BOWLEGS AND KNOCK-KNEES IN CHILDREN
Bowlegs and knock-knees are two conditions in which the legs are not as straight as they are in most persons. In bowlegs, the legs bend outward so that the knees are farther apart than usual. In knock-knees, the legs bend inward so that the knees are closer together.
Theoretically, when a child stands straight, the ankle bones should touch or almost touch each other, and the knee bones should touch or almost touch each other. With an infant lying on the stomach or back, the legs can be pulled straight with the toes and knees pointed straight ahead to determine whether the bones of the knees and ankles come together. If ankles touch but the knees do not, the child can be said to be bowlegged. If the knees touch but the ankles do not, the child is knock-kneed.
By these standards, however, all infants, children, and adults are bowlegged or knock-kneed to some degree, so you should not become alarmed. Most infants appear bowlegged until they walk. Then when they start to walk, they walk “cowboy” style. This condition usually corrects itself by age two. Most preschoolers stand knock-kneed, especially if they are plump. This condition also corrects itself.
True bowlegs and knock-knees either are due to rickets (vitamin D deficiency) or are inherited. Once common 50 and more years ago, rickets is now rare. An unusual form of bowlegs, often occurring only on one side, is Blount’s disease, in which the top of the tibia (shin bone) becomes deformed.
Signs and symptoms
Have the child stand with the legs straight and the toes pointed forward. Then observe if there is any distance between the knees or ankles. Remember that any distance between the ankles or the knees varies from person to person and that these differences are usually normal. If you think that there might be a problem, ask your doctor.
Home care
In most cases, no home care is needed. To prevent rickets, all children should receive about 400 international units of vitamin D daily. This amount is found in many commercial infant formulas and in most commercial milk. Some vitamin D is present in breast milk, but the amount varies. If your child is being breast-fed, ask your doctor whether the child is receiving enough vitamin D.
Precautions
• If you think your infant or child is bow-legged or knock-kneed, watch to see if, after several months, the condition worsens. If it does, consult your doctor.
• Do not use orthopedic shoes without your doctor’s prescription.
• Do not give your child vitamin D supplements unless your doctor has prescribed them. Overdoses of vitamin D can be harmful.
Medical treatment
In most instances, your doctor will examine your child and then prescribe no treatment—except to wait and watch. X rays of the knees may be required as well as blood tests for rickets. Use of orthopedic shoes or night splints is rarely necessary. For Blount’s disease, braces or corrective operations on bones may be required.
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General Health
ALCOHOL IN DIABETES
The Australian dietary guidelines suggest that alcohol intake should be limited. In diabetes there are additional reasons why intake should be limited.
1. Alcohol may affect blood glucose levels.
2. The effects of too much alcohol may be similar to the symptoms of hypoglycemia. (It may be important for friends to be aware of this.)
3. Many alcoholic beverages contain significant amounts of carbohydrate.
4. All alcoholic beverages are high in energy. This is important where weight control is a problem.
5. Alcohol may induce high blood fat levels and would need to be avoided if this were a problem.
A moderate intake of alcohol should not affect your diabetes. The following points should be kept in mind.
1. Don’t drink on an empty stomach. Food in the stomach will help slow the rate of absorption of alcohol from the stomach.
2. Choose beverages with a low carbohydrate content – Spirits, Dry Wines, Dry Sherries, Dry Vermouth.
3. For a longer drink mix with low carbohydrate drinks: Diet Coke, LoCal Lemonade, water, Soda Water, Natural Mineral Water, artificially sweetened Tonic Water, LoCal Dry Ginger, Diet Pepsi.
4. Avoid using alcoholic beverages with high carbohydrate content – Sweet Wines, Sweet Sherries, Sweet Vermouth, Liqueurs, Port and Stout.
5. Beers – all varieties contain carbohydrates (including diabetic beer). A low alcohol variety however contains less alcohol, is lower in energy and would be better.
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Diabetes
LIVING LONG: ALL IN THE FAMILY
Though many hospitals are equipped with Orwellian, high-tech equipment that can read your genetic legacy from a single drop of blood, the easiest way to know what’s in your genes is to look at your family tree, says Dr. John J. Mulvihill of the University of Pittsburgh. “You can definitely see your prominent risk factors in your family history,” Dr. Mulvihill says. “And we’re learning more all the time. Ten years ago, we didn’t think there was any family linkage to prostate cancer. Then people started talking about it and uncovered a strong family connection. The problem is that most men don’t know their family history.”
Worse, even when they do know, most don’t give it a second thought. Of the 58 people interviewed for one study, nearly half of those having family members who suffered from heart disease or cancer did not believe that their family history had any bearing on their own risk. And men were much less likely than women to think that having a family member afflicted with cancer was relevant to their own risk for the disease. Despite their disbelief, studies show clear connections. In Japan, for instance, researchers comparing 363 people with colorectal cancer with an equal number of people who were cancer-free found that those having one first-degree relative (a parent, sibling, or child) with colorectal cancer had almost twice the risk of developing the disease as those with no family history of colon cancer. In a similar Canadian study, researchers found that 15 percent of 640 men with newly diagnosed cases of prostate cancer had at least one blood relative who also had the disease, while only 5 percent of 639 men who did not have prostate cancer had any family ties to the disease.
And almost nowhere is family history a stronger link than it is for heart disease. As mentioned earlier, just inheriting one tiny bit of faulty DNA from both Mom and Dad can double your risk for developing heart disease In the final analysis, we’re all likely to be at genetic risk for something, concludes Reed E. Pyeritz, M.D., Ph.D., professor of human genetics, medicine, and pediatrics at Allegheny University of the Health Sciences in Pittsburgh. “I’m fairly convinced that, to some degree, all disease is genetic. So far, the major common diseases to which we’ve identified genetic links include Alzheimer’s disease; arteriosclerosis and all that comes with it, like heart disease, hypertension, and stroke; diabetes; and, of course, most forms of cancer. There’s surely more to come.”
That’s all the bad news. The better news is that studies show these genetic risk factors can be largely offset by making appropriate lifestyle changes or by seeking early medical help in some cases.
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General Health
HEART SAVING TIPS: EXERCISE IS VITAL
We all know that exercise is good for us, but you may not know just how much it can save your life. If someone could bottle the positive effects exercise has on our bodies and sell it as a drug, they would make a fortune because we’d all be taking it! Interestingly enough there was a weight loss supplement on the American market called “Exercise in a Bottle”; the US Federal Trade Commission has permanently banned the manufacturer of this supplement from marketing products for weight loss because of false and unsubstantiated claims made about this supplement. There’s nothing like the real thing!
Exercise has the following benefits for your heart:
• It makes your heart muscle stronger, so that it can pump more blood with less effort.
It helps you maintain a healthy weight by speeding up your metabolism and increasing your muscle mass.
• Reduces your chance of having high blood pressure.
• Strengthens your immune system and improves your ability to fight off infections.
• Exercise reduces LDL “bad” cholesterol and triglycerides, and is one of the few ways you can increase your HDL “good” cholesterol.
• It improves glucose tolerance, thus reduces your chance of developing Syndrome X and diabetes.
• Exercise helps you cope with stress and reduces anxiety and depression. It reduces tension, anger and fatigue, and helps to lift your spirits.
• Exercise improves your self esteem and makes you more motivated to eat well and look after yourself well.
• It causes your artery walls to release nitric oxide, which dilates your blood vessels, improving blood flow; reducing inflammation of the artery walls and reducing the tendency of blood clots to form in the arteries.
• Exercise makes you smarter! Yes it’s true; studies have shown that exercise helps thinking and decision making abilities, and speeds up brain activity.
• It helps you to live longer.
Clearly exercise is one of the easiest, least expensive things you can do to reduce your risk of heart disease. An ideal amount of exercise would be 30 to 60 minutes most days of the week. If you can’t fit it all in one go, you can split this into two or three sessions. For example, two fifteen minute walks would be just as good. If you don’t have time for formal exercise, you can still stay active by gardening, doing vigorous housework, walking to the shops instead of driving, taking the stairs instead of the lift, going out dancing, or having energetic sex. Find some way to be more active; it will be well worth it.
If you have diagnosed heart disease it is vital that you check with your doctor before starting an exercise program.
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General Health
LIVING LONG: THE QUEST FOR IMMORTALITY
Legend has it that young James J. Kilroy was like any other working stiff in the 1940s, loading freight ships day in and day out. Then one day he had a flash of how he could be just a little bit more. Chunk of white chalk in hand, he scrawled, “Kilroy was here” on a mother lode of crates full of blue jeans waiting to sail to harbors across the globe. When that slogan- generally accompanied by a face peeking over a wall-started popping up around the country, including such inaccessible places as the Statue of Liberty’s torch, the once-anonymous Kilroy achieved immortality.
“We all have a little Kilroy in us,” says Dr. Walter M. Bortz II of Stanford University School of Medicine. “We want to leave a legacy to show we were here. We have an inherent want for immortality. And that’s a healthy thing.”
There are a whole lot better ways to have your name live on than etching your John Hancock on a bathroom wall. Many can actually leave the world a better place. Others are just plain fun. So strap on some of these suggestions and rocket into eternity.
Sign a donor card. “The absolute best way for anyone to live on after their death is to make an organ, tissue, or whole-body donation,” says Dr. Kenneth V. Iserson of the University of Arizona College of Medicine. “There is a dearth of organ donors in this country, and the need for transplantable organs and tissues is enormous-and getting bigger.”
The number of people who have died while waiting for available organs has increased more than 2 1/2 times during the past eight years, according to the United Network for Organ Sharing in Richmond, Virginia. And every 16 minutes, a new person is added to the national transplant waiting list. Donor families consistently report that they feel their loved one is living on in someone else through their organ donation. Considering that about 25 different organs and tissues are transplantable, that’s a lot of immortality.
You can get a donor card from a local or regional organ or tissue bank, or you can fill out a donor card when you renew your driver’s license. Even if you have the sticker on your driver’s license, doctors most likely will still check with your family before donating your organs.
Make a carbon copy. Though God knows it shouldn’t be your only motivation, one of the benefits of having children is that you leave behind a living legacy. Your kids will not only carry on your tale about that 36-inch walleye you reeled in last summer but also pass on the only part of you that is truly immortal-your genes.
“The bottom line in life is that for a species that reproduces sexually, immortality has already been achieved through its genes,” says Dr. S. Jay Olshansky of the University of Chicago.
If you should decide to reproduce, you want to be sure that you’re passing along healthy, undamaged genes. You can help protect those mighty little mailmen of immortality by not smoking and by getting plenty of vitamin C, say experts. Studies show that nicotine damages sperm and reduces sperm count. Vitamin C, on the other hand, has been shown to protect the little guys from free-radical damage.
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General Health
PREVENTIVE MEDECINE: PSYCHOSEXUAL PROBLEMS
Sexuality is simply one aspect of a person’s personality and women who get pregnant when they know they shouldn’t often have some kind of psychosexual problem of which they may be unaware. The types of psychosexual disorder involved are numerous. An example of one of the commoner ones is a woman who believes that reproduction is the only justification for sexual pleasure. Such women may have had several babies yet deny that they are interested in sex. A second category includes those women who unconsciously believe that sex is sinful and that pregnancy is a punishment for their sin. This means that there must be a risk of pregnancy if they are to enjoy sex. Other women believe that sex is something done to them by a man and is therefore something for which they have no responsibility, so they don’t bother with contraception because to do so would be a contradiction. Many young women who believe that love is the only justification for sex refuse contraception until they are sure of the man (as a kind of denial that they are having sex) and get pregnant in the intervening time. Some women who don’t accept their sexual drives deny them consciously yet unconsciously try to indulge them (by getting drunk, losing control and then getting pregnant, for example). A small proportion of women cannot tolerate any sort of contraception because they feel guilty enjoying any form of sexual pleasure. Some women are so filled with shame about their sexual drives that they don’t seek contraceptive advice. Another common fear is that to accept effective contraception is to open the floodgates to promiscuity. Such women (especially when they are unmarried) refuse all contraception and then get pregnant. Some women are unconsciously incited to pregnancy by their mothers (who want a baby for themselves) but then regret the conception when it has occurred.
Lastly there is the teenage girl who has just started having intercourse. Such adolescent girls frequently refuse to accept that their status has changed and even though they are not virgins can’t bring themselves to accept the fact and continue to live with the fictitious belief that they are virgins. Many such ‘part-time virgins’ say that they are better able to keep up the lie to their parents and themselves that they are virgins if they don’t use contraception. Such a girl believes she is still a virgin (albeit a part-time one) and for this reason doesn’t really need contraception. Such a delusion in a part-time virgin unfortunately leads, all too often, to unwanted pregnancies.
Clearly an apparently simple thing like an unwelcome pregnancy is in fact enormously complex, and the unconscious mind plays a substantial part in almost all the mechanisms I have outlined. Consciously the woman says she doesn’t want to be pregnant. Contraceptive services are one of the most widely publicized and available of all the preventive services, yet still unwanted pregnancies abound.
Similar situations operate in all kinds of other health areas-not just those to do with sex. At certain times in our lives we might have an unconscious need to be ill as an escape from something or as a way of gaining attention or being cared for. A smoker may have quite unconscious needs for oral gratification, as does many an over-eater and no matter how good the preventive medical information is, nor how good his or her motivation, little progress can be made until the individual can confront and understand the underlying psychological drives that make him or her smoke or eat. Similarly, a man with a poor sense of his male self-esteem who smokes because he considers it manly to do so may be quite unable to stop smoking until this part of his personality can be satisfied in other ways.
It is only by confronting the psychological realities that it is possible to begin to understand why it is that even in the face of good information and motivation, most of us find it difficult or impossible to modify our behaviour in a way which prevents disease. And in this respect social class has little or no part to play-we are all ruled to a variable extent by unconscious motives and drives over which, by definition, we have no control until they are brought into the conscious mind and confronted.
Whilst we frequently hear that ‘prevention is better than cure’ hardly anybody behaves as though he or she believes it and it has now become such a piece of fashionable cant that it should be relegated to the waste-bin along with ‘health is better than wealth’ and other such empty phrases. Not until the medical and health educational fraternity come to terms with the reality of people’s health needs will prevention ever be anything other than a subject of lofty rhetoric.
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General Health
FEED YOUR BODY RIGHT: SHE LOST HER EATING “HABIT” AND 102 POUNDS
Robin Wade struggled with her weight for most of her adult life. Only when she learned to listen to her body did the pounds disappear.
A native of Louisiana, Robin was raised on a traditional “Southern diet of fried and gravy-smothered foods. Eventually, she turned her love of food and her talent for cooking into a successful career as a certified dietary manager, supervising the kitchens of restaurants in her home state.
The problem was that Robin got in the habit of taste-testing while she worked—whether or not she was hungry. And when she got home, she’d sit down to a traditional meal with her family.
Constantly being around food proved disastrous for Robin. By 1998, she was just 7 pounds shy of 300. And she was miserable.
Robin knew enough about nutrition to realize that she was not eating out of need. She was eating out of habit. A habit fed by being around tasty, delicious food all day—especially cakes and pies, since pastries were her specialty She realized that she had completely lost touch with her internal hunger cues.
Robin’s weight-loss strategy turned out to be one simple promise that she made to herself. “I told myself that I would eat only when I was hungry and that I would stop when I was satisfied—not stuffed, just satisfied,” she explains. This forced her to listen to her body and think about why she wanted to eat before she put food in her mouth. “If I realized that I wasn’t truly hungry, I’d distract myself until the impulse passed—usually by thinking about the pounds I’d gain if I gave in,” she says.
By adjusting her eating pattern and making healthier food choices, Robin was able to take off 102 pounds in about a year. She’s
still working to reach her goal weight of 149 pounds. And she says her conviction to lose weight is stronger than any urge to eat. “I felt an overwhelming desire to overeat only once,” she notes. “Reminding myself of my goal and focusing on my success so far is what keeps me on track.” •
WINNING ACTION
Listen to your body. Like Robin, I’ve learned to distinguish between when I’m actually hungry and when I’m just responding to the sight of tempting foods. It has made a huge difference in helping me keep my weight under control. Here’s a trick that I find helpful. Before eating anything, ask yourself, “Am I really hungry?” Rate your hunger on a scale of zero to five (zero being the least hungry, five being the most). Let your body tell you how much to eat.
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Weight Loss
APPENDIX VII: BOTTLED WATER
There is some confusion about the meaning of ‘mineral water’ which complicates the issue of bottled water. All tap-water, and any water from a spring or well, contains some mineral salts (calcium, magnesium, sodium, iron etc) dissolved in it. The composition of the water is affected by the sort of rock it percolates through, and some spring waters contain large amounts of minerals. At one time, it was believed that these waters had health-giving properties and they were marketed as ‘mineral waters’. (In fact, mineral-rich water is of little benefit to health, and some can be injurious to those with kidney problems.) Today’s bottled waters often come from the same springs and tend to be sold under the name ‘mineral water’ because this denotes that they are high-quality waters from a natural source. However, the most richly mineral-laden waters are not marketed, and those that are on sale are generally low in minerals – so they would not cause any health problems. A few brands are rich in sodium (eg Badois, Ramlosa) and should be avoided by those on low-sodium diets.
The main reason for buying bottled water now is not what it contains, but what it doesn’t contain. To a large extent it is free of the contaminants now found in most tap-water. Bottled waters are not treated with chlorine and, for the most part, contain far fewer nitrates. (Perrier is an exception. A Consumer’s Association survey showed that its nitrate content was almost as high as the maximum level permitted for tap water by the EEC, and twice as high as other mineral waters.) Because of the locations of the springs, bottled mineral water is unlikely to be contaminated by pesticides, industrial solvents and other pollutants. Bottled waters taste much better than most tap water, and are generally more palatable than filtered water as well.
Because they are not chlorinated,
bottled waters can foster large numbers of bacteria. Tests have shown very high levels in some brands. However, these are not harmful types of bacteria. Sparkling mineral water resists bacterial growth better than still water.
The price for still bottled water is about 90p to £1.30 per gallon. Sparkling mineral waters can cost up to £2.70. This makes bottled water very expensive, compared to filtered water, for long-term use.
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Allergies
STAGE 3 – RIGOROUS ELIMINATION DIET: THE EXCLUSION PHASE
Only a minority of those reading this book will need to try the Stage 3 diet. They will know they need to do this because they have tried Stage 2 with only partial success – or no success at all. Stage 3 is for those with multiple food sensitivities, which cannot be detected by a simple elimination diet.
Stage 3 requires planning, even more so than the previous stages. You must decide for yourself which foods you are going to eat during the exclusion phase, because this diet has to be tailored to your own eating habits. The aim is to come up with a list of at least twelve foods that are nutritious, obtainable, affordable, and which you have never eaten in any quantity, or with any regularity, before. They should include a variety of different items – some fruit, some vegetables, some meat or fish, and some starchy foods if possible, although this is often difficult. The approach we would advocate is a combination of the ‘fewfoods’ diet and the ‘rare foods diet’, with the exact mix of foods being chosen to suit your pocket and your palate.
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Allergies
PREVENTING FOOD SENSITIVITY: BREAST-FEEDING
A baby’s immune system is not fully developed at birth. To protect it against infection in the first few months of life, a mother’s milk contains antibodies to commonly found bacteria and viruses, and the baby’s gut is ‘leaky’ to allow these antibodies through into the bloodstream. Because the gut is so permeable, undigested food molecules also get into the blood in far greater quantity than in an older child or adult. At the same time, the control reactions that regulate damaging immune reactions are not yet up-and-running. In particular, the system that prevents the manufacture of IgE to harmless antigens is not fully effective.
Any food that the baby eats or drinks during the first three months of life will be absorbed into the bloodstream in appreciable quantities. Some unknown mechanism prevents a baby from mounting a damaging immune reaction against the proteins in its mother’s milk – although there may be cases of babies being allergic to their mother’s breast milk, these are extremely rare. Presumably the process by which the baby learns to tolerate the breast-milk proteins happens before birth, while the baby is still in the womb.
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Allergies
