Signs and symptoms

The symptoms of lead poisoning vary with the age of the child and the amount of lead that is in the child’s body, and are difficult to identify because they may build up gradually. Symptoms may include poor appetite, vomiting, constipation, extreme irritability, slow mental and/or physical development, aggressive behavior, seizures or convulsions, personality changes, clumsiness, or symptoms of anaemia – paleness, tiredness, weakness, breathlessness, and fainting. In severe cases, the child may become unconscious.

A routine blood or urine test will not detect lead poisoning. Before the problem can be diagnosed, the doctor must suspect that lead may be causing the child’s symptoms. Specific laboratory tests are then done to measure lead content in the blood and urine.

Home care

Parents should be alert for changes in a child’s behavior. Also, watch to see if your child has a habit of putting nonfood objects in the mouth and swallowing them. This habit, which is called pica, can result in lead poisoning. Check your home and yard for sources of lead. If your house was built before 1950, the paint and plaster should be tested for lead content.

Precautions

• If you are remodeling an older home, and especially if you are burning, scraping, or sanding paint and plaster inside the house, you may be releasing lead into the air. Pregnant women, infants, and small children should live elsewhere until the work is completed and the dust is cleaned up.

• Anyone who works in an occupation that involves exposure to lead should be especially careful about bringing home lead-containing dust on work clothes. Such occupations include lead smelting; storage battery manufacture, repair, and recycling; automobile assembly; automobile body and radiator repair; and others.

Medical treatment

Treatment for lead poisoning is called chelation therapy. The doctor prescribes a drug that combines with the lead in the body and draws it out of the body tissues where it is stored. The lead passes out of the body in the urine. A special diet or a change in diet may also be prescribed. Of course, this treatment will not be effective if the child is still taking in lead. The source of lead must be identified and removed first.

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Helpful things to prevent headaches and migraines include:

1. Stop smoking.

2. Come off the Pill.

3. Stop drinking tea and coffee.

4. Cut out alcohol.

5. Stop eating sugar.

6. Cut out tyramine-containing foods such as chocolates, yeast extracts and yeast products, liver, sausages, broad beans, pickled herrings and cheese.

7. Cut out histamine-containing foods such as sauerkraut, salami and sausage meat.

8. Don’t eat oranges-they contain substances that can precipitate migraines in some people.

9. Avoid foods containing additives such as tartrazine, benzoates and sodium glutamate.

10. Avoid wheat-containing and milk-containing foods.

•    Noise and annoying surroundings can also cause headaches.

•    True migraine can often not be prevented, unfortunately, as many sufferers know. Look through the triggering factors above and see if you can avoid at least some of them in your life.

•    If during the summer months or in hot environments you tend to get headaches, be sure to drink more watery fluids. Aim to keep your urine pale yellow.

•    Cluster headaches may be helped by anti-migraine medications. See your doctor.

•    The answer to tension headaches is to learn how to relax.

•    Hangovers can be prevented by following this list of tips. Drink a pint of water or other non-alcoholic drinks for every two pints of beer or two ‘shorts’ you take. Take an antacid in the morning to settle your stomach. Take 1 g vitamin Ñ with the water you drink last thing at night-the vitamin will help your liver to cope with detoxifying the alcohol. Take a simple pain-killer if you have to. Don’t mix drinks. Don’t drink alcohol to cure a hangover (‘hair of the dog’) because this only makes the final effects worse.

•    Avoid foods that give you headaches.

•    Have your eyes checked by a good optician just in case poor eyesight could be giving you tension headaches.

•    Have your blood pressure checked if you are over 40 and have repeated headaches for which you can find no explanation.

•    Massage your scalp. A US researcher has found that he can prevent headaches by a special hair-brushing technique. It involves massaging the scalp, which could, of course, be done with one’s fingers, but he found better results using a hairbrush. Use a natural brush which is stiff but not as rigid as a typical hairbrush. Synthetic bristles are too sharp when moved across the skin. Ideally the brush should be one that can be held in the hand comfortably. When buying a suitable brush use it on the skin on the back of your hand to test it. Move it in small circles to make the skin move but not so as to cause an abrasion or irritation to the skin.

The next thing, having found a good brush, is to make the scalp massage a regular part of your everyday routine, spending 90 seconds on it, morning and night. Starting at the temple just above the eyebrow, press the brush against the skin and rotate it in small circles so that the upper part of the circle goes towards the back of your head. Move up the skull with each pass from front to back of your head so that after three circles you are at the top of the head. Continue these small circles all over the scalp right down to the hair line.

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In the early 1980s, cardiologists were still arguing as to whether bypass surgery to improve the coronary artery flow was worthwhile. There were doubts about its safety and its long-term benefits. In the early days, many bypasses closed off a few months after the operation, leaving the patients no better off.

These doubts are now dispelled. Bypass surgery is now accepted as improving the quality of life of thousands of angina sufferers, and as saving many lives. It has a very high success rate, and the restenosis rate is diminishing year by year.

To bypass surgery has been added balloon angioplasty and, more recently, laser and stent treatment.

Stents and lasers

To balloons and bypasses have now been added stents and lasers. The catheter technology that uses balloons can also put stents in place. Stents are tiny tubes, made up of what looks like wire mesh, that can be placed in the narrowed section of artery to keep it open. The stent is placed there in a folded or collapsed form, and springs open when it is released at the right spot. It can be left there permanently, as the lining of the blood vessel grows around the mesh, holding it in place, and at the same time allowing it to remain wide open.

The catheter technology is also being developed to use lasers to burn away plaques that protrude into the bloodstream, under direct vision enabled by fiber optics. This is still a research procedure, but it cannot be long before it becomes one of the choices for the cardiologist.

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High blood pressure (hypertension), like cholesterol, smoking, and alcohol, deserves a chapter of its own in any book on angina. Hypertension causes complications for the heart in two ways: it directly increases the work done by the heart, so that the demand for oxygen is increased, and it accelerates the process of atherosclerosis, so that the coronary vessels in someone with hypertension are even more affected by atherosclerosis, and therefore narrower, than in someone with normal blood pressure.

Hypertension is linked with higher than normal risks of stroke, heart attack, and kidney disease, and it is vital that it should be controlled in anyone with angina. Professor Giuseppe Mancia of the University of Milan, one of the world’s leading experts in the study of hypertension, recently spelled out to me the risks of the combination of hypertension and angina.

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The “in” word for exercise in the 1990s is aerobics. Aerobic fitness is a measure of how well your heart, lungs, and blood vessels get oxygen to your muscles—in other words, your stamina. You become fitter aerobically by using your larger muscles continuously for a relatively long time. You don’t do so by stopping and starting a lot, as in gardening, golfing, or washing your car. You do become fitter if you continue your exercise until you get slightly out of breath, but can still keep up a conversation.

That is what you should aim at—an exercise lasting around twenty minutes that makes you slightly out of breath, three or four times a week. Don’t be disheartened if you can’t manage it yet, but aim to build up gradually towards that point. Even walking faster than usual for a few minutes is a start towards it, and week by week you will be surprised how much further you can walk before you get to the breathlessness point.

If you are so breathless that you cannot keep up a conversation, or your muscles are getting heavy or sore, then you are working too hard. You will not improve your fitness by exhausting yourself in this way. It is not true that exercise needs to hurt your muscles before it does you good. Muscles that are sore are being starved of oxygen, and that is not the aim!

Obeying this rule means that you should control your own level of exercise, and not be controlled by some outside influence, like the rhythm of music on a tape, or the need to compete with yourself (by, for example, timing your walking speed or distance).

Don’t do too much too quickly. No matter what your exercise, whether it is walking, cycling, running, or swimming, don’t push yourself to go further each time you do it. If your chosen exercise becomes like hard work, you are more likely to give it up, and the more likely you are to be injured. Your aim is to continue for life, and not for just a few weeks.

*57\86\8*

Another approach to the cholesterol problem was to target only those with high blood cholesterol levels, and to treat them with drugs. Drugs to lower blood cholesterol levels were studied first in the 1970s, but they have had a troubled history since then.

WHO and Clofibrate.

The first study, the WHO Cooperative Trial of the cholesterol-lowering drug clofibrate, followed 15,745 healthy men in Edinburgh, Budapest, and Prague. Treatment was based on their cholesterol levels. Those in the upper third for blood cholesterol levels were allocated at random either to the clofibrate, or to a placebo. Those in the lower third for cholesterol levels were also given a placebo—they were the baseline control. The study was double blind, so that researchers and patients did not know what they were taking or in what group they were.

The results for heart attacks were mildly encouraging, as the clofibrate group had fewer nonfatal heart attacks than the high cholesterol group given a placebo. However, the clofibrate group had the highest overall number of deaths—a result that stopped the use of the drug in its tracks! This was despite its lowering the cholesterol levels by an average of 9 percent.

The excess of deaths of people taking clofibrate were not due to a single disease or discernible cause. The greatest benefit of cholesterol-lowering was in younger men with moderately raised cholesterol levels, but this was overshadowed by the unexpected extra deaths. The use of cholesterol-lowering drugs in anyone other than people with extremely high cholesterol levels has never fully recovered from that trial result.

*37\86\8*

Take glucose in the serum as an example. Every cell in the body needs a continuing supply of glucose to stay alive. The burning of glucose with oxygen is your main supply of energy, so the level of glucose in the blood must remain within very strict limits. If it falls too low, you become faint and weak as your muscles and brain start to fail.

However, if the blood glucose level rises too high, as it does in poorly controlled diabetes, the blood becomes measurably stickier, and thickens. This is a problem for people with diabetes, who are at higher than normal risk of angina if they do not control their glucose levels very closely for this and other reasons.

A raised glucose level, however, is a very minor change compared to a rise in blood fat levels, or if the platelets become “stickier.” Even a small rise in fats—mainly measured as cholesterol—can make the blood much more viscous, and when this is combined with clumps (or aggregates) of platelets floating in the bloodstream in the smallest arteries, it can greatly reduce the smooth and easy flow of blood through them. These are changes that can happen to all of us, not just to diabetics, and that we can do much to reverse. If we let them continue, on the other hand, we are inviting the conditions for angina to develop.

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In the continuing debate over the risks versus the benefits of estrogen replacement therapy (ERT), a new study adds more weight to the positive side of the scales. Researchers at the University of Southern California monitored over 8,500 postmenopausal women and discovered that those who at some time had undergone ERT lived an average of 1 1/2 years longer than those who never did. The researchers also found that women who underwent long-term ERT—at least 15 years—lived up to 3 years longer than women who never had such therapy. The results of this study appear to support the many medical experts who are now maintaining that the benefits of ERT outweigh the risks.

Recent studies suggest that low dose estrogen replacement therapy may not be associated with an increased risk of breast cancer. In the study at U.S.C., women who underwent ERT and had any type of cancer were no more likely to die of the disease than those who did not undergo ERT. However, many experts believe that taking estrogen alone causes a slight increase in the risk of cancer of the uterus. But when progestin, a synthetic form of progesterone, is given in addition to estrogen, the risk is reduced. However, such combination therapy can cause continuation of periodic spotting.

Although much of the recent news about ERT is reassuring, the decision to undergo the therapy is still a highly personal one for most women. Experts also warn that ERT is not appropriate for everyone.

*202\27\8*

If you want to be sure you’re getting the best care from your doctor, you shouldn’t be afraid to ask questions and/or provide the doctor with any pertinent information. That’s the advice of researchers from Harvard University who recently conducted a study into the patient/physician relationships.

According to the study, doctors can become so intent on writing prescriptions and ordering the latest tests that they completely overlook providing patients with even the most basic information. In order to get the information you need about any medical problem, you must ask questions.

Over 500 physicians were involved in the study which presented a specific case scenario, requiring the doctors to indicate what questions they’d ask the patients and what treatment they would prescribe. In the hypothetical case, the patient was a man with stomach pain, and a test indicated stomach inflammation but not ulcer. Fully one-third of the doctors responded to the case scenario by saying they would not ask questions and would prescribe drugs, even though they were openly encouraged to ask for further information.

Researchers say that if those doctors had asked the patients a few questions, they would have found out that the patient took aspirin on a regular basis, was a heavy drinker and smoker and had recently gone through the death of a child— all factors which could contribute to the problem of stomach pain.

In order to avoid such “distracted” treatment and get the information you need, patients are encouraged to provide information and to ask their doctors questions, and doctors are advised to ask questions and to listen to their patients.

*240\27\8*

If you are 20 years old or older, The American Heart Association recommends that you have your cholesterol checked. If your test results show a cholesterol level within the borderline range— 200 to 230 milligrams per deciliter— you should have a second test done and average the two results. If the average of the two tests still indicates that you are in the high-risk group, you should begin immediate steps to lower your cholesterol level. A few changes in your diet may be all that’s needed to bring your blood cholesterol level down into a safe range.

If your cholesterol level is in the borderline-high range you should be tested once a year. If your is cholesterol level is 240 or higher, prompt medical attention is advised. However, if your cholesterol reading is below 200 mg/dl, you are within the desirable range, and need only be tested every five years or so, along with regular health care as appropriate.

Both The National Heart, Lung, and Blood Institute and the American Heart Association have determined that a relatively safe level of cholesterol is under 200 milligrams per deciliter of blood. The high-risk range is 240 mg/dl or above. More than half of all adult Americans are believed to be over the borderline-high cholesterol level of more than 200 mg/dl.

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