Smoking is the leading cause of preventable illness and death in the United States. More than 400,000 deaths every year (in fact, about 1,200 per day) in the United States are attributed to smoking. At least one-third of these are related to cardiovascular disease. Smoking kills more people each year than AIDS, alcohol (including drunk driving), cocaine, other forms of drug abuse, and accidents combined. Indeed, almost 20 percent of all deaths in the United States are related to smoking, according to the Surgeon General.The toll of this human tragedy is compounded by the immense expense borne by all members of society, smokers and nonsmokers alike, in terms of higher health insurance costs, lower productivity, and higher taxes. Analysis has shown that the cost to each American—every man, woman, and child, whether they smoke or not—is $221 to cover the consequences of smoking in terms of increased health care and insurance and lost productivity. A national financial burden of $37 billion to $50 billion per year suggests that the incentive to reduce tobacco use should be very high on an individual and national basis.*228\252\8*

Sometimes clotting of blood (thrombosis) inside an artery results in a blockage. A blood clot that forms and stays at its place of origin inside a blood vessel (or the heart) is called a thrombus. A thrombus can partially or totally obstruct the artery and prevent sufficient blood flow.When a blood clot forms in one place but breaks off and travels through the blood vessels to another point in the circulation where it lodges, the resulting problem is referred to as thromboembolism. The actual blood clot is a thromboembolus. A thromboembolus is often referred to simply as an embolus. Emboli can also originate from cancer cells in the circulation (septic emboli), from cancer cells that enter the circulation (tumor emboli), or from fat cells that enter the bloodstream, especially after major bone fractures (fat emboli).A sudden blockage (occlusion)) may occur when an embolus lodges in one of your arteries. Blood clots can originate from the chambers of the heart or can develop in large arteries and lodge in smaller arteries after they break loose. This process often occurs where arteries branch or divide.*193\252\8*

Normal sexual responses to a gynecological cancer include:•    Post-treatment obsession with body image and self- acceptance as a sexual being•    Inability-to accept that the surgical scar is a badge of ‘survival•    Concern that you will never have another orgasm. You will – all orgasms start in the mind!•    Difficulties in discussing intimacy and other issues with your partner•    Grieving over loss of fertility•    Extreme tiredness and loss of interest in sex in the early stages, and even after treatment•    Pain with penetrative intercourse, especially after surgery and radiation . . . medication and lubricants can help overcome this•    Early onset of menopause•   Anxiety over resuming sex, or discussing sexual concerns•    Fear of infection especially with decreased blood counts•    Fear of pain•    Fear that having intercourse will flare up cervical cancer, because symptoms often first appear with intercourse.Most concerns resolve themselves with time, patience, understanding, open honest communication and sometimes medical and psychological intervention.These concerns become abnormal when it creates depression and an inability to resume intimate activities of any type. Make sure you talk with your doctor right from the start.*36/144/5*

ExerciseIt is generally believed but not rigorously tested that exercise, even when it causes pain, shortens periods of pain.RelaxationApparently contradictory to exercise, relaxation is intended to correct abnormal postures.Deep massageIt is intended to break tissue free from constriction.Manipulation, osteopathy and chiropracticeThe most organized of complementary therapies, manipulation, osteopathy and chiropractice are designed to force tissue in abnormal locations into a normal position. They use escalating force to achieve this end. Evidence is lacking that the abnormal location existed in the first place and that normality is restored. A large number of so-called trials have been carried out but they are so far uniformly unsatisfactory. The most common problem if one therapy is compared with another is that the differences are so obvious to the patient. For example, chiropractors organized an elaborate trial in which randomly assigned patients received either chiropractic therapy or a course of hospital physiotherapy, and the chiropractic patients did better. But the chiropractic patients were given a series of treatments in the private offices of practitioners who knew their profession was on trial. The other patients went without fanfare to receive routine physiotherapy by unchallenged practitioners who gave fewer and shorter sessions. No wonder chiropractice appeared superior.In another recent analysis of various types of physiotherapy matched against so-called placebos, the only significant result was that the longer the treatment lasted, the better was the outcome. This result applied equally to the designated therapies and their placebos. Whatever the placebo component may be, there is no doubt that these therapies, like many of those we have considered, produce some tissue damage.*59\219\2*

There are four main types of protease inhibitors. Detailed below are the recommended dosages, interactions with other medicines and the side-effects of protease inhibitors.Indinavir: Eight hundred milligrams of this medicine is recommended either one hour before meals or two hours after meals. Common side-effects include disturbances of the digestive system. Occasionally some people may have headache, blurred vision, rash, dizziness, metallic taste in the mouth and abnormal bleeding or bruising in the body.Indinavir is not recommended with medicines such as rifampicin, cisapride, triazolam and midazolam.Ritonavir: The recommended dose of this medicine is six hundred milligrams twice a day to be taken with meals. This dose is reached by gradually increasing it during fourteen days. The first two days three hundred milligrams of ritonavir is recommended twice day followed by four hundred milligrams twice a day for the next three days. On days six to thirteen, five hundred milligrams is recommended twice a day. Thereafter, six hundred milligrams is recommended twice a day. Ritonavir is often recommended in combination with saquinavir, another protease inhibitor.Common side-effects include nausea, vomiting, diarrhoea, decreased sensation in the limbs, hepatitis and change in the taste sensation. Ritonavir is not recommended with medicines such as cisapride, tranquillisers, quinidine, etc. It can increase the levels of clarithromycin and decrease the levels of zidovudine.Nelfinavir: The recommended dose for adults is seven hundred and fifty milligrams three times a day with meals. Common side-effects include diarrhoea, pain in the abdomen, nausea, rashes and increased gas in the bowels. Medicines such as rifampicin, can reduce the levels of nelfinavir. This medicine is not recommended for use along with tranquillisers, cisapride, etc. It increases the levels of other protease inhibitors such as indinavir and saquinavir.Saquinavir: The recommended dose is six hundred milligrams to be taken three times a day. Some preparations may also be recommended in the dose of twelve hundred milligrams three times a day. Common side-effects include disturbances in the digestive system such as nausea, diarrhoea, pain in the abdomen,  headache and indigestion. The levels of saquinavir in the blood are increased by ritonavir and nelfinavir (protease inhibitors) and grapefruit juice. Their levels are reduced by rifampicin, some medicines used for treatment of epilepsy and steroids. It is not   recommended   along   with rifampicin and some tranquillisers. Zidovudine is recommended in almost all    combinations    of    medicines recommended for treatment of HIV infection. This is because its benefits have been observed for a long time and it can enter the brain more effectively than other medicines. HIV not only affects the blood but can also enter the brain. Thus, if a medicine does not enter the brain, it cannot control the infection effectively.*22\288\2*

What is Imuran?Imuran (azathioprine) is an immunosuppressant that changes the DNA structure of certain cells.It is used for rheumatoid arthritis that is difficult to treat and does not respond to other agents.Imuran in a dosage of 1 to 2.5 milligrams is generally given per kilogram of body weight. If your doctor weighs you before beginning this agent, this is why.Nausea, vomiting, belly pain, and occasionally hepatitis or problems with the making of blood cells are seen with this agent. If you also have gout and are taking the drug allopurinal (Zyloprim), make sure you tell your doctor, as your Imuran dosage will have to be adjusted.
What is leflunomide?This drug’s brand name is Arava. It is another drug that acts on the DNA of cells like the T cells. It is new and quite useful in the treatment of RA and is as effective as methotrexate or sulfasalazine.The doctor gives you a loading dose in order to get the blood levels of the drug up to therapeutic levels in your body: The patient is started with 100 milligrams per day for three days. After three days, the dose is lowered to 20 milligrams daily. If the patient tolerates the drug, the dose can be lowered to 10 milligrams per day.Diarrhea is the most frequent side effect. Changes in the liver function tests, reversible hair loss, and a rash are all part of this drug’s side effects.Women who expect to become pregnant and men expecting to father a child should discontinue the drug and replace it with cholestyramine for eleven days to bind up the drug and eliminate it. Your doctor can test your blood levels to make sure that it is out of your system before you get pregnant or father a child.*35/141/5*

People are often surprised to discover how much inner strength they can muster when they are faced with adversity. The truth, however, is that we all depend on our inner resources to get through each day. Intangibles such as courage, optimism, and faith as well as our creativity and skill in problem solving are at our disposal to help us overcome hurdles.You don’t have to depend solely on your own inner strength, however. Family, friends, health care professionals, arthritis support groups, religious groups, social service organizations, and vocational rehabilitation centers – any and all of these can provide an invaluable source of support and encouragement. Although some of these people are trained and skilled in helping, others who are willing to help will need some guidance to know what they are to do.Although you may be hesitant to seek outside help, you might consider that utilizing the special skills and support of other people is a coping strategy that benefits you and them. Ironically, by helping you to help yourself, their assistance may allow you to retain your independence. Their lives will also be richer since they have been able to contribute something to someone who needed their help.*36/209/5*

If the pancreas is under stress and secretes too much insulin this affects the output of several hormones, epinephrine, norepinephrine and adrenocorticotropin, which triggers the release of Cortisol. This is produced in the adrenal glands and slows down the fat-burning process. During times of stress a significant portion of spare fat in the bloodstream goes to your abdomen for emergency use. This could be the reason why many anxious people feel they are gaining weight and changing shape even when their eating habits remain the same. High Cortisol levels not only make you feel more anxious and deplete your immune system, leaving you more susceptible to infections, but also lower the production of another important hormone produced in the adrenal glands: DHEA –dehydroepiandrosterone.Until recent years, DHEA, a steroid hormone, has been given little attention. Formerly it was thought to be only a ‘bank’ on which the adrenal glands could draw to produce other hormones such as oestrogen and progesterone. Scientists have now shown that it has very important functions of its own. It may strengthen the immune system, and be of value in preventing heart disease, diabetes, cancer,Alzheimer’s disease, obesity, osteoporosis and chronic fatigue. DHEA has also been found to help rheumatoid arthritis by relieving pain and morning stiffness. Users have reported being able to reduce their anti-inflammatory medication.DHEA is on free-sale in the US and can be obtained in the UK from doctors who specialize in Nutritional Medicine. It is also available from some nutritionists. Whilst it is said to be non-toxic, it would be wise to have a saliva test and have the results interpreted by a qualified practitioner before embarking on self-medication. One sign that you could be low in this hormone is the loss of hair on the lower third of the legs. Taking supplements of DHEA has benefited many people, but as has been said this should be monitored by a physician.*65\326\8*

At a point, after about 3 months, when the sober alcoholic reaches some level of comfort with the new state of affairs, the focus can shift. The attention has been virtually at the level of the mechanics of daily living. With that out of the way, or reasonably under control, the focus can move on to sorting out the alcoholic’s stance in the world, feelings, and relationships. Though 3 months is a somewhat arbitrary designation, it is not wholly so. Recall the subacute withdrawal syndrome. The alcoholic may pass through the acute withdrawal period within 5 days, but a longer period is required to regain the ability to concentrate, for example. Thus, there is a physical basis for what the alcoholic can focus on productively. This does not mean that all the problems previously discussed are totally overcome, or that work is not proceeding along some of the above paths. It simply means that other problems may now be surfacing. It is also at this point that some assessment should be made as to whether to refer the client to other professionals if the present caregiver is not equipped to handle this next phase. Some problems are fairly common and counselors must be alert to them. Most of these basically require finding a balance point between two extremes of behavior that are equally dangerous. John Wallace, a psychologist who has had long experience working with alcoholics, has neatly described his observations. He compares these extremes to rocks and whirlpools that must be avoided in the recovery “voyage.”*103\331\2*

I have had asthma all my life. It was diagnosed when I was little more than an infant. I am now in my early 40s. Looking back to the bad old days, I really appreciate the advances made in asthma medication. I used to have to swallow some foul tasting, white powder called Rensop, which made me feel ill for hours, and take pills called Tedral, which made me shake. The aspaxadrine pump, which I used daily, will bring back memories for most asthmatics over 40. This device was a rather complicated affair made of glass and rubber; you poured a solution into it and squeezed the rubber handle to make a vapour. Again, this solution was a real shake-maker.When 1 was really bad, I was put on to quite long courses of steroids. I was on and off steroids for about eight years, and fortunately I did not suffer many side effects. I do have thin skin and bruise very easily now, which my doctor told me is a legacy of the amount of steroids I had to take.I was one of those weedy, sickly children who are usually portrayed in fiction as the teacher’s pet. In fact I barely knew any teachers, because I was bedridden for months at a time, propped up on pillows and wheezing more or less constantly. I missed a lot of school and while I had a good general knowledge, it was always a battle to try and keep up with my class. I was a determined child and I sat for and obtained my HSC with the same group I started out with 12 years previously. My school friends remember me as the classmate who was never there and recall they had to pray for my recovery during the times I was particularly unwell. I gather my parents were told by doctors I would be lucky to survive to adulthood.Most of my early memories are coloured by my chronic asthma. Looking back, I realize how awful it must have been for my parents and the rest of the family. My illness certainly curtailed family activities. Unless my grandparents could look after me, one of my parents always had to stay home, while the other one went out with my brothers and sister. If I was well enough to go out, we could not visit people who had cats ot lived in dusty, old houses. On one memorable occasion, when I was taken to afternoon tea in Canberra at the home of the Leader of the Federal Opposition, Dr Evatt, I disrupted the whole afternoon by having a massive asthma attack after sitting on a couch that was usually occupied by the family cat.I had scratch tests on my arm and was allergic to nearly everything. From about the age of five until I was 13, I had constant respiratory infections, contracted pneumonia a number of times and coughed incessantly. I remember finding life very tiring. I would often sit up half the night wheezing and coughing and then doze on and off during the day. I had no appetite and was very underweight. My father would try and help me put on weight by giving me glasses of Guinness Stout. I was quite partial to the stout until one day it arrived with a raw egg beaten into it, to try to get some nourishment into me. It was the most disgusting brew I have ever tasted and I still get goose pimples when I think of it.I kept waiting to grow out of asthma. People kept telling me I would. The years passed and the wheezing lessened, but did not go away. The aspaxadrine was replaced by a medihaler, which was replaced by Ventolin. By now I was an expert on asthma medication. At least Ventolin did not make me shake or tremble. I tried swimming at the baths, but I continually picked up ear and throat infections. I tried walking in the early morning, but the cold air would make me cough. So I swam in private pools and walked later in the day. I also bought a bike. I took up yoga, and tried meditation. All these activities helped make me stronger, but the asthma stayed with me. When I turned 20 and was still a chronic asthmatic, I decided I might have to learn to live with it for life. This was not a negative reaction, but rather a positive realization. I decided to beat asthma at its own game.And I have. I am still classified as a chronic asthmatic, but I describe myself as a controlled asthmatic. I do have the occasional lapse, but overall I stick to a fairly strict program and have done so for many years. I look after myself by eating a balanced diet, staying slim, exercising regularly, getting enough rest and avoiding as many asthma triggers as possible. I think I have increased my resistance to infection, which is one of my major triggers. In the past I would be hospitalized two or three times a year with asthma. I have not been to hospital for some years now except for a period last year when I had pneumonia.Until a few months ago I used Ventolin at least four to ten times a day. I have reduced this substantially since I have started on Becotide regularly. I will probably have to stay on Becotide for the rest of my life, but I have not had to use Ventolin for weeks, not even when I had a bad cold. I use my peak flow meter twice a day. I never miss testing my lung function by this simple and easy method. So far my peak flow reading has not gone down since I reduced the Ventolin dosage.I would like my experiences with asthma to serve as sources of encouragement for other asthmatics. I have been able to lead a full and active life, which has included two children and a career as a journalist. My emotional attitude toward my asthma is good; when I do become ill, I no longer see it as the end of the world. I don’t force myself to go on as I used to in the past. I increase my medication if necessary, rest, drink lots of liquid and avoid stressful situations whenever possible. (Obviously this is not always possible, and I have to admit that stress exacerbates my asthma.)It may have taken a long time, but I now apply common sense to coping with asthma. I see my asthma as a constantly lurking enemy, but an enemy who will never win the battle.*55\148\2*