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Cancer of the breast still threatens the lives of one in twelve Australian women. Little publicity surrounds the factors causing the appearance of breast cancer. Perhaps those factors would attract more attention if breast cancer was a disease of men; but it is not. Only one in a hundred cases of breast cancer will occur amongst the male population.
Excluding gender, the single most important variable in the development of breast cancer appears to be diet. A fat rich, low fibre western diet increases the risk of breast cancer by a factor of six times. High cholesterol alone doubles the chances of a woman developing cancer of the breast. Other factors of importance are age at the onset of periods, early onset of child bearing years, the taking of oestrogen tablets, a family history of breast cancer and the prior appearance of benign changes in the breast.
Looking at some of these risks in more detail women who start their periods before the age of 12 have nearly three times the risk of breast cancer compared to women who started their periods at age 14. Overall there is approximately a three fold increase in risk among first degree relatives of women who have breast cancer. However, among first degree relatives who had breast cancer before menopause or who had cancer in both breasts there is a staggering nine fold increase in risk.

Home Remedies
There is a clear and overriding imperative for more women to adopt a low fat, high fibre diet. The use of oestrogen, as Hormone Replacement Therapy (H.R.T.) after the menopause is still controversial concerning the risk of breast cancer. Current balance of opinion favours balancing oestrogen supplementation with progesterone. In any event, if H.R.T. is to be adopted, the reduced incidence of heart disease and osteoporosis will save more lives than any increase in the number of deaths caused by breast cancer.

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The main parts of a cardiovascular physical examination include measuring the blood pressure and the heart rate and rhythm, checking all the pulses, inspecting the veins of the neck (jugular veins), determining whether there is swelling (edema), and listening to the breath and heart sounds.
Blood Pressure
You have probably had your blood pressure checked many times. Measuring blood pressure is safe, simple, and a standard way to detect one problem that can lead to heart disease. This test also can give your doctor clues about the pumping ability of your heart and the resistance offered by your arteries.
In general, the harder the heart pumps and the narrower the arteries, the higher the blood pressure. A practical example of this principle is pushing water through a hose with a 1/2-inch diameter compare with pushing the same amount of water through a hose with a 1-inch diameter. The pressure will be higher in the hose with the smaller diameter.
Your blood pressure should be measured when you are resting quietly. Changes in blood pressure may be detected when you are lying down, sitting, and standing. A drop in blood pressure when you stand up could explain some types of  positional lightheaded. Your doctor may also measure your blood pressure in both arms, because a difference between the arm pressures may indicate a partial blockage in the aorta or either of the arteries going to the the arms. Blood  pressure downstream from a blockage is lower than the pressure upstream from a blockage.
Nervousness and anxiety increase blood pressure. The anxiety that some people have during medical examinations can lead to a phenomenon known as “white-coat” hypertension.
People who have ‘white-coat’ hypertension really may have normal blood pressure, but it is high when it is measured by a doctor.
Doctors do not rely on just one measurement of blood pressure to diagnose high blood pressure. Some variation in blood pressure measurements is normal. For an accurate diagnosis of high blood pressure, the blood pressure should be elevated on three separate occasions.
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Your doctor will almost certainly prescribe one of these before trying any other medication. Each has some individual side-effects in addition to those already mentioned which are common to all the drugs, but only a small proportion of people develop these individual side-effects. You will see that the drug you take has two or even more names. The first name given here is the drug’s chemical name. The name (or names) given in brackets is its trade name — the drug manufacturer’s ‘own-brand’ version of the drug. Sometimes several drug companies produce their own version of a drug. Usually there is no difference between any of these brands, but it is usually best to stick to one version of a drug if you have found that it suits you.
Whatever drug you are given, you will probably be prescribed a small dose to start with, which will gradually be increased if you suffer no side-effects.
CARBAMAZEPINE (TEGRETOL)
Carbamazepine is one of the best-known and most widely-used anticonvulsants. Most doctors believe that it has the fewest side-effects, and it is thought to be the safest drug for women who are pregnant. So it is the drug your doctor is most likely to try first.
Its main uses are in complex partial seizures and generalized tonic clonic (grand mal) seizures, during pregnancy and in people who are depressed, as it tends to brighten mood.
Probably the best preparation to take is Tegretol Retard – this is a slow-release form of the drug, which means you may need only one dose during each 24 hours, at night.
Possible side-effects
Rash If you develop a rash, your doctor will probably keep you on a low dose of the drug for a while and the chances are that the rash will disappear. A very few people develop a rash so severe that the drug has to be stopped.
A low white blood cell count These cells are the ones which fight infection, and so a low white cell count means that you may be more likely to develop infections. If your white cell count continues to drop your doctor will lower the dose, and some doctors prefer to take patients off the drug. However, my own view is that it
is not necessary to withdraw the drug altogether unless the white count does not rise when the dose of the drug is reduced.
Water retention, sometimes with swollen ankles and puffy face This happens because carbamazepine affects the hormone which controls water excretion by the kidneys. This can result in a low – sometimes a very low – blood sodium level. In your three or six-monthly check up your doctor should always measure your blood sodium level. Usually even if you have a very low sodium level it will come back towards normal if the dose of carbamazepine is slightly reduced. However, occasionally this does not occur and then the drug has to be discontinued.
Blocks the action of the thyroid gland Your thyroid may be tested from time to time to check that this is not happening.
Reduces the action of other drugs This is because carbamazepine causes the liver (which is the organ responsible for breaking down most other drugs) to produce more enzymes and so become more active. If you take the contraceptive pill, for example, it will be broken down more rapidly, and in order for it to be effective you will need to take a higher dose.
Toxic side-effects
(These indicate that the dose you are taking is too high.) Poor balance, double vision and tiredness.
When to avoid
Carbamazepine should not be taken if you have any liver damage, or have responded badly to the drug in the past. Carbamazepine may also be unsuitable if you have some form of heart disease.
PHENYTOIN (EPANUTIN)Phenytoin is a good anticonvulsant, but is a drug which is unpopular at the moment because of its unpleasant side-effects. It is used to control grand mal seizures, and complex partial seizures.
Phenytoin is a drug which is difficult to make up properly. Epanutin is the product of the drug company which was the first to produce this drug. Others have copied them, but not always so successfully. Not long ago, for example, the Australian government decided to save money and recommended the use of cheaper brands of phenytoin. Unfortunately, these different products had different absorption rates, and in consequence many people developed severe seizures. The government finally had to allow the prescription of Epanutin again.
So although there are other, cheaper brands of phenytoin on the market, I would always advise that you stick to Epanutin and make sure that your doctor prescribes it by name.
Possible side-effects
Rashes
Slows you down
Drowsiness
Roughens facial features
Swollen gums
Excessive hairiness
Tingling in fingers and toes (Peripheral neuritis)
Leaches calcium from bones
In high doses, reduces action of other drugs Like Carbamazepine, phenytoin makes the liver more active and produce more enzymes. The contraceptive pill, for example, may be less effective because it is destroyed more rapidly. In this instance you would have to take a stronger dose of the pill to get the full contraceptive effect.
Toxic side-effects
(These indicate that the dose you are taking is too high.) Rapid, jerky eye movements (nystagmus), disturbed balance, tremor. Most importantly, if too high a dose is given, phenytoin stops acting as an anticonvulsant and can actually induce seizures.
Double or blurred vision and headaches sometimes occur and, rarely, phenytoin can cause severe confusion and the inability to think clearly. But these side-effects are rare, and usually only happen in someone who has taken the drug for a very long time. If they do occur, see your doctor who will probably withdraw the drug.
When to avoid
Phenytoin should be avoided if you are pregnant, and not taken if you have any liver damage or suffer from osteoporosis (weakness of the bones).
SODIUM VALPROATE (EPILIM)
This is a useful drug for controlling generalized seizures (both grand mal, and absence seizures) and myoclonic jerks. It is also the drug most often given to prevent febrile convulsions in susceptible children. Sodium valproate has a short half-life (see p.44), so it may need to be taken three times a day to be effective. However, you will probably be given the ‘Epilim Chrono’ form. This is a slow-release preparation which you will probably only need to take once a day (although some patients like to take it twice a day). It is so much more convenient that I no longer prescribe ordinary valproate any more.
Sodium valproate interacts with another commonly prescribed drug, lamotrigine, preventing its breakdown. In effect, this means that too much lamotrigine will accumulate in the blood. So if you are taking both drugs your doctor will want to check your serum level of lamotrigine regularly to make sure it is not too high.
Possible side-effects
Hair loss If you take sodium valproate it is worth looking at your comb after you have combed your hair to see if you seem to be losing more hair than usual. Hair loss is sometimes dose-dependent; as sodium valproate is a good drug, it is usually worth trying a lower dosage before stopping the drug completely. If you do continue with the drug, the hair loss may become so bad that you will need to wear a wig, and when finally you do stop the drug and your hair grows back, it is likely to be of a different colour and finer texture.
Change in colour and texture of hair This is usually associated with hair loss, although it can occur on its own. Again a reduction of drug dosage may help.
Tremor This is a difficult side-effect to treat as it is seldom dose-dependent (although it can be a toxic symptom, due to too high a dose). I have found that if tremor occurs then it is best to withdraw the drug rather than to persevere with lower dosages.
Weight gain This is one of the most difficult side-effects to deal with. Most people are upset when they put on too much weight, and weight gain is particularly distressing for adolescents, who are, even in the best of circumstances, very self-conscious about the way they look. Unfortunately sodium valproate is usually very effective in this age group and very widely used. In my experience, weight gain cannot be avoided simply by reducing the dose of the drug. If it is very troublesome a change of drug is the only satisfactory solution.
Toxic side-effects
(These indicate that the dose you are taking is too high.) Poor balance, double vision, tiredness and tremor. Very occasionally, sodium valproate can have a serious effect on blood clotting. Children given the drug will be watched carefully as, rarely, it can cause liver damage in a very special group of young children.
When to avoid
Sodium valproate should be avoided if possible during pregnancy, or if you have ever had liver damage. It should be taken with care with phenobarbitone or primidone, as the combination can make you very frowsy. If you do become pregnant while taking sodium valproate, you should certainly discuss this with your doctor.
ETHOSUXIMIDE (ZARONTIN)
Ethosuximide is an alternative to sodium valproate as the drug of first choice to control absence seizures (petit mal). Both drugs are probably equally effective, but sodium valproate has the advantage that it controls generalized seizures too, so if you suffer both types of seizure, sodium valproate is probably the drug you will be given.
Possible side-effects
These are few. The most likely are:
Nausea
Dizziness
Headache
Drowsiness
Very rarely adults may also experience hallucinations (seeing things or hearing voices when no one is there) or suffer depression.
When to avoid
Ethosuximide should not be used during pregnancy, if you are breast-feeding or if you have ever had liver or kidney damage.
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Asthma sometimes occurs in infants who are only a few weeks old. Such attacks can be quite severe as well as difficult to monitor. More than 50 per cent of the children with asthma, experience attacks in the first two years of their life, with at least 10 per cent in the first year itself.
It is almost impossible to diagnose asthma in infants who are less than a year old. Usually there is a wheezy bronchitis which may either disappear or herald the beginning of childhood asthma. Treatment is very difficult and infants don’t respond to bronchodilators easily. The best recourse is local treatment with nebulized corticosteroids.
Most asthmatic infants have very mild symptoms when they are less than one year old, and these do not have much affect on their health. Medication may not be necessary. Those who have trouble are treated with inhaled short-acting beta-2 agonists, either through an MDI using a spacer and a face-mask or a nebulizer. However, some infants, particularly those suffering from virus-associated wheeze do not respond.
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Астма у молодых людей во многом напоминает детскую астму. Действительно, многие юноши и девушки, у которых астма развивается в возрасте 20-30 лет, болели в детстве или были недиагностированными астматиками, которых считали «бронхитными» детьми. По-другому выглядит астма у тех, у кого она возникла после 40 лет. В этом возрасте женщины болеют чаще мужчин, а фактор наследственности играет меньшую роль. Стимуляторы астмы бывает труднее выявить, а сама астма обычно относится к внутреннему, т.е. неаллергическому, типу. Астма, развившаяся у взрослого, принимает более тяжёлые формы и хуже поддаётся лечению, чем астма детская, а прогноз менее предсказуем. У взрослых с астмой более вероятны аллергия на аспирин, сульфитные реакции, хронические синуситы и полипы в носу.
Число случаев астмы у пожилых людей постоянно растёт. Хотя почти треть всех заболеваний астмой развивается в детском и подростковом возрасте, 10% вновь диагностированных пациентов-астматиков впервые начинают кашлять и хрипеть после 65 лет. Исследования, проведенные в домах престарелых, показали, что значительный процент их обитателей страдают от недиагностированной и потому нелеченной астмы. Причина нераспознавания астмы у престарелых, состоит в том, что они относятся к малоактивной категории населения и астма у них проявляется скорее в виде хронического кашля с обильным отделением мокроты, чем в виде острых неожиданных приступов одышки с хрипами.
Астма у пожилых может колебаться по степени тяжести от лёгкой до тяжёлой. Стимуляторы этой астмы выявляются с трудом, поскольку, вероятнее всего, связаны с загрязнением воздуха и с заболеваниями верхних дыхательных пyтей, а не с аллергией. Симптомы астмы у престарелых порой ограничиваются лишь чувством тяжести в груди, одышкой или кашлем.
Лечение астмы у пожилых по многим причинам может оказаться очень сложной задачей. Одна из наиболее распространенных причин – взаимодействие противоастматических лекарств с лекарствами, принимаемыми от других заболеваний. Лекарства от глаукомы или от гипертонии, способны усиливать симптомы астмы. Престарелый пациент может запутаться во множестве выписанных ему медикаментов, что приводит к их неправильному применению или ошибках в дозировке. Часто таким пациентам нужны гораздо меньшие дозы противоастматических препаратов, так что вполне реальна опасность непредумышленной передозировки. Доза, нормальная для молодого или средних лет пациента, может оказаться токсичной для пожилого человека.

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Virtually every child, no matter how easy his temperament, will go through a phase of temper tantrums. This is a manifestation of the struggle for autonomy that is an important developmental phase for the toddler. Temper tantrums are seen generally between 6 months and 6 years of age, and have their peak around 18-36 months (the ‘Terrible Twos’). Usually they decrease over time, unless reinforced by parents, in which case they will become a child’s learned response to frustration or to not getting his own way.

Cause

There is no discernible cause for temper tantrums. They are seen as an inevitable consequence of a youngster’s struggle to assert autonomy and independence from his parents. The immediate precipitating cause for a tantrum is almost always frustration, either to the parent saying ‘no’ to a request so that the child is not allowed to have his way, or else the frustration that comes from the child not being able to perform some developmental task. Usually the tantrum is manipulative and directed towards the parents.

Clinical features

All parents will be only too aware of the characteristics of a temper tantrum. While the precipitating factors, intensity, duration and action during a tantrum will vary from child to child, there are certain features which are universal. In response to frustration — usually the parent saying ‘no’ — the child may scream, throw himself on the floor, vigorously flail arms and legs, often kicking toys, furniture, the floor, or the parents. Sometimes toys and other objects are thrown across the room. The episode is usually terminated by the parent, who distracts the child or gives in to the original demand, or else picks the child up.

Left to his own devices, however, the child usually loses interest in the tantrum as soon as he is deprived of an audience. Parents will observe that the child stops the tantrum momentarily at regular intervals to make sure that the parent is still in the room. In other words, the parent is clearly the target of the demonstration, and this provides the most important clue for management of temper tantrums.

Toddlers seem expert at picking the times when parents are the most vulnerable to the effects of a full-blown temper tantrum, such as when they are out shopping (‘the supermarket syndrome’), or else visiting friends. This of course makes it even more likely that the tantrum will have the desired effect, and in turn will strengthen the child’s resolve to turn it on again the next time — ‘same time, same place’.

Sometimes the child seems to lose control during a tantrum, so he becomes really worked up and genuinely distressed. What started off as a manipulative ploy then becomes a rather frightening event for the child.

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