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Symptoms: paleness, weakness, or fatigue, spontaneous bruising, red, swollen, or bleeding gums, persistent low-grade fever, swollen lymph glands, bone pain, nosebleeds, blood in urine or stool, enlarged spleen or liver.

Home care

Treatment for leukemia must always regulated by a doctor.

Precaution

Many common diseases can imitate the symptoms of leukemia. Do not assume that a child has leukemia because he or she has one or more of the symptoms listed above. Have the doctor see the child to make a diagnosis.

Leukemia is cancer of the white blood cells. It can afflict children at any age, but most frequently occurs in children between three and four years old. Some 25 percent of leukemia cases are diagnosed during a routine physical examination before the child shows any symptoms of the disease. Symptoms similar to those of leukemia can also show up in a child suffering from some quite different (and often very simple) disorder. Although it’s rare, leukemia is one of the four types of cancer most frequently seen in children. The disease can progress slowly or rapidly.

Signs and symptoms

Typical symptoms of leukemia are: anaemia, indicated by paleness, weakness, or fatigue; bruises that appear on the body for no apparent reason; swollen, red, and bleeding gums; a low-grade fever (38.3°C); swelling of the lymph glands (although the glands are neither red nor painful); bone pain; frequent, heavy nosebleeds; and the appearance of blood in the child’s urine or stool.

Doctors may suspect leukemia when a physical examination reveals the above signs and symptoms along with an enlarged spleen or liver. Suspicion is strengthened by an abnormal blood count that reveals malignant (cancerous) white blood cells. The diagnosis is confirmed by an examination of bone marrow.

Home care

No home care is advised until a doctor has diagnosed the condition. Leukemia is a serious condition that always requires close medical attention.

Precaution

Leukemia itself is fairly uncommon. However, many illnesses imitate leukemia, and these illnesses are not uncommon; among them are infectious mononucleosis, herpes infections of the mouth, vitamin Ñ deficiency, rheumatic fever, rheumatoid arthritis, sickle cell anaemia, and other diseases that cause spontaneous bruising. Do not jump to the conclusion that your child has leukemia because of the presence of any of the signs or symptoms described above. To ease your mind, have the doctor examine the child.

Medical treatment

Today, leukemia can be treated with a wide range of anti-cancer drugs. These drugs may result in long periods of remission (during which the illness gets no worse) and perhaps even cure. Pediatric cancer specialists (oncologists) decide on and supervise the treatment of leukemia. The survival rate of childhood leukemia has been rising over the last few years because of the use of new, complex, anti-cancer drugs.

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It is a burning pain behind the breastbone, sometimes accompanied by watery acid coming back into the mouth. The reflux of acid from the stomach into the gullet is usually prevented by a valve at the junction of the two. This valve can become faulty in several medical conditions, or excessive amounts of acid may be produced by the stomach. Smoking reduces the effectiveness of the valve and, like alcohol, increases the amount of stomach acid produced.

What causes it?

•     Hiatus hernia-a condition in which the top end of the stomach ruptures through the diaphragm into the chest.

•     Heavy meals before retiring.

•     Lying flat in bed.

•     Smoking.

•     Alcohol.

•     Being overweight.

•     Tight, constrictive clothing.

•     Eating too heartily.

•     Stress.

•     Pregnancy.

•     Stooping.

Prevention

• Hiatus hernia is common in obese women, and slimming generally helps cure the condition. Prevention of hiatus hernia therefore includes keeping slim. Hiatus hernia is also thought to be caused by excessive straining to pass hard, sticky motions caused by eating highly refined and low-fibre foods. Probably the best preventive for hiatus hernia is a high-fibre diet with plenty of fruit and vegetables, whole meal-flour products and fluid. This keeps the motions soft and means that the individual does not have to strain to pass stools. When straining at stool the pressure inside the abdominal cavity rises dramatically and forces the top end of the stomach to rupture into the chest.

• A large meal before retiring means that the stomach is full and triggered to produce a large amount of acid. The full stomach will also force food up the lower end of the gullet if there is any weakness of the valve there. The acid will produce pain because it will come into contact with gullet lining that is sensitive to acid.

• Raising the head of the bed on books or a couple of bricks and keeping several pillows behind you is a good way of keeping the upper part of your body upright. This in itself can help cure and prevent heartburn.

• Cut down on or stop smoking.

• Cut down or stop drinking alcohol.

• Reduce your weight-this alone can work wonders.

• Don’t wear tight belts, corsets or even tight skirts or trousers. This can have the effect of forcing the abdominal contents upwards and making heartburn worse.

• Eating too heartily can produce indigestion and an over-production of gastric acid. Chew food well before swallowing and eat several small meals rather than having a smaller number of big blow-outs.

• Stress is a powerful producer of acid in the stomach. If acid travels from the stomach into the first part of the intestine it can cause a duodenal ulcer but if it flows into the gullet it can cause a lot of pain and a condition known as reflux oesophagitis. This can be prevented by taking medications that stop acid production in the first place (available on prescription from your doctor) or you can take antacids or stomach powder; to mop up the acid. Milk does not help as it actually increases stomach-acid production after a while. The best preventive is to sort out the causes of stress in your life and learn to relax.

• Pregnancy causes heartburn because the greatly enlarged uterus forces the abdominal contents upwards and encourages the reflux of gastric acid into the lower end of the gullet. The best preventives for this are: to sleep upright in bed at night; to adopt love-making positions that keep the woman upright; and to take antacids and frequent, small meals.

• Stooping can usually be avoided. Sit down to put on shoes, etc. Kneel down to pick things up. In short, avoid bending double for any reason.

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In the early 1980s, cardiologists were still arguing as to whether bypass surgery to improve the coronary artery flow was worthwhile. There were doubts about its safety and its long-term benefits. In the early days, many bypasses closed off a few months after the operation, leaving the patients no better off.

These doubts are now dispelled. Bypass surgery is now accepted as improving the quality of life of thousands of angina sufferers, and as saving many lives. It has a very high success rate, and the restenosis rate is diminishing year by year.

To bypass surgery has been added balloon angioplasty and, more recently, laser and stent treatment.

The Results

Thousands of people have now enjoyed more than ten years of full, active lives after bypass and angioplasty operations. Their lives have been changed beyond belief The benefits, however, cannot be put down entirely to their surgery. The ones who have done best are those who changed many other aspects of their lives, too.

They stopped smoking, controlled their drinking, changed their eating habits, exercised more, lost their excess weight, and adopted an altogether new lifestyle. Their hospital treatment offered them a chance to start life again, and they took it. This must be the definitive and lasting message for everyone with angina.

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A raised systolic blood pressure increases the risk of developing heart failure by fivefold, and a raised diastolic pressure raises the stroke risk by seven or eight times and the heart attack risk by three times. Trials have shown that reducing the blood pressure reduces the risk accordingly. Even if the blood pressure is only moderately raised, reducing it to normal levels will reduce the risk of a heart attack or stroke.

The treatment works regardless of age. The European Working Party on Hypertension (EWPH), of which Professor Mancia was a member, followed one thousand elderly people with hypertension for seven years who were either taking active blood pressure-reducing drugs or placebo. At the time the trial was started, many doctors believed that reducing blood pressure in the elderly might cause more illness than leaving it alone. It was feared that the lower blood pressure might lower the blood flow to the brain and cause thrombosis or memory problems.

The fear proved to be unnecessary. The persons whose blood pressures were lowered had 35 percent fewer strokes, heart attacks, and deaths than those given placebo.

Other trials have since confirmed this result (Collin, et al. 1990). When an analysis of all the available controlled (scientifically acceptable) trials was made, treating hypertension led to a halving of deaths from strokes and heart attacks.

From all the results, Professor Mancia calculated how many lives would be saved if all people with hypertension were actively treated to bring their blood pressure down into the normal range. Even using the lowest calculations of benefit, this action would significantly extend more than five thousand lives annually in a country such as Italy, with a population of fifty-five million people.

Of course, Professor Mancia performed his calculation for his own countrymen, but if you apply the numbers to the U.S., with a population of 250 million, 22,500 lives would be extended annually. The true figure of lives saved, Professor Mancia concedes, is probably much greater than 5,000, for the trials may have underestimated the benefit, because some people in the trials were not truly hypertensive, and many people who were supposed to be taking placebo also took antihypertensive drugs! When they found their blood pressures were rising, they switched to active treatment.

One trial in particular is important for angina sufferers. The SHEP (Systolic Hypertension in the Elderly Program) study showed not only that there was 32 percent less disease of the heart and circulation in those whose blood pressures were treated with blood pressure-lowering drugs, but that they had fewer heart attacks and had less need for coronary bypass grafts and angioplasty operations.

The message is that if you have angina and hypertension, lowering your blood pressure into the normal range and keeping it there is the most important and effective way to stay fit and alive, and, as a bonus, it may enable you to avoid surgery.

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Running

If you think you may enjoy running, then by all means try it, but buy the right shoes first. If you intend to run on roads or pavements, you must wear proper road-running shoes with air-cushioned soles. Hard surfaces and the wrong shoes can badly jar ankle, knee, and hip joints, to say nothing of the spine.

Running, however, doesn’t suit everyone. If you are overweight, then walk or swim instead, until you are closer to a healthy weight. Then, if you feel like it, you can start running. Don’t start running if you have trouble in the weight-bearing joints—the knees, ankles, hips, and back. Swimming and cycling is probably better for you.

If you find the running begins to get boring after a while, change to something else. You will not keep up any exercise for a lifetime if you don’t really like it.

Don’t Become an “Exercise Bore”!

Don’t take the exercise too seriously, either. “Exercise bores,” who can talk about nothing other than their times and speeds, are hardly popular! In fact, don’t buy a stopwatch; competitions and speeds should not be part of your approach. How long you spend on your exercise is probably more important than its intensity. A four-mile walk will get your heart as fit as if you had run the same distance in half the time.

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MRFIT was an American study in the 1980s of 361,662 men aged thirty-five to fifty-seven who volunteered for health screening through their employment. Some 12,866 in the upper range for risk, based on smoking, blood pressure, and blood cholesterol level, and who showed no evidence of heart disease, were admitted to the trial.

Half of the group (6,428 men) were allocated to a program of special intervention. They were seen every four months, asked to stop smoking, had their blood pressure well controlled, and asked to alter their eating habits to reduce their blood cholesterol. The other half (6,438 men) were given usual care, which meant that they were seen once a year and given no specific advice about how to change their coronary risks. However, they and their doctors were given all necessary information about their risk factors.

The control group, however, still got the health message, because smoking, blood pressure, and blood cholesterol levels were reduced in both groups, though significantly more so in the treatment group.

Over seven years, the heart attack morality was 22 percent less in the treatment group than in the control group. This difference, however, did not meet the criteria for statistical significance, partly because heart attack rates in the controls also fell, to almost half the rate expected from the Framingham experience. More detailed analysis suggested that the main causes of the reduction in problems for both groups were smoking cessation and reduction of cholesterol levels.

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The element that has the most effect on blood viscosity, or stickiness, however, is the red blood cell. Red cells, which carry the oxygen from the lungs through the heart and into the rest of the body, must be flexible, like very soft rubber, to pass through the smallest blood vessels. They are disc-like, with a diameter of around 7 microns (7 thousandths of a millimeter). The smallest capillaries (the blood vessels from which the oxygen is given up to the tissues) are only 5 to

10 microns across, so the red cells have to fold and bend to pass through them.

If the red cells become less flexible or pile up, almost like a tube of gumdrops, the circulation inside the capillaries becomes much less free, and the pressure needed to force the blood through the circulation has to rise. This, of course, is an extra strain on the heart.

Stiffened, piled up red cells can even lead to blockage of the capillaries, with thrombosis, so that the capillary circulation can even stop completely in places. This process is made worse in some people, in whom the substance fibrinogen, which promotes blood clotting, is present in higher than normal amounts in the blood.

What if the red cells are not only stiffer than normal, but they also don’t carry enough oxygen from the lungs? They are designed to take up oxygen in large amounts, then give it up freely when they reach the tissues. However, the red cell oxygen uptake mechanism works even better for the lethal gas called carbon monoxide. When you breathe in a mixture of carbon monoxide and oxygen, the red cells preferentially take up carbon monoxide, rather than oxygen, and it remains solidly bound to them, so that they can no longer take up oxygen from the lungs.

Cigarettes and barbecues, as well as car exhaust (which has been a favored method of suicide for many years) still contain carbon monoxide. However, you don’t need to breathe in a suicidal dose of carbon monoxide to do yourself harm: if you expose yourself to a small amount, day in and day out, you are giving your heart less oxygen and reducing the supply side of the equation even further.

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