DISORDERS OF THE SLEEP-WAKE SCHEDULE (DSWS):  DELAYED SLEEP PHASE SYNDROMEAll of us at times stay up later than we want to or later than we should—cramming for tests, completing projects for work, or enjoying a late-night social event. Usually we have no trouble readjusting to our normal schedule. If our sleep cycle is biologically delayed, however, we may find it virtually impossible to go to sleep at a “normal” or reasonable time. More often seen in young adults, delayed sleep phase syndrome (or, if you’ll permit me yet another acronym, DSPS) often causes its victims to go to bed before they’re really ready to sleep, in a futile effort to operate on a regular schedule. Once in bed, they are unable to drop off for an extended time—perhaps an hour or more. They usually sleep normally once sleep has come, but naturally they find it very difficult to rise and function in the morning. Given a choice, these patients would usually sleep from about three in the morning to about noon the following day. Because they often must be at work by eight or nine o’clock, however, they leave their beds too soon, depriving themselves of necessary rest. This form of sleep deprivation may have other effects which make the actual diagnosis of delayed sleep phase more difficult. One clue, however, is that DSPS sufferers may look forward to weekends because, as one patient put it, “I can get up at the crack of noon.”DSPS is estimated to affect some 7 to 10 percent of insomniacs. Physicians must be careful to distinguish it from difficulty initiating sleep, a different problem whose therapy—hypnotic drugs—is inappropriate in treating DSPS victims. One strategy that does seem to work is called chronotherapy. In this process patients are told to delay their bedtimes significantly—by three hours or so per night over a five- or six-day period. Thus, the first night, the patient might retire at midnight; the next night, at 3:00 A.M., and so on. Eventually, patients “catch up” with their cycles, resetting their internal clocks so that they are able to retire, and fall asleep, on a more normal schedule. One late night, however, can disrupt the pattern and result in recurrence of the disorder.*168\226\8*

ASTHMA DEVICES: THE PEAK FLOW METERWhen bronchospasms cause the airways to become narrow, the capacity to quickly move air in and out of the lungs is significantly reduced. A simple, accurate way to test the extent of narrowing is to measure the peak expiratory flow (PEF). As the airways become narrower, the flow is lowered. Measurement of your PEF is easily achieved by using a peak flow meter — a small, hand-held, plastic device that is ideal for use at home as a way of monitoring your lung function on a daily basis.For adults, individual PEF readings depend on age, height and sex. ‘Normal’ peak flow readings have been established according to these variables. For children, the reading is gauged on height alone. (Most children under the age of six are unable to perform a successful lung function test by this method.)Peak expiratory flow changes with age. It is lower in children than in adults, highest in early adult life and decreases in old age. It is higher in tall people than in short people and generally males have higher peak flows than females of the same age and height.Many doctors now recommend that asthma patients measure their lung function over several weeks with a peak flow meter and keep a daily record of their readings. Readings should be taken in the morning and at night. If you are on medication for asthma, your doctor most likely will advise you to take a reading before and after you take your medication. Chronic asthmatics should develop the habit of using their peak flow meter at least twice a day for an indefinite period, or until their asthma is less frequent and less severe.All peak flow meters have a chart enclosed for recording daily readings. If there is a lot of variation between readings at different times of the day, or between days, then indications are that your asthma is unstable. If there is little variation, your asthma is stable. A drop in a reading of more than 20 percent can be an early indicator of an impending attack.Any significant variation in your PEF readings requires prompt action — consult your doctor immediately about increasing or changing your medication. Prompt preventive action can often prevent further development of an impending attack. Every asthmatic should know what to do in advance in the event that readings drop. This knowledge should be part of a management plan worked out previously in accordance with your doctor. THREE HELPFUL PEF METER READINGS:Expected ‘best’ expiratory flow;The peak flow level when medication is advised;The peak flow level when medical assistance is required.USING THE PEAK FLOW METER:Check that the indicator is on zero;Stand up or sit upright;Inhale deeply through your mouth until your lungs are full;Hold the peak flow meter horizontally and place the mouthpiece in your mouth. Form a tight seal around the mouthpiece with your lips, making sure your fingers are not in the way of the indicator;Blow out as hard and fast as possible. Aim to clear all the air from your lungs in one second (many doctors suggest that you record the best of three consecutive readings);Check the highest reading reached by the indicator and record it on your chart.(If you are taking readings before and after a metered dose of bronchodilator medication, wait 8-10 minutes before recording again.)CARING FOR THE PEAK FLOW METERThe peak flow meter can be cleaned by rinsing in warm, soapy water.Only the mouthpiece can be boiled. You can also sterilize the mouthpiece in an antiseptic solution. The peak flow meter must be dry when used.*24\148\2*

Urethritis may present with urethral discharge, tingling, itchiness and dysuria. Posterior urethritis may cause frequency and urgency. The discharge may be watery or sticky or thick and pumlent If the discharge is frankly purulent, the infection is more likely to be gonococcal. Meatal inflammation may be present particularly in gonococcal urethritis.

The infection may progress to epididymitis, prostatitis or vesiculitis. Epididymitis is commonly unilateral. Infertility is an important sequel. Persistent or recurrent urethral symptoms may occur, often without discharge or any demonstrable microorganisms.

Most women with cervicitis present as the symptom-free contacts of men with NGU. Cervicitis may, however, present with vaginal discharge, symptoms of urethritis or lower abdominal pain. Speculum examination may reveal a cervical discharge and an inflamed cervix but the cervix commonly appears normal.

The most important complication of gonorrhoea or NGC is the spread to the upper genital tract causing endometritis, salpingitis and pelvic inflammatory disease (see chapter 6). Late sequelae are ectopic pregnancy and infertility.
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Introduction

Causative organisms

Urethral and cervical inflammation are common presentations of STD. The most common STDs manifested by urethritis or cervicitis are gonorrhoea caused by Neisseria gonorrhoeae and non-gonococcal urethritis (NGU), and non-gonococcal cervicitis (NGC) caused by Chlamydia trachomatis. Other causes of these presentations include the genital mycoplasmas, candidiasis, trichomoniasis and herpes simplex infection.
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Skin doctors have special praise for Accutane, a derivative of vitamin A. Taken orally; it helps almost miraculously to dry up the great red sores of cystic acne. Dr. Alan Shalita, dermatology professor at the State University of New York Downstate Medical School in Brooklyn, says that, thanks to Accutane, “there is little reason for almost anybody to suffer with acne.”
However, doctors reserve Accutane only for the most serious cases. It can cause liver problems, among others. If a woman gets pregnant while taking it, a deformed fetus might result.
Paul Smith, 23, a minister in Little Rock, Arkansas, has had acne since the seventh grade. Red sores covered his face, back, neck, and chest down to his wrists and thighs.
“I felt that my body had played a very dirty trick on me,” he says.
Today, Rev. Smith keeps his skin 90 percent clear, thanks to a method devised by Dr. Kenneth L. Flandermeyer, associate clinical professor of dermatology at the University of New Mexico at Albuquerque. Dr. Flandermeyer has written about the method in Clear Skin (Little, Brown). Essentially, Dr. Flandermeyer asks patients to apply medicines that dry and peel the skin. Rev. Smith placed himself under Dr. Flandermeyer’s supervision in 1980 and saw improvement in weeks. When Accutane became available in 1982, he tried it and found that it worked.
But four of five persons between the ages of 12 and 23 with less terrible forms of acne can fight blackheads, pimples, and sores with nonprescription medicines.
Dr. Shalita notes that over-the-counter drugs often effectively reach into hair follicles to combat germs living there. He contends that germs cause blackheads by turning natural skin oils into fatty acids that block follicle openings. Not all acne responds well to self-treatment. About 25 percent of young Americans must seek a dermatologist’s help. “We still don’t know why some people get acne and others do not,” says Dr. Shalita.
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There are about one million working units called nephrons in each kidney. Each nephron consists of a tuft of capillaries known as the glomerulus attached to a long winding tubule that empties into collecting tubules.
The glomerulus filters the blood that circulates through it. Water together with glucose, amino acids, urea, sodium chloride, and other small molecules filter into the tubules. Large molecules such as the blood proteins are held back in the circulation. Each glomerulus filters only a tiny drop of fluid in a day, but the volume of plasma filtered by the two million glomeruli amounts to about 125 ml per minute or 180 liters in 24 hours. The amounts of glucose, sodium chloride, and other substances filtered are equally large; for example, the sodium chloride filtered is over kilogram which is roughly 100 times the daily intake of salt!
The winding tubules bring about selective reabsorption so that the normal concentration of substances in the blood is maintained at all times. Normally, the urine volume ranges from 1000 to 2000 ml, which means that over 99 per cent of the filtered water has been returned to the circulation. Likewise, all of the glucose and vitamin C, and almost all of the amino acids, sodium and other substances have been returned to the blood. For example, if you eat foods containing more salt than your body needs, the renal excretion of water and sodium will be increased. On the other hand, if you greatly reduce your salt intake or if the body sodium is depleted, the excretion in the urine will be very small.
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Let’s revisit the high-carb menu as it relates to insulin/glucagon balance. Those healthy-looking menus from the diets espoused by Barnard, McDougall, and the Diamonds stoke your furnace with grains, fruits, and vegetables but are deficient in two macronutrients—protein and fat (essential fatty acids)—that help slow down the release of sugars into the bloodstream.

When protein and fat accompany carbohydrates into the stomach, digestion is slowed, allowing the release of sugars into the bloodstream in a time-release manner. In other words, the sugars are not just dumped into the bloodstream, which would generate a gush of insulin; they are slowly released into the bloodstream, providing a steadier stream of glucose to the brain and peripheral tissues. Because the energy is used immediately, insulin is not needed to store the excess.

When a meal doesn’t contain an adequate amount of protein and fat to balance the carbohydrates, sugars are both digested quickly and released quickly into the bloodstream. Insulin pours from the pancreas in a desperate attempt to stabilize the critical level of blood sugar, and many of those carbohydrate calories will be stored as fat.

Why, then, doesn’t everyone who eats a high carbohydrate diet get fat? Dr. Barry Sears, author of Enter the Zone, wrote about the role genetics plays in insulin/glucagon balance.

People’s genetic insulin responses to carbohydrates are diverse. In about 25 percent of a normal population, insulin response to carbohydrates is very blunted. When these lucky people eat excess carbohydrates, their insulin levels don’t rapidly surge upward. They can consume large amounts of carbohydrates and not get hungry or fat. (These people often do very well on high-carbohydrate diets, so the dietary establishment elevates them to iconlike status to demonstrate the moral superiority of such a diet. Heck, these people just had a lucky draw in the genetic lottery.)

On the other hand, 25 percent of an otherwise normal population has an unlucky genetic draw that dictates an extremely elevated insulin response to carbohydrates. These people simply have to look at a carbohydrate and they begin gaining fat.

Between these two extremes lies the other 50 percent of the American population. These people respond normally to carbohydrates, which means that if they eat too much carbohydrate they’ll have an elevated insulin response—not as elevated as the unluckiest 25 percent, but still elevated enough to do all the damage described above. These people will always fail on a high-carbohydrate diet. They’re accused of being weak-willed gluttons who can’t control themselves, when in fact they were just born with unfortunate genes.

Yes, some people will do well on high carbohydrate diets such as those found in the Diamonds’ book, Fit for Life, or the McDougall Plan. These people can eat carbohydrates willy-nilly and never suffer the unpleasant consequences of excess carbs like the rest of us. And sometimes, they do radiate a certain moral superiority about it.

The rest of us, for reasons as diverse as our lifestyles or the way our bodies are made, aren’t so lucky. When we eat a diet high in carbohydrates, our bodies are thrown into hormonal imbalance and we’re sensitive to even the good carbohydrates found in fruits, vegetables, and grains.

For example, Samantha commented that she notices an immediate insulin reaction when she eats rice cakes. Judy said, "I never realized how sweet vegetables are!" Please notice that rice cakes and vegetables are not "bad foods." They are terrific foods, and your body will love them if you eat them in balance with other foods to control the release of insulin.

If it’s difficult to believe that a grain-and-vegetable-based diet will put on excess fat pounds, visit your local beef farmer and ask him how he prepares his beef for butchering. He fattens it up for market by "graining" it. He feeds the cattle extra grain to marbleize the meat—to add fat to the muscle tissue.

In that sense, we aren’t any different from beef cattle. If we want to fatten ourselves up, we can "grain" ourselves and pack on the pounds, which is exactly what many of us have been doing for years in the form of whole-grain breads, spaghetti, and cereals.

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Television has an enormous influence on children, whether we like it or not. Almost every house in Australia has at least one television, and almost three in four have a VCR. The average child spends more time each year watching television than going to school. Only sleep occupies more of a child’s life than does television. In North America, the average preschool child watches 27 hours of television each week; at school age this has dropped only marginally to 25 hours, and has reduced to 23 hours at adolescence. Half of all homes have the television on at mealtimes. There is no reason to suspect that these figures are all that different for Australian children.

Television therefore has a pervasive effect on the lives of children. Whether this turns out to be positive or negative is largely under the control of parents. Unfortunately in Australia, with a few exceptions, little interest has been shown in the promise and potential of television for children. Here are some of the problems associated with children watching television:

Violence There is a well established association between aggression and the violence seen on television. Children have difficulty differentiating television from reality; they accept that what they see on television is the norm. They learn that solving problems through violence and aggression is acceptable.

Stereotypes Television frequently reinforces prejudices by its stereotypical portrayal of different cultural or racial groups, of women, and of particular socioeconomic groups.

Obesity There is a strong link between the amount of television watched and obesity. Children who watch a lot of television are less active and snack more while watching. Many of the advertisements during children’s shows in particular promote ‘junk’ foods, sugary cereals and other unhealthy food.

Effects of advertising Many of the advertisements screened during children’s viewing time are to do with junk food, violent toys, sweets, and other products that are often not in a child’s best interests.

There are other bad effects of television: children who watch an excessive amount of television tend to do less well at school; there is evidence that when television shows youth suicide, either in a news item or a program, there is a heightened risk of an increase in youth suicide, because of imitation among adolescents.

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Here are some rules of thumb to apply to the issue of heart disease and sexuality. Remember, talk to your doctor first!

1. Talk with your doctor as a couple, not individually. Your healing takes place within a system, a relationship, so give your doctor the opportunity to talk to both of you. Talking together prevents some of the problems of “interpretation” from spouse to spouse.

2. Talk as a couple and with your doctor about sex and about concerns about the heart disease. There are many types of heart disease and very little research on sex and heart disease, so communication and mutual openness is important. Everybody who has ever had heart disease wonders about sexual issues. You are not alone in your concerns. Anxiety is worse for the heart than embarrassment, so take the risk and share your concerns.

3. Don’t try to prove you are “all better” by trying a sexual marathon. Return gradually to the sexuality the marriage desires. Sexual tests always flunk anyone who tries them.

4. With or without heart disease, it is better to be sexually active when you are in good general health. Look at this issue as a general issue, not just one related to the heart muscle. Sexual health is a cornerstone of general health.

.5. Avoid alcohol and heavy, rich meals. We all should do this anyway, and the risk factor for stroke or heart attack is increased for anyone when he or she drinks, eats a lot, and has sex.

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Alfred Kinsey stated, “This is first of all a report on what people do, which raises no question of what they should do.” This statement became translated quickly by others to, “This is an outline of what you ought to or could be doing.” The second perspective was now beginning.

The Kinsey reports on male (1948) and female (1953) sexual behavior remain the most complete and reliable references on human sexuality. There has never been and likely will never be another work like them.

Kinsey’s background was in the study of insects. He spent more than twenty years classifying tiny gall wasps. He was a taxonomist who valued size and distribution of sample. He classified more than four million insects throughout the United States and Mexico. If Ellis thought in terms of process, Kinsey thought in terms of classification, or categories. The perspective on sex was changing. We thought now not only about what we did, but where we “fit” compared to other people and new sexual categories.

In the male study, he identified six categories of sexual behavior—”outlets,” he called them—that related to factors that influenced oudet. The energy orientation of the first perspective is clearly present, and “energy-outlet style” was the focus. The six categories were masturbation, nocturnal emission, heterosexual petting, heterosexual intercourse, homosexual behavior, and sex with animals or other species. A second-perspective vocabulary was evolving. Words such as “leaping” and “devouring” were replaced with “petting,” “mounting,” and the “seeking of outlets.” In some ways, animal sexual behavior became the model for human sex. If animals did it, then we ought to be able to do it. The focus changed from the romantic to the rural.

How are you doing in your category-four behavior? We had started to think in a partialistic, not holistic, fashion about sex. Kinsey studied orgasms as his exclusive measure of a completed sexual experience. Orgasms provided a category; either you had one or you didn’t, so it could be classified. The second perspective brought with it an “all or none” orientation to sexual expression, a less romantic view, a Sergeant Friday ism of “just the facts, ma’am.”

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