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Both hair and nails are derived from the epidermis, and both consist of the same dead tissue—the protein, keratin. Because of their derivation from the epidermis it is not surprising that diseases affecting the skin may affect the hair and nails as well. In addition, there are a number of disorders which are peculiar to the hair (including the scalp) and nails.

Hair loss may be temporary, when it is usually called alopecia; or it may be permanent, when usually called baldness. The most common form of temporary diffuse alopecia is that associated with the following conditions or circumstances:

acute mental stress

severe illness or injury

following pregnancy

stopping the oral contraceptive pill iron deficiency various hormonal deficiencies certain drugs rapid weight loss In these cases the hairs in the resting phase are the ones which are usually lost. As such the hair loss is temporary, and will right itself once the precipitating cause has been corrected.

Alopecia areata, where the loss is localized to one or more well-defined areas, is the most common type of hair loss seen in medical practice. There is sometimes a family history of it, and there appears to be a genetic association with some other conditions (known as auto-immune diseases) such as vitiligo (pigment loss), pernicious anaemia, and either over or under active thyroid disorders. There is often psychological stress or some emotional deprivation some weeks prior to onset. Although alopecia areata occurs at all ages the majority of cases are in children and young adults. It is estimated that there are about 100000 sufferers in Australia.

With this disorder patches of hair may be lost from any part of the body, although hair loss is typically limited to the scalp and beard areas. Symptomless bald areas up to a few centimetres in diameter develop, which may coalesce and produce the loss of all scalp hair (alopecia totalis) or even of the whole body [alopecia universalis). In the stage of active hair loss, very short, broken hairs shaped like exclamation marks may be found. These are not seen in the conditions which may, otherwise, be taken for alopecia areata (such conditions as ringworm and secondary syphilis). The prognosis for alopecia areata is good in the majority of cases, with most patients growing new, often initially white, hair within six to nine months. The longer the alopecia lasts and the larger the areas affected, the worse are the chances of satisfactory regrowth.

Small areas of hair loss which show evidence of regrowth are best left untreated. When improvement is slow or where areas are large, topical corticosteroids may be useful. Occasionally, they may be injected into the areas to promote regrowth, but this effect may be transient. Recently, various irritants and sensitizers—such as DNCB—have been used in an attempt to stimulate hair growth. It is important for patients or parents to fully understand what is known about the condition and its varied course. Considerable reassurance is frequently necessary, and recently a number of self-help groups have been set up to enable those involved to help one another and to seek further help both from the Government and the medical profession.

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The modem focus of eating plans for sustainable fat loss is a decrease in total dietary fat and an increase in the proportion of complex carbohydrates, followed in importance by a decrease in total energy intake. When assessing diet plans, these basic criteria need to be kept in mind. It is also important for health professionals providing advice to those seeking fat loss to know just how this is best achieved and to have an understanding of how popular diet plans manipulate the facts. The following is a review of some general diet plans.

Low-energy diets. These diets aim to provide 800-1200 kcal/day which is substantially lower than the resting metabolic rate of even very lean adults. The associated risks of the diet will decrease as the energy intake increases, but one of the main problems is dealing with hunger on these diets. The use of appropriately advised physical activity programs to support these diets is highly recommended.

When these reduced-calorie diets are based on regularly available foods rather than fortified products, there is a small risk of micronutrient inadequacy. Supplementation may be recommended, which would seem to defeat the purpose of creating a lifelong achievable plan that is nutritionally adequate. The needs of pre-menopausal women for iron and all women for calcium may not be met by these diets.

Many of the commercial weight loss organisations base their programs on this type of diet and include interventions in the form of a client attending a centre, a group meeting in community settings or home-delivered meals. The ready availability of frozen, pre-packaged meals for dieters in the supermarket is an area of concern, as these have little relevance to an overall rat loss strategy and are not concerned with nutritional adequacy.

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There are many reasons why hysterectomies are carried out, the most common being fibroids and unexplained heavy menstrual bleeding. Australian Institute of Health and Welfare studies indicate that fibroids account for about 6500 (22%) and heavy menstrual bleeding for about 5300 (18%) of the estimated 30 000 hysterectomies performed in Australia each year. In the US, fibroids are said to be responsible for as many as 30% of hysterectomies and a further 20% are due to excessive bleeding of uncertain cause. Other major reasons given for the hysterectomies performed in Australia are prolapse (7-21% depending on the type of hospital and State in which it is located), endometriosis and adenomyosis (6-23%), cancer (1-12%) and pelvic inflammatory disease (2-8%). Multiple reasons are given for the remaining hysterectomies.

While information is available about the number of women who have hysterectomies and the underlying reasons, much greater uncertainty surrounds the women who consider the option of hysterectomy but decide against it. It is probable that these women number many, many thousands.

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A television documentary recently reported an unusual case of insomnia in England. Loughborough University advertised for people who thought they did not need to sleep to come forward to join in a sleep research study. So people who were short sleepers volunteered to be tested under laboratory conditions. At night they were allowed to lie in bed to rest and their brain waves were monitored continuously. There was a man who claimed that after an accident causing head injury a few years earlier he did not sleep at all. He also claimed that he was functioning normally and did not feel worried when he was lying awake. Brain wave recordings showed that he slept only four minutes during the three day study.

The study findings suggest that perhaps the brain is programmed to sleep periodically. The man who did not have the need to sleep after the head injury may have had his brain reprogrammed in such a way that sleep was no longer required. Maybe in hundreds or thousands of years from now we will be able to reprogram the brain so that we will have the choice of not having to sleep at all. There is a Chinese saying, ‘Life is not as long as it seems, as half of it is spent sleeping’.

It is possible that there are other biological functions, yet to be discovered, which only happen in sleep. We have only just started to study sleep as a science, and sleep laboratories have been around only in the last 50 years. We are certain that we are only scratching the surface of the science of sleep and that there is much more to discover, for there are still many unanswered questions and why we need to sleep is one of them.

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The ready availability of reliable oral contraception has undoubtedly been a significant factor in relieving tens of thousands of women of tension and anxiety. On the other hand the advent of the contraceptive pill has brought tension and guilt to many women who might otherwise have been free of it.

If a woman believes that contraception is morally wrong, or if she is forbidden by her church to use it, and if she follows her conscience in these matters and does not use it, she may still suffer considerable mental tension arising from her knowledge that women all around her are using contraception. As a result, she is constantly under temptation in a manner in which other women are not. This is shown by the way in which many such women do in fact take the pill for a while, then feel guilty about taking it and stop. Then they take it again, and in the same way discontinue it; and so it goes on.

The position of course is much more difficult when husband and wife see the problem of contraception from different points of view. In such cases the unfortunate woman may have contraception forced upon her without consideration of her inner feelings at all.

It is not uncommon for couples who have religious doubts about contraception to feel that sexual withdrawal is less of a sin than chemical means of prevention. But this half measure only leads to further anxiety. There is still the tension from feelings of guilt, and added to this the woman is tensed fearing that her husband will not withdraw in time. In addition, the fact of withdrawing just at the moment when biological fulfilment demands deepest penetration

produces tension in both man and wife. This of course has been known for centuries and was considered by Freud as an important cause of anxiety.

There is yet another important social side-effect of the widespread use of the contraceptive pill. Girls who have been sexually promiscuous in the past are now relieved of much of their anxiety. However, the ready availability of the pill has undoubtedly led many girls into promiscuity who would have otherwise been continent. Many of these young women suffer nervous tension not from doubts about taking the pill itself, but from moral qualms about their new way of life.

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Most studies of the anti-depressant effects of St John’s Wort have used 300 mg three times per day. In my experience with using many other anti-depressants, however, I have been impressed by the wide variation in dosage required by different people. To some degree, this relates to the ability of a person’s liver to break the antidepressant down into inactive substances, which are then excreted.

This ability varies tremendously from person to person. To some extent, one can get an indication of how sensitive a person is going to be to a new medication by reviewing that person’s sensitivity to medications in the past. The amount of medication needed is often not related to the size of the person being treated and I have been impressed over the years by small women patients who have been able to tolerate enormous dosages of anti-depressants, in contrast to very large men who have been sensitive to tiny dosages.

I believe that there will be a range of optimal dosages for St John’s Wort as well. A good practical way to begin treatment is to start with approximately 300 mg a day, with breakfast, for a two to three days, followed by 600 mg a day (300 mg each at breakfast and lunch) for a further two to three days, followed by 900 mg a day (300 mg each at breakfast, lunch and dinner). As Kira is sold in the UK in 135-mg tablets, this would mean starting with two tablets per day, then increasing to four (two tablets twice a day) then six (two tablets three times a day). Then stay on this dosage for several weeks unless side-effects require reduction in dosage. The reason to begin with a low dosage is that whereas therapeutic effects often take weeks to appear, the side-effects of any antidepressant may occur very soon after taking it. If this should happen, one is always better off having taken a small rather than a large dosage. In addition, it sometimes takes a while for your system to get used to a new medication, and gradually increasing the dosage gives your system a chance to adjust to it.

Taking medications with meals reduces the likelihood of developing gastro-intestinal side-effects such as nausea, indigestion or abdominal pains, which may occur with St John’s Wort. The meal will not interfere with the effects of the treatment in any way. If you should develop side-effects after increasing the dosage to, say, four 135-mg pills a day and the side-effects are mild, try to remain on that dosage for at least a few days. Side-effects may settle down within a few days. If you increase the dosage without waiting for this to happen, it will most likely make the side-effects worse and discourage you from staying on the medication. It may turn out that the current dosage will be just right for you. Alternatively, if this dosage proves to be too low, once the side-effects diminish sufficiently you may be able to increase the dosage at a later time if you need to.

Taking a medication three times a day can be quite inconvenient. Somehow the midday dosage often gets missed out. It is generally much easier to the take medications twice a day, and some people have found that a twice-daily dosage of St John’s Wort (four 135-mg pills at breakfast and two at dinner) works well for them. One or two of my patients developed indigestion when they have used the herb in this way and found that taking it three times a day with meals completely resolved that side-effect. If you should happen to forget the midday dosage, however, it is preferable to double up the evening dose rather than missing one dose for the day, bringing the day’s total to six 135-mg St John’s Wort tablets. Because no one is sure of what the active ingredients are in St John’s Wort, it is impossible at this time to say what the best dosing schedule really is; more research is required to answer this question. At this time, I recommend that you start using St John’s Wort three times a day and, later on, after you have established that it works for you, it may be worth experimenting with different dosing schedules. It is possible that for some people, like the man whose wife mixed his St John’s Wort in with the breakfast vitamins, a once-a-day schedule will prove to be sufficient.

Just as it is possible that some people will not need six 135-mg St John’s Wort tablets per day but may respond fully to two or four tablets, so others may require more than six tablets per day. It is probably worth staying on six 135-mg tablets per day for at least five weeks before deciding to increase the dosage. In one study of more serious depression, 1,800 mg of Hypericum proved to be as effective as a conventional anti-depressant and the researcher running the study remarked that the frequency of side-effects did not appear to be greater than he had encountered on the more conventional lower dosage of 900 mg per day. It would be surprising to me if, just as with other anti-depressants, different people did not end up needing different amounts of Hypericum and I would encourage you and your doctor to experiment with different dosages up to 1,800 mg (approximately 13 135-mg tablets per day) provided you do not experience any particularly unpleasant side-effects and provided you give the lower dosage of 900 mg (six tablets) a fair trial of five to six weeks before increasing the dosage.

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Alcohol may undoubtedly precipitate seizures in those who already have had previous seizures.

There is also an association between chronic alcohol abuse and the occurrence of fits even when sober. Those who drink alcohol to excess are usually aware that they are running the risk of cirrhosis of the liver, but not many realize that chronic alcoholism can result in loss of cerebral nerve cells, seizures, and impairment of intellect.

Degenerative disorders-As advances in knowledge occur, fewer and fewer diseases will be assigned to this non-specific group. Creutzfeld-Jakob disease, the human equivalent of ‘mad cow’ disease for example, used to be regarded as degenerative , before it was shown to be caused by an infective agent. Pre-senile dementia (Alzheimer’s disease), in which the cerebral nerve cells gradually become fewer in number, is associated with seizures. Some cases are inherited, and almost certainly in most there is a biochemical abnormality responsible for this loss of nerve cells, and, hopefully, when this has been identified, some sort of pharmacological treatment will be possible. This sequence of events has already occurred in Parkinson’s disease. This was regarded as a degenerative disorder until 30 years ago. A defect in the metabolism of a transmitter called dopamine was identified, and a suitable drug (L-dopa) produced. A number of degenerative disorders which start in childhood (including one called Batten’s disease) present with frequent seizures.

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Mr. E.B., age 67, of Michigan reports that his arthritis symptoms first appeared over five years ago and had become a serious problem in his right knee for about two years. His hands were also affected. He writes that his doctor performed an arthroscopy and advised him that his “right knee was bone on bone, but it was not the right time for knee replacement.” CMO seemed worth a try.

He is now “lifting weights, ice skating once or twice a week, and getting ready to take a 200 mile bike riding trip. I can now get up ladders and paint. I know this doesn’t work for everyone, but I feel it helped me a lot. If my knee never gets worse, I will never think of having a replacement.”

Mr J.S. of Texas writes: “In early November of 1996, 1 was introduced to CMO through the Arthritis Pain Care Centres. The product impressed me so much that it overwhelmed my belief. Knowing that I had arthritis in my hands and elbows and lower back, I was willing to give it a try. Being an avid golf nut, I was willing to try anything that would give me some relief.

“So I did the CMO treatment… and around the fifth or sixth day, I noticed remarkable improvement in my hands, especially those sore knuckles, and my lower back. By the end of twelve days I noticed that a burning pain from the small of my back down through my leg to my foot was also disappearing. It’s now been eight weeks since I finished my treatment and I’m here to tell you that all my pain is gone.

“So golfers, tennis players, softball players and anybody with arthritis pain, do yourself a favour and do the CMO treatment.” [Editor's note: Now, over a year later, J.S. reports that he is still golfing vigorously and painlessly as a result of his one set of CMO capsules.]

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Precautions

•     Reye’s syndrome has been linked to the use of aspirin during influenza. Although a cause-and-effect relationship has not been established, aspirin should not be given if your child is suspected of having influenza. Watch for signs of complications and report them to your doctor.

•     If there are no complications, the fever accompanying influenza often peaks in two cycles. The child’s temperature is elevated for a day or two, normal for a day, then elevated for a day or two. Do not misinterpret 24 hours of normal temperature as a “cure,” and do not allow your child to resume activities until the temperature is normal for two or more days.

Medical treatment

If there are no complications, the doctor will tell you to continue with the home treatment described above. If complications occur, cultures, blood tests, antibiotics, and hospitalization may be required. Vaccines to prevent influenza are not very helpful for children. The influenza viruses have a number of different strains that change their structures from year to year. Therefore, last year’s vaccine may be useless against this year’s virus. Moreover, reactions to influenza vaccines in children are frequent, although these reactions are rarely serious. At the moment, medical experts advise that only children at special risk from influenza should be immunized annually. The conditions that constitute “special risks” are: rheumatic heart disease, congenital and hypertensive heart disease, cystic fibrosis, severe asthma, tuberculosis, nephrosis, chronic nephritis, chronic diseases of the nervous system, and diabetes.

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It is a condition in which a person has a reduced blood flow to the brain, causing him or her to feel faint, weak and eventually even to lose consciousness. On falling to the floor the person becomes horizontal and the blood flow to the brain is restored. Sometimes people, who feel they are about to faint feel giddy, sweat a lot and have a fast heartbeat. When a person faints they look pale, breathe rapidly and have a feeble pulse. After a few minutes consciousness usually returns.

Causes of fainting

• An emotional upset.

• Sickening for an acute infection.

• An overheated, ill-ventilated room.

• Prolonged standing, especially on an empty stomach.

• Severe pain.

• Pregnancy.

• Severe anaemia.

• Severe bleeding.

• Adolescence (notably in girls).

• A minor epileptic attack can be mistaken for a faint.

Prevention

The prevention of most of the above is fairly obvious and needs no elaboration. However, if you feel faint or likely to faint here are a few simple preventive hints.

• Always have breakfast if you know you are going to have to stand up for any length of time.

• Ensure that your environment does not become too hot and stuffy.

• As soon as you feel at all like fainting sit down, loosen your tie, belt or any other constricting clothing; get someone to open a window or to take you to an open window or outside the stuffy room. If you feel worse, lie down flat. Within a few minutes you should feel normal again. Look for the cause of the faint and take steps to prevent similar occurrences.

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