Symptoms: poor appetite, vomiting, constipation, irritability, slow development, aggressive behavior, seizures, personality changes, clumsiness, paleness, fatigue, weakness.

Home care

Discourage your child from putting nonfood objects into his or her mouth and swallowing them.

If your home was built before 1950, have the paint and plaster tested for lead content.

Watch for changes in your child’s behavior.

Precautions

-    Check your home and yard for possible sources of lead.

-    Scraping, sanding, and other tasks involved in remodeling an older building may release lead into the air. Such a location should be avoided by infants, small children, and pregnant women until the work is completed.

-    A person who works in an occupation that involves exposure to lead should take steps to avoid bringing lead-containing dust into his or her home on work clothes.

-    Sources of lead poisoning can include artist’s pigments, exhaust from cars, soil around buildings on which lead-based paint was used, city air, and improperly glazed pottery.

Lead is a heavy and dense metal that, in the human body, acts as a poison. Microscopic particles of lead can enter the body if a person swallows something that contains lead or inhales air contaminated with lead. The metal then accumulates in the blood and in body tissues. The most serious effects of lead poisoning are on the brain and nervous system. It can also damage the digestive system and the kidneys.

Before 1950, lead was an ingredient in paint, plaster, and putty, and most cases of lead poisoning occur when a small child eats fragments of lead-based paint that have peeled off a wall or have been left in the soil around a house. Today, house paint does not contain lead, but the metal is found in many other places. Some of the sources of lead poisoning include artist’s pigments, exhaust from cars (some petrol contains lead), soil around buildings that were once painted with lead-based paint, and the air in cities where lead may be used in industry and where the exhaust from many cars is concentrated. Also, lead is found in high-acid food and drinks (for example, orange or tomato juice) that have been stored in lead-containing pottery that was not properly glazed.

Lead poisoning can cause permanent damage to the brain, especially in cases where the symptoms are severe. Such damage may not occur if the problem is quickly identified and treated. However, a child who has had lead poisoning may take as long as a year to recover completely. Lead poisoning occurs most often in children under five. It is most dangerous if the child is under two years old.

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•     The causes of migraine are many. Some people are exceptionally sensitive to particular foods (typically cheese, citrus fruits, fried foods, chocolate, seafood or red wine). Others are sensitive to: stress; not enough or too much sleep; noise; certain smells; missed meals; excitement; bright and flickering lights; changes in daily routine; or the weather (especially thunderstorms and snowstorms). Migraines, and indeed all types of headache, are three times more common in women than in men. Perhaps a fall in oestrogen triggers an attack. Women taking the contraceptive pill often have headaches, and taking the Pill can make migraine worse.

•     Dehydration (too little fluid) is a common cause of headaches. Most people drink too little fluid and easily become dehydrated in hot surroundings or if they miss a drink or two.

•     Tension headaches are produced by anxiety and stress. They are often seen in people who are meticulous and fussy. Unlike with migraine the pain of tension headaches lasts all day. The sensation is described as being ‘like a weight pressing on the head’ or ‘a tight band around the head’. Sometimes the pain goes to the back of the head and down the neck. People who concentrate for long periods of time (such as lorry drivers) often get this kind of headache. A variation of this is the tense-jaw headache which is caused by the individual clenching the teeth.

•    Hangovers are a very common cause of headaches. They are the results of consuming too much alcohol, which overloads the body’s ability to detoxify the alcohol.

•     Foods cause headaches in certain susceptible people. Ice cream and very cold foods can cause pain in the head and throat. Cured meats often contain nitrates which make blood vessels around the skull wider and cause headaches. Monosodium glutamate (especially plentiful in Chinese food) causes a headache in some people-often accompanied by nausea, abdominal pains and dizziness.

•     Poor vision does not cause headaches but if you sit with your eyes screwed up, frowning to see better, you can easily get a tension headache.

•    Headaches are often a sign of an impending infectious illness or fever. A simple pain-killer usually tides the person over until the cause becomes obvious.

•     Head injuries are, undoubtedly, a cause of headaches but the cause is usually all too apparent and cannot readily be prevented (except for the obvious measures of driving carefully, and wearing seat-belts in cars and crash helmets on motorcycles).

•     Very high blood pressure can cause a severe, pounding headache which is worse in the morning and improves during the day. The pain improves with the head up and is worse when lying down.

•     Brain tumours certainly cause headaches and many people worry that they might have a tumour, especially if they have repeated headaches. However, brain tumours are very rare indeed. If your headache is worse on waking in the morning or if it is worsened by sneezing, bending down or exertion then you should see a doctor to discuss it. If you have double vision, vomiting, drowsiness or weakness in a limb and are not a migraine sufferer you should seek medical help at once.

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Angioplasty, also known as percutaneous transluminal angioplasty, means changing the shape of a blood vessel. In balloon angioplasty, a thin catheter is passed through an artery in the leg up the main artery in the abdomen, the aorta, into the heart, and the tip inserted into the affected coronary artery, under X-ray control.

The tip of the catheter is passed through the narrowed section (which has been identified by a previous coronary angiogram). Just short of the tip, the catheter forms a tiny balloon, which is inflated once it is exactly opposite the narrowed segment of artery. This compresses the atheromatous plaque back into the wall of the artery, widening it. After angioplasty, the blood flow through that section of artery is usually multiplied many times.

Original doubts about angioplasty have been cast aside, now that many thousands of people have been treated, and the successes have been obvious. It works best for those with single-vessel disease who fail to respond to medical therapy. It has a greater than 90 percent success rate in coronary arteries, and many angina patients feel much better immediately after it is done. The risk of restenosis is 25 to 40 percent and greater the first six months after the procedure.

Angioplasty is performed under local anesthesia and moderate sedation, so that you will be hazily conscious throughout it. It is performed in the operating room, however, with an anesthetist on hand, so that on the very rare occasions that the catheter causes angina, the team can swing into a full bypass operation.

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So what should we conclude about alcohol and angina? Can angina sufferers have the occasional drink? My feeling is that they can, but it has to be under strict control. I would restrict drinking to the odd glass of wine with meals, and I still recommend abstention for three days a week. If you also have high blood pressure, then I would go further and advise only the very occasional drink as a treat.

A final word about alcohol. Probably the busiest times of the year for family doctors are the days after a national holiday such as Christmas Day, New Year’s Eve, or Thanksgiving. Special occasions for a family, such as a birthday, anniversary, wedding, or reunion, provide the same circumstances. At times like these, people overeat, usually a meal full of fat, and overdrink. Inhibitions are lost, everyone is very happy, and they go to bed full of food and drink.

During the night, all the conditions for shutting down the blood flow through a coronary artery are fulfilled. The extra fat in the bloodstream makes the blood more viscous, and the flow more sluggish. The blood is more likely to clot. The alcohol that you have drunk ensures that the blood pressure remains just a little higher than usual, and the strain on the plaque sitting in your coronary artery is a little greater. The result, in the small morning hours, may well be a heart attack.

I hate to be a killjoy, but if you have taken the trouble to change your lifestyle to protect your heart, it is a pity to throw all the advantages away just because of one night of overindulgence. You can enjoy a party much better sober than you can even a little drunk, and think of how much better you will feel in the morning.

*80\86\8*

The best exercise to start with is simply to walk. This is the exercise that benefits your health with the least fuss. Whatever your age and occupation, you can “take our hearts for a walk.” You don’t have to walk far or fast to begin with. The initial aim is to walk for up to twenty minutes three times a week.

You can do it by walking to work or the shops, or walk, rather than drive, to the train station. Don’t make yourself suffer in bad weather; you won’t keep it up, and it may put you off the idea of walking. If you normally catch a bus, get off a stop or two before your own stop, and walk the rest of the way. If you have a dog, take it for a walk yourself, rather than telling the children to do so. Walk on weekends, with the family, to the park, or on a trail.

Whenever you can, climb stairs rather than use the elevator. Walk, rather than drive, to any destination within a mile of your home. Even throw away the remote control of your television set, so that you have to get up to change the program! Do things, rather than watch television, in your spare time. If you do stay at home, try gardening or doing the odd jobs needed around the house.

If you feel you can’t keep up your new activities, recognize that it’s always easier to start something new than to keep it going. That is why you must choose an activity that you like, then start it gently and increase it slowly. Don’t despair if you backslide on a particular exercise. Start again, and keep on starting, because your heart will benefit every time that you do.

Once you have started on the exercise program, you will soon begin to feel better. You will be carrying less weight around, which will be less work for your heart for the same exercise—the demand side of that supply-demand equation is getting better. Your heart and muscles will be working more efficiently with the training, and your circulation will be improving. So where do you go from here?

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However, not all educational projects have succeeded like the Finnish one. The WHO (World Health Organization) European Collaborative Trial was an attempt to prevent coronary heart disease using factory-based health education. The subjects were 49,781 men aged forty to fifty-nine years, working in forty-four pairs of factories in Britain, Belgium, Italy, Spain, and Poland. The health education message was given to everyone working at the treatment factories, and not to those in the control factories.

Over all, after six years, there was an average reduction in coronary heart disease risk of 11 percent, and an average reduction of 8 percent in actual deaths from coronary disease, in the treatment factories compared to the control factories. However, the different countries varied in their success rates. The best successes were in Italy and Belgium, and in Britain there was no benefit at all, except in that by the end of the study fewer men were smoking.

The Belgian results were particularly interesting, in that the men in the treatment factories with angina and an abnormal EKG at the start of the study showed the greatest proportionate decrease in heart attacks. In the control factories, the heart attack rates in such men were 138 per 1,000 men; in the treatment factories, they were 63 per 1,000. This meant that the health education message was halving the heart attack rate in the men at highest risk—and this should be an encouragement to any reader with angina.

Why were the Belgians so different from the British? It is hardly likely that they are genetically different. Are British factory workers less likely to listen to a health message than their Belgian colleagues, or was the message not put across in a satisfactory way by the researchers in Britain? The answer is unclear, but one message from that trial was that a considerable effort is needed to make major changes in a society.

*36\86\8*

The heart should beat efficiently, be in peak condition, and have smooth, wide blood vessels that supply it with enough oxygen and glucose to deal with any demand put upon it, without clotting or sticking. For this to happen, the blood itself must be in peak condition.

Blood is certainly thicker than water, and it contains within it a blend of substances and cells that makes it much less than free-flowing.

First, there is the serum, the watery fluid in which all the constituents of the blood float. It carries minerals, salts, and glucose—all the soluble substances needed for the continuing health of the tissues and organs, and the waste products that need disposing of through the kidneys.

Then there is the plasma, which is the name given to the serum plus a mixture of proteins and fats, mainly derived from food. Cholesterol and related fatty-protein compounds, the lipoproteins, are part of the plasma. Very fatty plasma, high in cholesterol, is more viscous than normal, it is sticky to the touch, like the stickiness left after frying food in a pan.

Whole blood is plasma plus the cells—the solid constituents. They include the white cells (leukocytes), which act to resist infection and inflammation; platelets, fragments of cells that initiate clotting in arteries; and the red blood cells (erythrocytes) that transport oxygen around the body.

A fluid engineer would be horrified to be asked to design a pump for a closed system of wide and narrow tubes filled with such a mixture of solid, fatty, and watery substances. The difficulties in calculating the various pressures and flow rates are huge. For example, in each blood constituent—serum, plasma, and cells—there are substances that can make it much more viscous. As a fluid becomes stickier, the pressure needed to push it through a small tube becomes much higher, and that means a much greater effort from the heart. The demand of the myocardium for oxygen rises steeply.

*15\86\8*

Many doctors recommend that women should take hormones only if their menopausal symptoms—especially vaginal soreness, hot flashes, and night sweats—are severe enough to cause extreme discomfort. Other doctors believe that most women should take hormones to protect themselves against the effects of osteoporosis, and other benefits (see chapter 10). The therapy is generally not recommended for women who have a history of breast and/or uterine cancer, stroke, pulmonary embolism, liver disease, or deep-vein thrombosis.

If you are taking hormones, you should follow your doctor’s instructions exactly—have regular medical checkups, including pelvic examinations; Pap smears; blood pressure checkups; and mammograms. In order to eliminate symptoms such as hot flashes, most women need to continue treatment for at least one year. If a woman stops her treatment abruptly, the symptoms can reappear in just a few months. Hormone replacement as a treatment to prevent osteoporosis may need to continue for five to ten years or longer.

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THE MOST OFTEN

There are several factors which can affect a doctor’s ability to diagnose a patient’s symptoms. Sometimes a doctor’s lack of knowledge of a disease can place certain limitations on his or her ability to diagnose a specific problem. At other times the elaborate array of tests doctors now have to help in making their diagnoses aren’t always conclusive, and doctors sometimes have trouble interpreting them.

To further complicate the process, the specialist may not have a complete medical history and physical exam to refer to. There are also many diseases that have similar symptoms, making their diagnosis difficult. As a result, diagnosis is not an “exact” science. Here are several of the most commonly misdiagnosed, or hard to diagnose diseases and illnesses:

1) Osteoporosis— in a study conducted at the University of Kansas in Kansas City, researchers evaluated 180 women who had either had or were suspected of having osteoporosis. The researchers learned that in 46 percent of the women involved in the study, there were other health factors that could cause or worsen the disease but that had gone undetected by their doctors. Among those factors: menopause before age 40, thyroid disease, asthma or other lung diseases, and a loss of calcium through the kidneys. The researchers recommend that women should furnish their doctors with a complete and detailed medical history.

2) Food sensitivity— this involves an abnormal reaction to food or a food additive. It may or may not be caused by a food allergy. The illness can cause vomiting and/or diarrhea; hives; headaches and stomachaches; fatigue; respiratory problems; and severe cases can result in a life-threatening allergic reaction.

The symptoms are vague and may be hard to diagnose because they can suggest any number of illnesses. It is also difficult to track down the precise food causing the problem.

The American Academy of Allergy and Immunology, 611 East Wells Street, Milwaukee, Wl 53202, can furnish you more information on food sensitivity. Write, or call, 414-272-6701.

3) Rheumatoid arthritis— this is an autoimmune affliction that causes inflammation of the joints. Its symptoms may include pain when moving; swollen, tender and painful wrist, knuckle or finger joints; stiffness; and difficulty forming a fist.

The problem can be hard to diagnose because blood tests may produce false-negative results. The symptoms are also similar to many other autoimmune disorders.

To get more information, you can write to: Arthritis Foundation, P.O. Box 19000, Atlanta, GA 30326, or call, 800-283-7800.

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According to a recent study conducted in China, a relatively small drop in blood cholesterol could mean a significant drop in the risk of having a heart attack— even if your cholesterol level is already within the safe range. Results from the study indicate that a 4 percent drop in cholesterol level may mean as much as a 21 percent drop in the risk of having a fatal heart attack.

The key words in the Chinese study appear to be “relatively small”. Research conducted in the United States suggests that those people with extra-low cholesterol levels are more likely to die in later years from a variety of causes, including certain cancers, liver disease and lung disease, than those people with “normal” cholesterol levels.

The latest findings do not question the standard recommendation that people with high cholesterol should go on diets or, in extreme cases, take drugs to reduce their levels. The concern is for people with extremely low cholesterol- -160 units or less. The research appears to indicate that to reduce certain health risks an individual’s cholesterol level should be neither too high nor too low.

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