Anyone interested in keeping real ageing at bay should do one thing above all others. He should practise the gentle and simple art of artery maintenance. It is now a commonly held belief that you are as young as your arteries. If you keep them clean and efficient, they will service your body well and maintain it in optimum condition.

If you allow them to deteriorate and become clogged, they will compromise the way you live: you may find you rapidly become puffed, you may get angina or you may readily feel tired and become impotent or even forgetful; of course, you may also eventually have a heart attack or a stroke.

It used to be thought that, with age, arteries inevitably became hard and clogged and that once this occurred little could be done to stop the process. Autopsies on road-accident victims and young soldiers showed evidence of ageing in arteries from the age of 18. It was accepted that this process advanced relentlessly.

Now we know differently. Not only is arterial ageing not inevitable but it is preventable. Furthermore, once it has begun, not only can it be stopped but it can also be reversed.

The orthodoxy changed when epidemiologists began comparing arterial health in different populations. They found that in Japan and China atherosclerosis was very uncommon, while in Mediterranean countries it was less common than in Australia or America. If it was an inevitable process, they asked, why were there geographical differences? The answer appeared to lie in lifestyle and diet. This was confirmed when people from those countries with low levels of atherosclerosis settled in America and soon developed signs of arterial disease.

There are five possible steps people can take to maintain their arterial health.

STEP 1

The first step is to modify diet and lifestyle and follow the example of people in those countries with low levels of atherosclerosis by eating a varied diet rich in fruit, vegetables and grains.

It is most likely that it is the total mixture of their diet rather than one component that confers benefits. To start with, cut down on hard animal fats and replace them with unsaturated vegetable fats, fish oil and carbohydrates that occur in fruit and vegetables. In terms of lifestyle, stop smoking and move more. You don’t have to jog or sweat – just walk.

STEP 2

While most premature ageing is self-inflicted, it is never too late to do something about it. There can be as much as a 20-year gap between chronological and arterial age, and the second step in artery maintenance is to lower blood pressure. This is one of the hardest steps to take and requires an ongoing commitment. It’s hard because high blood pressure is silent and doesn’t obviously worry you. But once you have it you’re in a vicious cycle. High blood pressure contributes to hardening of the arteries, which in turn leads to higher pressure.

There are several things you can do to break the cycle, bring the pressure down and give your arteries a chance to recuperate. You can change your diet, move more, lose weight, stop smoking, reduce salt, increase potassium, calcium and magnesium and try to relax.

If these measures are not enough to bring about a result, they can be combined with a medication plan. Reducing high blood pressure is vital for arterial health.

STEP 3

The third step is controversial: it is the use of aspirin to clear the arteries. Some experts advocate an aspirin a day. ‘Feeling old? Take an aspirin,’ is their answer.

Not only is aspirin a blood-thinner that helps to keep arteries free of clots, but it is also thought to help the body build auxiliary blood vessels around clots or blockages. In addition, it is believed to decrease inflammation in the walls of the vessels and thus promote a smoother flow. Aspirin is also known to reduce the incidence of strokes – especially the practically undetectable mini-strokes that are often associated with memory loss. But while aspirin can confer substantial benefits, it can also cause substantial harm and must never be taken without medical approval.

STEP 4

The fourth step is to take anti-oxidants in moderation to open up arteries. If you slice open an apple and leave it exposed, its surface will oxidise and go brown. Had you squeezed lemon juice over the surface first, it would have remained white. The juice contains vitamin C, an anti-oxidant that would have kept the apple from rusting. In the body, anti-oxidants like vitamins C and E do the same thing. Oxidation generally ages arteries. As you get older your arteries become more clogged with fat deposits. These clogs contain high levels of oxidised lipids.

Taken together, vitamins C and E may help to keep your cardiovascular system healthy by reducing the amount of harmful build-up on the walls of the arteries.

While the anti-oxidant theory is convincing, it is yet to be proved conclusively. While it is accepted that people with a high build-up of oxidised fats have higher rates of heart disease, it has recently been hinted that vitamin C may actually accelerate coronary artery disease.

STEP 5

The fifth step in arterial maintenance involves countering homocysteine, an amino acid that in high concentrations in the blood disturbs the inner lining of the arteries and significantly increases the risk of heart attacks. Homocysteine levels are known to build up when a person’s intake of folate and vitamin B6 is low.

Increasing folate and B6 has been shown to reduce homocysteine. But until there is scientific evidence that taking supplements of these vitamins will also reduce heart attacks, doctors prefer people to get folate and B6 from natural sources. B6 is found in meat, poultry, fish, bananas, yeast, bran and nuts. Folate is found in liver, dark-green leafy vegetables, dry beans, peanuts, wheat germ, whole grains and yeast.

*119\105\2*

Sleep disorders

Prolonged sleep deprivation also takes its toll on brain function. Sleep apnoea (see ‘Not Tonight Darling, I’m Snoring’ on p. 30) and disorders such as periodic leg movement and insomnia may cause such deprivation.

As they age, many men experience a disintegration in their diurnal rhythms. Their internal clock becomes less efficient and they spend half the night awake and half the day asleep. With this, their ability to concentrate deteriorates.

Early-onset dementia

Alzheimer’s and other dementias can start in the 40s and remain undiagnosed for long periods. They become evident when the man’s behaviour changes. Some men become socially inept and disinhibited. A disinhibited man will make poor decisions, will be impulsive and will not take all factors into account. Other men become withdrawn. They stop interacting and seem emotionally flat. They lose their drive and are not sufficiently organised to get to make a decision.

*93\105\2*

Some people call them joy pills. To others, they are nature’s Prozac. In Australia, they’re on the shelf in bottles labelled St John’s wort.

St John’s wort (wort means plant) has been used as a medicine for thousands of years and is now gaining popularity as an antidepressant. In Germany, which is known as the world’s herbal heartland, it is reported that more than 60 million doses of this herbal extract are prescribed every year for conditions such as moderate depression, fear and nervous disturbances.

Now the esteemed British Medical Journal has published a German study showing that St John’s wort (hypericum) is effective enough to be considered as a first-line treatment for mild to moderate depression.

The study showed that in moderately depressed people not only was this herbal extract as effective as mainstream tricyclic antidepressant medication, but it also had advantages in the way it could be tolerated by patients, and in their willingness to con-tinue taking it.

While this study found hypericum to be safe and to improve quality of life, the trial was limited to 8 weeks. The questions that now arise are whether the extract is effective and safe in the long term and appropriate for more severe forms of depression.

From an Australian point of view, it would have been more useful if these researchers had compared the extract with the modern antidepressants known as selective serotonin re-uptake inhibitors, or SSRIs. They did the comparison with the popular tricyclic, imipramine, because it is the most frequently prescribed antidepressant in primary care in Germany.

Commenting on the study, an editorial in the journal confirmed the research had provided further evidence for the effectiveness of St John’s wort, but said its place in antidepressant treatment was not yet fully established.

Such British caution contrasts strongly with the enthusiasm for the extract found on the Internet. One site, which offers joy pills for sale, claims that St John’s wort is a clinically proven all-natural mood elevator and stabiliser and is for anyone who wants to ‘decrease anxiety, gain greater mental clarity, get a good night’s sleep, enhance self-esteem, feel good (but not high), reduce guilt… create a level emotional playing field – on which to build a good life.’

But these pills shouldn’t be bought over the Internet because not all providers are entirely reliable and the consistency of preparations varies.

When the LA Times newspaper did a spot check of retail St John’s wort supplements available in Los Angeles, its independent laboratory tests found a marked range in the potency of different brands. Furthermore, of the 10 brands sampled, none of the laboratory results matched the claims made on the label about potency.

In Australia, this is less of a problem. All herbal preparations sold over the counter have to comply with basic standards set by the Therapeutic Goods Administration. Their producers have to have Good Manufacturing Practice licences, and any therapeutic claims have to be verified and approved.

Herbal preparations that have been listed in the Australian Register of Therapeutic Goods all carry an ‘AUST L’ number on their labels. Preparations with an ‘AUST L’ number are inherently low risk in nature. If this number is missing, the preparation has bypassed the authorities, and there is a fair chance it was personally imported or bought off the Internet.

Hypericum is available as an oil, tea, tincture, tablet, pill or capsule. The dose used in the German journal study was very large, at 350 mg of hypericum three times daily, in capsule form.

What is needed now is not another clinical study on raw extracts of hypericum but work that will isolate and characterise the active substances (or substance) and determine their likely pharmacological site and mechanism of action and their metabolic fate.

This had been done with numerous other useful medicines of plant derivation, from opiates to salicylates, and was the way of achieving better therapeutic agents.

In the past few years, there has been growing interest in St John’s wort. Two books about its effects on depression have recently been published. One suggests this herb could change the way depression is treated in America. The other is a how-to book about using it as an antidepressant.

Not everyone can take St John’s wort. There have been warnings against its use by children, in pregnancy, by breastfeeding mothers, by people with high blood pressure and by those taking other medication such as antidepressants, oral contraceptives and anticonvulsants. Its side effects include stomach upsets and, in rare cases, sensitivity to light.

Some of the more extravagant claims made in the name of hypericum include assertions that it has antiviral, anticarcino-genic, anti-inflammatory and antibacterial properties. Like many herbs named after saints, it is said to have spiritual effects.

If any of this is remotely true, St John’s wort may become the wonder drug of the new century. Move over aspirin!

*70\105\2*

In the life cycle of a melanoma there is a dreaded moment that no doctor can predict. It is the moment when the first malignant cell detaches itself from the melanoma and quietly slips into the bloodstream.

Once in the blood, it can travel to distant parts of the body. Other cells follow, and their combined potential for destruction is considerable.

If a melanoma is detected and removed before this crucial moment occurs, a man’s chance of survival is 100 per cent. This is why early detection is crucial.

In Australia, men fare far worse in a battle with melanoma than women. Although the incidence is almost equal – 3695 men and 3081 women were diagnosed with melanomas in 1994 -there is a vast difference in the death rate. In that year, 609 men died, compared to 288 women. If all factors are matched and a man and woman of the same age have identical melanomas in the same place, the woman’s chance of survival is far greater than the man’s. Men also have double the chance of developing a second primary melanoma.

For these reasons men should be highly vigilant about their skin. Unfortunately, in reality they pay less attention to it than women do. In fact, it is often women who first discover men’s melanomas.

Boston University’s School of Medicine conducted a survey to determine who ‘discovers’ melanomas and found that women are more likely than men to identify not only their own (66 per cent versus 42 per cent) but also their spouses’ (23 per cent versus 2 per cent).

Men tend to get melanomas on their back, head or neck. Women often get them on their legs, which might partly explain why they detect them sooner.

On rare occasions melanomas grow in unexpected places such as under nails and inside the mouth or rectum.

Even if their melanoma is in an obvious and visible position, men often fail to notice it because they expect that if they get a melanoma it will arise from a pre-existing mole and will be raised and ugly.

But 70 per cent of melanomas arise on normal skin and in the early stages are flat and look no different from a freckle. They do not itch, bleed or do anything to attract attention.

The depth of a melanoma usually determines a man’s likelihood of survival. If it is thinner than a credit card (less than 0.75 mm) his chance of survival is 100 per cent. If it is thicker than a 50 cent coin (3 mm) his chance drops to about 59 per cent. If it grows just a little more, to a thickness beyond 4 mm, his chance is less than 30 per cent and death occurs quickly, usually within 3 years.

Although Australia has the highest rate of malignant melanoma in the world, its survival rates are generally higher than those of other countries because of the high proportions of thin lesions.

About 15 years ago the incidence of melanoma was a touch higher among women but now it’s higher among men. After the age of 45, the incidence among women flattens out, but among men it continues to rise. This is probably due to their different habits of sun exposure. As women enter childbearing years they reduce sun exposure and protect themselves more. Men continue with their outdoor recreational activities. Intermittent exposure, such as on weekends and summer holidays, is more risky than continuous exposure. Men who work outdoors develop a tan and thickened skin, which gives them some protection against the sun.

The steady rise in melanoma deaths that was witnessed in Australia last century has been reversed. Figures show the number of Australians dying from melanoma peaked more than a decade ago. But while there is a distinct drop in the death rate among women, there is only a flattening in the death rate among men. The drop is attributed to greater awareness and increased early detection. It is anticipated that the death rate among men will drop in the next decade.

In the meantime, however, continue to examine yourself for odd spots (usually between 5 and 10 mm in diameter – the size of a shirt button) and don’t forget to check out-of-the-way places like the soles of your feet and between your toes.

*46\105\2*

The other significant complication of Self Injection Therapy (SIT) is Peyronie’s disease. This disease causes an unnatural curve in the penis at erection and can be very distressing. It can also progress to permanent impotence.

Before injection therapy was available, Peyronie’s would occur in one man in every 100. The men were usually over 40 and the origin of their unfortunate condition was unknown. Since Peyronie’s was first described 230 years ago, it has been attributed to everything from excessive masturbation to auto immune disease. It could spontaneously appear for no obvious reason, although it was relatively rare in young men. With the availability of injections, the picture is changing, and Peyronie’s across all ages is becoming a common feature of urology practice.

Many men naturally have a minor curve that is no impediment to intercourse. This should not be confused with Peyronie’s, which is caused by a gradual build-up of a plaque of scar tissue inside the tough elastic sheaf of the penis.

The plaque is inelastic and does not expand with the sheaf during erection. The erect shaft is forced to curve around it.

There are three ways injection therapy may lead to Peyronie’s. The injected chemicals may act as an irritant and cause scarring, they may be injected incorrectly in the wrong area, or they may cause an erection that is much harder than normal. Penile tissue in a man of 40 or 50 is not as elastic as it used to be. While artificially hardened, it is vulnerable to cracking if accidentally bent or bumped during intercourse. After a crack develops, scarring and Peyronie’s follow.

No matter how good their injecting technique, between 3 and 8 per cent of the thousands of men who use these injections long term develop Peyronie’s.

About a third of those who develop it as a result of injection therapy have it so badly that it stops them having sex. Their penis becomes too painful, too bent for penetration or just too limp.

The other two-thirds often feel a lump, perhaps go through anxiety about it being cancer and experience some pain during intercourse. The disease usually burns out in 12 months, leaving them with a painless scar. Often men are bitterly disappointed with injection treatment because they end up with a scarred, bent penis.

Doctors are experimenting with different drugs to try to arrest Peyronie’s in its early stages. If it is advanced and the bend is severe, there are two possible operations to straighten it. One is a nip and tuck procedure, which is 100 per cent successful but results in a shortening of the penis. Depending on the position of the bend, the shortening may be considerable.

The second operation involves removing the plaque and replacing it with a graft taken from a vein or a deep layer of skin from elsewhere in the body. This works about 70 per cent of the time, but if it fails, it can lead to further scarring and impotence.

*22\105\2*

Appendicitis is a very serious disease. When the appendix becomes inflamed and infected, the process can spread so fast that gangrene and rupture may set in within a matter of hours. Rupture of the appendix leads to peritonitis, one of the most serious of all diseases.

As the inflammation of the appendix develops, there are usually three main symptoms: nausea; abdominal pain that starts to localize in the lower right part over the appendix area; and mild fever in adults, sometimes high fever in young children. There may also be vomiting, constipation, and diarrhoea. Chills and convulsions, which are fairly characteristic of pneumonia, meningitis, and other severe infections, rarely occur at the onset of appendicitis in children.

How you can save a life

Statistics show that when a person with appendicitis takes a laxative, his chance of dying is three times as great as it would be if no laxative had been taken. With more than one dose of a laxative, the possibility of dying is seven times as great. This is due to the fact that laxatives and cathartics increase action in the intestine, and may also increase the pressure within the little sac. The more the pressure, the more likelihood that the sac will burst. The same is true for enemas. It has also been shown that a delay in operating lessens the chance of a cure. So many people have died as a result of taking a ‘good physic’ when they were developing appendicitis that I am inclined to call laxatives the first assistant of this killer.

Here are the rules to follow in order to save a life—your own or another’s—when appendicitis gives its warning signals. First of all, be sure to remember that any abdominal pain lasting for more than three or four hours may be appendicitis.

Call your doctor immediately. Or you can obtain a thorough examination for appendicitis in the emergency room of any reliable general hospital. You should be taken there by car, if possible.

Lie down and remain as quiet as possible. Do not massage the abdomen.

Take nothing by mouth—no food, water, or medicines. Especially avoid taking any cathartic or laxative.

Do not take an enema.

Do not use a hot-water bag. If the pain becomes very severe, an ice-pack may be applied.

*275\68\2*

Breasts

Some adolescent girls feel shy, or even ashamed, because of their breast development. Mothers should encourage them to be proud of their developing womanhood.

Mothers should not only emphasize the fact that breast development is a normal part of puberty, but also explain that shortly before or during menstruation, some tenderness and swelling are apt to occur and should cause no concern.

I describe the breasts and problems connected with their size in more detail in Chapter 18.

Body hair

The adolescent girl may develop an excess of hair over the thighs and legs or under the arms. Facial hair sometimes becomes disfiguring. Parents should take this seriously, because it can be very important to a sensitive young girl. If neither bleaching nor shaving seems a satisfactory solution, your daughter may want to have the hair permanently removed. This can be dangerous if it is attempted by anyone but an expert.

Menstruation

Usually menstruation begins at 12 to 14 years of age, but it may start as early as 10 or as late as 18. Maturing early or late often runs in a family. However, if a girl’s menstrual periods begin at 10 or earlier, or if they have not started by the time she is 17, a doctor should be consulted. A doctor should also be consulted if the characteristic changes of puberty—the development of the breasts, pubic hair, and so on—occur unusually early or late.

All girls, and boys as well, should be told about menstruation— preferably by their mothers—before they and their friends reach the age of puberty. It is not easy to say exactly how they should be told. Parents should not give children information which they cannot understand, or in which they are not interested. The opportunities for privacy, the possibility of the child’s learning about menstruation from other sources, and similar factors must all help to determine the age at which each child should be told about it. The important thing is the attitude of the person giving the information.

Menstruation is not a sickness, and it is not something to be ashamed of. It should not be called the curse. Mothers should explain to their teenage daughters that many females experience some discomfort or cramps in the lower abdomen, usually at the onset of a period, and that menstruation may be a nuisance for the first day or days, especially if the flow is profuse. However, it should cause no real difficulty.

Pad Versus Tampon. Either is safe from a health standpoint. If the flow is profuse, pads may be required to absorb it. Most virgins can use the small-size tampons, and mothers should not imply that a girl who uses a tampon is not ‘nice.’

Feminine hygiene

Aside from ordinary washing and bathing, no feminine hygiene measures are necessary. Baths or showers may be taken during menstruation, although extremely hot or cold ones should be avoided. Women and girls who prefer not to bathe during their periods should wash the outer genital parts with warm water and soap at least once or twice a day.

If strong odours persist or if there is a discharge from the vaginal passage between periods, be sure to see a doctor. These discharges and odours usually result from an infection that should be attended to.

*219\68\2*

In the first few weeks of pregnancy, there may be a slight loss of weight, especially if there is any morning sickness. Then the increase begins, and it usually becomes a problem to keep the weight down.

If you are of normal weight, an ideal increase during the course of your pregnancy would be 20 pounds. If you are underweight, the doctor may decide that this is a good time for you to pick up a few permanent extra pounds. But if you are already too heavy, he may actually put you on a reducing diet.

You should watch the quality and the amount of food that you eat. You should consume about 2000 calories a day. These should come mainly from meats and other proteins, green vegetables, and fruit. Starches, fats, and sugars—bread, rice, potatoes, spaghetti, butter, and desserts—should usually be restricted. Most nutrition experts believe that the pregnant woman needs one and a half times as much protein as the non-pregnant one.

Fluid

Drink plenty of fluid, at least eight glasses a day. This may be water, but anything liquid—milk, coffee, tea, fruit juices, and soups —counts, too. Avoid fattening beverages like sweetened sodas and soft drinks. You need a large amount of fluid to flush the kidneys and bladder frequently. This greatly reduces the danger of infection to the urinary tract. You may have heard of women who retain an unusual amount of water and suddenly become large and puffy in appearance. This is not due to the fluid they have been drinking, but it is a sign that something is wrong, and it requires the immediate attention of the obstetrician.

Diet problems

You may experience acute cravings for certain foods, such as pickles, lobster, and sweets. Do not be upset if you have an intense desire for something you may never have been interested in before. Provided it is edible, it will do no harm to eat it. But it will not hurt you or the baby if you do not!

*164\68\2*

The seas around Australia harbour a number of species whose bite or sting has proved fatal to man. Numerous other fish will, if eaten, cause serious illness, even death. The only warning that should be followed is: do not eat any fish which you cannot easily identify.

Three well-known lethal species of marine animals are the stoncfish, the blue-ringed octopus and the sea wasp (or box jellyfish).

The stonefish inhabits the coral reefs and estuaries around the coasts of the northern half of Australia. The fish, lying dormant on the bottom, resembles a piece of weathered rock or coral, but one of its 13 dorsal spines can pierce the foot of an unwary wader.

The immediate effect is unbearable pain, swelling, and paralysis of the muscles near the sting. The victim begins to find difficulty in breathing, and unless an immediate antivenene injection is available, his condition may become critical. Breathing should be encouraged by artificial respiration, and the excruciating pain can be relieved by soaking the affected part in very hot water. Get the victim to the nearest hospital as soon as he can be moved.

The blue-ringed octopus is a tiny creature, three or four inches long, found in rock pools along the coast. When disturbed, the coloured rings turn brilliant blue, and if the creature is picked up or examined, the bite of its tiny beak injects paralysing venom. Within minutes, a feeling of weakness, numbness about the face and difficulty in breathing are followed by respiratory paralysis. The only treatment at this stage is artificial respiration to aid the patient’s breathing and this may need to be applied for several hours. Urgent hospital care is necessary.

The sea wasp, or box jellyfish, found in the warm tropical waters of Australia, has up to 64 long invisible tentacles trailing behind it, each loaded with tiny stinging capsules. On encountering the tentacles, the victim recoils quickly, causing the tentacles to be torn from the animal and to be wrapped around the victim, resulting in more stings and excruciating pain.

The outcome of the stings is dependent on the amount of venom injected as well as the age and state of health of the victim. If a lethal dose of venom has been injected, there is little that can be done to avoid respiratory failure. If the sting is less severe, pour methylated spirits or alcohol over the affected area, taking care to avoid spreading the tentacles to unaffected skin; artificial respiration may become necessary during this procedure. Rush the victim to the nearest hospital.

*109\68\2*

Most diseases and sores of the lips, tongue, and mouth are either very minor or very serious. The slight cracks from dried-out lips heal readily, and the irritating lumpy spots in the mouth called cankers disappear quickly. But other whitish spots, lumps, or sores may indicate early stages of cancer, or they may be signs of syphilis or some other serious disease. You can usually tell the mild from the serious conditions by the rapidity with which they heal. Any canker or fever sore or a lump that does not heal readily should be seen by a doctor—or by a dentist, if it appears to be due to a rough spot on a tooth that is irritating the lining of the mouth.

Trench mouth (Vincent’s angina) is a common infection characterized by sores and ulcers on the lining of the cheeks, the gums, and the back of the throat.

Most lipsticks are harmless unless you happen to be allergic to something in them. They have no value except for their appearance. Cracked, chapped lips, from which you may suffer during cold, or dry and hot weather, will usually get better if you apply a soothing preparation such as boric acid ointment, petroleum jelly, or cold cream.

Your mouth does not need, and may actually be harmed by, so-called medication that claims to cure bad breath.

*54\68\2*