Regardless of which measurement technique is used, it is important to view body-fat assessment results as measures on a continuum. They are not precise points on a scale that when exceeded magically increase a person’s risk for health problems. For example, although 24.9% body fat for a man does not technically fall into the category of “obesity,” it is only one tenth of a percent removed from the “magic number” of 25 and for all practical purposes carries the same risk as someone who is classified as obese. Research on obesity shows that a man with 25% body fat should not view himself as crossing a line that somehow suddenly exacerbates his health risks more than his “non obese” peer who is at 24.9% body fat.

Causes of Obesity

The laws of thermodynamics state that energy cannot be destroyed; it is used for work or converted into another form. Accordingly the progressive accumulation of stored fat in the body is the result of consumption of more calories (energy) than are expended. Food energy in excess of the body’s need results in storage of fat in adipose cells. This relationship applies to almost all individuals. For the majority of people, excessive caloric intake and deficient energy expenditure are responsible for their obesity. What are more difficult to explain, however, are the differences in peoples’ responses to the laws of energy conservation and expenditure. Two people may be overfed the same number of calories and yet differ in the amount of weight gained, even if their activity levels are held constant. What accounts for these differences? The answer is not simple and suggests that obesity is a complex issue, involving both biological and behavioral theories.

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Anyone who is addicted to a hard drug must take it in gradually increasing doses both to maintain the pleasurable effects of the drug and to keep from breaking down physically and emotionally. This is called building up tolerance to the drug. If the addict’s need for the drug is not satisfied, unpleasant physical and psychological effects called withdrawal symptoms will result. In some cases the withdrawal symptoms can be harmful, or even fatal, and withdrawal from the drug should be medically supervised.

What are The Symptoms?

Every type of drug produces its own kind of mental and physical symptoms . In general, any addiction is likely to cause a gradual deterioration of the addict’s standards of work, personal relationships, or both. The behavior of addicts is often erratic and their moods may be changeable, with periods of restlessness and irritability alternating with extreme drowsiness. There is often a loss of appetite, and unreasonable fatigue and surliness. If someone close to you has some of these symptoms, they do not necessarily indicate drug addiction. But if he or she also spends increasing amounts of time away from home and seems to be always out of money for no apparent reason, you have cause for suspicion.

What are The Risks?

There are no reliable statistics available on the total number of drug addicts in the United States, partly because many addicts never receive treatment, and obtain drugs illegally. Estimates of the number of heroin users in this country range from about 400,000 to almost four million, and about seven million people are reported to use sleeping pills once a week or more. It is not known how many people are actually addicted to these drugs.

Hard drugs taken habitually violently upset the body’s chemical system. In extreme cases the result can be serious physical or mental illness, or even death. With some drugs, an addict can build up a tolerance for the drug that is dangerously close to the dosage at which the drug can kill you. Also, when drugs are obtained illegally, there are no controls over the strength or purity of the drug. It is very possible to take a fatal dose by mistake.

What Should be Done?

Anyone who is addicted to a drug needs help, but addicts are unlikely to seek help unless desperate. If you are concerned about drug abuse in yourself or anyone else, consult your physician or a drug counseling center.

What is The Treatment?

Self-help: No self-help is possible for severe addiction. If you seem to be dependent on regular doses of some prescribed drug such as a tranquilizer, do not hesitate to speak to your physician about the problem. The doctor will probably either allay your fear of possible addiction or recommend appropriate measures to break the habit.

Professional help:

Hospital treatment, preferably in a special drug unit, is essential. The addictive drug is withheld either immediately or gradually, depending on the severity of withdrawal symptoms for that particular drug or combination of drugs. Once the withdrawal process is over, the second stage of treatment begins. It consists of an attempt to prevent renewed addiction by means of psychotherapy and vocational therapy. It is not easy to “kick” a drug habit permanently. Before they are discharged from the hospital, “cured” addicts may be offered temporary housing in a new environment and are usually advised to avoid their drug-taking friends and form new relationships.

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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.

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In general, if you are able to keep your mental balance during periods of emotional stress, you can call yourself mentally healthy. If you lose that balance you are ill, at least to some extent. The articles in this section are designed to help you recognize some of the warning signs of common forms of mental illness, not only in yourself but also in others. The arrangement of articles is based on two groupings. First, there are illnesses that arise primari1y from internal influences, such as schizophrenia, depression and compulsions. The actual causes of such disorders are not known, but personality factors and slight variations in the amount and type of chemicals in the brain may be the cause. Second, there are addictions, or illnesses triggered off by external influences such as alcohol or other drugs. Certain personality types appear to be especially susceptible to these disorders.

Some people are overwhelmed by trivial crises such as minor marital quarrels. Others retain their balance in daunting circumstances such as the break-up of a once happy home. Such mental health is not necessarily inborn. You can cultivate it in yourself and thus stand a better chance of coping well with the problems of living.

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Visualization (imagery) is a form of relaxation that uses the imagination. Begin as before, by finding a comfortable position, shut your eyes, and take several deep breaths. Several variations of visualization can then be used. You can imagine a tranquil scene, such as a beach on a sunny day or a valley with a stream or forest, and then place yourself in the scene. All the sights, sounds, smells, and feelings can be imagined. People suffering from a terminal illness frequently imagine scenes in which their immune system attacks or destroys their disease, or they envision themselves as healthy and disease free. Individuals who want to make major life changes, such as losing weight or stopping smoking, can envision themselves slim or not smoking or imagine themselves in trouble situations. Difficult situations can be prepared for by envisioning yourself in a situation in which you are tempted to overeat or smoke and then see yourself making wise choices or not engaging in the undesirable behavior. Visualization can also be used to improve athletic performance. Tapes are available that can assist in learning how to develop this technique.

Biofeedback

Biofeedback is based on scientific principles and is designed to enhance awareness of body functions. Sensory equipment is used to demonstrate subtle body changes, such as increases or decreases in skin temperature, muscle contraction, and brain wave variations. Biofeedback enables people to become aware of muscle tensions and learn how to control these tensions through awareness of sensations that are relaxing. Biofeedback is an educational tool. After a few sessions, people should begin to recognize and thereby alter their typical bodily responses to situations that serve as stressors for them.

Massage Therapy

In recent years massage therapy has become an acceptable form of stress reduction and a healing alternative. Some people consider today’s American society to be in the midst of a “touch famine”: appropriate touching is lacking even though we recognize the need for physical interaction. Babies who are not handled can actually die from this type of deprivation. Although adults are not as likely to respond as babies do, the need to be touched does not vanish with age. Research findings indicate that massage can promote physical relaxation and well being. Certified massage therapists are licensed by the American Massage Therapy Association.

Music

The power of music is undisputed. A strong beat and rhythmic music instill the desire to respond by moving or dancing in almost all people of any age. Quiet music soothes by causing people to breathe more deeply, stilling turbulent emotions, reducing metabolic response, and calming the autonomic nervous system.

Humor

Laughter is a powerful stress-reducing agent. A deep laugh temporarily raises pulse rate and blood pressure and tenses the muscles. After a good laugh, however, pulse rate and blood pressure actually go down and the muscles become more relaxed. Laughter works in two ways. Being able to laugh at a situation reminds you that life is seldom perfect or predictable. Laughing helps keep events in perspective. Laughing also works to reinforce a positive attitude. Laughing or even smiling can actually improve a mood.

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Being aware of the mental and physical signals associated with stress is the beginning step in learning how to manage it. will aid you in identifying some of the major stressors. By using self-assessments to monitor for signs of stress, you can avoid excessive stress. Some indicators of excessive distress include the following:

• Chronic fatigue, migraine headaches, sweating, lower back pain, sleep disturbances, weakness, dizziness, diarrhea, and constipation
• Harder and/or longer work or study while accomplishing less, an inability to concentrate, general disorientation
• Denial that there is a problem or troubling event
• Increased incidence of illness, such as colds and flu’s, or constant worry about illness or becoming ill; overuse of over-the-counter drugs for the purpose of self-medication Depression, irritability, anxiety, apathy, an overwhelming urge to cry or run and hide, feelings of unreality
• Excessive behavior patterns, such as spending too much money, drinking, breaking the law, and developing addictions
• Accident proneness
• Signs of reclusive ness and avoidance of other people
• Emotional tension, “key up” feeling, easily startled, nervous laughter, anxiety, hyperkinesia, and nervous tics

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Certain behaviors or habits can unnecessarily rob you of time that can be used more effectively. These include the following:

1. Workaholism. Workaholism is spending excessive amounts of time working, even though the activity may not be productive. Generally, people who engage in workaholic behavior like to work long hours and do not use time-saving techniques. They also may become over involved in unimportant tasks that eat at their time, requiring them to use extra time to accomplish important tasks.
2. Time juggling. Time jugglers constantly over schedule themselves, often making promises to be in more than one place at a time. Because it is frequently impossible to do several things at once or be two places at the same time, this behavior often results in important activities being neglected.
3. Procrastination. Procrastinators consistently put off until later things that could just as easily be done now. Some procrastinators choose the simplest of two tasks to do now so that really important ones are avoided until the last possible minute, when the pressure is on.
4. Perfectionism. Perfectionists go beyond trying to do one’s best to the point where only perfect will do. Because the concept of “perfect” may vary from one person to the next, this behavior rarely results in a sense of accomplishment and the inability to achieve impossible goals contributes to feelings of dissatisfaction and failure.
5. “Yesism.” Yesism is the inability to tell anyone “no.” Often, extremely nice people suffer from this condition because they don’t like to disappoint others or fear being rejected, even at their own expense.

Although difficult to overcome, many of the aforementioned characteristics can be moderated if you are determined to do so. More effective suggestions for appropriate use of your time are as follows:

Organize and write down realistic goals and priorities. Current activities should be assessed as to whether they are essential, important, or trivial. Ask yourself the question, “When does the task have to be completed?” Write down the priorities for the next day before going to sleep each night and rank them in order. This provides a night to “sleep on them.” They can then be approached systematically, according to need, the next day.

Develop a time framework. To help alleviate stress, establish the amount of time to be spent on each activity. Some tasks cannot be completed in a day’s time. If this is the case, estimate the days or weeks required to complete the task. This is especially important in accomplishing long-term commitments. Allotting blocks of time each day of each week helps to alleviate the extreme pressure of completing a difficult task in a short time. For example, if a term paper is due at the end of a semester, you can spend a certain number of hours each week working on the paper. You can establish goals for the completion of the paper with a reward for yourself each time a goal is achieved. Another example is to study each course every day by allotting a specific time to read and review the subject material covered in class.

Know where and when you can best complete a task. Know the circumstances under which you function best. Is it easier for you to concentrate if you work in the library or the dorm room? Where will you have the least interruptions? Do you concentrate best in the morning, afternoon, or evening?

Establish priorities. To find time for everything that must be done, you have to know your priorities. Tasks can be divided into those that must be done immediately, those that can wait a brief time, and those that are not essential to accomplish. Once priorities are established, start with the highest priority item and work through the list.

Ask for help if responsibilities become over whelming. Say “no” when there are too many tasks to handle. Do not feel guilty about saying “no,” this only adds more stress. For example, if sorority or fraternity demands are too great, either ask others to share the workload or refuse the responsibility.

Take a break. Every day should provide for fun, leisure, time alone, and relaxation. Make the most of every day. Schedule in time every day for yourself.

Use it to record your daily activities for several days to a week. Then review it and see if you are spending your time as effectively as you thought or if you have overschedvuled what you can do in a 24-hour period. This can provide you with a basis for improved time management plans.

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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.

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You breathe to supply your body with oxygen and to get rid of carbon dioxide, a waste product of energy produc­tion. The lungs are the center of the respiratory system. In your lungs, the oxygen in the air you breathe is exchanged for carbon dioxide from the blood. The channel that the air follows in and out of your lungs is called the respiratory tract. It includes the nose, throat, and trachea, or wind­pipe. Deep in the chest the trachea divides into two main tubes, which are called bronchi. Each one goes into one lung, where it divides into increasingly smaller air pas­sages called bronchioles. At the tip of each bronchiole there is a balloon-like cavity called an alveolus. There are about 300 million of these alveoli in each lung. The vital exchange of oxygen for carbon dioxide occurs through minute blood vessels in the thin walls of the alveoli.

You use several muscles to suck air into your lungs. The main one is the diaphragm. A dome-shaped muscular sheet attached to the lower ribs, the diaphragm divides the chest cavity from the abdomen. When the diaphragm contracts, along with other muscles between the ribs, a vacuum is created around your lungs. This causes them to expand, sucking air into the respiratory tract. When the muscles relax, the lungs contract, forcing the air back out. If this mechanism works well, you hardly notice that you are breathing. However, a numberof things can go wrong, with the lungs themselves, with essential parts of the respiratory tract, or with the muscular action.

The articles in this section are arranged in three groups.

Each group concentrates on disorders that affect one area of the respiratory system. The first group deals with problems that affect the nasal cavity and the sinuses, or air spaces behind the nose. The second group of articles deals with disorders of the throat. These include problems of both the larynx, or voice box, which is located at the top of the trachea, and the pharynx, the funnel that leads from the nasal cavity and the back of the mouth down to where the esophagus, which carries food and water to the stomach, separates from the trachea. The third group of articles deals with common diseases of the trachea, lungs and breathing mechanism.

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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.

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