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Most breast cancers arise from the epithelia in the breast, and these are known as carcinomas. In-situ carcinoma is the term used for a carcinoma which remains in the position in which it developed, with no sign of invasion into the surrounding tissues. Sarcomas – tumours arising from the connective tissue -are rare in the breast.

Some 90 per cent of breast cancers develop within the epithelial lining of the ducts. Of the remainder, about 5 per cent occur within the lobules of the breast, and these are likely to be associated with second tumours in the same or the other breast. The remaining 5 per cent are a combination of ductal and lobular cancers. There are variant forms of most types of breast cancer, sometimes with a different prognosis from that of the tumours they resemble.

Different names are used to identify the same cancers in different countries, and by different doctors within a country. Confusion is therefore rife – not least amongst the medical profession itself.

Ductal tumours

Scirrhous/non-specific ductal carcinoma

This is the most common form of ductal breast cancer, which usually develops as a hard, painless swelling in women near their menopause. It often occurs in the upper outer quadrant of the breast and may spread into the surrounding fat. Malignant cells may also be present in nearby lymph vessels and blood capillaries. A scirrhous carcinoma that has invaded the lymph nodes or the lymph vessels near the skin is likely to have a worse prognosis.

Atrophic scirrhous carcinoma

This is a very slow-growing tumour which may cause contraction and deformity of the breast in elderly women. It is often only found during routine medical examination and can remain localized in the breast for many years.

Medullary carcinoma

Also called lymphocytic or encephaloid carcinoma, this is a softer, more rapidly growing tumour than the scirrhous. It is said to have a better prognosis, even when spread has occurred to the lymph nodes in the armpits. If the body launches a strong defensive response itself, the prognosis can be even better. There is less fibrous reaction (unlike with the scirrhous type), and many disease-fighting lymphocytes are seen within the cancer.

There is also a variant of this type of cancer which is known as atypical medullary carcinoma. This is an intermediate form combining characteristics of a medullary and a scirrhous carcinoma.

Inflammatory carcinoma/carcinoma of pregnancy and lactation

These tumours may resemble a breast abscess. They grow rapidly and may cause the breast to become hot and tender. They do not normally become apparent until it is too late for them to be treated successfully.

Papillary carcinoma

Papillary carcinomas are a rare variant of the non-specific ductal form, with a good prognosis. They develop as a mass of cells within the lumen of a duct, and they present early with bloody nipple discharge.

Cystic carcinoma

Cystic carcinomas are rare (only about 1 per cent of all breast cancers), but they have a poor prognosis. When aspirated, the fluid they contain is bloody, and malignant cells can be seen within it when it is examined under a microscope.

Lobular tumours

Cancers in the lobules of the breast are 10 to 20 times less common than ductal tumours. The prognoses are similar, but lobular tumours are more likely to occur in both breasts, Sometimes several being present at the same time.

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Screening procedures that are definitely not worth doing routinely are barium enemas; barium meals; looking for cells in the sputum (spit); stress testing; lung-function tests; and biopsies of the lining of the uterus. All of these are, of course, useful diagnostic procedures in specific individuals.

Screening can be carried out in the community in general or it can be focused on specific sub-groups who are thought to be ‘at risk’. As we have seen, when screening for cervical cancer, money is best spent on screening women from lower down the socio-economic scale because it is much more common in this group.

Families are population sub-groups ripe for screening. The predisposition for many diseases (as well as truly hereditary disease, of course) runs in families. Common examples are breast cancer, diabetes, asthma and high blood pressure. Doctors have always considered screening families in the context of infectious diseases in the past but few do this kind î intra-family screening for chronic conditions.

Screening, especially the sort that involves paying a fixed sum for a batch of tests and examinations, is currently enjoying something of a revival. One of the attractions of screening programmes is that the; can often be inexpensive and can be implemented by relatively low grade personnel rather than doctors. But as the price has come down, fewer questions tend to be asked and screening is now-with the coming interactive computer systems-set become even more popular, after decade of apathy and serious questioning of its worth. Another reason for an increased interest in screening recently is that, with the setting-up of new health maintenance and prevention-orientated medical organizations, screening equipment and personnel can be used with the curative staff on hand. A major criticism of screening centers in the past has been that they left the patient high and dry with his or her findings from the screening. These new ways numbers of false positives that occur of working enable responsible follow- with certain screening procedures, up to be a part of the whole picture. This is essential in the light of the Much more research needs to be done before we can be absolutely sure just how valuable many screening procedures are. What looks like commonsense preventive medicine is often not so on deeper analysis. The danger with the coming of cheaper and easier screening methods is that society might ask fewer questions, not more.

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When Dave Venne moved in with some of his buddies, he was looking forward to the companionship and fun. What he didn’t expect was a 15-pound weight gain.

“Those guys ate all the time, and I was right there with them,” says the 25-year-old landscaping-design supervisor from Tempe, Arizona. “Still, I couldn’t believe how quickly the pounds piled up. I went from 225 to 240 in 12 weeks. More than a pound a week!”

At 6-foot-4, Dave carried the extra weight well. But it made him feel heavy and uncomfortable. “I work outside in the heat, and I felt miserable,” he says. “Plus, I wasn’t running as fast or jumping as high when I played basketball, one of my favorite pastimes.

“My roommates and I would play basketball or do something else for a couple of hours practically every night,” he continues. “By the time we finished, we’d be so hungry that we’d eat just about anything that we could get our hands on.” Their foods of choice were pizza, burgers, and Mexican takeout, all washed down with copious quantities of soda and beer. “Sometimes, I’d eat an entire pizza and drink three or four beers, plus a couple of Cokes, before going to bed,” Dave says. “And that was on top of eating a sandwich or something else when I got home from work.”

Feeling out of shape and overweight, Dave decided his late-night eating habits had to go. “I figured that if I ate a good dinner, I wouldn’t get hungry later that night,” he says. “I’m not much of a cook, but even I can heat up a can of soup and put together a turkey sandwich.”

As he began paying more attention to his food choices, his other meals became healthier, too. He traded in his usual sausage-egg-and-cheese breakfast sandwich for a bowl of cereal, a glass of orange juice, and sometimes toast. For lunch, he still favored fast-food restaurants, but he replaced his bacon double cheeseburgers with grilled chicken sandwiches. And he carried bottles of water with him everywhere. “I have to drink a lot while I’m working,” he explains. “I used to down seven or eight sodas a day. I think that switching to water helped me lose weight.”

Indeed, Dave got rid of those 15 extra pounds, plus 8 more, in about 6 months. He has held steady at 217 pounds, a comfortable weight for his size, since 1998.

These days, Dave seldom eats after 8 o’clock at night. If he feels hungry after a couple of hours of shooting hoops, he’ll eat fruit or fat-free frozen yogurt. When his roommates order out, he helps himself to a healthy snack or goes to bed instead.

“Being around junk food and not eating any of it was hard at first,” Dave admits. “But now I feel so much better about myself that I don’t even miss that stuff.”

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These are drugs which mimic the effects of naturally produced adrenaline, the messenger of the sympathetic nervous system (see p144) which produces the ‘flight or fight’ reaction. Sympathomimetics have various effects, but one local effect is to make small blood vessels (capillaries) contract. Thus they have an opposing effect to histamine. This is exploited in some nasal sprays for hay-fever and perennial rhinitis. The drugs concerned are phenylephrine (Neophryn), oxymetazoline (Afrazine) and xylometazoline (Otrivine).

These sprays make the capillaries in the nose contract providing immediate relief from congestion, but if used for more than two weeks they can-have adverse effects. The blood vessels become ‘hooked’ on the drug so that when the spray is discontinued they react by expanding, causing congestion again. These sprays are for short-term use only.

Some sprays combine sympathomimetics with antihistamines (eg Hayphryn and Otrivine-Antistin). Others combine sympathomimetics with antihistamines and antibiotics (Vibrocil) or with corticosteroids and antibiotics (Dexa-Rhinaspray). Sprays containing antibiotics are only used where there are signs of infection as well as allergy.

Sympathomimetics such as pseudoephedrine and ephedrine are sometimes combined with antihistamines in medicines taken by mouth, such as Congesteeze (pseudoephedrine and azatamine), Haymine (ephedrine and chlorpheniramine) and Sudafed Plus (psudoephedrine and triprolidine) When taken by mouth, the sympathomimetic helps to overcome the main side-effect of the antihistamine, drowsiness.

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The simplest and most effective method of treating food intolerance is to avoid the culprit foods. Assuming that you have successfully identified your culprit foods, by following an elimination diet, the next step is to establish an adequate menu that excludes those foods. Make a list of the foods you cannot eat, and a list of those that you can. Talk to your doctor about your proposed diet, and ask for advice on its nutritional value.

After about six months, you can retest each of the incriminated foods, to see if you still react to them. If you do react, then try again six months later. If not, then you can begin eating them once in every four days. After a year of this, you can increase the frequency cautiously, but you should never go back to eating the food every day, or in large amounts. If symptoms recur, cut out the culprit foods again for a couple of months.

If you are not fully well, even after the elimination diet, then it is worth considering other possibilities – it could be that you have other problems, in addition to food intolerance. Nutritional deficiencies, candidiasis and chemical sensitivity are possible candidates. A continuing tendency to diarrhoea and wind may indicate gut-flora disturbances. The only treatment for this is to eat plenty of live yoghurt.

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The most drastic form of the elimination diet is to fast for the first five days, taking nothing but bottled spring water. This method has several drawbacks. Fasting requires a great deal of will-power and it is bad for anyone who is underweight and in poor health. Even for those who are not underweight, there are major metabolic changes that occur during fasting, as the body begins to break down its fat reserves. These metabolic changes, and others which occur when food is reintroduced, may themselves produce symptoms. For these reasons, we would not recommend fasting except in certain very difficult cases.

One step up from fasting is the lamb-and-pears diet, probably the best known type of elimination diet. This is something of an oddity because lamb is quite a common food in Britain. The diet originated in the United States in the early days of clinical ecology – America does not have the steep upland pastures that have made sheep-farming so popular in Great Britain, so lamb is not widely eaten there. While sensitivity to lamb is unusual, it does occur in Britain, so a lamb-and-pears exclusion phase is less appropriate here than on the other side of the Atlantic.

A modified version of the lamb-and-pears diet, used by some doctors, is turkey-and-pears or turkey-rice-and-pears – turkey being less commonly eaten in Britain than lamb. While these diets are useful when someone has a great many sensitivities, they are unnecessarily strict for most people. Again, they require a lot of will-power, and they involve eating huge quantities of two or three foods, which is never a good idea.

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Always bear in mind that the diet may not be the answer. If you pin all your hopes on it, you may see improvements where there are none, and in the long run this could be very damaging to your child. Be careful, also, not to give the child the impression that the diet will ‘make everything alright’. He may be so anxious to please you that he tries extra hard to be good. Psychogenic reactions on food testing can occur just as easily in children as in adults, and if knows he is expected to go wild when he tries milk he may well oblige. Throughout the diet, try to keep an open mind about the outcome, and do not put any ideas into the child’s head about what might happen.

On the other hand, you do need the child’s cooperation, especially if he is old enough to go out and buy sweets or other foods for himself. Rather than forcing the diet on him, you should explain that it might help and ask if he would like to try it. You need to impress on him that it will only work if it is done properly – that there must be absolutely no cheating.

Because food additives are so important in hyperkinetic syndrome, you need to be aware of other ways in which they can be consumed. The colourings in toothpaste are identical to certain food colourings, so white toothpaste should be used. Put any coloured toothpaste well out of reach. Medicines also contain colourants, often in very large amounts, which is why you should try to discontinue syrups and tablets during the diet (as long as your doctor agrees) or get colouring-free alternatives. Try to stop your child from chewing things, and from licking sticky paper or stamps. Bear in mind that there can be additives in unlabelled food such as bread from a bakery, fish-and-chips, other take-away food, and restaurant food eg French fries.

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One of the main chemicals to be released is called histamine -hence the use of drugs that counteract its effects, antihistamines, in the treatment of allergies. The packets of chemicals inside the resting mast cell look like small granules under the microscope, so the process of releasing the chemicals is called degranulation.

Histamine and other chemicals released by mast cells are called mediators because they bring about or ‘mediate’ changes in the body. A powerful cocktail of mediators, containing ten or more separate substances, spills out of a degranulating mast cell. Each mediator has its own particular effect on the body – some make the blood vessels open out, others make them more leaky so that blood escapes through the vessel wall. Several mediators make smooth muscles contract – these are not the muscles by which we move around, but those that operate our lungs, stomach, intestine and bladder. When they contract sharply, air may be expelled from the tubes leading to our lungs, or semi-digested food from our bowels.

This is bad news for parasites, which may be directly affected by the mediators themselves, and then assaulted by the body’s reaction to the mediators. In the case of parasites in the gut, for example, the direct effect of the mediators may make the parasites loosen their grip, and the diarrhoea that follows flushes them out of the body. For parasites in the blood, the expansion and leakiness of blood vessels produces the redness and swelling that we describe as inflammation. One feature of inflammation is that all-purpose defensive cells called phagocytes (which simply means ‘eating cells’) are attracted to die site of the invasion.

One group of phagocytes, the macrophages (‘big eaters’) have the role of perpetuating the inflammation reaction. They produce an enzyme called phospholipase or PLA. What PLA then does is to cut up certain fat molecules – the phospholipids – found in the membranes of all our body cells. The fragments released from the phospholipids by PLA are then worked on by other enzymes, which turn them into potent chemical mediators, known as prostaglandins.

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Best of all, however, is the effect that bear’s garlic has on hardening of the arteries. In this respect it can considerably lengthen the lives of older people. Bear’s garlic juice or bear’s garlic tonic can help prevent a stroke, and if a person has already suffered a stroke, this simple plant can restore him to health better than some of the most expensive proprietary medicines. Elderly people who have high blood pressure and are in danger of a stroke can ward it off with four plant remedies: bear’s garlic (Allium ursinum), mistletoe (Viscum album), hawthorn (Crataegus oxyacantha) and Arnica (Arnica montana). So why risk falling victim to paralysis when simple natural remedies exist that will prevent a stroke and at the same time strengthen the heart and the vascular system, giving new life to the body?

To benefit fully from bear’s garlic it may be eaten fresh and uncooked as a salad or mixed with other vegetables. Steamed with a little oil, it is similar to spinach and, although not as beneficial as when eaten raw, it is still better than ordinary vegetables.

Taken as a wine or tonic, or an extract in the form of drops, it has also proved invaluable. If you do not wish to go to the bother of gathering the leaves yourself to use as a vegetable, you can take advantage of the fresh plant extract, in which all the goodness of the plant is preserved.

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The bones of the feet are of a very simple design, but the structure and arrangement of the muscles is a technical masterpiece. The muscles are designed for walking on uneven ground, that is, natural ground. If they are not exercised they degenerate and the shape of the foot will change. The foot will lose its efficiency and especially the long muscles, the long flexors of the toes, will become slack. Changes in the natural structure of the feet will lead to deformities such as flat feet, splay feet, club feet, and whatever other names they are known by.

It was for a good reason that Priessnitz, Sebastian Kneipp, Rickli and other nature cure teachers recommended again and again that we walk barefoot as much as possible, particularly in the summer. It is good to walk on dew-wet grass early in the morning. This is refreshing and strengthens the foot muscles, while walking on uneven natural ground provides the feet with an invigorating massage. However, there are many other ways in which we can care for our feet. These are the subject of the following sections.

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