By 1992, Americans were doing better, dropping to 16th worldwide, behind Germany, England, Argentina, and a dozen other countries in CVD risks. (The Russian Federation was now number one.) This 23-year drop in CVD death rates was due to a number of things. Better education, improved surgical techniques, clot-busting drugs, and sophisticated emergency and health care system factors were instrumental. Individually, important behavior changes, including reductions in smoking and consumption of dietary fat, increased exercise, and defensive techniques such as cardiopulmonary resuscitation (CPR) also contributed to lower rates.

Despite these early encouraging signs, we still have a long way to go. In 2000, several databases indicated that Americans were more prone to obesity than ever before and led more sedentary lifestyles. Also, the epidemic of obesity was getting worse among our nation’s youth. Dietary excesses, particularly high-fat diets, and large portions, appeared to make a comeback.

Today, CVD continues to be the leading single cause of death around the world. In the United States, death rates from cardiovascular disease in men (ages 35-50) are three times greater than in women of the same age, but in later years (65-74) the incidence is about the same. In 1999, CVD accounted for over 41 percent of all deaths, or nearly 1 out of every 2.5 deaths. This is nearly 3 times the rate of the second leading killer, cancer, and more than the number of deaths caused by all other diseases combined. Of the nearly 2 million deaths per year in the United States, CVD was listed as a primary or contributing cause of death on about 1.4 million death certificates. CVD has been the number one killer in the United States since 1900, in every year but one -1918, when another killer, a particularly virulent strain of influenza (the flu), struck with blinding force. To help clarify just how serious CVD is to Americans, consider the following points:

- More than 2,600 Americans die of CVD each day, an average of 1 every 33 seconds. That’s more than 950,000 per year.

- Many of these deaths are sudden cardiac deaths, meaning that these Americans die from sudden, abrupt loss of heart function (cardiac arrest), either instantly or shortly after symptoms occur. Most of these deaths result from coronary heart disease (CHD); in fact, over 220,000 people, nearly half of all victims of heart attack, die from CHD before they get to a hospital.

- People who attempt to save such victims through cardiac resuscitation are sometimes riddled with guilt when they fail to save a life. However, many such deaths are due to sudden heart stoppage or slowing that even the most heroic efforts cannot prevent.

- CVD claims nearly 11,000 more lives each year than the next 6 leading causes of death combined.

- More than 150,000 Americans killed by CVD are under age 65.

- The 1998 death rates from CVD were 419.3 for white males and 532.0 for black males; for white females 294.9 and for black females 400.7 (rate is per 110,000 of population).

- From 1988 to 1998, death rates from CVD declined by 20.4 percent. However, due to increases in the total population, the decline in actual numbers of deaths was only about 3 percent.

- According to the most recent CDC/NCHS calculations, if all forms of major CVD were eliminated, life expectancy would rise by almost 7 years.

The probability at birth of eventually dying of CVD is 47 percent; of dying from cancer, 22 percent; from accidents, 3 percent; from diabetes, 2 percent; and 0.7 percent from HIV

Though these statistics seem grave enough, they do not include the effects of CVD experienced by the untold numbers who live with the ravages of the disease. Today, nearly 61 million Americans live with one of the major categories of CVD. Many do not know they have a serious problem. Nearly 13 million of these people have a history of heart attack, angina pectoris (chest pain), or both. In spite of major improvements in medication, surgery, and other health care procedures, the prognosis for many of these individuals is not good:

- Twenty-five percent of women and 38 percent of men will die within 1 year after having an initial heart attack.

- People who survive the acute stages of a heart attack have a chance of illness and death that is 1.5-15 times higher than that of the general population, depending on their sex and clinical outcomes. The risk of another heart attack, sudden death, angina pectoris, heart failure, and stroke – for both men and women – is substantial.

- Within six years after a recognized heart attack, 18 percent of men and 35 percent of women will have another heart attack; 7 percent of men and 6 percent of women will experience sudden death; about 22 percent of men and 46 percent of women will be disabled with heart failure about two thirds of heart attack patients won’t make a complete recovery, but 88 percent of those under age 65 will be able to return to their usual work

- CHD will permanently disable 19 percent of the U.S. labor force.

You can reduce your risk for CVD by taking steps to change certain behaviors. For example, controlling high blood pressure and reducing intake of saturated fats and cholesterol are two things you can do to lower your chances of heart attack. By maintaining your weight, decreasing your intake of sodium, exercising, not smoking, and changing your lifestyle to reduce stress, you can lower your blood pressure. You can also monitor the levels of fat and cholesterol in your blood and adjust your diet to prevent arteries from becoming clogged. Having combinations of risk factors seems to increase overall risk by a factor greater than those of the combined risks. Happily, the converse is also true. Reducing several risk factors can have a dramatic effect.

Understanding how your cardiovascular system works will help you understand risks to cardiovascular health and reduce them.

*2/277/5*

Theories abound concerning the mechanisms that regulate food intake. Some sources indicate that the hypothalamus (the part of the brain that regulates appetite) closely monitors levels of certain nutrients in the blood. When these levels begin to fall, the brain signals us to eat. In the obese person, it is possible that the monitoring system does not work properly and that the cues to eat are more frequent and intense than they are in people of normal weight.

Other sources indicate that thin people may send more effective messages to the hypothalamus. This concept, known as adaptive thermogenesis, states that thin people can often consume large amounts of food without gaining weight because the appetite center of their brains speeds up metabolic activity to compensate for the increased consumption. Older studies have indicated the possibility that specialized types of fat cells, called brown fat cells, may send signals to the brain, which controls the thermogenesis response.

The hypothesis that food tastes better to obese people thus causing them to eat more has largely been refuted. Scientists do distinguish, however, between hunger, an inborn physiological response to nutritional needs, and appetite, a learned response to food that is tied to an emotional or psychological craving for food often unrelated to nutritional need. Obese people may be more likely than thin people to satisfy their appetite and eat for reasons other than nutrition.

In some instances, the problem with overconsumption may be more related to satiety than to appetite or hunger. People generally feel satiated, or full, when they have satisfied their nutritional needs and their stomach signals “no more”. For undetermined reasons, obese people may not feel full until much later than thin people. The leptin and GLP-1 studies seem to add credence to this theory.

*9/277/5*

Now let’s turn to some specific skin infections. Lately I have noticed a gradual increase in Impetigo. The lesions of this contagious skin infection are characterised by thin, rolled vesicles or pustules, in a thick superficial crust, often caused by haemolytic streptococcus and staphylococcus influences. To my mind impetigo is caused more often nowadays by a faulty diet than by poor hygienic management. In hot climates impetigo problems seem to be becoming more common and there I think the causes lie in diet and hygiene in equal importance. Fortunately, impetigo can be cleared relatively easily, as long as the right measures are taken.

With children in particular, one should look at the child’s constitutional condition and likely causes will be malnutrition or a poorly balanced diet. Introduce plenty of fruit and vegetables into the diet and consider substituting cow’s milk with goat’s milk. Try to make the child eat raw food, such as salads, although I admit that this may not be so easy in younger cildren. Added to this, bathing in Epsom Salts baths and the use of Echinaforce, Violaforce and Urticalcin, makes a very good all-round treatment to clear impetigo.

*25\147\2*

Arousal depends on the woman’s (1) anatomy and physiology; (2) mental and emotional make-up; (3) environmental factors; (4) cultural conditioning; and (5) partner.

ANATOMY AND PHYSIOLOGY: The highly sensitive sensuous clitoris is the primary organ for sexual pleasure in the female. Other  erotic zones which arouse a woman sexually are the lips, the ears, the side of the neck, and the breasts.

MENTAL AND EMOTIONAL MAKE-UP: ‘It’s all in your mind,’ a lady remarked while talking to-me about sexual arousal and response, adding, ‘There should be no mental blocks about sex. Take my sister’s case. She has some aversion in her mind ever since she broke off her engagement.’ If a woman has a mental block about sex due to an unpleasant episode like a man forcibly trying to possess her, or the boss at the office pestering her about a date, she may not be aroused fully.

Men are more erotically aroused than women by psychic stimuli like reading about a torrid love episode, seeing a nude picture or a shapely female. Women are aroused more by touch than by sight.

*96\262\8*

That is the question put by Dr Rogers, and the title of her book, which I recommend everyone should read. She may as well have asked: Are you an asthmatic or just toxic?

The Body Detoxification System

The body possesses a unique detoxification system that, until recently, had been neglected. In fact, most medical textbooks of the 70s and 80s do not even mention it in terms of environmental illness.

Yet a detoxification system exists in every cell of the body, although the one we are most concerned with is the one in the liver: the so-called cytochrome P-450. Its study received a great impetus when space medicine found it had to resolve problems arising from chemical contamination from outgassing materials in space capsules. Other scientists studied how the body protects itself against the onslaught of an ever-increasing number of chemicals, or xenobiotics, which permeate our environment. Our body has to process, metabolise or change practically everything that enters it. Most xenobiotics are changed into safer or less toxic substances so they can be excreted without poisoning the body further. As we have seen, however, the detoxification system can be inefficient, overloaded, damaged and, on occasions, swamped so that it almost comes to a standstill.

The two phases of the detoxification process

DETOXIFICATION

Inhaled, ingested, or absorbed xenobiotics (foreign chemicals)

Any of these pathways can be blocked or damaged by:

Vitamin deficiency

Mineral deficiency

Amino acid deficiency

Fatty acid deficiency

Endo-toxin micro-organisms

Foreign chemicals for which the body has no mechanism for detoxifying

Newly formed metabolites (breakdown products) of xenobiotics

Detox enzymes poisoned by heavy metals (mercury, aluminium, cadmium)

Detox pathways overloaded from everyday chemicals in the environment

Poor genetics (lack of specific detox enzymes)

Phase 1 occurs primarily in the liver and involves reactions like oxidation, reduction, hydrolysis and so on. All these fancy names mean is that the composition of the chemical is changed in specific ways (removing or adding electrons or hydrogen atoms, for example).

The process of changing these chemicals in readiness for excretion cannot proceed efficiently without producing a cascade of ‘free radicals’, highly reactive particles that can cause unseen damage to delicate portions of living cells. Even when the poison eventually starts to exit from your body, it may do some damage to the kidneys, for example, on its way out.

The back-up detoxification system which tries to take care of such eventualities is the second detoxification phase. This process is known as ‘conjugation’, from the Latin for attach, and it is a rather complex procedure by which the body attaches a protein or amino acid to the changed chemical, now called a metabolite, making it bigger and giving it an electric charge. This makes it easily excretable via the bile or stools, thus keeping the more delicate kidneys out of it. Amino acids play a major role in this process and one of the most important is a combination of three different amino acids (glutamic acid, cysteine and glycine) called glutathione ](GSH). Unfortunately, GSH is also involved in many other processes, such as the making of hormones, genetic materials, and enzymes. If the body is overloaded with chemicals which need GSH, less may be available for these other important functions.

Cysteine appears to be the key to successful GSH synthesis and ability. The most efficient form is called ‘N-acetyl-cysteine’.

Unfortunately all this is not as simple and foolproof as we would like. The process of detoxification (scientists prefer to use the term biotransformation) is a very complex one and the body has to choose between many possible metabolites into which to change the chemical. Sometimes it chooses the wrong one and the body ends up with a metabolite that is more toxic than the chemical we started with.

Then there is another problem. The body has to choose, from so many available pathways, the most suitable at the time. Because detoxification involves enzymes and because there are innumerable enzymes, each highly specialised and specific for one reaction only, when the body is overloaded with one particular chemical it may not have enough reserves of one of the special enzymes needed at the time. Because no other enzyme will do, the xenobiotic continues on its own path of destruction. Many, if not all, the enzymes involved in detoxification need a particular vitamin or mineral in order to work. They are practically paralysed if there is a deficiency. Now you understand why most environmental doctors will give you what seems a mountain of vitamin pills to take. It’s a little bit like having lots of policemen lining the route of a demonstration, just in case something happens, because if trouble does start, any place where there are no police is likely to see havoc. The fact that there may be lots of priests or Salvation Army personnel around will not make a bit of difference because neither is specialised to arrest or fight rioters. The detox police are, in this case, the antioxidants.

It’s quite possible to be affected by xenobiotics simply because you are, unknowingly, deficient in a key mineral or because your body has unusual requirements for that one nutrient. In that case it is called a ‘dependency’ rather than a deficiency. When, for whatever reason, there are more chemicals in the body than the detox system can handle, damage can occur, often to the mitochondria — the so-called powerhouse of the cell. By the time the detox system catches up with any backlog, some damage may already have occurred. This is why you do not always feel better as soon as you take all the supplements prescribed. They may just stop further damage from occurring.

A blockage or slow-down of detox activity can cause other problems. The chemical that can’t get through may damage you, but so will all the chemicals which follow. They may cause further damage to the detox system, starting a chain reaction that can lead to all sorts of health problems, including cancer. The pathway your body chooses to get rid of a chemical depends on what enzymes are available, the level of nutrients (vitamins, minerals, amino acids etc..) on hand, the total load at the time and the degree of damage to detox pathways that may have been caused by other chemicals.

The detoxification pathway bottle-necks

In phase one, some xenobiotics are first changed into alcohols which then must be metabolised to aldehydes. Only from the aldehyde stage can the chemical be safely excreted as an acid, via the urine. Alcohol dehydrogenase is the enzyme that changes an alcohol into an aldehyde.

Two important facts

Females tend to have fewer alcohol dehydrogenase enzymes than males. That is one of the reasons they are more easily affected by lower doses of alcohol.

Compared with Europeans, Australians have a disproportionate number of asthmatics. They also drink more alcohol, or they drink more without eating at the same time, than most Europeans.

Phase two bottle-necks occur whenever there are not enough antioxidants.

What are some of the clues that you have become sensitive or overloaded chemically?

You will be aware of strong-smelling chemicals, perfumes, cleaning materials and so on. They may make you feel uneasy.

You are not able to tolerate a lot of alcohol.

If you think of it, from time to time you seem to feel vaguely unwell, or some symptoms seem to be worse when you go into a shopping mall, a department store or a new hotel.

There are some medicines that simply don’t do you much good and you can’t tolerate.

The same applies to some nutritional supplements, herbs, vitamins or minerals, which sometimes make you sick.

Here Today, Gone Tomorrow

One of the most frustrating experiences for an environmental doctor is to be faced by a patient who is clearly bombed out by chemicals but says: ‘Impossible! If chemical X was a problem, how come nothing happened when I was exposed to it on some days, while at other times I felt unwell? It so happens that the days I am unwell (at the office, home or wherever…) are always the days when I have a lot of stress. Also I know it’s not the chemical, because when I am unstressed and happy, many of the symptoms disappear, even though I am working/living in the same place. And anyway, I have been exposed to X for twenty years and it’s never worried me before.’ What these patients say is such common sense! Alas, common sense sometimes needs to be replaced by lateral thinking.

The body is not trying to get rid of exactly the same number or types of chemicals all the time or every day. Say your body is working flat out to rid itself of the trichloroethylene you were exposed to all night long because you had a batch of freshly dry-cleaned clothes in your wardrobe. It may also be busy trying to get rid of an accumulation of formaldehyde out-gassing from your new lounge-room carpet, which you inhaled while watching television. As an analogy, let’s say that by the time you wake up the camel’s back has a high pile of ‘straws’ on it. You enter the office, someone turns on the photocopier and ten minutes later, bingo! You feel unwell. The last straw broke the camel’s back. But only because you slept in a room with a wardrobe full of freshly dry-cleaned clothes and spent several hours in the same room as a new carpet. So although the photocopier is the last straw, it is no more responsible for your trouble than the dry-cleaning or the carpet. Remove any one of them and you may not have become sick. Anyway, you get better later on and by the time you get home many of the xenobiotics have outgassed from the dry-cleaning and you don’t watch television as much that night.

The next day when the photocopier starts up, there is still a little room on your camel’s back, so you don’t feel a thing.

Naturally, the same thing happens if your stress levels are high enough to lower your resistance, place demands upon your body, use up energy, and so on.

Let’s go back for a moment to detox Phase 1 and its bottlenecks. When the detox process is halted at this point, some of the alcohols and aldehydes may be metabolised to epoxides. These are dangerous and highly reactive chemicals, suspected of playing a major role in the predisposition to cancer (mutation), allergies, immune suppression and cellular ageing.

Nutritionally, the best protection against such blockages is an ample supply of zinc, GSH, selenium, magnesium, vitamins C and E, beta carotene and amino acids containing sulphur (apart from meat and fish, sulphur can be found in eggs, cruciferous vegetables, onions and garlic).

When detoxification pathways don’t work well, chemicals get shuffled around by the body, searching for a way out. In doing this they can interfere with the detoxification of other chemicals so that any one xenobiotic which, until then, was being cleared merrily on its way, all of a sudden starts to pile up. What can happen to your body as a result of all this?

Judy, who until that day was unaffected by the toluene outgassing from her carpet, feels unwell at home. If she tells anyone, chances are they will shout ‘neurotic’ unless, of course, they are familiar with the biochemistry of detoxification. When considering environmental illness, it is well worth keeping in mind a few simple principles:

Health is not just the absence of disease.

Many illnesses do not have a single, easily identifiable cause.

Everyone is biochemically unique.

In a group of sick people each individual may have his or her particular trigger or allergen that is responsible for much the same symptoms.

The opposite is also possible. The same trigger, allergy, chemical or whatever may provoke different symptoms, even different illnesses in some individuals. An asthmatic may suffer more breathing difficulties but someone with chronic fatigue may just become more tired.

Any material which outgasses (emits particles called ‘osmols’) can be breathed, will enter the bloodstream and may affect any organ, including the brain, even if you can’t smell it.

Once you become sensitised or overloaded, chances are you will become more and more sensitive to more and more factors, be they foods, chemicals or inhalants.

Once exposed, there sometimes occurs a resetting phenomenon whereby one becomes affected more easily by lower doses or shorter exposure times. The symptoms may become more severe with repeated exposure.

The brain is a common target of xenobiotics.

The environment is not constant. It changes all the time.

For that reason, among others, reactions or symptoms are not always the same, as they depend on both the state of the environment at the time and the individual’s capacity to detox.

Therefore, reducing the total load must be the most basic step.

In practice, this means that even apparently minor, superficial factors which are not known to provoke noticeable symptoms or reactions must be eliminated if possible. Such factors as allergies, moulds sensitivities, Candida, dust mites, hypoglycaemia, hormonal problems, pre-menstrual syndromes, nutritional deficiencies, imbalances or dependencies — even excesses.

So remember: detox, avoid, protect and educate yourself and others.

There is a general set of rules for environmentally ill people:

Understand, and get your doctor to learn, that xenobiotics can take up residence within macrophages and produce no symptoms or illness until further stimulation by an antigen (allergen, virus, bacteria) causes them to begin a flood of interlukins, thus altering dramatically that individual’s immune response capabilities, sometimes without measurably altering the actual numbers of immune components. It is in this way that one becomes an asthmatic and starts to react allergically to all sorts of things only after a severe viral illness.

The effects of exposure to xenobiotics (in the following example, solvents) have been shown to be time-synergistic. This means that damage by a single solvent may take about twelve years to occur. If someone is exposed to two solvents simultaneously, the mean time before damage occurs is reduced to about seven years. Exposure to three solvents can shorten this to around four years. There is a good possibility that the same or a greater degree of exponentiality occurs with many xenobiotics.

Remember that moulds can be toxic and cause allergies. Fungi can produce powerful mycotoxins.

If your home has been treated with pest-control chemicals, do not vacuum too often as it redistributes dried-up chemicals into the air. Have the carpet thoroughly cleaned first, without using more chemicals.

Never sleep in a freshly painted or wall-papered room.

Switch electric blankets off at the main plug site before getting into bed.

Do not leave clock radios on near the bedhead.

Do not have a bedroom over your garage.

If you are allergic, and especially if you are asthmatic, avoid barbecues and charcoal-cooked foods.

Avoid permanent-press clothes and do not sleep on a synthetic mattress or polyester sheets.

Use natural, non-toxic paints and do not use wood oils and oil paints in the bedroom.

If you want to nurture your liver, sleep between 8 and 11 p.m. is the most important recuperative time for that organ.

Avoid jogging or riding a bicycle in a metropolitan area and never do it where there is vehicle traffic.

If chemicals are a problem and if you are asthmatic you will have to detox your diet, your body, your home (especially your bedroom) and your mind.

Diet

Eat as naturally as possible. Choose organic products whenever possible. Even organic lamb and beef are available these days. Check food allergies and intolerances and make sure the diet is optimal for you.

Body

Avoid drugs whenever possible, including alcohol. Use as few chemicals on your body as possible. Use hypoallergenic natural products whenever possible.

Home, Especially the Bedroom

Clean up dust, mould, outgassing sources, and so on, and use plants to ‘soak up’ chemicals.

Always get advice from experts on equipment and systems such as water filters, air conditioning, dehumidifiers and anti-mould and anti-dust mite procedures, but be careful. There are firms which advertise such services that will take your money and not do a suitable job. As a safeguard, ring one of the environmental groups to find out who they recommend.

Mind

Remember that angry, negative thinking is stressful. Love and laughter are the best medicines.

*25\145\2*

There are so many symptoms associated with PMS  that diagnosing the condition is not always easy. Some medical textbooks list up to 150 symptoms that have been associated with the condition and many of the symptoms of PMS are also found in other illnesses.

Headache, insomnia, feeling ‘low’, irritability, and sugar cravings are not only felt by women with PMS. Men, children and women without PMS may all experience these symptoms.

The key definition of PMS, now accepted by most doctors, is that symptoms occur only in the two weeks before a period and that there are absolutely no symptoms for at least seven days after a period has started.

Symptoms tend to fall into two categories: physical and psychological. Given the huge number and range of symptoms associated with PMS, it is not surprising that it is sometimes confused with other conditions. Indeed some conditions, such as depression, may be masked because a woman also has PMS or mistakes her symptoms of diary. No good practitioner would diagnose PMS until a monthly pattern to the symptoms has been established.

Doctors are also reluctant to treat PMS unless the symptoms are severe enough to significantly alter a woman’s lifestyle. Many women who experience irritability, or fatigue, or who gain weight before a period will not be diagnosed as having PMS because these symptoms are regarded as normal.

However, that does not mean you have to stand by and do nothing. There is plenty you can do to ease these problems .

*2\120\4*

When the brain’s learning/unlearning cells are being over-stimulated and the circuit breakers are beginning to switch off overloaded circuits, the brain’s normal capacity for inhibition is seriously impaired. Consequently, the ability to tolerate things previously tolerated begins to be lost.

This loss began in the second stage, with loss of the ability to use the will-power to inhibit emotional display. Now the situation has become worse, and the person begins to lose the ability to ‘put the lid on’ reactions which were previously suppressed. In stage three stress breakdown, people will suddenly become intolerant to things they previously accepted. Common statements made during this time, include:

‘Henry,’ (she is speaking very quietly, through clenched teeth), ‘if I hear you slurp your soup just once more, like you have been doing for the last thirty years, so help me I’ll throw it over you!’ or ‘The next time you squeeze the toothpaste from the top of the tube will be the last time you’ll ever do it!’ or ‘If I find your dirty overalls just thrown on the floor behind the bedroom door just once more, they’ll be thrown out into the yard, and I hope next door’s dog rips them to shreds!’

I have found that an adult audience will often warm to providing examples such as those above, indicating to me that many people can recognize this aspect of stress breakdown, and one which is very often misunderstood. Men are often quite perplexed at finding that their wives are no longer willing to put up with their little faults and bad habits that the wives were able to tolerate for years. ‘What’s come over her, doctor?’ ‘I think she must be going through the change of life!’

*32/129/5*

Once the cancer penetrates a couple of layers of skin, its wild cells break loose and travel the tiny canals of the body to lodge in the liver, brain, kidneys, and other sites on the skin. There they settle and form ever larger clumps, choking the organs they have invaded.

For early detection, Dr. Rigel and his colleagues have developed an “ABCD” system to help you locate a cancer or a potential cancer on your body:

•   A stands for asymmetry, or irregularity of shape, meaning that you cannot draw a line through it to create matching halves. Non-cancerous pigmented lesions usually are round and symmetrical (when cut down the middle, their halves have matching shapes), but early malignant melanomas usually are asymmetrical.

•   В is for an irregular border – common to cancerous growths. Benign growths usually have regular margins.

•   С is for color. A harmless growth generally is one color overall and flat. Cancerous growths, however, harbor various shades – from tan and brown to black, sometimes mixed in with pink or with red and white.

•   D is for diameter. If the growth measures more than 6 millimeters across (about one-fourth of an inch), it is dangerous.

The Skin Cancer Foundation recommends regular self-examination of every inch of your skin – from the top of your head to the soles of your feet and between your fingers and toes. (Be sure to have a dermatologist examine you annually.) To do it yourself, stand nude with your back turned to a full-length mirror. Then look into a hand-held mirror to examine the back of your neck, torso, rump, and legs as reflected in the full-length mirror. Anything you see that doesn’t clear the ABCD test requires a medical exam. Even if you find skin spots (dysplastic nevi) that almost fail the ABCD test, they may be warnings that you have a genetic predisposition to melanoma. Watch these carefully and see your doctor immediately in response to any change in them.

In addition to self-examination, all of us – black-skinned to fair – need sun protection. The sun’s ultraviolet light harms our skin, including the soles of our feet and our palms. Evidence suggests that damage done during childhood and the teen years creates the greatest risk, so we must teach small children caution.

To avoid trouble, heed these pointers from the Skin Cancer Foundation:

•   Avoid the sun, especially between 10 a.m. and 3 p.m.

•   Wear a broad-brimmed hat to shade the face; wear long pants and long sleeves.

•   If you must expose your skin to ultraviolet light, use sunscreens rated 15 or higher – it will take you 15 times longer to get sunburn. Sunscreens do not filter out all the ultraviolet rays, however, and doubts have been raised about the toxicity of urocanic acid used in some of them. It has been found to suppress the immune system and allows tumors to grow. The Food and Drug Administration is reviewing a petition to investigate.

*3/266/5*

In all patients with rheumatoid arthritis, the wrists are affected. In fact, if the wrists do not appear to be involved, I would not diagnose a person as having RA. The knuckles and the middle finger joints are’ usually involved on both hands. Some changes that may occur in the hands include what doctors call ulnar deviation, which is the bending of the fingers toward the outer part of the arm (where the ulnar bone is located). The so-called “swan-neck deformity” is very typical in hands affected by rheumatoid arthritis. Here, the middle joint of the finger bends down and the joint nearest the tip of the finger bends up, giving the finger the appearance of a swan’s neck. This deformity is very typical of the rheumatoid hand. The hand can also have what are called “boutonniere deformities,” in which the middle finger joint pops up, resembling a boutonniere.

Swelling of the various ligaments around the wrist can result in trapped nerve syndromes like carpal tunnel syndrome, where the median nerve that goes through a closed space into the wrist is compressed. Another syndrome, also the result of nerve entrapment, is ulnar-nerve compression syndrome at the elbow. This causes extreme weakness of the pinky finger.

Sometimes rheumatoid nodules form on the tendons of the hands and may rupture. Tenosynovitis, inflammation of the tendons and the linings of the joint and tendon spaces, can also affect the hands. This can result in a rupture of the tendons and loss of mobility of fingers or, in severe cases, of the entire hand.

*12/141/5*