For millions of people, depression is a living hell. Traditionally associated with middle or old age, it also afflicts young people as well. Depression can ruin childhood, blight marriage, destroy careers, and wreck plans for a happy retirement. Indirectly, depression can kill, since it is responsible for many of the suicides in our country. Depression is marked by lethargy, disorientation, melancholy, and/or unresponsiveness. The depressed person is usually rational, but can lapse into paranoid or deluded thinking.

Few medical problems are as difficult to treat as depression. A number of procedures have been developed, such as electroshock therapy, psychotherapy, and drug therapy. There is no need here to dissect the successes and failures of these established methods. Each of them has had its vogue, and new drug therapies (such as lithium chloride for manic-depressive disease) come along periodically. What many of them have in common, however, is a symptomatic approach. They attempt to relieve the results of the disease, rather than discovering and eliminating the underlying environmental factors which are responsible.

The treatment of depression by the methods of clinical ecology has been successful, on the other hand, because it concentrates on discovering causative factors. As with other manifestations of allergy, the responsible exposures lie in the physical and chemical environment of the patient. This would seem to be the most obvious place to look for the source of an illness, yet most doctors never consider the actual, material surroundings at all. It is easier and more lucrative to treat symptoms.

Depression can be either a minus-three or a minus-four symptom, depending on the degree of severity. It is the end of the line for many individuals who are maladapted to their environment. Depression rarely strikes out of the blue. It is preceded, in most cases, by a prolonged period of illness, including both stimulatory reactions and lesser withdrawal reactions.

In fact, the alternation of extreme stimulatory symptoms (mania) and extreme withdrawal symptoms (depression) is well recognized in the medical literature as “manic-depressive disease.” In this illness, the patient’s mood changes from “highs” to “lows” quite rapidly. There is an ever-increasing tendency, however, for the “down” periods to crowd out the “up” periods. Depression becomes more and more the rule, while the overexcited manic phase becomes less frequent and less prolonged. While this disease is recognized in its most extreme form, doctors generally fail to see the alternation of stimulatory and withdrawal symptoms in less advanced cases.

Both depression and manic-depressive disease can be the result of environmental factors such as commonly eaten foods and chemicals. The two illnesses can occur alone but more commonly are found in conjunction with a long list of other symptoms in susceptible persons.

It has long been suspected that some persons are depressed because of reactions to nonpersonal environmental exposures. My first demonstration of this was a motion picture filmed in 19501 and reported preliminarily.2 Hydrocarbon exposures were demonstrated as causes of depression in 1956.3 Confirmation and extension of these observations of the effects of given foods in highly susceptible persons led to a scientific exhibit at the Annual Meeting of the American Psychiatric Association in 1956 and the founding of the Section on Allergy of the Nervous System of the American College of Allergists in 1957. This was called ecologic mental illness in 1959.4 Numerous subsequent reports are listed in a bibliography, which will be provided upon request, as mentioned earlier.

Others, especially Donan and associates,5,6 Speer,7 Mackamess,8,10 Mandell and Scanlon,9 and Philpott and Kalita,11 have published in this area.

It so happened that these observations of the causative demonstrable roles of foods and environmental chemicals in depression and related mental illnesses were first noted in 1950, the same year that psychotropic drugs became available to physicians. Since these mass-applicable approaches were promoted vigorously by their manufacturers, the highly individualized approaches of clinical ecology did not receive serious trials for several years until the hazards associated with psychotrophic drugs became more apparent.

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Sleep apnea is the condition in which people frequently stop breathing at night for a disturbingly long time. Each episode ends in a burst of snoring. Because this occurs many times a night, it can interfere significantly with the brain’s oxygen supply and result in morning headaches, drowsiness, and the need for many naps during the day. Ultimately, high blood pressure, heart failure, and intellectual deterioration may supervene.

This condition is due to laxity and flabbiness of tissues at the back of the throat. When the person is sleeping, this allows the tongue to fall back into the throat and cause choking. A surefire way of curing sleep apnea is to operate and create a false opening into the windpipe (tracheotomy) below the site of blockage. This, however, is disfiguring and renders the patient more than usually prone to serious chest infection.

In a safer operation, loose, redundant tissue at the back of the throat, including the tonsils and part of the soft palate, are removed, making the upper airway larger and not so prone to become blocked during sleep. A recent article in the Archives of Internal Medicine (141:990) supports this method of treating sleep apnea, citing a marked reduction in the number of episodes of sleep apnea that have been reported in adults whose enlarged tonsils were removed.

However, this is a painful operation and every effort should first be made to help the sleep apnea victim by non-operative means. One easy way of doing so is described in the Southern Medical Journal (79:1061). It points out that sleep apnea is like ordinary snoring in that it is unlikely to occur unless the victim sleeps on his back. The trick, then, is to keep the sleeper on his side and stop him from rolling onto his back. This can often be done by sewing a tennis ball onto the back of the victim’s pajama jacket.

One other point to make on the subject of sleep apnea is that sedatives and alcohol tend to aggravate the problem. Therefore avoidance of sedatives and alcohol is important if you are treating this problem.

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Symptoms: Swollen lymph nodes, rash on face, spreading to body, low-grade fever, slight loss of appetite, slight redness of throat and whites of eyes

Home care: Give aspirin or paracetamol to relieve fever. Keep your child isolated from pregnant women.

Precautions

-    Rubella, or German measles, contracted during the first three months of pregnancy presents a 50-50 chance of damage to the unborn baby. Before trying to become pregnant, a woman should be tested to find out if she is immune to rubella. If she is not immune, she should be vaccinated at least three months before trying to become pregnant.

-    A pregnant woman who has been exposed to rubella should consult an obstetrician immediately.

-    Remember that a pregnant woman, who is immune to rubella, because she had the disease earlier or has been immunized against it, will not pass rubella to her unborn child by being exposed to the disease.

-    All children should be immunized against rubella.

Rubella, or German measles, is one of the mildest contagious diseases of childhood. However, it can damage the unborn baby of a pregnant woman who contracts the disease. Women who contract rubella during the first three months of pregnancy have a 50-50 chance of delivering an infant who has cataracts, a cleft palate, heart problems, or who is permanently deaf or mentally retarded.

Rubella is caused by a specific virus and can be transmitted by direct contact with an infected person or by contact with articles contaminated by urine, stool, or secretions from the nose or throat of the infected person. The incubation period – the time it takes for symptoms to develop once a person has been exposed to rubella – is 14 to 21 days. One attack provides lifelong immunity.

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1.     The diabetic diet is planned to provide a well balanced, nutritionally balanced diet. As with any diet, it is important that there are plenty of all essential nutrients to ensure good health, satisfactory growth and development.

2.     Maintain ideal body weight for height and age. Particular emphasis is placed on the energy or calorie content of the diet to be sure that weight gain is satisfactory and obesity does not develop. There will be regular dietary reviews as your child becomes older. Sometimes, particularly in teenage girls, the energy content of the diet may need to be reduced to avoid obesity.

3.     Help maintain blood glucose levels within satisfactory limits. This requires restriction of sugar and sweetened foods, a constant intake of carbohydrate spread over the day, and regular times for meals and snacks.

The diabetic diet uses normal foods and can be enjoyed by all members of the family. There is no need for a person who has diabetes to have meals prepared separately for them. The main principles and guidelines for a diabetic diet are consistent with the Australian Dietary Guidelines for better nutrition and health for all the community. They are as follows:

1. Eat a variety of foods each day.

2. Prevent and control obesity.

3. Decrease fat intake in the diet.

4. Decrease consumption of sucrose in the diet.

5. Limit alcohol consumption.

6. Increase intake of bread, cereals, fruit and vegetables.

7. Reduce salt intake.

8. Encourage intake of water.

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Here are some guide-lines that seem appropriate for most families.

1.     Be about when you are needed. Even when a teenager is being most disagreeable he still needs to feel his parents love him and are there to care for him. He may want to fly solo and fly high, but it is nice to know the ground is down there to land on later.

2.     Listen as well as advice. Teenagers have points of view which give you insights into their feelings and behaviour. This will help you understand them and will make them less frustrated that their parents don’t understand. Never mind that their ideas seem immature or misguided: sometimes the way to work things out is to talk and to work it out for yourself that way.

3.     Provide firm and sensible guidelines for behaviour. Don’t relax your own standards just to accommodate a rebellious youngster. Be prepared to discuss rules and the reasons for them and then make decisions together.

Despite teenagers rebelling against adult authority, and their many complaints to the management, they do respect firm guidelines. If you don’t set high standards, how can you achieve even minimal behaviour?

4.     Discuss with your teenager how much help with diabetes care they would like you to give and how much reminding they need from you. You will still be accused of nagging but at least you will have an agreement to work to. You may feel that it is helpful to have your child’s doctor discuss this with you both and act as an independent arbiter if there is disagreement.

5.     Trust your teenager. He will probably let you down many times, but that’s part of development. The less you trust him the more he will give you reason not to do so. Giving responsibility is a good way of developing a responsible attitude.

6.     Remind yourself of your teenager’s good points and strengths. Don’t dwell on all the bad things which may be so much in evidence.

7.     If communication isn’t going well between yourself and your teenager, involve someone you both can trust. Teenagers can still relate to some adults even if they are temporarily rejecting their parents. Perhaps your teenager’s physician can talk to him or a school counselor or youth leader or another relation.

If your teenager is giving you concern and doesn’t seem to be looking after himself, discuss it with your doctor. But take heart; this is usually a temporary phase and often the most rebellious teenager becomes a model of zealous good care within a few years.

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There is no shame in diabetes

There is nothing shameful about diabetes, but still some people do feel some sense of shame. All medical conditions suggest to some people perhaps that the person is less than perfect, or has some weakness. This is largely due to ignorance, and the thing that gives the lie to this attitude is the sight of the child with diabetes in perfect health and vigour, succeeding at school and at sport and socially with friends. Naturally you, as a parent, and your child with diabetes, do not parade the fact that he has diabetes – but neither should you conceal it like a shameful thing. Anyone who ought to know for the child’s sake (such as teachers, scout master, close friends) should be told in a matter-of-fact way, without any emotional overlay, and be given information about the condition that might be useful and relevant to their day-to-day contact with your child.

As with you as a parent, so it is true with members of the community; the most important thing to avoid is pity. No child wants to be pitied, and it does not help him to regain his self-confidence in himself, and self-esteem as a healthy individual.

Be prepared to talk about diabetes

You will want to be aware of his problems, be prepared to talk about diabetes when he wants to do so, and give help with adjustment to the treatment when needed. Try to avoid giving the impression you are worried about him or sorry for him. You will feel sorry for him at times of course, and perhaps worry about him often. But to show this will be upsetting for him, and will stop him feeling like a normal child.

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Examples of what to give for a hypo reaction

On first sign of a hypo, give at once one of the following:

150ml Orange Juice

3 level teaspoons Sugar or 3 Sugar cubes

15g Barley sugar – i.e. 3 pieces

150ml Lemonade or other ordinary soft drink (not low calorie soft drink)

5 level teaspoons Glucose Powder e.g. Glucodin

3 level teaspoons Honey – may be especially useful for young children as it can be placed in the mouth and is difficult to refuse.

If the hypo did not occur just before a meal or snack it is sometimes a good idea to give an extra exchange of more complex carbohydrate, e.g. bread, biscuits, as well as the sugar. Otherwise the usual meal or snack should be taken promptly to prevent a recurrence of the hypo. The sugar you gave was an extra – don’t deduct an exchange from the usual diet allowance.

If the hypo is not improving in 10 minutes or so, or if it appears to be becoming worse, give further sugar as above.

An early or mild hypo reaction

The early signs (including the warning signs) of insulin hypoglycemic reaction may include one or more of the following:

Paleness, sweating, tremulousness

Dizziness and vagueness

Headache

Odd behaviour, bad temper, misery, crying

Trembling, twitching

Drowsiness

The things to do are:

1. Give sugar quickly: 3 teaspoonful or equivalent.

2. Make a note on the test record of the hypo.

A late or severe hypo reaction

The late signs of an insulin reaction may include:

Intense sleepiness, uncooperative behaviour.

Loss of consciousness or ‘coma’.

Convulsion.

The things to do are:

1. Give sugar if you can: 6-8 teaspoonful or equivalent.

IF NOT:

2. Give a glucagon injection.

3. When he responds, give the sugar at once.

4. If no response, call your doctor at once.

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Older children should do their own tests

As soon as your child is old enough to do the test (perhaps at the age of 5 or 6) he should be encouraged to do it himself. This will give him a greater sense of responsibility and will help him to accept blood testing as part of his daily routine. Some supervision will be needed.

Some children object to tests

It is common for children, as they become adolescent, to object to doing their tests. This is part of the general resentment of ‘being different’ that is common and natural at this age. Also if they do not appreciate the reason for doing the tests, they will be less inclined to do them.

Also the teenager is starting to have a busier social life, school work is getting more demanding or sport more important, and it is harder to get up in time in the mornings. For these and other reasons many tests may be left undone, and the parent may wonder how much to push the child, and how much to do the tests herself.

Your child may want privacy when doing the test, and this should be respected. A child needs some discipline at this age, but also a lot of understanding. Each child presents a different problem for himself and for those who are trying to help him. Usually it is best to allow your child’s doctor to help with the solution of this problem, if it should arise, rather than allow it to be a continuing battle between parent and child.

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Ruined sex life: Cholesterol is the building block for several hormones, including those made by the adrenal glands, as well as sex hormones. This means that taking cholesterol lowering drugs can lower testosterone levels in men and women, reducing libido, physical and mental drive, and energy. As well as a loss of sex drive, several studies have shown that cholesterol lowering drugs can affect sexual performance in men, leading to erectile dysfunction. This is the case for both statins and fibrates (another type of cholesterol lowering drug). Cells in the testes are capable of producing cholesterol, as it is required in high amounts to produce testosterone. Statin drugs do reach the testes, and they can inhibit cholesterol production there, as well as in the liver. Sexual dysfunction symptoms vanish when the medications are discontinued.

The drug simvastatin (Zocor, Lipex) is able to directly inhibit testosterone production independently of its cholesterol lowering action, via a different mechanism. In some men statin drugs have caused them to develop gynaecomastia; this is the growth of breast tissue in men. The Australian Adverse Drug Reaction Advisory Committee has eleven reports of gynaecomastia connected to simvastatin use. The UK Committee on Safety of Medicines lists “a few cases” of gynaecomastia linked with the use of cholesterol lowering drugs.

Be aware that the risk factors for coronary heart disease, such as obesity, diabetes and smoking are also risk factors for erectile dysfunction. If you do suffer with erectile dysfunction, it could be an early warning sign that you also have clogged arteries and are at risk of a heart attack or stroke.

Cataracts: Taking statin drugs can cause irreversible damage to the lens of the eye. Taking the antibiotic erythromycin in combination with a statin increases the chances of developing cataracts. A study published in the Archives of Internal Medicine found that a single course of an antibiotic, typically lasting ten days doubled the risk of cataracts when taken with a statin. Two or more courses of antibiotics tripled the risk.

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Calendar method

Using the onset of bleeding as day 1 and the day prior to the onset of bleeding as the last day of the cycle, map out your cycles for eight months. Find the longest and shortest and work out the times of ovulation in both cycles. This occurs fourteen days before the first day of bleeding in any one cycle. So if your cycle is 28-32 days long you will ovulate at some point on days 14-18 in any one month. Allow four days either side for safety. This means (continuing the example-the days will differ for different individuals) that you are unsafe from day 10 to day 21 in any month. Outside this time span you are probably safe.

Advantages

•     Costs nothing.

•     Gets around religious prohibitions on using ‘artificial’ methods of birth control.

•     No medical side-effects.

•     Makes couples more aware of the woman’s reproductive cycle and the functioning of her body.

•     Leads to couples finding alternatives to penis-in-vagina sex.

Disadvantages

•     Very unreliable.

•     Needs constant checking of cycle lengths to be sure that they are not changing.

•     Rules out penis-in-vagina sex for twelve days a month unless you are absolutely regular. Couples who don’t like making love during the woman’s period will add at least four days during menstruation to this, making half the month either unsafe or unsuitable.

•     Constant worry about timing can be unpleasant for both partners and probably leads to less sex overall.

Sympto-thermal method

A method which combines the taking of the woman’s daily body temperature and an awareness of the state of her fertility cycle through charting her cervical mucus condition. The method is complicated to do well and needs practice. In principle it works as follows:

When the cervical mucus is relatively thick and cloudy in the early days of a cycle it may be safe to have sex unless your cycle is very short.

As the mucus becomes slippery, thin and clear, ovulation is about to occur. As soon as the mucus appears to stop being thick and cloudy stop having unprotected sex. Avoid intercourse until three full days after the ‘peak’ of slippery mucus. Obviously, this takes some experience at judging.

The safest time for sex using this method is from the fourth day after the peak slippery mucus day until the first day of a period.

Advantages

•     Costs nothing.

•     Good for religious groups for whom contraception is prohibited.

•     No medical side-effects.

•     Makes a woman (and her partner) much more aware of her reproductive cycle and the functioning of her body.

•     Encourages the use of methods of love-making other than penis-in-vagina intercourse.

Disadvantages

•     Unsafe. Studies have shown that in the best hands the reliability can be near to that of the diaphragm but this can only be achieved by restricting sex to a relatively few days of the month.

•     As with the calendar method, travel, illness, drugs, stress infections and so on can all affect cycle length and so throw off the calculations. Women with irregular cycles find such methods tricky too.

•     As with the calendar method, many days every month are unsafe, and others may be regarded as unsuitable because of menstruation. This can suit the couple with a low sex drive very well but for others it means using alternative methods of love-making, many or all of which are unacceptable to some.

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