Although the available evidence cannot exclude with certainty contaminated polio vaccines as the source of the AIDS pandemic, the balance of evidence argues against it—contaminated vaccines do not appear to have been responsible for what is shaping up to be one of the worst pandemics in human history. Does this conclusion mean that we do not need to worry about vaccines as a source of emerging disease? No. Vaccine contamination has already shown its ability to cause outbreaks of nasty viral diseases. As the United States was playing catch-up during its first year in World War II, a yellow fever vaccination program inadvertently infected over a quarter million soldiers with the hepatitis B virus. Fifty thousand became sick, but they got a lucky break. Apparently, when the hepatitis B virus infected people through this vaccine, it generated a fantastically low number of carriers and thus almost no chronic hepatitis and no liver cancer. Otherwise the vaccination might have caused around ten thousand deaths among the soldiers, and perhaps many more as the virus continued to spread through their contacts.Now, more than a half century later, vaccine researchers are still nervously watching a contaminant of polio vaccines: simian virus 40 (SV40), the virus that lent credibility to the polio vaccine hypothesis for the origin of AIDS. SV40 naturally infects the monkey cells in which the polio vaccine viruses were grown. Safety experts knew it was there but were not particularly concerned about it because it was not known to be harmful to humans. Their level of concern changed in the early 1960s when experimental studies showed that the virus could cause lung and brain cancer in hamsters. The virus was expunged from the vaccines by the mid-1960s, but that was too late for those of us who were vaccinated between 1955 and 1963. In the United States “those of us” make up about one third of the population. No one knows yet just how bad SV40 is. We are now the experimental hamsters being studied to obtain the answer. We do know that SV40 is found in most cases of a rare, dangerous lung cancer called mesothelioma, which has been increasing in the United States, Britain, and Europe since the use of SV40-contaminated vaccines. This is the same kind of lung cancer that SV40 causes in hamsters. The virus sabotages the same defenses against cancer that are sabotaged by papillomaviruses: p53 and a protein known as retinoblastoma suppressor. The emerging consensus is that SV40 is not just an innocent bystander but is causing the human mesotheliomas in concert with asbestos. SV40 is also found in human brain tumors. Whether it causes brain tumors is still being debated, but its activity in these cells is not comforting: as in the mesotheliomas, SV40 was found in human brain tumors bound to the cells’ tumor-suppressing proteins.The role of SV40 in human cancer will become more apparent as the experiment on the human hamsters continues. The most recent studies indicate that those who received the vaccine are about twice as likely to develop mesothelioma; the risk of the particular brain tumor most associated with SV40 appears to be increased by about one third in vaccine recipients.If SV40 does not get transmitted from person to person, then the cancer caused by SV40 contamination of polio vaccines can be viewed as another it-could-have-been-worse lesson imparted by the vaccine practices of the twentieth century. But the potential for transmission of SV40 between people is unclear. It has been recovered from children and HIV-infected patients who were born after SV40 had been purged from polio vaccines. The source of these SV40 infections is unknown, but if the virus is transmissible from person to person, our lesson may be just beginning. Concern is heightened because SV40 is a polyomavirus, a kind of virus that includes two other members, called JC and BK, which are full-fledged human pathogens. Most people are infected, for example, with JC polyomavirus, which resides in the brain and other organs. The scope of its effects are not yet clear, but it has recently been linked to colon cancer.Though vaccine contamination is frightening, in the long run it will probably turn out to be preventable, as soon as the people responsible for vaccine safety know what infectious contaminants to look for. This goal could be reached in time to benefit our grandchildren or great-grandchildren. In the meantime, we can expect that molecular techniques for identifying unwanted hitchhikers will provide incremental advances toward this goal.*41\225\2*
THE KINDS OF SEIZURE: SIMPLE PARTIAL SEIZURES – WITH LOSS OF CONSCIOUSNESS AT ONSET LISA\S CASE HISTORY
The teacher has called and says Lisa is daydreaming in school. You have noticed some episodes of “daydreaming” at the dinner table. Does she have absence seizures? Does she have atypical absence seizures? Does she have complex partial seizures or is she daydreaming?The questions your physician will want to ask you about Lisa are:• “How frequently is she having these episodes?” Daydreaming would occur infrequently and be situational. Absence seizures may occur many times a day. Complex partial seizures rarely occur more than several times a day or a week.• “How do these episodes begin?” While most seizures have an abrupt onset, occasionally complex partial seizures begin slowly and a warning precedes them. Daydreaming usually does not start abruptly.• “Can you interrupt these episodes?” Daydreaming can easily be interrupted by calling Lisa’s name or by physically touching her. Seizures, on the other hand, cannot be interrupted.• “How long does the episode last?” Daydreaming can go on until something else catches a child’s attention. Absence seizures rarely last more than fifteen seconds. Complex partial seizures may last up to several minutes.• “What does the child do during the episode?” While daydreaming or during absence seizures, the child is likely to stare into space. During complex partial seizures, the child is likely to smack her lips, pick at her clothes, or display other automatisms.• “What is the child like when she ‘comes back?’” The child who is daydreaming or having an absence seizure immediately is alert. The child with a complex partial seizure is usually confused for seconds or minutes.• “Does the child remember what was said during the episode?” While daydreaming, the child may be aware of what is happening but not pay attention. During a seizure, the child is not fully aware of what is happening around her.• “Do the spells occur only at special times?” If they happen only, say, in math or geography class, the child is likely to be daydreaming. If they occur at random times or whenever the child is tired, they are more likely to be seizures.With these careful observations, you and your physician can usually differentiate the type of episode.*73\208\8*
lthough lung cancer rates have dropped among white males during the past decade, the rate among white females and black males and females has begun to slow, but still continues to be a pervasive threat. Lung cancer caused an estimated 164,000 deaths in 2000. Since 1987, more women died from lung cancer than from breast cancer, which for over 40 years had been the major cause of cancer deaths in women. Today, lung cancer continues to be the leading cancer killer for both men and women. As smoking rates have declined over the past 30 years, however, we have seen significant declines in male lung cancer. But these rates are not dropping as quickly among women. Another cause for concern is that although adult smoking rates have declined, tobacco use among youth is again on the rise.Symptoms of lung cancer include a persistent cough, blood-streaked sputum, chest pain, and recurrent attacks of pneumonia or bronchitis. Treatment depends on the type and stage of the cancer. Surgery, radiation therapy, and chemotherapy are all treatment options. If the cancer is localized, surgery is usually the treatment of choice. If the cancer has spread, surgery is used in combination with radiation and chemotherapy. Unfortunately, despite advances in medical technology, survival rates for lung cancer have improved only slightly over the past decade. Just 13 percent of lung cancer patients live five or more years after diagnosis. These rates improve to 47 percent with early detection, but only 15 percent of lung cancers are discovered in their early stages of development.
Prevention Smokers, especially those who have smoked for over 20 years, and people who have been exposed to certain industrial substances such as arsenic and asbestos or to radiation from occupational, medical, or environmental sources are at the highest risk for lung cancer. The American Cancer Society estimated that in 2000, over 430,000 cancer deaths were caused by tobacco use and an additional 20,000 cancer deaths were related to alcohol use, frequently in combination with tobacco use. Exposure to sidestream cigarette smoke, known as environmental tobacco smoke or ETS, increases the risk for nonsmokers. Some researchers have theorized that as many as 90 percent of all lung cancers could be avoided if people did not smoke. Substantial improvements in overall prognosis have been noted in smokers who quit at the first signs of precancerous cellular changes and allowed their bronchial linings to return to normal.*14/277/5*
Women whose epilepsy started when they were children very often find that when they reach puberty the nature of their epilepsy changes. About two-thirds of women experience some sort of change. Usually there is an increase in seizure frequency, or a new type of seizure develops. But in about a third of cases the change is positive; seizure frequency decreases and seizures may even stop altogether. As a general rule, absence seizures tend to become less frequent or to stop. The chances of a woman’s epilepsy getting worse at puberty are greater if she reaches puberty later than average, or if her epilepsy started early in childhood, or if she has an abnormal EEG and has previously had a great many generalized tonic clonic seizures.
MENSTRUATION AND EPILEPSY
Does epilepsy affect periods:
It is very unusual for a woman’s periods to be affected if she develops epilepsy. However, a few women have seizures which affect the part of the brain that regulates the menstrual cycle, and in this case they may be more likely than other women to have menstrual problems such as irregular periods. In addition, some anti-epileptic drugs, particularly sodium valproate (Epilim) affect the menstrual cycle.
Do periods affect epilepsy?
Nearly everyone who has epilepsy discovers that the frequency of their seizures varies. There will be times when you seem to have more seizures than at others. So it is not surprising that quite often a woman notices that she seems to have more seizures around the time of her period. However, if you keep a seizure diary you will probably find that this does not happen every month. Seizures are nearly always more irregular and unpredictable than this.
A few women (probably less than 10 per cent of all women with epilepsy) do have what is called catamenial epilepsy — a type of epilepsy in which every month there is a regular and definite increase in seizure frequency around menstruation. Often they start to have regular, recurrent ‘bad patches’ of seizures just before they reach puberty. When their periods start it is clear that they have catamenial epilepsy.
Catamenial epilepsy is probably somehow related to the relative levels of the hormones oestrogen and progesterone which are produced during the menstrual cycle, though it is difficult to find a clear relationship. The normal pattern is that during the first half of the menstrual cycle, oestrogen is the main hormone produced. During the second half of the cycle both oestrogen and progesterone are produced. Oestrogen is known to have a seizure-provoking effect, while progesterone is an anticonvulsant and tends to protect against seizures.
But even if hormones play a part, they cannot provide a complete explanation, because there does not seem to be any noticeable difference in the hormonal changes between women who have catamenial epilepsy and those whose epilepsy is no worse at the time of their periods. Another explanation is that pre-menstrual tension may play a part, and that women with catamenial epilepsy are more likely to suffer PMT. Stress and anxiety are known to precipitate seizures and the mood changes of PMT may have something to do with their seizure increase at that time. At the moment, however, this is only a theory.
EPILEPSY AND FERTILITY
Another worry many women have is that epilepsy may affect their ability to conceive. Fertility rates are slightly reduced in both men and women with epilepsy. Women may find it more difficult to become pregnant if seizures affect the part of the brain that regulates the menstrual cycle and they experience irregular periods, or if they are taking anticonvulsants which affect the menstrual cycle. Yet although you may take a little longer to become pregnant, these factors will not stop you conceiving. If after a year of trying you are still not pregnant, talk to your doctor. Modern methods of fertility treatment should solve the problem.
EPILEPSY AND CONTRACEPTION
Hormonal contraception (‘The Pill’)
Hormonal contraception is a safe and very effective form of birth control. It can be taken orally, in the form of the combined pill (which contains two hormones, oestrogen and progesterone) or the progesterone-only ‘mini-pill’. It can also be given as a slowly absorbed (depot) injection or an implant under the skin. These two methods have the advantages that the implant or injection lasts several weeks, and you do not have to remember to take a pill every day.
Because it is so effective, hormonal contraception, usually in the form of the Pill, is the method of first choice for many women. However, if you have epilepsy, you need to discuss its pros and cons with your doctor before you decide it is the right method for you.
If you are taking sodium valproate, vigabatrin, lamotrigine, gabapentin, clobazam, clonazepam or ethosuximide, there is no problem and you can take the oral contraceptives, or use contraceptive injections or implants, in the normal way. However, a few widely-used anticonvulsants (phenytoin, phenobarbitone, carbamazepine, and primidone) make the liver break down the hormones in these contraceptive preparations more rapidly, reducing their effectiveness. The sign that the contraceptive effect of the pill has failed is that you get ‘breakthrough’ bleeding.
You are not prevented from using hormonal contraception if you are taking any of these latter drugs, but for them to be effective you may need to take a higher than usual dose of the oral contraceptive, or receive more frequent injections or implants. The dose of the Pill, for example, may need to be increased two or three times until you have a cycle with no breakthrough bleeding. Until you have a cycle without breakthrough bleeding you will need to use a condom or some other form of contraception.
The larger dose of the contraceptive will not have any more side-effects than the normal one, because the excess hormone is being broken down and disposed of by the liver.
A few women with epilepsy find that the Pill makes their epilepsy worse. But it is more likely that going on the Pill will reduce your seizure frequency by helping to reduce pre-menstrual seizures. Some women therefore decide to take the pill continually on a 28 day cycle without the usual seven days’ break.
If it is to be effective, the pill has to be taken regularly, every day and at the same time every day. Remembering to take it may be a problem if you have frequent seizures. If you want a hormonal method of contraception, but do not feel that you can rely on your memory to take the Pill regularly, contraceptive injections or implants may be a better solution. These are hormones with a long-term effect and are either given by injection or implanted beneath the skin. This must be done by a doctor or specially-trained family planning nurse.
Emergency contraception used to be known as the ‘morning after’ pill, but in fact it need not be taken the morning after unprotected intercourse. Ideally, it should be taken within 3 days (72 hours) of having sex. However, it may even work if taken within five days; sperm can survive for a couple of days, and so it is always possible that you may have ovulated and conceived two days after having sex. The pill consists of two hormonal pills taken immediately, and another two taken 12 hours later. You can use emergency contraception if you are taking anticonvulsant medication, but, depending on the drug you are taking, you may need a slightly larger dose. If you tell the doctor who gives it to you that you have epilepsy, and what drugs you are on, your anticonvulsant medication can be taken into account.
The menopause is often another time of seizure change though, as ever, epilepsy is so unpredictable that it is difficult to say which direction the change will take. Seizures may increase or decrease in frequency, go into remission, recur if they have been in remission or there may be no change at all. And a few women who have never had seizures before in their lives may start to have them at the menopause, though no one knows the reason for this.
If your seizures have always been related to your periods they will probably improve during the menopause. You can also feel optimistic about improvement if your seizures began late in life and have always been infrequent. However, there is some evidence that in women who have an earlier than average menopause seizure frequency tends to remain unchanged, or to increase.
One of the inevitable results of old age is that bones grow less dense and more brittle (a condition called osteoporosis). Until women reach the menopause, oestrogen gives some protection against thinning of the bones, and many doctors advise women to have hormone replacement therapy (HRT) to prevent osteoporosis. This is especially important for women who have a family history of osteoporosis. It is also very important for women with epilepsy, because anticonvulsant drugs, particularly phenytoin, tend to cause calcium deficiency and increase the risk of brittle bones.
HRT contains the same hormones as the contraceptive pill, and so you may need to take a higher dose than normal to be effective if you are taking phenytoin, phenobarbitone, carbamazepine, or primidone. In a few women HRT increases seizure frequency, though if you have this problem it may be possible for you to find a different form of HRT which does not have this effect.
Everyone has some kind of sexual problem at some time in their life, and people with epilepsy are no exception. If you have epilepsy you are almost bound to have to deal with, at some time or another, the same sexual problems that most people occasionally encounter. Sex is not always perfect. Many men have erection problems, many women find it difficult to reach orgasm. People vary very much in their need for sex, their interest in it, and even in their enjoyment of it.
In addition to these ‘normal’ problems which everyone has, people who have epilepsy may also have sexual anxieties and occasionally problems which are related to their epilepsy. Many, perhaps most, of the special sexual problems of people with epilepsy are a by-product of anticonvulsant medication. But most of these problems can be solved. Epilepsy need not stop you starting a family, or affect your chances of marriage or of having normal sexual relationships.
After the ovum has been implanted in the lining of the uterus, this does not merely stretch to make room for the growing child. It also grows, becoming a heavy muscular organ. At the fourth or fifth month it has grown as high as the umbilicus, and at full term reaches to the top of the abdomen. When labor starts, the powerful and decidedly unpleasant contractions demonstrate the presence of plenty of musculature. I said that the uterus grew large but did not stretch. That is so until labor begins and then this versatile muscle adjusts itself most remarkably. While the upper part remains heavy and strong, the lower part does begin to stretch until finally there is an opening large enough to let the baby’s head through. And then when the baby leaves, the great muscle contracts down until, having pushed the placenta or afterbirth out, it is small enough to nestle well down in the pelvis. Truly an ingeniously adaptable musculature.
Shakespeare tells us that Brutus gave Caesar the most un-kindest cut of all; one of my fellow-surgeons way back in those days did just the opposite, for it is said that Caesar was born by way of a cut through his mother’s abdominal wall and into her uterus. Such deliveries have become common now and, until the last quarter century or so, had not changed greatly since the old Roman days. It must have been rare for a woman to survive this operation before the days of anesthesia and asepsis. Even with those aids, one took an added risk in doing a Caesarean. There was considerable blood loss and danger of peritonitis if the woman had been subjected to previous examinations. Today surgeons proudly do an operation which does not open the abdominal cavity at all. I am able to give you a good description of this operation from a source one hundred and twenty-five years old. Dr. William Potts Dewees wrote a famous System of Midwifery and in it was a letter from one Dr. Horner, regarding the Caesarean section. I quote:
Dr. Physick proposes that in the Caesarean operation a horizontal section be made of the parietes of the abdomen just above the pubes. That the peritoneum be stripped from the upper fundus of the bladder by dissecting through the connecting cellular substance which will bring the operation to that portion of the cervix uteri where the peritoneum goes to the bladder.
As some of these words may be unfamiliar to you, I will elucidate. The operation consists in cutting across the lowest part of the abdominal wall. The lining of the abdominal cavity reaches as low as that. As it is loosely attached to the bladder it may be dissected free and pushed up. Hence without opening the cavity the surgeon may reach the lower part of the uterus. This is cut open, the baby and afterbirth extracted, and all the layers sewn back in place. When Dr. Physick suggested this, there was no anesthesia or asepsis. Patients just could not stand such long careful dissections. About a quarter century later the use of ether for anesthesia was begun, and before the end of the century asepsis was developed. It was a good many years more, however, before this operation so well described by Dr. Physick was adopted. This was presumably due to the modern contempt for historical perspective. The late Dr. Samuel C. Harvey, professor of surgery at Yale, told me that it was a rare student who felt there was anything worth knowing that was over ten years old. Probably some proud surgeon invented this operation a century after Dr. Physick had described it. It might well have been used many years before.
Although experts say that losing weight simply requires burning more calories than are consumed, putting this principle into practice is far from simple. If it were this easy, the more than 50 percent of Americans who are overweight would find it relatively easy to exercise willpower. According to William W. Hardy, M.D., president of the Michigan-based Rochester Center for Obesity,
to say weight control is simply a matter of pushing away from the table is ludicrous. Nature is a CHEAT. Sure, calories in minus calories out equals weight, but people of the same age, sex, height, and weight can have differences of as much as 1,000 calories a day in “resting metabolic rate” – this may explain why one person’s gluttony is another’s starvation, even if it results in the same readout on the scale. And while people of normal weight average 25-35 billion fat cells, obese people can inherit a billowing 135 billion. A roll of the genetic dice adds more variety: at least 240 genes affect weight.
Remember that weight loss doesn’t happen easily for everyone. Not only is it more difficult for some, but it may actually require considerably more effort, more supportive friends and relatives, and extraordinary efforts to prime the body for burning more calories and depriving it of others. Being overweight or obese does not mean you are weak-willed or lazy. As scientists unlock the many secrets of genetic messengers that influence weight gain and loss and other variables, as well as increasing their understanding of the role of certain foods in the weight loss equation, dieting may not be the same villain in the future that it is today.
Your body temperature is a good guide to the state of your metabolism. To test your thyroid function you need to measure your basal body temperature, which is your temperature at rest. First get a thermometer. There are some good electronic ones on the market which only take a minute to register the temperature and bleep when they have done it.
- Put the thermometer by your bed before you go to sleep.
- When you wake in the morning, put the thermometer in your armpit and leave until it bleeps. Your temperature needs to be taken with you lying as still as possible. Do not get out of bed or have a drink before you take your temperature.
- Record your temperature in the same way over three mornings. It needs to be taken at the same time each morning.
- If you are still having periods, you need to do this test on the second, third and fourth day of your cycle. Your body temperature rises after ovulation so it would not give a clear picture of what is happening to take your temperature later in the cycle. Your basal body temperature should read between 36.4 and 36.7°C (97.6 and 98.2°F).
If the temperature is low, it would be worth speaking to your doctor or health practitioner about possible problems with your thyroid.
Weight gain also often follows a hysterectomy. I have seen women who have put on at least 12.7kg (2 stone) after this operation. This level of weight gain is also often linked to taking HRT, so make sure you have eliminated all possible causes for the weight gain.
Once you have checked these possibilities there are a number of other ways to try to lose weight. First try a food-combining regime based on avoiding eating proteins and starches together at the same meal. The theory is that both protein and starches need different enzymes to be digested, so there will be a ‘fight’ as both cannot be digested effectively at the same time. This theory does not seem to have been proven scientifically and yet people get very good results by trying it. This ‘fight’ can cause bloating and weight gain because the undigested food is being stored and not properly assimilated. Women who have lost weight using food combining often choose to eat this way permanently as they feel it gives them more energy and fewer digestive troubles. The easiest way to understand this method of eating is to follow a few simple rules.
1. Don’t mix starchy foods with proteins.
2. Eat fruit on its own.
3. Don’t have milk with either starch or protein.
The realization that migraine is a disorder causing a vast amount of unnecessary suffering has led to an increased interest in the subject. Specialist centers have been set up with the support of the Migraine Trust for treatment and research of acute migraine attacks in London (the two clinics serving this purpose are the Princess Margaret Clinic and the Charring Cross Hospital Migraine Clinic). In addition to offering treatment of the acute attack, these and other clinics provide consultation facilities for general practitioner referrals, so that all sorts of treatment methods are tried and many trials undertaken.
Perhaps the most important function of the migraine clinic is to deal with and study the acute attack which, surprisingly, is rarely seen by most hospital doctors. In the clinic, tests can be performed on those with an acute attack which, it is hoped, when pieced together will give a better idea of what happens during the acute attack. This insight should help in the development of more appropriate treatment.
These studies are also important in the assessment of treatment. For instance, the recognition that tablets taken during an attack do not always help led to the measurement of levels in the blood of aspirin taken during an attack; these were shown to be lower than when taken at any other time. It was this finding that confirmed the slowness of emptying of the stomach and the consequent recommendation to use Maxolon to stimulate the gut and aid absorption, so making the levels of ingested drugs higher.
The advantage of grouping patients with the same disorder together is that it allows the clinic staff to concentrate on specialized areas and makes research easier. The facility for treatment of acute attacks helps not only patients but research workers. However, in countries where patients visit a specialist, a neurologist, directly rather than being referred on from their general practitioner, there is not such a demand for such clinics. This means that research workers do not have the opportunity of studying patients during an acute attack.
A town (or catchment area of population) has to be of a particular size in order for such facilities to be viable, e.g. about a quarter of a million people is probably the smallest size for this purpose. Alternatively, there needs to be a large concentration of commuter workers in the area (as there is in the City of London where the Princess Margaret Clinic is situated).
In the United States there are several organizations operating such clinics which, although privately run, are fully used.
This produces a very severe headache, usually in older people over the age of 55 years. The arteries in the temples can be seen to be more thickened and tortuous and they are particularly tender. The sufferer is generally unwell and may have had pains all over the body (polymyalgia rheumatica) for weeks with loss of appetite and loss of weight. The diagnosis is easily made by doing a simple blood test with confirmation by examining a small piece of the temporal artery under the microscope (and finding ‘giant-cells’) – Early diagnosis is important in this condition because a major complication is blindness. The headache disappears completely following treatment with steroids.
Of all the causes of headache, this is the one that most patients and doctors fear most. In fact, it occurs only in a very small minority of headache sufferers and can often be recognized by the characteristics of the headache.
The history is usually of short duration e.g. less than three months, but of increasing severity. The headache is made worse by coughing, sneezing, and bending down (but this can also occur in benign headaches). The headache may wake the patient from sleep and tends to be worse in the morning. There is often associated morning nausea or vomiting.
Other ominous symptoms include drowsiness, yawning, or hiccup. If there are neurological signs present, then further investigation is mandatory.
These occur frequently and have no serious significance. Two types of these have recently been described by Dr. John Pearce: The ‘exploding head’ occurs in middle aged or elderly people, most often women. It always occurs at night when the sufferer is woken up with a painful sensation as if a forceful explosion has taken place in the head. Although the sensation soon goes, it leaves the person with a sense of fear, sweating, and rapid pulse rate. The ‘needle-in-the-eye’ syndrome is more common and feels like a sharp jab with a needle in the corner of the eye. It lasts only a matter of seconds and can recur several times a day.