One of the cosmetic toxins that consumer advocates are most concerned about is nitrosamines, which contaminate a wide variety of cosmetic products. In the 1970′s nitrosamine contamination of cooked bacon and other nitrite-treated meats became a public-health issue, and the food industry, which is more strictly regulated than the cosmetic industry, has since drastically lowered the amount of nitrosamines found in these processed meats. But today nitrosamines contaminate cosmetics at significantly higher levels than were once containe$$$1[ bacon.

The FDA has long known that nitrosamines in cosmetics pose a risk to public health. On April 10, 1979, FDA commissioner Donald Kennedy called on the cosmetic industry to "take immediate measures to eliminate, to the extent possible, NDELA [a potent nitrosamine] and any other N-nitrosamine from cosmetic products.” Since that warning, however, cosmetic manufacturers have done little to remove N-nitrosamines from their products, and the FDA has done even less to monitor them.

Individual FDA scientists are speaking out. The FDA’s Donald Harvey and Hardy Chou proclaimed that the continued use of these ingredients contradict what should be a social goal: keeping “human exposure to N-nitrosamines to the lowest level technologically feasible, by reducing levels in all personal care products.”

*43/165/1*

The gender roles in most societies have a strong impact on sexual attitudes and behavior. For example, in America it is still widely thought that males are innately more interested in sex than females, that males characteristically assume an active role in sex while females are characteristically passive, and that male sexual arousal occurs quickly and automatically, while females require sweet talk and special handling and even then have only a precarious degree of arousability. Each of these stereotypes has some behavioral consequences: in general, men try to measure up to the cultural expectations and women often accept the notion of being second-class citizens from a sexual viewpoint.

By looking at a culture that has a very different set of expectations about sexual interaction, we can see how limiting these stereotypes are. In Mangaia, a tiny Polynesian island in the South Pacific, the cultural message is that sexual pleasure is for everyone. As a result: “Less than one out of a hundred girls, and even fewer boys — if, indeed, there are any exceptions in either sex — have not had substantial sexual experience prior to marriage” Female sexual passivity is frowned on among Mangaians, and sexual intimacy does not require prior establishment of personal affection. Girls are expected to learn to be orgasmic at a young age, and although their first sexual experiences are likely to be with boys of their own age, older and more experienced partners soon become desirable because they can give more sexual pleasure. One particularly interesting observation: “upon hearing that some American and European women cannot or do not achieve the climax, the Mangaian immediately asks (with real concern) whether this inability will not injure the married woman’s health.” On Mangaia, all women learn to be orgasmic.

We have previously mentioned the double standard that applies to sexual behavior in our society. According to the traditional double standard, males are permitted to have premarital sexual experience while females are expected to remain virgins. After marriage, while fidelity is “officially” expected, it is acknowledged that men might roam and women are expected to remain faithful. In recent years, the double standard has undergone some subtle changes. Many teenagers have discarded the belief that female virginity is necessary or desirable, but it now seems that a young woman must wait for a “serious relationship” to have intercourse, while young men are not so strongly saddled with this expectation.

The double standard also assigns responsibility for being the sexual “expert” to the male. The male is expected to initiate sexual interaction, to control the timing and tempo, to select the proper activities to bring about his partner’s arousal, and to bring his partner to orgasm. While this version of the double standard (the idea that sex is something a man does “for” a woman) may be an improvement on the older belief that “good” women had no sexual feelings (in this view, sex was something a man did “to” a woman for his own release), it hardly encourages flexibility and sharing.

The double standard and its variations can create a number of sexual problems. The female, for example, may develop a narrow view of sexual interaction. Feeling that she must prevent the male from “trying to get all he can,” her potential pleasure is decreased by her need to set limits. The male, on the other hand, may feel compelled to prove his masculinity by making sexual advances even when he is not particularly in the mood or attracted to his companion.

It now appears that the sexual double standard, like many other gender-role stereotypes, is beginning to be replaced by concepts of equal opportunity and mutual interaction. What a great many men and women are learning is that they cannot achieve the pleasure they both want until they realize that sex is not something a man does to or for a woman but something a man and woman do together as equal participants.

The woman who honors her sexuality learns that she can,

when she chooses, express openly the full range of her excitement and involvement — the delight of wanting and being

wanted, touching and being touched, seeing and being seen, hearing words and uttering them, of fragrances and textures, silence and sounds. The man who appreciates her as a partner can enjoy letting go of responsibility for her satisfaction and can savor her varying moods and desires in conjunction with his own.

The responsiveness of both partners is based on acceptance of each other as vulnerable human beings with unique needs, expectations, and capabilities. Both can express their creative impulses without fear of violating the gender-role expectations of ladyhood or chivalry. Emotional needs, which vary with the mood, time, and place, are not labeled “masculine” and “feminine.” Each partner can appreciate the other’s sexual urges. If their sexual needs conflict at times, they can gently negotiate a solution — not as representatives of two different sexes but as two separate partners united by a mutual concern.

Sexual emancipation grows out of a sense of self-respect and personal freedom. If you are nothing to yourself, you have nothing to give and expect nothing in return. Sexually perhaps you might consider yourself useful, as an object is useful, but that is all. Before a true partnership is possible, both individuals must have pride in themselves and feel happy in being male or female.

At least half the potential pleasure of the sexual experience comes from how a partner responds. If there is virtually no reaction, or at best passive acceptance, the emotional current steadily weakens and eventually flickers and goes dead. However, with an actively involved partner, one individual’s spontaneous feelings, spontaneously communicated, stimulate the other and heighten his or her tensions, impelling that person to act on his or her own impulses. Whatever she gives him returns to her and whatever he gives her comes back to him.

The relationship between the sexes is often conceived in terms of a misleading image: two on a seesaw. Power is the pivot, and if one sex goes up, the other must come down. What women gain, men lose. But the sexual relationship itself shows the analogy to be false. What men and women achieve together benefits both — the quality of life, as it is individually experienced, can be greatly expanded by a fully shared partnership.

*107\342\2*

The cardiovascular benefits of an exercise program include the following:

Increases the ability of your heart to pump blood

Decreases your heart rate at rest and during moderate exercise

May decrease your blood pressure if you have hypertension

May increase your HDL cholesterol level

May decrease LDL cholesterol and total cholesterol levels

May decrease your triglyceride level

Helps you control weight

May help reduce stress >

Helps reduce elevated levels of blood sugar (glucose) in people with non-insulin-dependent diabetes

Other benefits of an exercise program include the following:

Increases your exercise capacity, resulting in an improved ability to perform physical and mental work

Reduces fatigue, tension, and anxiety

May improve joint function

Potentially reduces loss of bone mineral, therefore lessening the risk of osteoporosis

Improves appearance and a sense of well-being

Helps maintain bowel regularity

*272\252\8*

Mrs and Mr. Rakesh were a very happy couple. They had been married 3 years ago, but from their happiness one could only say they had just returned from their honeymoon.

One day there was an argument between the two on a small matter, and Mr. Rakesh lost his temper and threw a glass on her which cut her face

He was immediately penitent, wept bitterly, struck his hand and his head against the wall. He sobbed out his heart “Oh God, how could I do it, why did I do it”.

The doctor attended to the wound and it was cured in a few days. But the shock to Mr. Rakesh was more deep-seated. He was always brooding on the incident and was visibly upset. Mrs. Rakesh tried her level best to console her husband, but he was fast losing his interest in his business and in life itself.

Mrs. Rakesh watched the change with great anxiety and brought her husband to us for medical advice. Honey Suckle Remedy T.D.S for one week improved the case. Then a combination of Honey suckle (to break link with old memories) and Pine Remedy (to remove his feeling of self-condemnation) was given for 2 weeks which brought his condition to normalcy.

Out of ample care a course of CHERRY PLUM was given T.D.S for 6 weeks to strengthen his control of the mind. Already he had shown lack of control over his mind, when he struck his wife in a fit of anger.

According to Dr. Bach “Honeysuckle Remedy is meant to remove from the mind the regrets and sorrows of the past, to counter act all influences, all wishes and desires of the past and to bring us back to the present”.

*122\308\8*

The cruciate ligaments—so named because they crisscross each other—are embedded deep inside the knee joint. The ACL, which connects the femur to the tibia, is only 2 inches in length and 3/4 inch in width, but it is critical in helping to maintain stability. The ACL limits rotation of the knee and restricts the forward motion of the tibia. There are between 100,000 and 250,000 ACL injuries each year. It is more prone to injury than other ligaments and can be stretched or torn by a sudden twisting or torquing motion. For example, losing control of your skis or landing improperly during a basketball game (in which your feet go one way and your knee is turned another way) can result in an injured ACL.

A torn ACL may or may not hurt at the time of injury, depending on the type of injury. Very often, a patient will talk about hearing a pop and suddenly finding that her leg has literally buckled under. Depending on the extent of the injury, stiffness and swelling may persist for some time. In the case of a minor stretch or tear, the injury may resolve itself; however, if the tear is significant, an injured ACL can severely curtail activity.

The PCL is about 2 inches long and slightly wider than the ACL. It connects the femur to the tibia. This ligament restricts the backward motion of the leg and is rarely injured in sports but may be ripped or torn as a result of a traumatic injury such as an automobile accident.

Diagnosis

Physical Examination. Palpating, or feeling, the knee in conjunction with stability testing are the primary ways that a physician can make a quick assessment of an injury without surgical intervention. However, because the cruciate ligaments are deep inside the knee, the physician can’t palpate the area for pain or tenderness. Therefore, unlike tears of the collateral ligaments, which can be graded according to severity (grade 1, the least serious, to grade 3, the most serious), cruciate ligaments cannot be graded in a similar fashion because they cannot be felt.

Stability Tests. The Lachman test (see page 29) is often used to test the ACL. In this test, the doctor puts the leg in full extension and then pulls the tibia forward, almost as if he’s trying to pull the tibia away. If the leg moves 5 millimeters or more from the right to left, it could signify a torn ACL. A KT test quantifies the displacement with a Lachman test. The KT is a handheld machine placed on the tibia as the physician performs the test.

An anterior drawer test is also used to assess the integrity of the ACL. The knee is bent 90 degrees, and the physician pulls the tibia forward. If it moves more than 5 millimeters forward, it strongly suggests a torn ACL.

The posterior drawer test is used to test the PCL. In this test, the physician bends the knee 90 degrees and pushes the tibia back. If the leg moves more than 5 millimeters backward, it strongly suggests a torn PCL.

MRI. An MRI has an accuracy of almost 90 percent in determining a normal or completely torn ACL or PCL. Normally, the ACL or PCL appears as a dark structure that runs from the corresponding origin to its insertion. The MRI, however, is not very good in detailing a partial tear. The partial tear can be diagnosed by arthroscopy.

Arthroscopy. During arthroscopy, the physician can gently pull the ACL to determine the degree of injury and whether it warrants further treatment. However, this is very subjective, and much of the diagnosis depends on the skill and experience of the surgeon.

Treatment

The ACL. There are two courses of treatment for ACL injuries, the nonoperative approach and surgery.

Nonoperative   The physician and patient may opt to try an exercise strengthening program in lieu of surgery.

Surgery   The ACL is surgically reconstructed, and the patient is then put into a rehabilitation program.

The treatment approach depends primarily on the injury and the lifestyle and goals of the patient and any other associated injuries, for example, a concurrent torn collateral ligament or meniscal tear.

Only one-third of all people with a completely torn ACL will be able to build up their muscle strength to the point that they will be able to resume normal activity without surgery. In time, these lucky few will be able to run, jump, ski, play basketball—in short, do whatever they want—with little more than a functional knee brace for added support. The odds of success through exercise alone are not as good for women as it is for men. Born with less muscle strength than men and looser ligaments, most women will not be able to develop enough muscle strength to compensate for the insufficient ligament.

Sedentary younger people who don’t mind curtailing their activities and older, less active people may opt for an exercise strengthening program instead of surgery. Because the injury is not interfering with their lifestyle, there is less urgency to operate. However, an active, athletic person will often choose immediate surgical intervention followed by a rehabilitation program geared at getting her back to full activity as soon as possible.

Lifestyle is only one consideration in choosing treatment; the long-term implications of not surgically correcting the ligament tear is another important factor. Studies show that about 65 percent of all patients with a torn ACL will go on to develop a torn meniscus, which we now know may predispose them to the early onset of arthritis. Although the data are still lacking to directly link a torn ACL with arthritis, the indirect association has been established. Meniscal tears and/or subsequent resection of either all or part of the meniscus in most settings lead to arthritic changes, the primary reason for the trend toward repairing the meniscus. Because 65 percent of people with a torn ACL will eventually develop a torn meniscus, the ACL at least indirectly contributes to the development of arthritis. Consequently, it appears that a reconstruction might play some role in the prevention or minimization of the development of arthritis. The appropriate data, however, necessary to support this hypothesis are still lacking. As the years accumulate, we should eventually have the hard facts to support this assumption.

No matter which treatment option you choose, I want to stress that the recovery process for an ACL injury is not easy. For the patient selecting a nonoperative approach, the rehabilitative process will take approximately 4 months. In fact, the rehabilitative training for a cruciate injury can take anywhere from 3 months to a year and requires a significant time commitment (at least 3 days a week for about 45 minutes each day). However, in most cases, your efforts will be rewarded: surgical intervention along with appropriate rehabilitative training has a success rate of 90 percent, meaning that 90 percent of patients will have a functional knee allowing them to return to their recreational lifestyle.

Surgery

PRIMARY REPAIRS. It seems logical that if you have a torn ligament, the simplest solution would be to suture or sew it back together, a procedure called a primary repair. However, results of resuturing the ligament have been quite dismal. Initially, the patients did well, but over time, the ligament will show symptoms of instability. Reconstruction, or making a new ligament, is now the rule rather than the exception. There is only one situation in which a primary repair of an ACL is appropriate: an avulsion injury in which the ligament remains intact, but it has been pulled off the bone. This type of injury can easily be repaired by simply reattaching the bone avulsion to its previous insertion. An avulsion injury is rare and occurs in skeletally immature individuals (children), whose growth plates are still open. Because the plates are still open—the skeleton is still growing—the attachment to the bone is actually weaker than the ligament itself. Thus the ligament will tear at its weakest link, the attachment to the bone.

RECONSTRUCTION. The most common type of surgery for an ACL injury involves reconstructing the torn ligament with either a healthy tissue (a graft) from the patient, called an autograft; a ligament from a cadaver, called an allograft; or a synthetic ligament.

An Autograft

The most successful type of reconstructive surgery involves using an autograft, which means that the healthy tissue used to reconstruct the damaged ACL comes from the patient’s own body. Typically, the graft is taken from the central one-third of the patellar tendon, which is located just below the kneecap. Although it is less common, the graft can also be taken from the semitendonosis and gracilis tendons, which are located on the inside of the knee. However, studies show that the bone-patellar tendon-bone graft is stronger and heals better and, therefore, whenever possible is the procedure of choice.

Prior to surgery, the patient is given a sedative-hypnotic to induce sleep and then given a general anesthesia. In some cases, depending on the duration of the surgery, the patient might be intubated with a tube and respirator or given a spinal or epidural anesthesia. Patients do not feel anything and are not aware of the surgery.

A small incision (2 to 3 inches) is made to remove the portion of the patellar tendon that is to be grafted. The rest of the procedure is done arthroscopically. The autograft, which becomes the new ACL, is attached to the origin (femur) and inserted to the tibia through drill holes that are cylindrically reproduced to match the size of the bone-tendon-bone graft. The metal screws are a primarily temporary fixation until your own bone fills in and becomes the permanent anchors of the knee. Except in a small percentage of cases, the screws are left in place. In rare cases, one of the screws might become tender to the touch and require removal, which usually would not be done until a year after surgery.

Immediately following the surgery, the new structure is significantly stronger than a normal ACL, but it quickly loses strength as the body begins to fully incorporate the new ligament with the other components of the knee. There are several steps involved in the process of adopting the new ligament to its new location (or, in the case of an allograft, to its new body). First, the body undergoes a process called revascularization in which it passes a new blood supply to the ligament. Without an adequate supply of blood, the ligament cannot survive. This critical stage is followed by another important process called the recollagenization stage. In recollagenization, the body “changes” the collagen of the reconstructed ligament with that of its own collagen. It takes the body approximately 6 to 12 months to fully accept the new ligament. Unfortunately, during the process, the ligament loses approximately 40 to 50 percent of its initial strength. However, because the transplanted ligament was so much stronger than the normal ACL to begin with, the loss of some strength should not interfere with the patient’s ability to return to a functional lifestyle. Although the reconstructed ACL is not a normal ACL, it should be good enough so that the patient can return to a preinjury sports and activity level.

Albeit rare, complications from surgery can include infection (approximately 1 percent); peroneal nerve palsy, which would mean loss of foot function (less than 1 percent); loss of screw fixation at either the tibial or femoral tunnels (less than

1 percent); fracture of the patella (less than 1 percent); and other potential problems that are rare but could make the patient worse.

The gracilis-semitendonosis tendon combination shows a good early result, but with increasing time, this combination does not hold up as well to the bone-patellar tendon-bone combination. This procedure usually requires one incision to harvest the appropriate autograft and several punctures to accommodate the arthroscope and the surgical instruments. It usually lasts less than 2 hours, and most patients are home within 24 hours.

An Allograft

In some cases, a cadaver ligament is used to reconstruct the new ACL, which helps preserve the patient’s own patellar tendon. This procedure, which is called an allograft, works almost as well as the autograft, but it can take longer to heal microscopically—12 to 18 months as compared to 6 to 12 months. Also, there is some evidence to suggest that the allograft might not be as strong as the autograft and may not yield as good a result.

At one time, grafting cadaver ligaments was risky because screening for human immunodeficiency virus (HIV, the AIDS virus) was not performed. During that era, there was one documented case of HIV transmission due to a cadaver ligament transplant. Today, however, screening techniques and specimen tests for these diseases along with superb sterilization techniques have substantially diminished that risk to what is now approximately 1 in 2 million. Even though the risk is minuscule, to be on the safe side, I believe that allografts should be restricted to patients for whom the benefits clearly outweigh any potential risks. For example, an athletic older patient whose tendon may be weakened by age may fare better with an allograft from a younger person. In addition, if a patient has already used his own patellar tendon and requires a second reconstruction, the best choice might be an allograft.

A Prosthesis

By far, the safest and easiest way to reconstruct an ACL would be simply to use a synthetic or man-made ligament. Unfortunately, synthetic ligaments have such a poor track record that they are rarely used in the United States. In the 1980s, a synthetic ligament made out of Gore-Tex was used in ACL reconstructions. Initially, the synthetic ligament worked well, but the success rate at 5 years was below 50 percent. The man-made ligament could simply not withstand the normal stresses placed on the knee and quickly frayed and broke. A new and supposedly vastly improved version of this ligament is now being used in Canada, and I suspect it will be approved for use in the United States soon. Although the early results are encouraging, it will be several years before we know whether this synthetic ligament can withstand the test of time.

Postsurgery and Recovery

After ACL surgery, you will probably spend between 2 and 3 hours in the recovery room. A large bandage and drain will be put on your elevated knee to control bleeding. The dressing is usually removed the day after surgery. A lightweight brace that allows for motion is worn for up to 2 weeks to protect the knee. You can bear weight on your leg the day of surgery. As soon as possible, you will use a continuous passive motion (CPM) machine, which flexes and extends the leg as you lie in your bed. CPM can help prevent the joint from becoming stiff due to inactivity. You will probably be in pain and will be given pain medication as needed. Ice will also help control pain and swelling. At one time patients used to spend up to 48 hours in the hospital, but most insurance companies are now insisting that patients leave within 24 hours.

Over the next 2 to 3 weeks, you may experience night sweats and a fever of up to 101. This is normal and if you’re uncomfortable and your physician agrees, you can bring your fever down with two acetaminophen (Tylenol) or a dose or two of antibiotics to minimize the risk of infection.

In the morning, your knee may feel particularly stiff or painful. An ice pack can help relieve the pain before you begin your therapy.

The average return to sports takes around 6 months, but it can range anywhere between 3 and 12 months, assuming you are diligent about doing your exercises. Your knee will eventually heal with all but a tiny scar remaining. Scar tissue has a tendency to tan darker than normal skin, so if you are out in the sun for a prolonged period of time within the first 12 months after surgery, you might want to cover your knee.

The PCL     PCL injuries are not as well understood as that of the ACL and are currently being studied. As the follow-up studies are becoming available, it becomes apparent that people whose physical examinations or KT evaluations reveal a 1 centimeter or more movement side to side (normal is under 3 millimeters) on a posterior drawer test will probably not do well with an exercise program and will need surgery. The exercise program should stress quadriceps strengthening until both legs are equal in strength. The patients are then healed and can return to their sports. For those whose examination is more than 10 millimeters, a reconstruction using a bone-patellar tendon-bone autograft or allograft or achilles tendon allograft is recommended. To date, there is no consensus of opinion of the superiority of one preparation over the other.

*35\185\2*

People with diabetes routinely test their blood sugar level to monitor how well their condition is being controlled. Checking on the amount of sugar in the blood several times a day helps give a better idea of how much insulin is needed. Keeping blood sugar levels under control can help to prevent or even reverse some long-term complications of diabetes.

In the past, urine tests were commonly used for monitoring diabetes. But this is not the best way to measure glucose levels. If there is glucose in the urine, you don’t know when it spilled over. A urine test might be negative when blood glucose levels are actually dangerously high. Urine tests don’t tell you how high the blood sugar was, either, and they can’t tell you when blood sugar levels are too low.

Fortunately, technology has provided an affordable way to measure blood sugar levels by using devices called blood glucose monitors. You can find out exactly what your blood sugar level is in just a few moments. This makes it possible to adjust food and insulin more appropriately than ever before. Using a monitor regularly can also give a timely warning when an insulin reaction is developing, because the blood test shows when there is too little glucose present.

To test blood sugar, you just prick your finger or earlobe and place a drop of blood onto a chemically sensitive strip. In some systems the strip is compared to a color-coded chart, or it is simply placed into a small portable machine that provides a digital readout of blood sugar levels.

Wearing Medical Identification

Wearing a medical identification bracelet or necklace and/or carrying an identification card can also help in case of an emergency. Information on your illness and what to do in case of insulin reaction or ketoacidosis, as well as your name and the name and number of someone to contact, may mean the difference between life and death if you are found unconscious.

A nonprofit organization, Medic-Alert Foundation, can provide you with an identification card or tag, and maintains a central file containing vital information on every case registered with it. This information can be obtained twenty-four hours a day by a collect telephone call.

*39\268\2*

Can’t women take estrogen injections?

They can and for a long time they did. But the popularity of such shots has fallen off in the face of numerous reports as to their adverse side effects. Such injections, so some research indicates, produce an appreciably greater risk of cancer, among other things.

Are some races more vulnerable to high blood pressure than others?

A. Apparently. For example, one out of three American Blacks can expect to suffer from high blood pressure. This is about double the rate for American Whites.

Isn’t this due to the greater stress which characterizes so much of Black life in this country?

A. This could be the case. Certainly, Blacks in Africa show no disposition in this direction. It could also come from the fact that Blacks lived for so many centuries in an environment that contrasts so sharply with that of the present-day United States. In doing so, they may have acquired certain physiological characteristics which make it more difficult for them to adapt to our present environment. For example, almost all doctors accept the fact that salt has an adverse effect on blood pressure and we know that salt was and is in short supply in many parts of Africa. This may have caused many Africans to become accustomed to less salt than Europeans and therefore to become less able to handle the tremendous amounts of salt in the current American diet.

The New York Times reported the results of an interesting 10-year study conducted in Detroit. It revealed that the darker a Black person’s skin, the more likely he or she was to have HBP. There was a direct relationship between pigmentation and blood pressure. As you probably know, over 90 per cent of all Blacks in this country have had one or more white ancestors. Thus, it may be that those Blacks with fewer or no white forebears are more vulnerable to HBP. In any case, those who conducted the study felt the greater emotional stress which Blacks are subjected to in our culture was only one factor in the situation and not the whole problem.

Did the same type of skin-colour relationship hold true for Whites?

No. For Whites the reverse is true: the darker the skin colour, the less likelihood of HBP.

*12/151/5*

Simply pour about 1/2 cup of baking soda into a bowl, and add enough liquid detergent to make a texture like frosting. Scoop the mixture onto a sponge, and wash the surface. This is the perfect recipe for cleaning the bathtub because it rinses easy and doesn’t leave grit. Note: Add 1 teaspoon of vegetable glycerin to the mixture and store in a sealed glass jar, to keep the product moist. Otherwise just make as much as you need at a time.

1/4 —1/2 teaspoon liquid detergent 3 tablespoons vinegar 2 cups water spray bottle

Put all the ingredients into a spray bottle, shake it up a bit, and use as you would a commercial brand. The soap in this recipe is important. It cuts the wax residue from the commercial brands you might have used in the past.

1 cup or more baking soda water

a squirt or two of liquid detergent

Sprinkle water generously over the bottom of the oven, then cover the grime with enough baking soda so that the surface is totally white. Sprinkle some more water over the top. Let the mixture set overnight. You can easily wipe up the grease the next morning because the grime will have loosened. When you have cleaned up the worst of the mess, dab a bit of liquid detergent or soap on a sponge, and wash the remaining residue from the oven. If this recipe doesn’t work for you it is probably because you didn’t use enough baking soda and/or water.

*33/165/1*

People with BDD have very poor quality of life. Most feel distressed, don’t get much enjoyment or satisfaction from life, and have difficulty functioning at work, in school, socially, and in other important areas of their life.

I’ve studied quality of life in my two series of people with BDD. Both studies used a standard and widely used questionnaire—the SF-36 (also known as the Medical Outcomes Study 36-Item Short-Form Health Survey). The people in these studies reported unusually poor mental health status and mental health-related quality of life (which reflects psychological distress, problems functioning in one’s role because of emotional problems, and social functioning). The more severe the person’s BDD symptoms, the poorer his or her quality of life. When compared to published norms, mental health-related quality of life for people with BDD is much poorer than for the general U.S. population. As figure 3 shows, it’s also worse than for people with an acute medical condition (a recent heart attack) or a chronic medical condition (type II diabetes). It’s even poorer than for people with depression.

My second series of people with BDD also completed the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). On this questionnaire, too, people with BDD reported unusually poor quality of life. As Figure 4 (p. 132) shows, scores were very poor in all areas that the questionnaire assesses: emotional well-being, general functioning, work, school, household functioning, social functioning, leisure, and physical health. The more severe the person’s BDD symptoms, the poorer their quality of life tended to be. When compared to a sample of people from the community, 96% of community subjects scored better than the average BDD score. Importantly, scores for people with BDD were also poorer than have been reported for people with major depression, chronic major depression, dysthymia, obsessive compulsive disorder, social phobia, panic disorder, premenstrual dysphoric disorder, or post-traumatic stress disorder. These research results underscore the fact that BDD is a severe illness that needs to be taken seriously.

*133\204\8*

It’s not unusual for a woman to experience a letdown after the birth of a baby. Aside from the fatigue of labour, there are hormonal changes in the body that often cause bouts of blues and periods of inexplicable weepiness or mild depression. But these can be combated by paying special attention to your diet.

•   Be sure you’re getting enough calcium and calcium-rich foods; also, the proper amount of magnesium. (The combination is a natural depression defeater.)

•   Vitamins Bi, Вб, and В12 can help improve mental attitude substantially.

•   L-tryptophan, a natural relaxant and antidepressant, can pass rapidly from the stomach to the brain’s nerve centers. (Turkey is especially high in this amino acid.)

•   Manganese, present in leafy green vegetables, peas, egg yolks, beets, and whole-grain cereals, has been found by many new mothers to be effective in warding off depression.

•   L-phenylalanine is another amino acid and can work in a fashion similar to tryptophan, but unlike L-tryptophan, L-phenylalanine can raise blood pressure.

*11/137/5*