Symptoms: hoarseness, dry, hacking cough, scratchy throat, low-grade fever.

Home care

Use a vaporizer in the child’s room.

Give the child warm drinks.

Give aspirin or paracetamol to reduce fever and relieve pain.

A nonprescription expectorant cough remedy may relieve a troublesome cough.

A child with laryngitis should be discouraged from talking.

Precautions

-    If laryngitis is accompanied by breathing difficulty, the child should see a doctor.

-    A cough along with climbing fever and breathing difficulty may indicate inflammation of the epiglottis. This is a medical emergency; take the child to the doctor at once.

-    If laryngitis persists, the doctor may have the child see an ear, nose, and throat specialist.

Laryngitis is an inflammation of the voice box (larynx). It is closely related to croup but, unlike croup, it isn’t associated with breathing difficulties. Laryngitis is almost always due to a respiratory virus, and may last from a day to a couple of weeks.

Signs and symptoms

Signs of laryngitis are hoarseness, dry hacking cough, and scratchy throat, sometimes accompanied by low-grade (37.8°C) fever. Diagnosis is based on the typical symptoms of hoarseness and dry cough unaccompanied by breathing difficulty.

Home care

Use a vaporizer in the child’s room. Give your child warm drinks. Encourage the child not to try to talk. Give aspirin or paracetamol for fever or pain, and a nonprescription expectorant cough remedy for temporary relief of cough.

Precautions

• If any breathing difficulty arises, notify a doctor.

• If a child has a climbing fever and difficulty breathing, he or she may have an inflammation of the epiglottis (the structure in the back of the throat that prevents food from entering the larynx and windpipe). Inflammation of the epiglottis is a medical emergency; take your child to a doctor promptly.

Medical treatment

The doctor will verify a diagnosis of laryngitis and rule out other conditions by physical examination of the child. The doctor may take a throat culture and a complete blood count. If laryngitis persists your doctor my X ray the child’s chest and neck or refer you to an ear, nose, and throat specialist.

*150/84/5*

What is it?

A viral disease which produces cold sores on the lips, a venereal disease that is difficult or impossible to cure, and a potentially fatal infection in newborn babies.

Although many think of herpes as a new disease this is not so-it has been around since ancient times. What is new is the extent of the disease in society and this was almost certainly brought about by the sexual revolution of the 1960s. The larger number of sexual partners that this social change has brought about has meant that any venereal infection spreads more quickly than before. Coupled with this is a greater readiness to experiment with new sexual techniques. Thirty years ago oral sex was considered a perversion but over the last twenty years it has become fashionable. Now the transfer of the virus from the mouth to the genitals is a major source of the disease. Lastly, as with polio virus, about fifty years ago most children would have contracted the herpes virus and would have built up at least some resistance to it. Today this is less likely. Having had oral herpes (cold sores) affords at least some protection against the genital variety but the level of such protection is not great.

Herpes became the media scare story of the 1970s, and understandably so, with stories of an ‘incurable’

disease which killed babies of affected mothers, produced intermittent, long-term infections in adults, might be implicated in cancer of the cervix, had serious harmful effects on people’s sex lives, and so on.

Herpes is caused by the herpes simplex virus that is related to the chickenpox virus, the glandular fever virus and cytomegalovirus. Although, as with other viral infections, the virus can affect many different parts of the body, the real scare (and what this piece is about) is genital herpes.

In a man herpetic sores can affect any part of the penis and scrotum but they are most often seen on the head of the penis. The sores are painful and the glands in the groins enlarge. Herpes can also affect the area around the anus and can cause extreme pain on opening the bowels.

In women the same pattern occurs as in men but with certain differences. One is that there are more ulcers and they are much more painful. Passing urine can be ‘agony’ and there can be considerable difficulty in passing urine at all in some women. The virus may attack the neck of the womb and such women have a temperature and pain in the lower abdomen as well as the other signs. An attack of thrush can also occur alongside the herpes as the woman’s local defense mechanisms break down.

Between 40 and 70 per cent of all herpes sufferers have recurrent attacks and some people go on having them for years.

What causes it?

Genital herpes is caused by two viruses, HSV1 and HSV2. The vast majority of infections with the virus are subclinical, that is they produce no effects of which the sufferer is aware. That an infection has occurred can be detected by finding antibodies to the herpes virus in the individual’s blood. The first attack of the virus tends to occur in childhood or adolescence-just as with other viral illnesses. Such attacks produce a ‘flu-like illness with relatively few local symptoms.

Herpes virus is transferred from person to person by close body contact between wet areas of the body. This is why the lips, genitals, mouth and gut are affected. The virus enters the cells and some enter sensory nerves up which they travel to clusters of nerve cells close to the spinal cord. Here they remain to produce recurrent infections over the years.

*168/72/5*

Why should children feature in this book? They are at the other end of life, after all, from the years of angina. Yet, shockingly, they are already on the way towards it. Many experts in heart disease are fearful for the future of this generation of schoolchildren.

Think of the changes in society that are pushing children towards heart disease. They no longer walk to school, because of parents’ fears of letting their children walk alone in the dangerous streets. Due to financial cutbacks physical education classes and after-school sports programs are suffering.Im some schools, physical education classes amount to less than two thirty-minute periods a week, and often these seem less vigorous than a generation ago. At the last school P.E. period I witnessed, half the children had clipboards monitoring the other half’s exercise! Tj-, the Thatcher years in Britain, thousands of acres of school playing fields were sold off to provide short-term profits for the Treasury. What a shortsighted policy!

One of those changes would be worrying in itself, but all of them together make a nightmare that will arrive in the early years of the next century Heart disease rates have been falling in many countries as pecipjg have accepted the health message. Does the next generation have to learn again the hard way? If you have children in your home, whose lifestyles you recognize from the last few paragraphs, please take some time to discuss these things with them. Most do listen, even if they may not at first.

*107\86\8*

Three other tests, thallium-201 scans, echocardiography, and positron emission tomography (PET), should also be mentioned. They are used in addition to treadmill testing.

A thallium-201 scan is a radionuclide imaging technique that gives more information than the stress test alone. It shows more precisely which part of the regional coronary blood flow is blocked and how badly. Thallium-201 or one of the newer technetium-complexed agents is given intravenously during the test. Heart muscle cells that are underperfused (getting less blood) during exercise will appear as “cold spots” because they get less blood and so take up less of the isotope. Several pictures (thallium scintigraphs) may be taken over time. Two to four hours after exercise, the cold spots may have “filled in” because enough isotope-containing blood finally got to them.

A thallium-201 scan may be necessary for patients whose regular stress test results don’t explain their clinical situation. Middle-aged women with chest pain frequently have false positive results on their regular stress tests. They may require thallium scans to demonstrate reliably whether their symptoms are due to ischemia or not. So may people with abnormalities on their EKGs that obscure changes during regular stress tests.

Echocardiography uses sound waves to show the structures of the heart. Abnormal chamber size and turbulence in blood flow can be detected and the integrity of heart valves and abnormalities of heart wall motion can be assessed. Echocardiograms can reveal heart walls that are thickened by hypertension or bulging due to weakness caused by earlier heart attacks.

PET, a complex combination of nuclear medicine techniques with multiple X rays, can measure the blood flow through different areas of the heart. It can identify the effect that a particular stenosis has on the heart muscle beyond it, differentiating between muscle that is still working and areas of infarction (muscle death).

Of all these techniques, PET is the most accurate, but it is also the most expensive. It may not be in general use for the investigation of all angina cases for a long time.

*87\86\8*

Some people find it easy to relax; they can fall asleep at will when they sit in a chair. Others find it difficult; their minds are racing around some problem or other, and their muscles are tense. If you can spend a few minutes every day in a completely relaxed state, this will complement your exercise schedule, and improve your chances of avoiding the next attack of angina.

The following relaxation technique takes about ten minutes, and can be done anywhere, even at work. It has helped many patients, and I recommend it:

1. Find a quiet place.

2. Sit in a chair that provides good back support with your feet on the floor.

3. Rest your fingers on your stomach and close your eyes.

4. Breathe in and out slowly and gently so that your stomach rises and falls.

5. Take one slow, deep breath.

6. Hold the breath for a slow count of four.

7. Breathe out slowly and steadily, while relaxing all your muscles, and saying to yourself “relax.”

8. Repeat the sequence for as many times as you wish, always slowly, without strain.

It can be difficult to know whether your muscles are fully relaxed or not. One way to learn how to relax them is, paradoxically, to tense them, so that you know how that feels. If you find relaxing difficult, try the following for around fifteen minutes a day:

1. Lie down on your back with your arms by your sides on a comfortable floor, and a book under your head so that it is not tilted backwards and your chin is not dipped down towards your chest.

2. Tense up one group of muscles for seven seconds—start with your neck muscles.

3. Notice what the tension in these muscles feels like.

4. Relax the muscles.

5. Notice the different feeling in the muscles now that they are relaxed.

6. Let these feelings and the relaxation increase.

7. Do the same with the rest of your muscle groups, throughout the whole body, one at a time. Plan your own way around your body—you might start with the right arm, then the left, the neck, scalp, face, shoulders, back, chest, stomach, right leg, and left leg.

If you would like to learn more formal ways to relax, try yoga or Tai Chi, the slow exercises favored by the Chinese. Several recent studies comparing the benefits of various forms of relaxation found Tai Chi the most effective in lowering blood pressure and heart rate (Jin 1992; Ng 1992).

*63\86\8*

They have banded together to form the Veritas Society, a leading light of which is George V. Mann, an American nutritionist and doctor who was an associate director of the Framingham Study for three years. The Veritas Society exists to fight the hypothesis that the fat content of food determines the level of cholesterol in the blood and the risk of coronary heart disease.

Its members met in Washington, D.C., in November 1991, and their deliberations were published in Coronary Heart Disease, the Dietary Sense and Nonsense (1993). The gist of the book is that the American food and drugs manufacturing companies have conspired together to construct a scare around blood cholesterol levels for their own profit, and the U.S. authorities and public have been taken in by them.

Dr. Mann puts the blame for the current high rate of angina on transfatty acids, which are mainly unnatural fats that occur during the manufacture of margarines from seed oils. He listed common foods in the United States that contain very high levels of transfatty acids, such as biscuits, sweets, french fries, puddings, pastries, potato chips, and, of course, margarine. For Dr. Mann, animal fats and butter are much healthier than manufactured margarines and many manufactured “low saturated fat” foods.

He goes further, citing the mortality rates for female vegetarians as evidence for his theory. Female vegetarians, he says, have a higher death rate from heart disease than female nonvegetarians; and a very much higher death rate from all causes. The differences do not apply to males. Dr. Mann does not give an exact definition of “vegetarian,” and without further supporting evidence his claims cannot be considered conclusive.

I do not know for sure whether Dr. Mann is correct, or whether he and his colleagues in the Veritas Society are just maverick eccentrics, outside the mainstream of informed opinion. However, even if his views are eventually found to be correct, it would not make much difference to the advice I would give to most people with angina. This is because living with angina is not just a question of cholesterol and diet; it is a matter of changing your life in many ways, not just the fat content of your food.

My own feeling is that all the trials point towards the same conclusion: Changing your lifestyle (by stopping smoking, losing weight, eating differently, and exercising more) can help you to avoid or diminish angina and prevent a heart attack. In future, new drugs may help further, but the onus will always be on yourself to do the best you can—and how you can do it is described later.

*43\86\8*

Around the same time, the Seven Countries Study was started by Professor Ancel Keys of Minneapolis. More than twelve thousand men from the United States, Japan, Yugoslavia, Finland, Italy, the Netherlands, and Greece were followed over five years, and then ten years. In this study, too, the key influence on heart disease was the blood cholesterol level. Cholesterol levels (measured as the percentage of men with cholesterol levels above 250mg/dl) were lowest in Japan, Greece, and Yugoslavia, and highest in the Netherlands, the United States, and Finland. In the middle was Italy. The heart disease rates exactly mirrored that pattern.

The Seven Countries Study concluded that other factors promoting heart disease, such as smoking and high blood pressure, only come into operation if the blood cholesterol level is high. In Japan, high blood pressure is very common, and cigarette consumption is very high, yet the heart disease rate is low. Finns exercise more than nationals of other countries, yet their heart attack rate is high and linked with their very high cholesterol level.

Where did the high blood cholesterol levels come from? The Seven Countries Study showed conclusively that it was dietary. When the blood cholesterol levels in each were compared with the percentage of dietary calories derived from animal fats (containing saturated fatty acids), the Finns were far and away at the top of the graph, and the Japanese were at the opposite pole. There was a very close correlation between eating saturated fats and blood cholesterol levels in each country.

*23\86\8*

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• HOSTILITY AS DEADLY EMOTION: TEST; STEPS TO ACQUIRE FEELING OF TRUST
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• CHILD’S HEALTH: INFECTIOUS DISEASES: CHICKENPOX (VARICELLA)
• LEAVING YOUR CHILDREN SOMETHING TO LOVE BY: SOME RECOMMENDATIONS FOR TALKING WITH KIDS ABOUT SEX
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