly – reduce your overall load of allergens and substances generally and do not assume that you will be hypersensitive for ever more. Many reactions will be just temporary. Multiple sensitivity is not an automatic life sentence and it is rarely crippling. Stay calm and you will come through. Never throw anything away until you are absolutely sure that you do not tolerate it permanently. It is common to find that you can use or wear something for a while and then become sensitive to it again. If you leave it off for a time and then try once more, often you can tolerate it after the break. Some people use this process to help them cope with multiple sensitivity – rotating the fibres of the clothes or bedding they use, or keeping curtains, rugs or pieces of furniture in a spare room and bringing them out for short periods. So, put things away in a spare room, outhouse or attic, and give them a rest before you test them again.

*30\117\8*

The following dishwashing liquids are well tolerated by people with allergy and sensitivity – Boots for Sensitive Skin, available from Boots the Chemist, and Clearspring by Faith in Nature, stocked or to order from a health food shop, or by post from Faith in Nature (address below). Both have very little fragrance, which is the most common cause of sensitivity to other liquids.

If you cannot tolerate these, you could try using Amway’s LOC Regular which is a concentrated general cleaner. Alternatively, you could use a shampoo that you tolerate. This is an expensive option, so use with moderationYou can also use washing soda for washing dishes. Use a dessertspoonful in a washing-up bowl full of hot water. This is very effective for cutlery and normal plates and glasses; but if you have very dirty dishes, or burnt or greasy pans, you would be best to soak them for at least half an hour in a solution of washing soda before finally washing them. Do not use washing soda on aluminium utensils.

Remember always to rinse washing-up very thoroughly to remove any traces of detergent or washing soda, so that you are not ingesting any when you use your utensils.

Remember to use gloves as hand protection, especially if you have sensitive skin.

For dishwashing machines, you can use washing soda as a detergent. Simply fill the detergent container full of soda and use as normal. You will not need rinse aid. Salt used for softening is no problem and can be used. Faith in Nature make a liquid for dishwashing machines called Clearspring Dishwasher Liquid, which is virtually unperfumed and is well tolerated by people with allergy and sensitivity.

*304\117\8*

If you are weaning a baby on to solids for the first time, most babies will be happy at first on a very simple diet and you should feel no great pressure to expand their diet or increase the range of foods they eat. Once you have identified four foods that the baby tolerates well, follow the advice above on how to keep these on a four-day rotation -one food per day – as the core of the diet. Give these on a four-day rotation for a few times round to be sure that the baby is well, then introduce new foods singly as the first meal of the day using the protocol above.

You can then either give the new food for the rest of the day if the baby seems fine, or go back to the usual food for that day of the rotation. Repeat a second time round four days later to check a new food, then add new foods to the diet as suits. Build up and expand the diet slowly, month by month, following the timetable in Table.

Weaning Foods

First Weaning
Next Weaning
Not Before
Not Before
Foods
Foods
Nine Months
Twelve Months
Potato
All fruits
Rice
Wheat
Carrot
(except citrus
Oats
Yeast
Sweet Potato
fruit)
Rye
Corn
Avocado
Other vegetables
Millet
Sugar
Parsnip
(except cabbage

Cow’s milk (and
Swede
family)

products)
Turnip

Goat’s milk
Aubergine

Sheep’s milk
Banana

Meat
Buckwheat

Poultry
Sago

Eggs
Tapioca*

Beans, pulses

peas Fish

Nuts and seeds Citrus fruit Cabbage family Tapioca**
*For totally breastfed babies **For part or totally bottlefed babies

Babies often tolerate foods better eaten singly – just on their own, rather than combined – so do not be in a hurry to combine foods. The longer you can keep your baby well, and not reacting to foods, the stronger and better his or her system will function.

Many babies will stay quite happily on a rotated diet, at least until they are well over 12 months and become more wilful. Provided they are getting plenty of a milk that they tolerate, and your doctor or dietitian is happy with their nutritional balance, keep to a rotation diet until the child really refuses it.

If the baby’s diet seems eccentric, do not worry if he or she is happy and healthy and your doctor has no worries. Babies will happily eat things that they need and like, that adults would never consider eating. Babies on restricted diets have been seen to devour large bowls of sago, tapioca or buckwheat cooked just with water, and be totally satisfied and happy.

*236\117\8*

You may have already recognised your own pattern of symptoms from the description above of what moulds are and where they are found.

Skin prick tests are reasonably reliable in diagnosing mould allergy. You can ask your GP for referral for such tests. Other ways of detecting mould allergy are to:

• analyse the seasonal pattern of your symptoms

• compare the pattern of your symptoms to high mould situations

Seasonality

Although some moulds are found year round, especially indoors, there are periods of the year when their concentrations are much higher. In the UK, unless there are unusual climatic variations, moulds will have seasonal peaks in the autumn, and in the summer months. April, May and early June are often relatively mould-free. August and September can often be good months unless the weather is warm and humid (as was the case in the late 1980s and early 1990s). In such years, there will be no real dying down of late summer moulds before the damp, rotting moulds of autumn and winter take over.

If, most years, you feel better in April, May, early June and in August and September, suspect mould allergy.

There are often significant daily and regional variations to this pattern, according to the specific conditions that cause the level of moulds to fluctuate widely, even by the hour. A sudden high dew, a change in pressure, wind or temperature can cause a local explosion of spores.

Chemical pollution combined with fog can also aggravate mould sensitivity; the damp cloud holds down the mould particles which would otherwise escape higher into the atmosphere. If you have a very capricious pattern to your reactions, these may be explained by specific climatic or local conditions, or the effect of local chemical pollution on mould levels.

*167\117\8*

Finding a sex therapist who is qualified, experienced and trained to handle problems like yours is important. We believe that a personal recommendation from a qualified professional is one of the best ways to find someone to help you. Ask the urologist who examined you for physical problems for a recommendation.

Another good source of referral is a university which has a sex therapy clinic, or a program to train sex therapists. Even if the clinic itself is too far away or otherwise inconvenient for you to use, many will provide referrals to graduates or other qualified sex therapists who practice near you.

Paying for Sex Therapy

How much you pay for sex therapy depends on where you live, which therapist you see, the length of treatment and the type of program. Hourly rates may be the same or close to those charged for other types of therapy. Intensive programs may cost $1,500 to $2,000, or substantially more. Some therapists do offer sliding scales based on the client’ s ability to pay, and some university training programs may occasionally offer therapy at reduced prices.

What’ s important is that you understand, up front, how much the therapy will cost. Get an estimate as to the number of sessions. And ask if at any point in the program you decide not to continue—or if the therapist decides you should stop—do you get a partial refund of any money you’ve paid in advance?

Many health insurance policies will not pay for sex therapy, so be sure to check out your coverage in advance.

*178\184\8*

If muscle fatigue during sex has become an unwanted presence in your life, you need resistance training. This type of exercise will increase overall muscular strength in your arms, abdomen, back, and legs. To measure the current state of your muscles, get down on the floor and see how many push-ups you can do in a minute. A man in his forties should be able to perform at least twenty. A fifty-year-old should be able to manage fifteen. If you can’t meet these numbers, start performing this classic exercise daily.

To test your midsection strength, see how many crunches you can perform in a minute. Lying on the floor with knees bent, feet flat on the floor, and arms crisscrossed over your chest, curl up until your shoulders come off the floor. Then return to the starting position. I expect a man in his forties to be able to do anywhere from twenty to forty crunches. A fifty-year-old should be able to accomplish at least fifteen in sixty seconds. If these numbers are high for you, add crunches to your daily regimen.

If you really want to build muscle strength, ten to twelve repetitions with light weights for each muscle group two times a week will be very effective. Get a professional to show you what to do to avoid injury.

Remember: regular aerobic exercise, such as walking briskly, running, or swimming laps for twenty minutes or more several times a week can protect against ED development. However, for all of you men who ride a bicycle there is an ED connection that you should be aware of: prolonged sitting on the traditional narrow riding saddle.

*134\183\8*

The man currently taking any number of medicines—either prescription or over-the-counter—that give him ED is now able to counteract the negative condition without compromising his health. Research bears this out. Dr. Harin Padma-Nathan, director of the Male Clinic in Santa Monica and an associate professor of urology at the University of Southern California, has had extensive clinical experience with both Vasomax and Viagra. His findings, which relate to men taking antihypertensive medication, are extremely positive. He says, «ED will be much less of an issue for men taking hypertensive drugs.»

One of the pivotal trials with Vasomax suggests it overrides the ED-inducing effects of antihypertensive medications. In the study, men were allowed to continue with their current prescription. When the testing was over, researchers analyzed the data to see if hypertensive medications, a single class of drugs which cause more ED than any other, were still inhibiting sexual function. The results were conclusive: Vasomax was also equally effective in restoring erectile function, whether a man was taking antihypertensive medication or none at all. Vasomax was also effective in men who had mild to moderate dysfunction, whether they were taking medications for other conditions or not.

Dr. David Ferguson, clinical director for the American trials with Vasomax, is even more optimistic about the ability of the drug to override ED-related side effects of medications. He states, «You can improve function while still getting all the benefits of the other medications you are currently taking. In my experience, Vasomax seems to be compatible with all other drugs.»

This has been borne out in cases with my own patients. Gary’s story is an excellent illustration of the restorative powers of the oral intervention in the face of a serious disease. When he first came to see me, the forty-one-year-old advertising executive had dangerously high blood pressure. My immediate concern was that, left unchecked, his hypertension could lead to a heart attack or stroke. Naturally unnerved by the news, Gary was shattered when I informed him that hypertensive medication very often causes ED. His response was a very common one: «Forget it! Why can’t you give me something that will let me live the way I want to? Do you really expect me to give up my sex life?»

I explained to Gary that he had a life-threatening condition but that we could try several different drugs to see which one least affected his sex life. Finally capitulating, he said he would try a prescription. However, when he came back several weeks later, his blood pressure readings were unchanged. Suspecting that he had cut—or even eliminated—his medication, I confronted Gary, asking him if that was the case.

«Okay, you caught me,» he confessed. «I did try the medication— but as soon as I did, I couldn’t get hard anymore. Look, it’s my life and I make the decisions about it, okay?»

I told Gary that in my view it wasn’t okay, and that compromising his health in such a dangerous fashion was something I could not condone. Having reached a stalemate, Gary left my office, telling me he wasn’t planning to start taking his medicine again.

But later, after I became involved in the Vasomax trials, one of the first men I thought of was Gary. When I called him, he admitted that he was worried about his health. He still had erections, but he’d experienced some problems over the past year, he said. And then there was the untreated hypertension. He said he felt that he was a time bomb that could explode at any moment.

*106\183\8*

The introduction of erection pills has opened the door to the pharmacological enhancement of sexual pleasure. We all know that the human reproductive system is no longer reliant solely on nature to make the decision about when, and if, pregnancy should take place. Vasectomies and birth control pills are commonplace features of our lives. New technology has stretched the years in which a woman can have a baby. Today, even post-menopausal women can have children.

By altering the procreative destinies of men and women—as they wish them to be—sex is most often about pleasure. Therefore, how can the medical establishment deny humans the right to the most exciting and fulfilling sex, including entirely restored erectile function? And, for those with «healthy» function, who is to say that it shouldn’t be enhanced any further?

With the approach of rapidly evolving medical technology and newer medications, is it right to prescribe drugs for a person who isn’t sick? If we look at what is demanded by healthy people, the answer is a definitive yes. We are living in an era in which the public is receptive to custom-tailored pharmacological interventions that not only fight disease but also raise and maintain the quality of their lives. Our century has been marked by the nationwide use of vaccines that prevent serious illnesses in otherwise healthy people. Standardized vaccinations and injections have rendered a number of life-threatening diseases, including measles, diphtheria, polio, tetanus’, typhoid fever, and even different types of hepatitis powerless.

*77\183\8*

Of course, psychologically caused erection problems aren’t confined to basically unhappy relationships. Sometimes a good relationship can get sidetracked by the man becoming too concerned with his abilities as a lover. He gets so involved with giving his partner an orgasm that he doesn’t feel his own pleasure. And he can lose his erection as a result of this preoccupation.

Henry, for example, always took great pride in his ability to satisfy a woman and «give» her an orgasm. As Henry got into his 40′s, he noticed that on occasion, his erections took longer to appear. This is a normal result of aging, but Henry didn’t look at it that way. He saw it as a personal defeat, as a sign that his powers were waning, His new wife, Anne, didn’t have orgasms every time they made love, but she told Henry she didn’t feel deprived by this, saying «I don’t keep score.» But Henry took his wife’s occasional lack of orgasm as yet another sign that his skills as a lover were on the decline. He agonized over this state of affairs. One night, Henry lost his erection while making love. He became terribly upset and decided he needed medical attention. As it turned out, Henry didn’t have an erection problem until he created one in his mind; his overconcem about his adroitness as a lover was the initial stress, and his anxiety about his «failure» was the fuel that kept it going.

It’s important to check out all physical causes of potency problems before attributing the situation to psychological factors. At the same time, we think it’s essential not to ignore the psychological impact that physically caused erection problems can have, especially if they are allowed to continue untreated for a long time. Simon, for example, became severely depressed when he could no longer get an erection. His condition was due to a problem with his blood-flow system. After a complete workup and evaluation, Simon decided to have a penile implant. Several weeks after the surgery, he recovered his potency and his wife was very pleased. Simon, however, remained somewhat depressed, although he insisted that he was satisfied with the implant. But the memory of his lack of erection seemed to dog him. «He doesn’t realize that he’s not impotent anymore,» his wife remarked. For this middle-aged man, the lack of erection signified a great loss of self; after his problem was corrected, he remained unhappy for several months. It took a long time for him to let go of his feelings of loss and resume normal living.

*46\184\8*

1) Headache

Besides eyestrain, long hours in front of a VDT can also lead to headaches. Rest breaks are important as a means of prevention, and some experts recommend that you wear some type of tinted glasses to reduce the risk of headache from staring at a bright VDT screen.

2) Neck Pain

Many people who work with a VDT all day end up with neck spasms and muscle fatigue. That’s usually because the terminal is positioned in such a way that these people have to look up or down all day. Experts recommend that you position your VDT at eye level to avoid the discomfort of neck pain. The height of your desk should also enable you to sit at your keyboard so that your lower arms form a 70 to 90 degree angle to your upper body. The monitor itself should be within a 30 degree viewing angle of your direct line of vision.

3) Backache

Poor posture while working long hours at a computer can contribute to backache. To avoid this problem, you should adjust your chair to suit your height at the desk and to provide adequate support for your lower back. The height of your chair should allow you to sit in a relaxed position with your feet firmly on the floor and your back straight.

*164\27\8*

Here are several ways you can avoid an overdose of vitamin A:

1) To supplement your body’s store of vitamin A, take carotene supplements instead of vitamin A supplements. Consult with your physician for his or her advice.

2) If you take a vitamin supplement, be sure you never exceed the RDA for vitamin A (see chapter 2) unless you have your doctor’s permission.

3) Don’t take vitamin A supplements if you are currently taking fish oil or cod liver oil supplements. Both of these contain large amounts of vitamin A, and the result could be an overdose. Because of their high level of vitamin A, you should use cod liver oil and other fish oil supplements only under a doctor’s supervision.

4) Don’t take vitamin A supplements if you are using birth control pills, unless you have your doctor’s permission. Some studies indicate that women taking birth control pills sometimes experience an increase in their levels of vitamin A.

5) You shouldn’t take vitamin A supplements if you are currently taking prescription drugs that are made from vitamin A. There are two drugs in use today which are derived from vitamin A— Accutane for acne and Tigason for psoriasis. Retin A is a vitamin A ointment which is used for smoothing out wrinkles in skin which has been damaged by prolonged exposure to the sun and aging.

*84\27\8*

Fish oil contains a special type of unsaturated fat called omega-3. Research has shown that fish oil may be effective in counteracting a high-cholesterol diet by lowering blood levels of very-low-density cholesterol and triglycerides. There seems to be no disagreement that fish is good food, but most authorities, including The American Heart Association and The National Heart, Lung, and Blood Institute, strongly recommend that you get fish oil from fish rather than through the use of fish-oil capsules.

The latest research hasn’t show how much fish oil you need to get the beneficial effects, but there are indications that certain doses of fish oil may be harmful. In any event, eating fish as much as three times a week may indeed be good for you, but since precise dosages are not known, it’s best that you avoid fish-oil capsules, and get youi oil strictly from the fish.

The Healthest Type Of Fish You Can Buy

Studies have shown that farm-raised fish are less contaminated by pollutants, such as mercury, PCBs and DDT than fish that are caught in open waters.

*44\27\8*

A low-dosage hormone pill, known as melatonin, may reset the body’s internal time clock and help cure «night owl» insomnia. The pill may also serve as prevention for jet lag.

According to researchers, the hormone melatonin brings on drowsiness and is secreted by the brain naturally overnight. However a pill with 0.5 milligram of melatonin, taken during the day, may «trick» the body clock into thinking that it is nighttime.

When tne pill is taken in the late afternoon, the body tends to think that night time has Come on, and begins to get sleepy.

In order to prevent jet lag, the hormone pill would most likely be taken for a few days beginning the day before departure. Its use would be combined with exposure to outdoor light at the travelers destination.

Still in the experimental stages, the hormone pill is not yet available. However, researchers say that if their findings continue to be positive, it could be available on the market in a few years.

The study, reported in Archives of Ophthalmology, while not conclusive, does lend more support to the importance of proper lens care.

*5\27\8*

Some diseases of the respiratory system, such as allergies, may continue to bother you as you grow older. Antihistamines are effective for burning eyes, itching nose, or mucous drip that often occurs with allergies. Although these drugs may improve the symptoms, they may also cause excessive drowsiness and mental confusion and should not be taken if you are about to drive, and never when you drink alcohol. Preparations such as terfenadine and astemizole cause less drowsiness.

Bronchodilators relieve the wheezing and the shortness of breath that accompany acute and chronic bronchitis or asthma. An infection of the bronchi or lungs aggravates these symptoms. Bronchodilators widen the bronchi and allow more air to reach the lungs. However, they sometimes lead to an excessively fast heartbeat, mental confusion, nausea, and vomiting. Usually an adjustment of dosage will alleviate these side effects.

An important class of drugs in this family is theophylline, which can be taken as pills, syrup, injection, or suppository. It is often prescribed in combination with the beta-stimulators, a group of medications that mimic the effects of adrenaline. Among them are isoproterenol, salbutamol, orciprenaline, and terbutaline. They can be taken as pills or inhaled four or five times a day. The preparations preferred for use in older people have less stimulatory effect on the heart than adrenaline itself.

For severe respiratory problems, cortisone may be required. Many serious side effects are caused by cortisone when taken orally or by injection, and its prolonged use should be avoided. A type of cortisone has been developed that can be inhaled, which reduces the usual side effects. A number of these preparations, such as beclomethasone dipro-pionate, can be taken through an inhaler four or five times daily, often in conjunction with other bronchodilators. New and effective preparations for the control of asthma become available each year.

*47\166\2*

Older people often raise the question of whether it is advisable to take biological calcium preparations, for example Urticalcin, or even to eat foods high in calcium, since it is known that in later years the potential danger of the hardening of the arteries and other body tissues is greater. It is an indisputable fact that during old age calcium is being withdrawn from the bones and deposited in vessels and tissues. This process causes the bones to become porous and fragile and the tissues, blood vessels and scar tissue to accumulate calcium deposits. At a quick glance, this argument would appear to favour a reduced intake of calcium. However, experience has proved that a diet low in calcium, surprisingly enough, can even promote osteoporosis, the loss of calcium from the bones.

How can this problem be solved? Calcium is a basic mineral that compounds easily with acids. If during the latter part of life the body accumulates certain acids, for example, oxalic and other acids, which should have been eliminated with the urine, the body compounds these with calcium to form calcium salts. When reduced to an unsaturated state in this way they are rendered less harmful. If we do not permit a deficiency to develop in the mineral metabolism, and we see to it that the calcium level remains normal, we can be sure that there will be no abnormal decalcification of the bones, even during old age. For this reason, too, there will be no calcium deposits in the blood vessels and tissues. This leads us to the question: what can be done to prevent premature aging?

*218/28/1*

If you try to be conscientious in living according to these seven rules, you will definitely increase your life span and help yourself to avoid many health problems in your advanced years. For example, hardening of the arteries will not incapacitate you, neither will coronary thrombosis, and you will have no need to fear a sudden end through a heart attack. It is simple to obey nature, and doing so will reward us in turn with good health and long life.

Women especially suffer from swollen veins, which often occur after surgery or just after childbirth. Generally, the blocking of venous blood vessels happens sometime between the third and the eighth day following surgery or delivery. In such cases a physician will usually give anticoagulant and vasodilator injections. However, more appropriate and helpful than this medical intervention is the following prophylactic treatment, which is to be recommended to all those who show a congenital or acquired tendency to embolism and thrombosis, and in particular to people with varicose veins.

First of all, take proper care of the bowels, because intestinal disorders such as insufficient bowel movement or the retention of a faecal matter causes the blood, and hence the whole body, to become affected by metabolic toxins. Going on a juice diet for one day a week usually helps to improve regularity. The question of diet or nutrition for the rest of the week is no less important; only natural, unadulterated, unrefined foods will contribute to the eventual correction of irregular bowel movements.

*214/28/1*

A narrowing or hardening of the arteries has serious, in time even incurable, consequences. The victim literally degenerates, both physically and mentally. To this day more people in the civilised, industrialised world, especially in Europe, the United States and Australia die of diseases of the arterial walls, and the number of deaths is on the increase. The length of our life is often determined solely by the condition of our arterial walls.

Hardening of the arteries (arteriosclerosis) begins with a small alteration, which looks like a flat sore or ulcer. This sore then develops into a growth of the connective tissue, followed by a deposit of calcium salts, with the result that the inside of the artery becomes gradually narrower and the blood has less space in which to circulate. The artery loses more and more of its elasticity, eventually becoming hard and brittle. The blood pressure then rises and the victim may eventually the brain or a cerebral haemorrhage. Dilation of the heart or haemorrhage of a blood vessel near the heart, as well as nephrosclerosis (nephritis due to a hardening of the kidney blood vessels ) may also occur.

*210/28/1*

Thus far we have spoken of only one function of the circulatory system, the supply. But, as in every manufacturing plant, we must also concern ourselves with the waste products the body produces. They must be promptly eliminated if congestions, in other words breakdowns, are to be avoided. The train on its way back to Basel may be compared to our venous system, which is responsible for returning all the waste products resulting from burning-up processes, for example carbon dioxide and uric acid. Some of these waste products are recycled by the liver or eliminated with the help of the kidneys. If this process of transportation becomes obstructed, problems will be inevitable, since the accumulation of waste causes tension and pressure. The train may be derailed and the mail scattered, lying undelivered on the rails. In terms of our body this means the formation of varicose veins.

*206/28/1*

Neurological presentations

Many patients develop neuropsychiatry manifestations including cognitive and memory impairment, personality change and mental slowness progressing to mutism, incontinence and paraplagia. The virus is neurotropic causing dementia of presenile type (AIDS-dementia complex).

Myelopathy may present as ataxia.

Peripheral neuropathy is characterised by symmetrical glove and stocking sensory loss associated with muscle pain and weakness.

Choroidoretinitis due to CMV or HIV infection may result in progressive visual loss.

In some cases, central nervous system disease is related to opportunistic infection such as toxoplasmosis, cryptococcosis or HSV or to primary lymphoma of the brain.

Neoplastic presentations

Kaposi’s sarcoma (KS) is characterised by painless red-purple lesions on any part of the body including palms, soles, gastrointestinal tract and lymph nodes. KS is more common in homosexual men (up to 25%) than in other patients.

Extranodal B-cell lymphoma including brain lymphoma is reported with increased frequency in patients with HIV infection

Pyrexia of unknown origin

MAI infection becomes disseminated in ADDS patients and may present with fever, pancytopacnia and hepatitis. Kaposi’s sarcoma and lymphoma may present as pyrexia of unknown origin.

*92/56/1*

Cardiovascular syphilis and neurosyphilis

Prednisolone 20 mg twice daily for two days prior to commencement of penicillin is recommended for patients with cardiovascular or neurosyphilis.

Aqueous procaine penicillin G 1.5 g daily intramuscularly with probenecid 500 mg four times daily by mouth for 21 days may be used for patients with cardiovascular syphilis and for patients with neurosyphilis managed as outpatients.

For patients with neurosyphilis treated as inpatients, intravenous benzylpenicillin G 4 g at four hourly intervals with probenecid 500 mg four times daily by mouth for 10 days may be used.

Asymptomatic patients with positive CSF findings should be treated as having neurosyphilis.

Patients with neurosyphilis should be referred for specialist advice. Benzathine penicillin should not be used for the treatment of neurosyphilis because an adequate level of penicillin in the CSF is not achieved. However, if the CSF examination is negative, benzathine penicillin G 1.8 g intramuscularly at 7 day intervals for 3 doses may be used for the treatment of cardiovascular or gummatous disease in patients unable to comply with daily injections.

*67/56/1*

Infection may ascend from endocervix to the upper genital tract causing endometritis, salpingitis and pelvic inflammatory disease. Late sequelae include tubo-ovarian abscess and peri-hepatitis (Fitz-Hugh-Curtis syndrome).

Urethritis in females may cause dysuria and frequency without much discharge and be misdiagnosed as cystitis.

Infection of one or both Bartholin’s glands just inside the vulva may result in local pain, swelling and tenderness.

Anorectal infection secondary to genital infection is common in females. Anal sex may result in anorectal infection in both males and females. Anorectal infection may be asymptomatic or may present as a mucopurulent anal discharge and anal discomfort, including discomfort on defaecation.

Oral sex may result in oropharyngeal infection which may be asymptomatic or present as sore throat or pain on swallowing.

Conjunctivitis may occur in neonates as a result of transmission from an infected mother during parturition. Gonococcal conjunctivitis may occur as a local outbreak in older children or adults due to close contact or autoinoculation in communities with high carrier rates of gonorrhoea and poor hygiene standards.

*43/56/1*

The physical examination should include oral, genital and anal examination. In female patients, a vaginal speculum should always be used to visualise the cervix and bimanual pelvic examination should be done. In patients with anorectal symptoms and in homosexual men, proctoscopy should be done to exclude anal canal pathology.

Patients must be treated with the same consideration as other patients. The examination should be carried out in privacy without interruption. Appropriate instruments should be used with gentleness and skill.

Laboratory investigations are directed at:

confirmation of the existence of disease; and

identification of the causative organism or organisms.

Patients should be told what investigations are being done and why they are considered necessary.

The investigations to be undertaken will be determined by the presentation and clinical findings, test results and the differential diagnosis

*18/56/1*

Tobacco can cause headaches in two ways. Firstly, carbon monoxide is produced when tobacco is burned. Usually this doesn’t cause a problem by itself, however, long-term exposure to carbon monoxide furs up the arteries of the heart, a condition known as arteriosclerosis.

Some people are allergic to tobacco smoke, and can get severe headaches when in smoky atmospheres. This effect seems to be allergic rather than pharmacological, so even a small amount of tobacco smoke will be enough to trigger a headache. The only true remedy here is to avoid smoky conditions.

Detailed methods to help you give up smoking are beyond the scope of this book, but the essence of them all is will-power. All the aids to stopping smoking will be completely useless if you don’t try – hard! (And it is hard, too.)

Complementary treatment

Tobacco smoke is toxic because of the tars (cancer-causing substances), nicotine (artificial stimulation) and carbon monoxide. Smoking also increases the risk of heart disease, stroke, bladder disease and cancers of the stomach and the neck of the womb.

Regular exposure to smoke depletes the body of Vitamins A, B, C and D, as well as bioflavanoids and zinc. Do ensure that you are getting adequate quantities in your diet; if you are a heavy smoker you may need supplementation.

Acupuncture can help to relieve the pain of tobacco-induced headaches, and, if you are a smoker, help you to give up. Oats, skullcap and valerian will help deal with the headaches caused by exposure to tobacco smoke. A combination of colt’s foot and plantain can be given to clear out the respiratory system after stopping.

Bach flower remedies can help deal with negative emotions while trying to give up smoking; for example, there is impatiens for impatience and irritability; gentian for despondency, and cherry plum for uncontrolled, irrational thoughts. Controlling your emotions will prevent them building up to become another cause of headaches. For irritability, B-complex vitamins. Niacin can be used under a doctor’s supervision to detoxify the body.

There are numerous homoeopathic remedies available to help with headaches caused by tobacco withdrawal, passive smoking, and oversmoking.

An aromatherapist might suggest massage with anti-depressant oils like bergamot, camomile, clary sage, jasmine and rose. Detoxifying oils, used in the hath or the vapouriser, include fennel and juniper. All are useful for headaches caused by smoking, even passive smoking.

Reflexology offers a programme to help you give up smoking.

*137\20\2*

Pre-menstrual syndrome (PMS) covers a wide variety of symptoms, the most common of which are irritability, breast swelling and tenderness, bloating, backaches, headaches, anxiety or depression, weight gain, food cravings, fatigue and abdominal bloating. Usually only a few of these symptoms occur in any one woman. Obviously, all of these symptoms can occur for other reasons, but in PMS the common factor is that the symptoms come and go in relation to the menstrual cycle, typically starting in the second half of the cycle and reducing or ceasing as or shortly after the period begins. In mild cases, the symptoms are only present for a couple of days before the period, but in severe cases the symptoms can occur through at least half and sometimes three quarters of the cycle.

Why does PMS occur? There are many theories, most of which revolve around imbalances of the female hormones. Note that word ‘imbalance’; there isn’t an absolute amount of each hormone that needs to lx’ present, but a relative balance between them. The honest answer is that we don’t yet know precisely why PMS occurs.

Orthodox treatment

One of the most potent ways to help sufferers of PMS is to make sure that both the patient and her family realise that they are dealing with a physical illness. The trouble with PMS is that sufferers feel that they’re going mad. for women to recognise the fact that it’s PMS, and to understand that her partner and her family also know that it’s PMS, is a great relief.

Water retention is a common symptom of PMS. Certainly, giving a mild diuretic (a drug that encourages the kidney to excrete more fluid) often gels rid of PMS symptoms, especially bloating, weight gain and breast tenderness. Vitamin B6 is also used in PMS, taken in doses of about 50mg-100mg per day. There is as yet no completely objective evidence that it works, though many doctors use it. Vitamin B6 is thought to exert its action on the brain, possibly by affecting the way in which the pituitary gland releases the hormones which control the female cycle. However, Vitamin B6 can cause inflammation of the nerves if given for long periods and especially if used in high doses, Evening Primrose Oil may help in some cases. Its active constituent, gamolenic acid, is now available on prescription.

As far as hormone treatment of PMS is concerned, one of the most helpful methods is to take extra progesterone in the week before the menstrual bleed starts. Progesterone is normally released from the ovary during the second half of a cycle, and the extra progesterone in tablet form boosts its effects. In severe cases it may help to add progesterone for two or even three weeks leading up to the period. Extra oestrogens, which must be used with extra progesterone (see below) can sometimes improve pre-menstrual symptoms. Oestrogen and progesterone together make up the combined contraception pill, so putting the patient on the contraceptive pill could help. Sometimes the preparations used in hormone replacement therapy (HRT) can also be used to boost the levels of oestrogen and progesterone in PMS.

Bromocriptine can reduce pre-menstrual breast pain, but it’s not appropriate if you’re planning a family.

Some types of painkillers such as mefenamic acid help reduce PMS symptoms, and relieve the pain of any headache directly. The drugs in this group are of a type often used to reduce inflammation in rheumatism and other musculo-skeletal problems. Anti-depressants may also be of use in some cases of PMS, especially where there are psychological symptoms such as anxiety or depression.

Self-help

Acknowledging that you are a PMS sufferer is a great ‘step forward. It doesn’t mean that you’re hiding behind a convenient syndrome.

Diet can sometimes help. Follow the rules of low-fat, high-fibre, low-sugar diet, with lots of fruit and vegetables. Cut down on caffeine and alcohol, which will encourage mood swings. Keeping your sugar level as constant as possible may help; in some cases changing to a three-hourly starch diet, which includes lots of unrefined carbohydrates, will also make a difference. However, you’ll have to make sure that your total daily intake doesn’t rise and cause you to gain weight.

Complementary treatment

If you suffer from pre-menstrual craving for sweet things, a chromium supplement might help – this is because chromium is linked to our insulin levels, and this in turn controls the amount of sugar in our bloodstream.

Sometimes reducing fluid and/or salt intake before the period may lessen the sensation of bloating.

Relaxation and exercise, which both reduce tension, will help alleviate symptoms.

A supplement of Vitamin B6 can be helpful, starting two days before your symptoms normally begin and stopping just after your menstrual cycle has started. Evening Primrose Oil works for some women, taking it alongside Vitamin B6. Note that Evening Primrose Oil can cause fits in those suffering from temporal lobe epilepsy, so beware.

Acupuncture can help with many symptoms, including bloating (by helping the body eliminate excess fluid), cravings (by suppressing your appetite), mood swings (by calming your nervous system), painful breasts and headaches (through various methods of pain relief and reduction). Obviously, when the other symptoms of PMS are relieved, a great deal of pressure may be lifted from the sufferer. Simply controlling mood swings can provide relief from headaches by making the patient feel she is back in control of her own body – and that’s a good starting point for banishing emotionally linked stress.

Aromatherapy has much to offer PMS sufferers. Geranium and rosemary are said to help prevent water retention. A head, neck and shoulder massage with lavender, sandalwood, camomile or geranium helps to relieve tension and relax the muscles, in the case of headache. Geranium, bergamot, rosemary and lavender (singly or in a Mend) may act as stimulants to overcome lethargy and tiredness. Cold lavender compresses can relieve painful breasts. Where muscle tension is a feature, any of the manipulative therapies are likely to help.

Homoeopathy will work, best if remedies are prescribed according to your specific symptoms – or group of symptoms. In general, however, lachesis and nat mur are used to relieve water retention; mood swings can be treated with kreasote, lycopodium and causticum; sore breasts may be relieved by Pulsatilla.

The clinical intuitionalist might suggest some of the following. Vitamin B6 acts as a mild and natural diuretic, as does Fenugreek lea or dandelion root coffee. A low-fat, low-sugar, low-salt diet (as above) should he implemented, especially the week before, and the week of, your worst symptoms. Supplements of Brewer’s yeast and adrenal glandulars can help with cravings and mood swings (included anxiety and depression). A calcium, supplement, taken along with evening primrose, is said to reduce headaches by restoring the hormone balance between oestrogen and progesterone.

In terms of medical herbalism, you might try coughgrass and cleavers, drunk as a tea, which acts as a diuretic. Gentian can control blood-sugar levels; skullcap or oats can control mood swings; camomile, peppermint or feverfew can reduce headaches by improving circulation and relieving tension; and chaste tree or white deadnettle are said to improve the circulation, reducing congestion and pressure.

Royal jelly is also said to be helpful. Reflexology and biofeedback are also often recommended.

*94\20\2*

Many substances can cause headaches, and these include chemical solvents, gas appliances, alcohol, certain foods, additives and preservatives, car fumes and drugs, both prescribed and over-the-counter varieties. Sometimes the headaches are caused by the sudden withdrawal of a substance to which you’re addicted -such as caffeine; a food to which you’re allergic; or one of the addictive drugs. In each case, the treatment is obvious – identify the problem, and then permanently eliminate the offending substance.

Some of the reactions we get to chemicals are caused by a direct effect of the chemical on the body. The effect may be related to the dose we receive – a pharmacological response. In other cases the reaction is allergic. This works by a completely different pathway, with the offending substance triggering off the body’s immune system. In this case you get a maximum response for anything other that the tiniest dose.

Although pharmacological and allergic responses work through completely different routes, treatment is much the same. The only difference between the two is that it will be harder to completely remove something to which you are allergic, because even tiny amounts of the offending chemical may trigger symptoms.

Let’s look at some of the more common sources of chemicals that can cause headaches.

*129\20\2*

Cerebrospinal fluid (CSF) is formed inside the ventricles, which are spaces deep inside the brain. From here it moves slowly outwards and downwards, passing out through a narrow canal to enter the space around the outside of the brain and spinal cord. It is then gradually absorbed into the veins which line the inside of the skull.

The weak link in the chain is the canal connecting the ventricles with the outside of the brain. If this is obstructed, CSF cannot get out from the inside of the brain. Unfortunately, this fluid continues to be formed, gradually increasing the pressure within the brain, blowing it up like a balloon. This condition is called hydrocephalus, commonly known as ‘water on the brain’.

Conditions that obstruct the outflow of CSF include a congenital narrowing of the drainage channel; a tumour pressing on the channel; or, after meningitis, which scars the canal so that it become blocked and can no longer drain CSF properly.

Hydrocephalus is a disease which affects those at the extremes of life. It is common in young children because they are more prone to those conditions which obstruct The outflow canal. These are congenital malformations, meningitis and brain tumours. Hydrocephalus also occurs in adults, but is significantly different from that in children. Most childhood tumours are tumours of brain tissue itself, whereas in adults many tumours are secondary growths spreading from other parts of the body. Hydrocephalus in adults gives severe headaches, with vomiting and confusion. Again, the skull is unyielding, and the brain tissue is severely compressed by the rise of pressure. Treatment is difficult. If by any lucky chance it is due to a benign tumour obstructing the outflow canal then it can be removed, but often hydrocephalus in adults occurs from inoperable malignant tumours.

Benign intracranial hypertension

Benign intra-cranial hypertension is a permanent rise of pressure within the CSF, but without any obstruction of the drainage (outflow) canal. It is more common in obese women; occasionally it occurs following pregnancy or miscarriage; it can also be related to brain infections and mild head injuries in certain people.

Ultra-cranial hypertension causes generalised swelling in the brain, due to the presence of excess water, a condition called oedema. Its symptoms are very similar to the effects of hydrocephalus in an adult – there is headache, vomiting and impairment of consciousness.

Benign intra-cranial hypertension responds well to steroids and they can often keep it completely under control.

Lumbar puncture headache

The brain floats inside the skull – moored in the cerebrospinal fluid (CSF). If CSF is drawn off, then the brain tends to sink down inside the skull, pulling on its moorings – and this is exceptionally painful.

Normally, of course, this doesn’t happen. However, when a lumbar puncture is performed some of the CSF fluid is drawn off. This causes the brain both to tug on its moorings and also to swell slightly to make up for the fluid that has been drawn off. This hurts. It is quite common for a headache to develop for twenty-four hours, following a lumbar puncture, while the body is replenishing the level of CSF. During this time the patient is encouraged to lie still and Hat (he usually wants to) and the headache is usually lessened if the patient stays in this position, lying in bed.

*117\20\2*

Tension headaches made worse by intercourse come on as a dull ache over the whole head, developing before orgasm. It may pulsate in time with the heart beat. The pain of a sub-arachnoid haemorrhage brought on by intercourse is typical of all other sub-arachnoid haemorrhages – a feeling of being hit on the back of the head or neck, followed by an explosive headache of immense severity.

The pain of a true coital headache is a sharp, one-sided, sudden onset, explosive pain which lasts anything from a few minutes to a few hours.

What else could it be?

There is no one disease called ‘headache during intercourse’; headaches with intercourse could be any one of the conditions that have been outlined above.

Because a severe, sudden onset of head or neck pain occurring for the first time at intercourse could be due to a sub-arachnoid haemorrhage you must get medical help immediately. On the other hand, if you’ve already had headaches with intercourse, and this is just another of the series, then it is unlikely to be a subarachnoid haemorrhage.

Headache with intercourse is often due to (or made worse by) tension headache, and, depending upon the sexual techniques used and the position of the neck, it might also be related to previous neck or hack injury, or neck muscle spasm., especially if the head is held in an abnormal position for some time. In particular, bending the head back for any length of time can induce severe neck pain of the muscle spasm variety. The distinguishing features of tension headache, neck injury and neck muscle spasm are that there is often a previous history of injury to the neck, local tenderness of the neck or its muscles, stiffness on bending the neck to the side, and the neck muscles can often be felt in spasm.

*104\20\2*