In young people with diffuse goiter of moderate size, there is much in favor of a long-term trial of antithyroid drug therapy. If successful, normal health and normal thyroid function may be restored. About 50 per cent may expect a long-lasting remission. If the response is satisfactory the treatment should be adequate and long enough, from one to two years or longer. A favorable response may be indicated in most instances by reduced pulse rate, increase in weight, and return of well­being feelings.

Treatment should be stopped in those patients who experience adverse reactions to antithyroid drugs, such as skin wheals, (urticaria), loss of head hair (alopecia), or marked drop in the white blood cell count (agranulocytosis). Blood counts should be performed regularly at monthly intervals and a drop to less than 50 per cent of the initial white blood cell count should serve as a warning. Only a few patients are adversely sensitive to propylthiouracil or methimazole, the antithyroid drugs of choice.

Surgery

It is the considered opinion of the author that surgery should be reserved for those patients who are unable to cooperate on a program of long-term therapy or for whom it is economically unsound; it should be reserved for patients with very large goiters and particularly those with adenomatous goiters.

The operation is an elective procedure to be undertaken only in patients who have been adequately prepared by drug treatment. The toxic patient must be restored to a more normal state prior to surgery by antithyroid drugs, and then two or three weeks of treatment with potassium iodide before the operation is added to the program. With such preparation, the operation is attended by few risks and the possibility of thyroid “storm” or crisis is avoided.

Radioactive Iodine

Radioactive Iodine has become the treatment of choice of most physicians for the elderly patient. Children and pregnant women are not suitable candidates for this form of therapy.

In the pregnant woman, radioactive iodine may damage the thyroid gland of the unborn child. In children, radioactive iodine therapy is proscribed because infants and children are quite susceptible to carcinogenic effects of radiation.

The greatest problem in treatment is selection of a dose of radioactive iodine, contained in water and drunk as a “cock­tail”, which will destroy enough but not all of the gland, and restore to normal the amount of hormone produced and released. In treatment, several small doses of two to three millicuries of radioactive iodine are administered two to four months apart, depending on need. In this manner excessive amounts are avoided.

General Considerations

The patient with a thyrotoxic condition needs rest, a quiet environment, good dietary intake, vitamin supplements, and some sedation before surgery and after. Reserpine may be employed to great advantage to help relax the overanxious patient and slow the pulse rate.

EXophthalmos, or bulging eyes, may be a prominent sign in Graves’ disease. This may disappear or be reduced considerably with adequate management of the thyrotoxicosis. In some individuals the exophthalmos worsens in spite of treatment, and others who had minimal signs may develop severe exophthalmos following surgery. Treatment is difficult once severe or malignant exophthalmos has developed. Radiation of the pituitary gland has been used successfully in a few instances. Decompression operations which remove the posterior part of the bony eyeball socket are sometimes necessary to save vision. In the milder forms, diuretics, sleeping in a semi-recumbent position, tranquilizers, or cortisone-like hormones have been employed with some degree of success.

Vomiting is not to be confused with regurgitation, which is simply the spitting up of food after eating. This is usually caused by a bubble of air in the stomach. As a rule it is of no significance. It is very common in the newborn and young infant. Regurgitation of this type usually subsides and disappears before a child is six months of age. In a few instances it may continue as long as a year.

The time-honored method of preventing regurgitation due to air-swallowing is “burping the baby” – holding the infant upright over the shoulder and patting him gently on the back until he “brings up a bubble.” A certain amount of air is bound to be swallowed with food, but things such as thumb sucking or a slow nipple may aggravate the condition.

There are a number of types of vomiting. Vomiting as such is due to the expulsive force of the stomach. If the force is very marked, as in pylorospasm or pyloric stenosis, the undigested or partly digested food is vomited out with such force that it is thrown one to two feet from the body. This is called projectile vomiting. Vomiting which is immediate would signify either an irritated or sensitive stomach, an allergy to a specific food, or a marked narrowing or closure of the esophagus (gullet). Vomiting which is yellow signifies that in the course of stomach contractions bile has been sucked in from the intestines below. Blood in the vomitus or “coffee­ground” vomitus may occur when capillaries bleed in the course of severe vomiting. It may also be a sign of a serious blood condition where capillaries are fragile. This is always an indication that a physician should be called.

The chief characteristic of anorexia nervosa is a refusal to maintain a minimally normal weight for age and height. Refusal to eat is the hallmark of the disease, regardless of whether other practices, such as binge-purge cycles, occur. Although specific causes of anorexia have not been identified, a combination of biological, social, and psychological factors contribute to the disorder. Support for an organic influence has centered on the hypothalamus (the portion of the brain reputed to house the appetite center) and the pituitary gland (the master gland of the body). Sociocultural theories focus on the compulsion of adolescent girls to become and remain lean. This exaggerated goal manifests itself at a time when girls are naturally depositing fat.

Warning signs of Anorexioa Disorder

Warning signs of Anorexia includes weight loss, amenorrhea (absence of a menstrual period), and a variety of psychological disorders culminating in an obsessive preoccupation with the attainment of thinness. Fortunately, most anorectics recover fully after one experience with the disease. The longer a person practices anorexic behaviors, the slimmer the chance for recovery.

When confronted, anorectics typically deny the existence of a problem and the weight-loss behaviors that have resulted in their emaciated physical appearance. They also avoid medical treatment, refuse the well-intended advice of family and friends regarding professional assistance, and submit to treatment under protest. Anorexia is a subtle disease, and anorectics become secretive in their behaviors. They are evasive, and many hide their disease in deep denial even while undergoing treatment, making the diagnosis especially difficult.

The course of treatment for anorexia is complex, involving a coordinated effort by several healthcare specialists. Hospitalization is often required because anorectics may have to be fed intravenously or by some other method if they cannot or will not eat. Medications that stimulate the appetite and medications that calm the patient are usually necessary. Nutritional counseling and psychological counseling individual, group, and family-are integral compo” nents of treatment. Finally, behavior-modification techniques are used to help change the perceptions and lifestyle of the anorectic. At this point, no single treatment has proved to be unusually successful in the treatment of anorectic patients.

Pulmonary hypertension occurs when pulmonary artery pressure rises above normal, but is not caused by aging or altitude. Primary (idiopathic) pulmonary hypertension is rare, occurring most often in women between ages 20 and 40; pregnant women have the highest mortality. Secondary pulmonary hypertension is caused by existing cardiac or pulmonary disease. The prognosis depends on the severity of the underlying disorder.

What causes it?

Pulmonary hypertension Casues include altered immune mechanisms. Secondary pulmonary hypertension is caused by oxygen deprivation from an underlying disease.

What are its symptoms?

Most people complain of increasing shortness of breath on exertion, weakness, dizziness, and fatigue. Many also show signs of right-sided heart failure, including peripheral edema, ascites, neck vein distention, and liver enlargement. Other clinical effects vary according to the underlying disorder.

How is it diagnosed?

Diagnostic tests for pulmonary hypertension include the following:

• listening to the lungs through a stethoscope
• arterial blood gas analysis
• electrocardiography
• cardiac catheterization
• pulmonary angiography
• pulmonary function tests.

How is it treated?

Treatment usually includes oxygen therapy. For people with right ventricular failure, treatment also includes fluid restriction, digitalis glycosides to increase cardiac output, and diuretics to decrease intravascular volume and extravascular fluid accumulation. Of course, an important goal of treatment is correction of the underlying cause.

What can a person with pulmonary hypertension do?

• Avoid overexertion, and always rest between activities.
• Be sure to follow the prescribed diet and medication schedule.

Causes

Cancer is caused by both external (chemicals, diet, radiation, viruses, pollutants, etc.) and internal (hormones, immune conditioning, and inherited mutations) factors. Any combination of these factors may work together to initiate or promote carcinogenesis-the development of cancer cells. Ten or more years often pass between exposures or mutations and the actual detection of cancer.

Although the causes of cancer are not clearly understood, correlations have been found linking cancer to everything from genetic factors to exposure to the sun’s radiation. Many carcinogens (cancer causing agents) trigger development of cancer.

An inherited tendency for cancer has been theorized for years. Everyone seems to have genes that may cause cancer, but not everyone gets cancer. In most cases environmental factors actually activate the cancer. A good example of the interplay between genetic and environmental factors is cigarette smoking. Approximately 87% of lung cancers occur in cigarette smokers, but only 15 % of smokers develop lung cancer. Why not the other 85%? The 15% who develop cancer are thought to be susceptible to the disease on the basis of their genes. If they had not activated the cancer genes by smoking, they probably would not have contracted the disease.

A gene that causes cancer is called an oncogene. Within a tiny segment of DNA is an area that can be activated to form an oncogene. This segment is called a protooncogene, and unless it is activated, it will never become an oncogene or cause cancer. If an oncogene is formed, it acts with other oncogenes to produce abnormal cells that can replicate and spread. The presence of certain oncogenes is being used to predict which tumors are likely to recur after surgery and/or to identify family members at risk. Suppressor genes also playa role in cancer. Suppressor genes exist in normal cells and control cell growth. If suppressor genes mutate, cells are permitted to grow unrestrained.

Another explanation of cancer is an error in cell duplication on the basis of chance alone. Several trilion new cells are formed each year, and perfect duplication does not occur with each new cell formation. When an abnormal cell develops, the immune system recognizes it as a rogue cell and attacks it. Every cancer cell needs to be killed because almost all cancers arise from a single cancer cell. Cancer develops as a result of the immune system’s failure to clear the body of cancer cells. This is one reason the immune system is receiving considerable attention among cancer researchers.

Much research appears to link psychological states with the prevalence of disease in individuals. People with positive, involved attitudes who view life’s challenges as opportunities for personal growth seem to have fewer diseases and recover from them more often. Individuals who feel lonely and depressed and lack appropriate social support are more cancer prone than their mentally healthy counterparts.

Emotional factors, such as stress reduction, social support, and the ability to express and cope with the range of emotions brought on by a frightening diagnosis of cancer, have been linked to the progression of cancer. Several studies have reported that patients who participate in support groups while receiving standard medical care live significantly longer than those receiving medical care alone. Conversely, cancer patients who are socially isolated have poorer survival rates than those with more social connections. This doesn’t suggest that stress and social isolation cause cancer. It does suggest a significant correlation between emotion and the progression of cancer once the disease is established. Many experts believe that a person’s emotional state somehow bolsters the body’s natural cancer-fighting power.

Although some of these concepts are controversial, it is generally accepted that substances such as tobacco, tobacco smoke, alcohol, asbestos, herbicides, and pesticides are carcinogens. Scientists believe more than 80% of all cancers are associated with lifestyle factors that are easily controlled-diet, smoking, and exposure to the sun. Almost two thirds of cancer deaths are attributed to diet and tobacco. According to a 20-year study of 115,195 healthy women ages 30 to 55, one third of cancer deaths are caused by excessive weight.

One of the major carcinogens may be radiation from the sun, more specifically excessive exposure to the ultraviolet (UV) rays of the sun. People who spend hours in the sun without protection have an increased risk for skin cancers. UV light peaks from 10 AM to 2 PM (11 AM to 3 PM during daylight savings time). Avoiding sun exposure during these hours can cut UV-light exposure up to 60%. Fortunately, most major newspapers now include the UV index as a routine part of the weather report . The index is based on a 15-point scale with 15 representing the highest exposure to UV light. Sunscreen lotions absorb or block UV rays and therefore protect against skin cancer. For most people in the United States sunscreen with a sun protection factor (SPF) of 15 is usually sufficient. Using tanning beds also increases the risk for skin cancer.

Finally the herpes viruses have been connected with cancer of the cervix. Viruses may be involved in the development of some forms of leukemia, Hodgkin’s disease, and Burkett’s lymphoma. The exact role of viruses in causing cancer is not known, but they may provide an opportunistic environment for cancer development. Other researchers have suggested that a combination of factors, of which the virus may play a part, rather than the virus itself causes a cancer.

Sites

The American Cancer Society reports each year on the incidence and number of deaths from cancer for a variety of sites. Skin cancer is the most common cancer. More than 800,000 people are diagnosed annually with basal and squamous cell skin cancer. Almost all of these are considered sun­related cases. Fortunately, the majority of skin cancers are highly curable. For both genders the cancer that kills most often is lung cancer. Excluding basal cell and squamous cell carcinomas, the breasts are the most prevalent cancer site for women and the prostate is the leading cancer site for men. In 1995 an estimated 244,000 new cases of prostate cancer and 182,000 new cases of breast cancer were reported. For any cancer, early detection is imperative. If cancer is diagnosed while it is still localized, the cure and/or survival rate may be 90% or higher for some cancers such as skin, colon, and rectum cancers.

Treatment

Cancer is often treated surgically. A surgeon removes the malignant tissue and some additional normal tissue. Today, the tendency is to remove less surrounding normal tissue and combine surgery with chemotherapy and/or radiotherapy. Radiotherapy is the use of radiation to destroy cancer cells or their reproductive mechanism so that they cannot replicate. This treatment can cause unpleasant side effects, such as diarrhea, itching, and difficulty in swallowing. When cancer has spread throughout the body, chemotherapy is used. Chemotherapy is the use of drugs and hormones to treat cancers such as acute leukemia and testicular cancer. About 50 anticancer drugs are in use.

Another technique that offers hope for treating cancer is immunotherapy. This process involves stimulating the body’s immune system to help destroy malignant growths. Interferon and interleukin-2 (proteins produced by the body to protect against viral invasions of healthy cells) are undergoing research for this purpose. Interferon is used for treatment of a rare blood cancer called hairy cell leukemia. Interleukin-2 is under study in the treatment of kidney cancer and melanoma. Vaccines against several types of cancer are also being developed.

New technologies enhance the diagnosis and treatment of cancer. Magnetic resonance imaging (MRI) and computerized tomography (CT scanning) help to detect and map hidden tumors. Bone marrow transplantation is now a treatment option for select patients with leukemia and lymphoma. And, novel drug-delivery systems are allowing more drugs to reach cancer cells.

Psychosocial and behavioral research is also having a significant impact on symptoms of cancer and its treatment, such as pain, nausea, and vomiting. Interest in this area of research has been sparked by the mounting evidence that lifestyle and environmental factors influence a person’s general health and chances of developing cancer, as well as the mental and emotional ability to cope with cancer if it occurs.

Exercise

Researchers are currently investigating the role of exercise in the prevention of some types of cancer, including colon cancer, breast cancer, and cancer of the reproductive organs. Since 1980 at least eight studies involving large numbers of people in America, Europe, and China have examined the relationship between physical activity and colon cancer; seven concluded that exercise reduces risk. A more recent study of 17,607 college graduates ages 30 to 79 years also confirmed a lower risk of colon cancer and lung cancer among men who were physically active. Other studies involving the risk of breast cancer among more than 5000 alumnae of 10 colleges and universities revealed 86% higher rates for nonathletes compared with their athletic peers. In another study of 25,000 women in Washington state, women who worked at physically demanding jobs were less likely to have breast cancer than those with sedentary jobs. Cancers of the female reproductive system also seem to be related to exercise. In the Harvard alumnae study, women who played sports during their college years were less likely to develop cervical, uterine, ovarian, or breast cancer than nonathletes .

How Much Exercise is Enough?

If the results of colon cancer studies are representative of other cancers, exercise that requires as little as 1000 calories per week lowers the risk of cancer. Although large-scale studies indicate that physical fitness appears to postpone the risks of dying from a variety of malignancies, the evidence falls short of cause and effect. Several hypotheses attempt co explain the reasons exercise may prevent cancer. One possible mechanism involves the effect of exercise in reducing body fat. The amount of body fat is positively correlated with the incidence of cancer. In the case of colon cancer, physical activity promotes bowel movements, thus reducing the exposure of the intestinal wall to potentially toxic fecal material. some studies have also indicated that exercise may augment or stimulate the body’s immune system in several ways, the end result being that cancerous cel1s are recognized and destroyed early in their development.

At this point, the recommendation regarding consumption is that there is no reason to fear iron and no clear justification for taking iron supplements if one’s iron count is normal.