MEN AT THE TABLE: CAFFEINE CASE STUDY

A doctor reported that one afternoon a man came into his room complaining of poor sleeping patterns, profuse sweating, ongoing chest pain, palpitations and headaches. His symptoms were not new. He had suffered them for 3 years and produced a wad of papers from doctors he had previously consulted.

Having been through months of extensive tests, he was confident he was not having a heart attack. Tired of the medical run-around, he wanted answers. A standard examination yielded nothing apart from clammy skin, a rapid pulse, elevated blood pressure, a fine tremor in the hands and a sense of restlessness. Having a special interest in nutrition, the doctor went back to the beginning and started with a detailed dietary review. Within seconds the diagnosis became evident. He was a caffeine fiend. All day he virtually had one continuous cup of coffee. It began with two before work, then about one an hour at the office and another four during the evening.

A gradual ‘caffeine fading’ program was devised and he went away with detailed instructions for the next two weeks. A fortnight later he was a changed person. He had followed the program, replaced the bulk of his coffee with plain water and had improved on every front.

*106\105\2*

THE LONG GOODBYE: THE PAIN OF PLACING A PARTNER IN CARE

After 40 or 50 years of marriage, placing a partner in a nursing home can be a traumatic experience. No matter how necessary or rational the decision, after a man has placed his wife in care, he usually goes home bereft. The relief in knowing that she is being properly cared for is mixed with remorse and sadness.

After such a long marriage, the partners’ identities are intimately linked. These ties are ‘broken’ when a wife is placed in a nursing home, and the husband feels guilty. He believes he has failed to fulfil his marital obligations and vows.

Agreeing to have his partner placed in care often goes against a man’s sense of fairness, particularly if he and his wife have weathered many difficulties as a couple. ‘She looked after me and the kids and did so much for us. Now she needs help and I can’t provide it,’ is a typical response.

Apart from being involuntary, the separation is incomplete and turns into a long goodbye. Unlike widowers, who can fully grieve for a loss and are supported by community rituals that acknowledge it, men putting their aged wives in an institution experience complex emotions that are little understood.

Men find themselves in this situation when their wives need more care than the men can provide at home. The wives may have suffered a series of strokes, have advanced Alzheimer’s or be physically disabled, and their husbands may not have either the strength or the finances to provide 24-hour-a-day home care.

If a joint marital decision about the placement is not possible, men often feel intense guilt. Instead of being seen as a medical transfer, the relocation is framed as a family eviction, and men have described taking a confused and clinging wife away from home as the worst day of their lives.

It is very important for both parties that the transition to the nursing home be carefully managed. After a partner has gone, men who remain at home are generally more lonely than women in a similar situation. Women are kin-keepers: they keep social relations going, remember birthdays and talk to neighbours. By comparison, men are socially isolated and at 75 may not have the skills to develop a social life as a separate person.

Their loneliness is compounded by the loss of contact with the people who might regularly have visited the wife at home, such as physiotherapists, nurses and doctors, and by the loss of the structure of care. Many men withdraw from outside activities to care for their wives. When the wives go, there is a void.

Men expect to die first and are not prepared for living alone, going out alone, eating alone or making decisions alone. Left to themselves, they feel their independence is threatened. There is uncertainty about their own health, no-one to care for them and the worry that they too might have to move into a nursing home.

It may be difficult for them to be in the house alone. Some men report that they feel suicidal the first day they return to the empty house. They view the house as their wives’ territory and feel wrong living in it by themselves. The sense of grief and loss they experience can be so painful that they may move out of the marital bed, close off sections of the house and live in it differently.

Men are more task-focused than women are and often deal with the situation by taking a practical approach. A man is likely to think, ‘She needs more care, she has to go to the experts, it can’t be helped.’ A woman, however, will probably think that no-one else could look after her husband as well as she can.

Similarly, men are often much happier with the quality of care and with the nursing staff because they accept them as the experts. Women are more likely to come into conflict with nursing staff because they see themselves as the experts in caring for their husbands.

Commitment to the marriage does not end with placement. Visiting is the only way of continuing the relationship and demonstrating affection. Men are generally more likely to express this affection through tasks. They will take in fruit from the garden at home or find something to do at the nursing home.

When they find a task, like taking tea around, it frees them from the inactivity of sitting next to the bed of a partner who perhaps no longer knows them. Many men want and need to be included in the life of the nursing home.

*81\105\2*

A WARNING EAK: ACT FAST

There is one kind of headache you should never ignore. It is the headache that warns you a potentially disastrous incident is on its way. It’s an explosive headache that comes out of the blue and can be so severe that it feels like a slug on the head from a cricket bat. The ache can last from a few hours to a few days and often causes nausea.

If you heed it and seek medical attention, you will have a good chance of preventing a major insult to your brain. If you ignore it and suffer the insult, you are likely to be left disabled or dead.

People who have experienced such an event describe it as a headache unlike any they have ever had. Compared to other headaches, which tend to build up slowly, this one comes on at full power. It can be so forceful that it can knock you unconscious. A stressed executive can be working away at his desk when suddenly he collapses and falls to the floor unconscious. Colleagues will immediately suspect a heart attack but minutes later he will wake with the most intense headache imaginable. He may also be vomiting.

These headaches are caused by a small leak from a blood vessel in the head. The leak is into the subarachnoid space, which is between the membranes that separate the skull from the brain. This leak signals that a major blow-out in the vessel will soon follow. When the blow-out occurs, there will be a mighty haemorrhage, which, in 40 per cent of cases, will be fatal.

The warning leak is usually small and does not last long. After 1 or 2 days or so, the person begins to feel better and shrugs off the event. In a few cases, the leak also causes palsy in one eye. The eyelid won’t open of its own accord but when forced reveals a dilated pupil in an eye that only tracks outwards.

Half the men who suffer such a major haemorrhage have had a warning headache. After suffering a leak, many stay home from work and wait for the headache to subside. They never report it and days, or maybe weeks, later experience the blow-out. Only 20 per cent of them will ever fully recover. The tragedy is that if their leak had been detected, rapid surgery could almost certainly have prevented the blow-out.

The leak comes from a bulge in an artery, called an aneurysm. This bulge can vary in size. While most are as small as a cherry, there have been giant ones the size of hens’ eggs. Once this bulge is detected, surgeons can clip it off and prevent its bursting. This procedure takes about 3 hours, and the man can usually go home after a week.

While at least 2000 Australians are known to suffer this kind of haemorrhage every year, the figures could be higher. A sudden death in a middle-aged man, for example, might be automatically attributed to a heart attack. The examining doctor will assume a heart attack and decide no post mortem is necessary. But the sudden collapse may have been caused by a burst cerebral aneurysm.

People aged between 40 and 60 are most at risk of this condition, and the risk rises if there is a family history of the condition. First-degree relatives of people who have had a cerebral aneurysm are possibly more likely to have one than the general population. This risk increases to 10 per cent if two family members are known to have had one. Some diseases, such as polycystic kidney disease and fibromuscular dysplasia, also increase risk.

Research is under way to find methods of screening for these cerebral aneurysms. The goal is to recognise which patients are harbouring an aneurysm before they go on to have a haemorrhage. If a bulge in an artery is ready to leak or rupture, a sudden rise in blood pressure can trigger it. This rise may be caused by mental stress, or by physical exertion such as a jog or a game of squash.

*58\105\2*

WHY YOU DON’T WANT A ‘CLEAN’ COLON

By engaging in a physical process that seems worthy and theoretically sound in the pursuit of inner cleanliness, many men may be doing themselves unintended harm.

During the past decade, colon cleansing has become increasingly fashionable in this country. Cities now have dozens of natural health clinics offering this cleansing under the name of colonics, colonic irrigation, colon therapy or colon hydrotherapy.

Typically, the process involves pumping a large volume of liquid into the rectum and, with the aid of massage, swishing it around the colon. When it is finally expelled, it carries away pieces of faecal matter.

The naturopathic theory is that this flushes out rancid bits of old faeces and other toxins that have been clinging to the colon wall. It restores the wall to its natural condition so it can once again function efficiently. If allowed to accumulate, this material builds up and may, the theory goes, lead to disease.

Sydney writer Robert Treborlang has been having colonic washouts for years.

T don’t feel any better or any different afterwards,’ he says. T do it for inner cleanliness just as they did in ancient Rome and Greece and still do in India.’

The very word ‘analysis’, he says, comes from the examination of faeces. From such examinations, ancient doctors used to work out the state of people’s health. This was probably the first chemical matter human beings analysed.

Treborlang goes to a naturopath for one session at a time. ‘I lie on my side, draw up my legs and he inserts a tube attached to a machine that pumps in fluid. Should I want to, through another transparent tube I can watch what comes out. What is important is not how much liquid is used but how deep it goes. That depends on how relaxed I am.’

In the last few years stressed-out corporate types from all over the world have been making their way to a small island in Thailand that has become known for colon cleansing. The island, Koh Samui, has three health spas devoted to this process and a couple of private practitioners who offer the service. Typically, men come for a week of cleansing, wrap on a sarong and crash out on the beach between sessions.

But mainstream medical practitioners have doubts about the whole business. Some dismiss the theory behind colon cleansing as a mixture of pseudoscience and wishful thinking better suited to the Middle Ages than today.

Besides saying there is no scientific basis for colonic irrigation, they warn that it might do harm. The mucous layers that line the colon are very important for the maintenance of its health. So are the millions of bacteria that reside in the colon.

These bacteria constantly ferment food residue. The product of this fermentation supplies nutrition to the bowel lining, and it has been shown that it may play a role in preventing bowel disease.

Studies are presently under way to see if this fermentation process plays a role in the prevention of bowel cancer too. Doctors say gut bacteria are highly specialised and very important for bowel health, and should not be flushed out in the first place.

In Australia, colonic irrigation is not a standard hospital-based practice. Only in cases of severe constipation would a patient be irrigated or given an enema. The concern is that there is no regulation of infection control outside hospitals. When inserting anything into the body, it is crucial that absolutely sterile techniques be used. The bowel is not robust, and introducing foreign bacteria into it can lead to a range of gastrointestinal complaints.

Other potential hazards include perforating the bowel with the hard end of the tube and actually bursting the bowel with too much liquid. If there is a growth obstructing the colon, the fluid might bank up against it and cause a rupture.

A further danger is that irrigation could disturb the fluid and electrolyte balance within the bowel. Too much water, salt or sugar could cause problems. The colon absorbs fluids and electrolytes, and the condition of a person with kidney problems or heart failure could worsen if the water used was high in salt. Even plain water used to irrigate the colon of a healthy person could be absorbed through the wall of the colon and cause dilutional problems in the blood, making them feel unwell.

The best way to achieve a healthy bowel, doctors say, is to eat good, fibrous foods, exercise regularly and, if there is a problem, see one of them.

*33\105\2*

MEN ASLEEP: EIGHT HOURS

The new status symbol

Not only is sleep back in fashion, but it has now become a status symbol. Until a few years ago, people boasted about how little sleep they needed. Requiring only 4 or 5 hours a night was seen as a sign of success. It implied there was more time for work.

But people are waking up to the costs of chronic sleep deprivation and are rejecting round-the-clock workaholism. These days corporate big shots in America are talking about sleep as an essential component of excellence, and they want as much of it as they can get.

As the last century closed, the Wall Street journal reported that in the upper echelons of American business 8 hours of sleep had become the ultimate perk for the truly successful. Sleep seemed to be especially attractive to Internet entrepreneurs, who, contrary to popular imagination, were not propped up in front of their screens all night surfing the Net. They were tucked up in bed, recharging their brains for the next assault on cyberspace.

For such people, sleep underpins performance. One executive, Marc Andreesen, was quoted in the newspaper article rehearsing his sleep-performance ratio like a computer algorithm: ‘I can get by with 7/4 without too much trouble. Seven and I start to degrade. Six is suboptimal. Five is a big problem. Four means I’m a zombie.’ On the weekends, Andreesen, who co-founded Netscape Communications Corp., indulges in 12 plus!

This contrasts strongly with the sleep patterns of veteran insomniacs such as Michael Milken and Donald Trump, who used to announce proudly that they could manage perfectly on 4 hours a night. Cumulatively, it is also a long way from those executive foot soldiers who marched through the eighties and nineties rarely getting more than a straight 6.

The average person needs between 7 and 9 hours of sleep a night to be sufficiently refreshed to perform well in the workplace. Sleeping fewer hours for a day or two will not make a difference to your performance, but if the sleeplessness continues, your productivity will begin to fall.

Studies show that when a person consistently gets no more than 6 hours of sleep a night, their productivity falls by 17 per cent. If they reduce this amount to 5 hours there is a dramatic loss of 43 per cent, while if they manage only 4 hours the loss plummets to 62 per cent.

For those who just cannot get a full 8 hours of sleep, there is another way: they can nap. Although napping seems counterintuitive to executives, who do not want to be seen sleeping on the job, it can provide a valuable top-up. It is estimated that a 30-minute nap during the day can be worth 2′A hours of normal sleep and can dramatically boost evening work capacity.

In some parts of the world, people appreciate this very much. They know the body likes to doze off around midafternoon and Inspect the sound physiological basis for taking a siesta.

The business community might frown on siestas, but they do work. One study found that a 26-minute nap resulted in a 34 per cent improvement in performance and a 100 per cent improvement in alertness.

People who say they habitually manage on 3 or 4 hours of sleep a night are probably not telling the full truth. They may believe I hey have that little but in reality they drift off into mini-sleeps during the day.

Even Randy Gardener, the US student who managed to go without sleep for a record 11 days, had to be kept awake by minders. They had to pull him out of episodes in which he would lower his lids and slip away in a daydream. During these ‘micro-sleeps’, an electroencephalogram showed he was technically asleep even though his eyes were technically open.

Unlike birds, humans cannot sleep with one eye open and one eye closed. Birds have an astonishing sixth sense that, in risky situations, allows them to be asleep and awake at the same time so they can rest and watch for predators. Behaviourally, they can control sleep and wakefulness simultaneously in different hemispheres of their brain. To make sure both hemispheres get a rest, every hour or so they stand up, turn around and sit down so that the other eye can close.

This bird characteristic is the envy of many humans who are too exhausted to realise it wouldn’t serve them well at all. Humans need a good break – down time when they can relax and let unconscious and involuntary processes take over.

The new breed of American executive argues that sleep is the best – perhaps the only – escape possible from escalating work demands.

‘Technological change – email, voice mail, Intranets, the Web, hand-helds, notebooks etc. – has made the twenty-four-hour work day possible,’ says Andreesen. ‘It is important that the work culture of the future includes the ability to not work for a certain number of hours per day, or we are all going to burn out.’

*9\105\2*

THE KILLER DISEASE: CANCER

Cancer can best be Heated if detected early. In many instances it can be completely cured. Countless people who have been treated have lived long, healthy lives, with no new sign or symptom of cancer.

Why are people so afraid of cancer?

The reasons vary, but they usually include some of the following:

Despite the progress that has been made in regard to this disease, old attitudes persist that little if anything can be done about it.

Even today, cancer is the second greatest killer among diseases.

Cancer can attack people of all ages—men, women, and children. It can affect almost any part of the body.

The disease seldom issues clear and obvious warnings. There is no general lest that can definitely rule out all possibility of cancer.

Most of the causes of cancer are not known, and we tend to feel helpless when facing a mysterious adversary.

These are, indeed, reasons for regarding cancer as a serious enemy. But they are not reasons for becoming panicky. Even though the enemy has not been wiped out, he is being cornered.

We do not understand why cells sometimes go on multiplying until there is too much tissue. That is what a tumour is: a lump or mass produced by the unchecked growth of cells in some part of the body.

Tumours are either benign or malignant. A benign tumour may be large or small. It may become so large that it causes trouble because it occupies too much space. But it does not spread.

A cancer is a malignant tumour: a shapeless mass that keeps on growing in a disorderly fashion. Some cancers grow rapidly, some slowly. But they do not stop, nor do they remain confined to a small area. This is what makes them dangerous, and it is the reason why a person cannot afford delay in the treatment or removal of a cancer.

If not checked, cancers grow until the enlarging tissue crowds and presses on other organs of the body. The cancer prevents the organs from doing their proper work, and robs the healthy cells of their food and blood supply. Some cancers spread like wildfire, destroying the organs around them. Pieces of cancer tissue may break off and, carried by the blood or the. lymph, start growing in a new and perhaps distant part of the body.

WARNING

Only a doctor can tell whether a tumour is malignant or benign. Usually, a pathologist has to examine a bit of the growth under a microscope in order to know whether or not it is cancer. Never decide for yourself that it is only a harmless growth. Once a cancer has spread, the chances of a cure diminish rapidly.

*263\68\2*

SICKNESS IN INFANTS AND CHILDREN: MEASLES AND MUMPS

Measles is a very contagious disease caused by a virus. The disease starts with the same symptoms as a cold. After a few days, a characteristic rash appears. These spots are pink and may show up first behind the ears or on the forehead or the cheeks, and then spread downwards. Usually, the spots itch when the fever is at its highest point. The rash begins to fade after four or five days.

Complications such as ear infections and pneumonia are possible after measles. It can also result in permanent brain damage, and may even be fatal, although these extremes are rare. A live virus vaccine against measles is now available and is believed to give life-long immunity. Many doctors think that measles will be the next childhood disease to be almost eliminated.

German measles

Like ordinary measles, German measles, or rubella, is caused by a virus. It usually begins with a slight cold, a fever, and a sore throat. Then the rash comes in the form of rosy-coloured spots that quickly spread over the entire body. At first, the rash looks like a measles rash, then like scarlet fever. The lymph glands behind the ear and in the neck swell up. The rash lasts two or three days.

German measles is a contagious disease. In children, it is usually mild and without complications. The real threat occurs when an adult woman catches it during the first three months of pregnancy. In such a case, there is serious danger that the child will be born deformed. The pregnant woman exposed during her first three months to German measles should consult her obstetrician immediately.

Mumps

Mumps is a contagious childhood disease caused by a virus. The parotid gland beneath the ear, which secretes saliva, swells up, first on one side of the face and then sometimes on the other side. Less often, the virus attacks other salivary glands under the jaw.

In adult males, mumps can be a painful illness because it can attack the testicles. If the father or any other young male in the household has not had mumps, he should consult his doctor.

Mumps is treated by rest in bed until the fever and swelling have cleared.

*206\68\2*

METHODS OF BIRTH CONTROL: THE RHYTHM METHOD

This is a method of partial abstinence, based on the fact that women are unable to conceive during part of each month.

The ‘safe period’ is, on the average, about 20 days long. It starts ten days before menstruation and lasts until approximately ten days after the onset of menstruation. Usually, pregnancy can result only when coitus is performed during the middle days of the menstrual cycle, the period four or five days before ovulation to four or five days after ovulation takes place.

As the ‘safe period’ varies according to the menstrual cycle, each woman must determine it for herself. Some women know when ovulation occurs. At that time, midway between periods, they experience an inter-menstrual pain, a peculiar, sudden, spasmodic sensation associated with one of the ovaries, followed by a heavy feeling in the lower abdomen that may last several hours. If they are alert to it, most women will also observe an unusual mucous secretion. These indications are helpful in determining the exact day of ovulation. Far more accurate, however, is the rise in temperature that occurs in women at the time of ovulation, usually between 0.6° and’ 0.8° F. To determine the period of ovulation, you should keep a temperature chart for no less than three months. A five-minute temperature should be taken every morning after awakening, while you are still in bed.

Even in women whose periods occur with great regularity, ovulation may be hastened or delayed when they are ill or emotionally upset. If this should happen, the calculations will be in error. Because of this possibility, the rhythm method cannot be considered as reliable’ a means of preventing conception as the condom or the pessary. It also has the disadvantage of limiting the days for having intercourse.

The advantages of the rhythm method lie in the fact that it does not depend on either the man or the woman alone. It is a partnership responsibility. Also, it is not dependent upon a mechanical or artificial device. This makes it morally and ethically acceptable, not only to Roman Catholics but to members of certain other religious denominations.

For absolute safety—when, for example, pregnancy would constitute a serious threat to health or life—I feel that all couples whose religious scruples permit should use both the condom and the diaphragm with contraceptive cream, and should not have intercourse at the time when conception might take place.

*152\68\2*

HOW GERMS GET INTO YOUR BODY

Your body has an excellent coat of armour in the skin, which keeps out germs. But cuts or other breaks in it, and openings such as the nose and mouth, provide opportunities for the microbes to enter.

Nose, throat, and lungs

Many bacteria and viruses are spread and taken into the body through the nose and throat. Most germs thrive in moisture, and spitting, coughing, and sneezing keep them circulating. When you sneeze, you may expel a spray of liquid to a distance of several feet. The common cold, pneumonia, tuberculosis, whooping cough, scarlet fever, diphtheria, influenza, and meningitis are spread in this way.

Colds offer many bacteria—especially streptococci and pneu-mococci—a chance to get a foothold and infect your body with more dangerous diseases.

Nursing mothers with colds should ask the doctor about wearing a nose-and-mouth mask when handling the baby.

More people than you would guess have tuberculosis. Any cough that lasts more than six weeks calls for a chest X-ray. In fact, everybody should have periodic chest films.

Infection from food and water

Typhoid, now uncommon, is typical of the infections that can enter through the mouth. Other diseases of this group include amoebic dysentery and bacillary dysentery (caused by bacteria).

Typhoid germs are found in food, milk, and water that have been contaminated by faeces. Flies that have fed on body eliminations may carry the typhoid germs to food and drinks. Every precaution should be taken to keep food, especially warm food, covered.

Habits of cleanliness should be practised by all members of the family. Washing your hands after going to the toilet and before eating should be as automatic as breathing.

All the milk that comes to your table should be pasteurized. You can do your own home pasteurization whenever in doubt about the milk by boiling it for three minutes. Another method of home sterilization is scalding the milk in a double boiler. The milk should be kept at 150° F., as measured by a cooking thermometer, for a half hour.

Never drink raw milk, because the cow or the people who work with the milk may transmit disease.

In most cities, the water that comes from the tap is safe to drink. But if you live in the country or are going there on vacation, be careful about the drinking water. Boil it for ten minutes before drinking it.

Meats can also carry disease. Uncooked pork may contain the living parasite that causes trichinosis. For complete protection, pork should always be cooked thoroughly. Any pinkness means that it is underdone. For roast pork, an hour to the pound at 350° F. is safe. Brucellosis (undulant fever) may be acquired from pork, beef, milk that has not been pasteurized, and cheese and ice cream made from unpasteurized milk. Raw fish, beef, and pork may contain tapeworms. Thorough cooking of all meats and fish is the best protection.

Diseased rabbits cause tularaemia, a serious illness that may be contracted even just from skinning and preparing the rabbit.

Dangers may be lurking in bakery goods, especially those with custard fillings, such as éclairs, on which bacteria thrive. It is most important to buy your pastry from a clean, reliable bakery, and to put it in the refrigerator immediately when you get it home.

Frozen food can be a means of economy, but it can also be a source of danger. Most meats, poultry, and fish can be quick-frozen and kept safely for long periods. Vegetables, bread, and cake are also popular. But most foods—fruit juices, for example—should be used as soon as they are thawed and should not be refrozen.

*96\68\2*

CARE OF THE BODY’S INDIVIDUAL PARTS: GALL BLADDER

The gall bladder is a side pocket in the channel through which the bile flows from the liver into the intestine; it acts as a storage place for the bile, and aids digestion whenever fatty food is eaten.

There is nothing you need to do about the everyday care of your gall bladder except to keep your weight normal. Obesity probably increases the tendency towards gall bladder disease. Women who have had several children are more likely to suffer from gallstones; in general, after the fortieth birthday, about twice as many women as men have this problem. Once stones have formed, they cannot be dissolved; sometimes, they pass spontaneously into the intestines. However, your doctor has ways of stimulating the flow of bile and of decreasing the infection in the gall bladder; these measures may conceivably reduce the formation of additional stones.

*42\68\2*