SLEEP PATTERNS: THE ROLE OF CIRCADIAN RHYTHMSIt is now believed that one major role of the circadian timing system is to organize our bodily processes and systems so that they occur in the proper sequence. In this way those functions that depend on each other can be coordinated, and those that are incompatible or that might interfere with each other can be separated. As suggested above, I like to think that the circadian system acts as a factory manager who schedules workers, ar> ranges the delivery of goods, determines production, and orders shipment of final products so as to achieve maximum efficiency. To demonstrate the point, let’s assume that a high body temperature is incompatible with secretion of a given hormone. The circadian pacemaker might coordinate the lowering of temperature so that, among other reasons, the hormone can be released to function properly. The pacemaker allows enough time for the hormone to complete its task, then brings the temperature back up to enable other body functions to operate at their peak. This is admittedly a simplified example, but it illustrates the point.Jet lag, which was covered in greater detail earlier (pages 51-58), appears to be largely the result of disruptions in our circadian cycles caused by our attempts to adjust suddenly to a new time zone. There are other, potentially more serious ramifications as well. It has been shown, for example, that one- and two-car accidents tend to occur, not during rush hour as you might expect, but at those times of day (between midnight and 7:00 A.M. and between 1:00 and 4:00 P.M.) which coincide with certain low points in our physiological function. Some researchers attribute this statistic, at least in part, to those circadian rhythms which dominate during these hours and which tend to make us vulnerable to unwanted sleep. Also, investigators ascribe some airline crashes to the circadian disruptions that are a known occupational hazard for pilots on long flights or flights at odd hours. And in the previous chapter I mentioned the fact that some cardiac diseases and other afflictions such as cranial hemorrhage are more likely to strike during the night, while some of our circadian defenses are down.*98\226\8*

CLASS-SPECIFIC SIDE EFFECTS OF ANTIHISTAMINESClass I: The Ethylenediamines Sleepiness and gastrointestinal (loss of appetite, cramping) side effects are common with the use of this class of antihistamines.
Class II: The EthanolaminesSleepiness is a common side effect of this group. Drying of the mouth and nose, difficulty urinating, gastrointestinal cramping, and loss of appetite also occur.
Class III: The AlkylaminesThese drugs are not as apt to cause sleepiness or drowsiness as most of the other classes of antihistamines. Nervousness (restlessness, irritability, excitement) is a more common side effect of this class of drugs.
Class IV: The PiperazinesHydroxyzine by far is the most commonly used member of this class and has a marked tendency to cause sleepiness and drowsiness. Hydroxyzine has strong anti-itch properties, however.
Class V: The PiperidinesIn general, these have a very low incidence of side effects because they do not tend to enter the brain as readily as some of the other antihistamines. Also, there is a lower incidence of dry mouth and nose, urinary difficulty, gastrointestinal symptoms, sleepiness, and nervousness with the use of this class. Cyproheptadine and astemizole are unique to the class in their ability to cause an increased appetite.
Class VI: The PhenothiazinesThis class of antihistamines is known for its ability to dry secretions and cause drowsiness or sleepiness.
Class VII: The ButyrophenonesThis class is noted for its lack of sedation, due to its inability to enter the brain. Its most common side effect is headache, which occurs in a small percentage of users.
Class VIII: The OthersThis is a catch-all class that has no common characteristics. All antihistamines that do not fit into any of the other classes are grouped here.*41/322/5*

DIABETES TREATMENT: VITAMINS AND SUPPLEMENTS AND MORE
Vitamins and supplements (daily)B-complex, natural, high potency. Must include min.25 mcg.B12 Chromium supplement – 2 mg. for six months. If not available, brewer’s yeast is a rich source Manganese, or comprehensive trace element formula containing manganese Brewer’s yeast – 3 to 5 tbsp. F, unsaturated fatty acids (extremely important) – 6 capsules or 2 tbsp. of cold-pressed vegetable oil C- 1,000 to 3,000 mg. E -400 to 1,200 IU A-D capsulesB6 -50 to 100 mg.Niacin – up to 100 mg.Lecithin – 2 tbsp.Bone meal – 3 tabletsPotassium – 300 mg.Kelp – 1 tsp. of granules or 3 tabletsGarlic capsules – 3 to 5
Juices String-bean juice, parsley, Jerusalem artichoke, cucumber, celery, watercress, lettuce, sauerkraut juice. Juice of onions and garlic can be added to other vegetable juices. Best fruit juices: citrus. Cucumber contains a hormone needed by the cells of the pancreas in order to produce insulin. The natural hormones contained in onions and garlic are also beneficial in diabetes.
Herbs String-beans, blueberry leaves, sinita (Sinita Organo), juniper berries (Juniperus Sabina Pinaceae), dandelion root, periwinkle, raspberry leaves, alfalfa, centaurea, comfrey root. String-bean pod tea is excellent natural substitute for insulin and extremely beneficial in diabetes. The skins of the pods of green beans are very rich in silica and certain hormone substances which are closely related to insulin. One cup of string-bean skin tea is equal to at least one unit of insulin. The recommended dose: one cup of string-bean skin tea morning, noon and evening.
Specifics String-beans, cucumber, chromium, manganese, B-complex vitamins, brewer’s yeast, vitamins С and E, garlic. Small meals, no refined or processed carbohydrate foods, and plenty of strenuous exercise or heavy physical work.
*3/103/5*

ADVANCES IN SURGICAL TECHNIQUES AND DRUGS TO SAVE YOUR HEARTOne of the most successful heart savers in use today was invented in 1966 by Dr. Adrian Kantrowitz, now of Sinai Hospital in Detroit. He devised the balloon pump, a highly effective aid for a weakened and dying heart. It squeezes blood through the arteries.Stanley Burkoff, a Detroit advertising executive, lay dying from a heart attack. His blood pressure dropped dramatically, sending him into coronary shock. No medicine could raise his pressure. Such patients, Dr. Kantrowitz knew, have only one chance in a hundred of surviving.Mr. Burkoff vividly remembers how it felt. “I was driving the car over a cliff. I was going into shock.”In a procedure similar to the one that the Texas doctors used to squirt streptokinase at Mr. Schield’s blood clot, Dr. Kantrowitz opened an artery in Mr. Burkoff’s groin and slipped a catheter up into the aorta near the heart. But at the end of the catheter, Dr. Kantrowitz had placed a 10-inch-long, sausage-shaped balloon.Within 15 minutes, helium gas, which was driven by a pump outside the body, pulsed in and out of the balloon, blowing it up and collapsing it. With each cycle, that little pump moved an ounce of blood through Mr. Burkoff’s heart, brain, and body. This kept him alive throughout the day and the next night until Dr. Kantrowitz could bypass the clogged artery. Then the pump was removed.After his balloon-pump experience, Mr. Burkoff retired to writing, happy that Dr. Kantrowitz’s invention was there to help him.Approximately 30,000 balloon pumps have been temporarily inserted each year into arteries where they pump blood for anywhere from a few days to 6 months. They save a third of the heart attack victims in shock. Dr. Kantrowitz has developed a permanent balloon pump, which is now under test.In essence, the balloon pump can be considered the grandfather of the artificial heart that kept Barney Clark alive for 112 days until he died of multiple organ failure at the University of Utah Medical Center on March 23, 1983. It was the balloon pump that first proved you could put a mechanical device inside the body to pump blood and keep the heart going for weeks and months.In 1972, Dr. Kantrowitz sent Haskell Shanks home with a permanent balloon pump sewn into his aorta wall. But that experiment raised some disturbing doubts.Three months after surgery, Mr. Shanks died from infection. Germs had apparently crawled along the tube that brought gas from the outside. Although there has been no official report, the same kind of infection may have killed Barney Clark.In fact, infection may bar permanent installation of a total artificial heart regardless of how well the pump operates. But Dr. Kantrowitz’s team believes it has the answer: a plastic skin plug that creates a biological home for skin cells. The cells grow into the plastic, making the seal between skin and plastic so tight that germs cannot pass through.*6/266/5*

DIET THERAPY FOR CANCER: MANAGING EATING PROBLEMS DURING TREATMENTAll the methods of treating cancer – surgery, radiation therapy, chemotherapy and biological therapy (immunotherapy) – are very powerful. Although treatments target the cancer cells in the body, they can sometimes damage normal, healthy cells at the same time. This may produce unpleasant side-effects that cause eating problems.Side-effects of cancer treatment vary from patient to patient. The part of the body being treated, length of treatment and the dose of treatment also determine whether side-effects will occur. The doctor should talk to the patient about how the treatment may affect him.The good news is that only about one-third of cancer patients have side-effects during treatment, and most effects go away when treatment ends. The doctors try to plan a treatment that keeps side-effects down.Cancer treatment may also affect eating in another way. When some people are upset, worried or afraid, they may have eating problems. Losing appetite and nausea are two normal responses to feeling nervous or fearful. Such problems should last only for a short time.One should not be afraid to give food a chance. Not everyone has problems with eating during cancer treatment. Even those who have eating problems have days when eating is a pleasure.*5/356/5*

TESTS TO DIAGNOSE OR MONITOR ACTIVITY OF RHEUMATOID ARTHRITIS: BIOPSY BiopsyWhen diagnosis is proving particularly difficult, a biopsy of the synovium (joint lining) is sometimes required. This procedure involves removing a small piece of the synovium from the joint with the use of a special needle or, more commonly, an arthroscope (an instrument through which the physician can view the inside of the joint). Needle biopsy is performed in the office by a rheumatologist or an orthopedic surgeon. The skin and tissues are numbed with local anesthetic (usually lidocaine). This procedure usually causes mild discomfort. Arthroscopic biopsy is performed in a surgical suite. After a local, spinal, or general anesthetic is administered, a small incision is made. A scope about the diameter of a pencil is then inserted into the joint through the incision. The tissue is generally removed with the same instrument. This procedure usually involves only mild discomfort. The tissue removed allows the doctor to verify the diagnosis of RA and to exclude other conditions.Biopsy of other tissues in the body, including muscle, nerve, lung, and skin, is indicated in some of the rare complications of RA. Successful execution of these biopsy procedures requires the special skills of physicians who have been trained to perform them.
HLA-DR4 A blood test can determine whether these genetic markers are present on the surface of specific white blood cells. Many people with RA-about 65 percent of RA patients-have these genetic markers, and the presence of these genes may indicate that a person is susceptible to developing RA. However, since approximately 25 percent of people who do not have RA can have HLA-DR4 markers, too, the test is not conclusive. These tests are not routinely available and are performed only in research settings or universities.*21/209/5*

EMERGENCIES: ANIMAL/HUMAN BITESThey can cause serious infectionsThe most common type of animal bites involve young children bitten by pets — usually dogs. In 5% of these cases, infection is common. (Cat bites become infected 30% to 50% of the time.) Adult human bites, which become infected in 15% to 20% of cases, most frequently result from injuries sustained in fist fights. Bites like these that break the skin can cause several types of serious infections:Rabies, most commonly from bites by dogs, cats, skunks, bats, raccoons, opossums, foxes and other wild animalsTetanus, which can develop after any kind of bite if you have not been inoculated within the last five years or if you have not completed your primary series of tetanus shotsPasteurella infection, commonly caused by cat bitesInfection caused by various bacteria or microorganisms that can enter the woundWhat you can do immediately after being bittenGet emergency care if the bite seems serious, or affects the face or hands.Rinse and clean the wound immediately.Blood flow helps cleanse the wound. Control excessive bleeding by wrapping the wound with a bandage and applying direct pressure.Watch for signs of infection, usually within 24 to 48 hours.Report all animal bites to the local health department, especially if the bite is from a wild animal or domestic animal whose rabies vaccination status is unknown. If a wild animal has symptoms of rabies (drooling, foaming at the mouth), it should be destroyed and tested. A domestic animal with uncertain rabies vaccination status should be observed for 15 days even if the animal appears healthy.PreventionTreat all unfamiliar pets with caution.Don’t try to touch any wild animal, especially if it appears sick.Obey “Beware of Dog” signs.Teach children not to touch or feed any animal they do not know — domestic or wild.Never leave an infant, young child or defenseless person unattended with a pet, especially a large dog.*12\303\2*

ACUTE BACTERIAL CONJUNCTIVITISThis is caused by a wide range of gram-positive and gram-negative organisms but is most often due to Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenza. S. aureus conjunctivitis is common in adults, whereas the other pathogens are more likely in children. Contact lens wearers are at greater risk for Pseudomonas aeruginosa conjunctivitis. Acute bacterial conjunctivitis is highly contagious and can be spread by direct contact with the patient or with contaminated fomites.The symptoms and signs of acute bacterial conjunctivitis are far less severe and less rapid in onset than those of hyperacute bacterial conjunctivitis. There typically is redness and continuous purulent discharge from one eye, although both eyes can be involved. Patients may complain that the affected eyelids are “matted together” or “stuck shut,” but this is not useful in distinguishing this type of conjunctivitis from others. More purulent discharge appears within minutes after wiping the lids.Acute bacterial conjunctivitis is usually self-limited, lasting approximately 1 to 2 weeks, and does not cause any serious harm. In most cases, the diagnosis is based on clinical evaluation. Laboratory studies to identify an organism and determine its sensitivity are usually performed in severe cases or in those that are unresponsive to initial therapy.*29/348/5*

VIRUSES CAUSING ENCEPHALITISEnterovirusesCertain types of enteroviruses, particularly polio and enterovirus 71, have potential to cause severe encephalitis. The clinical features are fever, macular or maculopapular rash, and seizures. Examination of the CSF may reveal a lymphocytic pleocytosis with a mildly elevated protein level. The enteroviruses can be isolated in viral culture of the CSF and can be detected by the use of PCR. There is specific antiviral therapy for enteroviral encephalitis.
Varicella-zoster virusEncephalitis can be a complication of varicella-zoster virus infection. Acute cerebellar ataxia is the most common neurologic complication of varicella (chickenpox) and generally develops toward the end of the first week of the exanthem. Approximately 1 in 4000 patients who have varicella virus infection and who are younger than 15 years of age develop this complication. Encephalitis may also complicate a herpes zoster eruption within days to months of the rash and usually occurs in the setting of dissemination. The diagnosis is suspected on clinical grounds. Evidence of ischemic or hemorrhagic infarctions as well as demyelinating lesions may be seen on MRI scan. Analysis of CSF shows a mild lymphocytic pleocytosis, slight increase in protein level, and a normal glucose level. PCR can be used to detect varicella-zoster virus DNA in the CSF, and virus can be grown in culture. There is no proven treatment once encephalitis develops, although acyclovir is often given.
Measles VirusEncephalitis is an infrequent complication of measles virus and is of three distinct types:1. Post-infectious encephalomyelitis – manifests as sudden recurrence of fever, altered mental status and multifocal neurologic signs approximately 4 to 8 days after the measles rash. The mortality rate is 10% to 20%, and the majority of survivors are left with permanent neurologic sequelae.152. Subacute sclerosing panencephalitis – manifests as the insidious onset of neurologic dysfunction with myoclonus and seizure activity 6 or more years after an acute measles infection. Progression to coma and death occurs in 1 to 2 years.3. Subacute measles – manifests with a decline in mentition, focal seizures (epilepsia partialis continua), or focal neurologic deficits in an immunocompromised individual 1 to 2 months after a measles infection.Diagnosis can be confirmed by brain biopsy. Therapy is supportive. A live attenuated vaccine is very effective in preventing measles.
Mumps VirusEncephalitis due to mumps virus is a rare sequela of infection. Encephalitis can precede, occur with, or develop up to 2 weeks after the parotitis caused by the virus. It can also occur in the absence of parotitis. Other associated findings include orchitis, oophoritis, and pancreatitis. Examination of the CSF may demonstrate two important findings. The CSF leukocyte count is often elevated above 1000 cells/mm3 in cases of central nervous system mumps infection, and there is a modest decrease in the glucose concentration. The diagnosis can be confirmed either with viral culture or by serology. Most patients with mumps encephalitis make a complete recovery, although neurologic sequelae such as deafness, a seizure disorder, or decline in cognitive function can occur. A live virus vaccine can prevent mumps and is indicated for all people born after 1963 who have not had mumps.
Human Immunodeficiency Virus (HIV)Acute self-limited encephalitis symttoms have been reported at the time of primary HIV disease and seroconversion to HIV infection.
RabiesIn cases of encephalitis due to rabies virus infection, patients demonstrate agitation, hyperactivity, hydrophobia, and spasms of the larynx and pharynx. The symptoms wax and wane but ultimately progress to coma and death. The disease carries a 100% mortality rate. The incubation period can be as long as a year. Because of the public health implications, this diagnosis must be considered in every patient with undiagnosed encephalitis. In the United States, most human rabies infections are due to the bat variant, although a history of a bat bite is unusual. In addition to bats, other mammals that have a relatively high prevalence of carrying rabies include raccoons, foxes, and skunks. There has never been a documented case of rabies acquired from the bite of a rodent or lagamorph (rabbit).*25/348/5*