QUESTIONS ABOUT DRUGS USED FOR RHEUMATOID ARTHRITIS TREATMENT: CYCLOSPORINE, CYCLOPHOSPHAMIDE AND OTHERS

What is cyclosporine?
Cyclosporine (brand names Neoral and Sandimmune) is an immunosuppressant that is very effective in the treatment of rheumatoid arthritis, but side effects like high blood pressure, drug interactions, and cost have limited its use.
When is cyclophosphamide used?
Cyclophosphamide is a very potent chemotherapeutic agent, which is used only for the most severe forms of rheumatoid arthritis. I have rarely used this agent to treat this condition. It has many bad side effects like hair loss, suppression of the production of bone marrow, and the later risk of cancer.
Don’t all of the chemotherapy drugs have a risk of cancer later on?
Generally speaking, anything that suppresses the immune system has the risk of causing cancer. However, some agents that interfere with DNA synthesis run a higher risk of cancer development as the patient ages.
What is plasmapheresis?
Plasmapharesis is the removal, cleansing, and replacement of the blood. In the case of rheumatoid arthritis, the removal of immune complexes and certain antibodies through plasmapharesis has resulted in some improvement of the patient’s condition. This has not been impressive.
What is Adsorption for RA?
Columns that contain a substance called protein A absorb materials from the blood. In the case of RA, absorption of immune complexes and certain antibodies have resulted in marked improvement of the patient’s condition. These treatments are very costly, and the number of treatments and long-term effectiveness of this kind of therapy is not known. This treatment also requires that you be in an office setting where it can be done or in a hospital. You would have to go to the hospital with some frequency to the short pheresis-stay unit.
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GLOSSARY: COSMECEUTJCALS

You’re probably very familiar with cosmeceuticals, even if it’s the first time you’ve heard such a word. Famed dermatologist Albert Kligman, MD coined the term and, without a doubt, the advent of skin care products featuring these types of ingredients – from retinol and alpha hydroxy acids to vitamin C –  has revolutionised the way skin behaves and looks. Traditionally, a drug has been defined as a substance that can treat and prevent disease, or bring about a change in the body. On the opposite end of the spectrum are cosmetics, which are classified as inert substances that only cleanse or enhance the skin. Cosmeceuticals fall somewhere within this gray area and their ability to bring a significant and tangible change to the skin is the real deal.
That said, however, the extensive list of benefits that these products promise to deliver should be taken with a pinch of salt. With the exception of retinoids, none of these claims have been evaluated by the relevant governing bodies. To do so requires a process that is almost comparable to sending a fewtrainee astronauts to the moon; it’s a process so exhausting and costly that most skin care companies decide to soften their claims and do without this endorsement.
Now that you know what a cosmeceutical is, let’s talk about what a cosmeceutical does. And that, in one word, is plenty. Pretty much everyone can benefit from a cosmeceutical product. Actually, you might have already indulged and never even realised it. Here are a few cosmeceutical ‘superstars’ proven to deliver myriad benefits, from smoothing lines and wrinkles to imparting a healthy glow.
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CONDITIONS WHICH MAKE ASTHMA WORSE – EMOTIONAL STRESS

Hippocrates, the Greek physician, as early as the fourth century B.C., noted the relationship between asthma and emotions and stated that an asthmatic, if he were to master his own condition, must guard against his own anger. Until allergic phenomenon was discovered, asthma was considered primarily a nervous disease, and was referred to as asthma nervosa in text-books of medicine.
Most studies conducted so far indicate that mental tension and asthma are interlinked in many ways. A tense situation can trigger an attack in a child with an asthmatic tendency. Fear of an attack can itself trigger an attack. The more tense a child, the more severe the attack. So long as the child is under tension, it is difficult to get rid of the attack despite medications. That is why when a child is tense, a mild sedative maybe given, besides other anti-asthma drugs. However, care should be taken that even this mild sedative does not unduly depress respiration.
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RECOGNISE YOUR ARTHRITIS BY THE SYMPTOMS

The emphasis of this entire book is on oils and tin battle to prevent dryness. Why wait for your joints to become worn and “frayed” at the edges from friction? You can prevent such a painful condition by starting now to obey the warning signals.
Symptoms of arthritis are the very proof in themselves that this disease is mainly a problem of dryness. Here is my list of danger signs.
SYMPTOMS OF ARTHRITIS
Dry, cracking, inflamed joints.
Dry skin, on various parts of the body.
(Advanced cases show white, flaky skin over the ankles,
knees or elbows.) |a Dry scalp, dandruff in hair.
Dry, scaly ear canals, absence of ear wax.
Brittle or splitting finger-nails, ridges in nails.
Wrinkles in skin, frequently at the sides of the neck.
Stretch marks in skin over muscles of arm and over the hips after substantial weight loss. This shows lack of elasticity in tissue. Proper dietary oils can even prevent stretch marks which follow pregnancy.
Loss of pigment in the hair (prematurely grey) earlier than is considered compatible with the person’s age.
Itching in the area of the rectum.
Encrustations in the corner of the eyes.
Constantly “itchy” nose.
Buzzing in the ears.
Loss of colour and complexion changes.
Stiffness upon arising.
Varicose veins.
Sterility.
Etch markings on teeth.
Bleeding gums.
Numbing and tingling in extremities.
Cold or clammy hands and legs.
If you have any of the above symptoms, perhaps you will readily agree that arthritis is a “drying out” process within your body. You may have one or many of these symptoms and still have arthritis. If any of these danger signs are present and they may come five to ten years before actual arthritis— it proves that you are susceptible to this disease. Take warning, now!
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BED-WETTING: PARTICULARLY VITAL CLUE

Another particularly vital clue might emerge from my conversation with you concerning your attitudes toward your child’s toilet teaching. Are you particularly adamant that your child perform to a certain high level of expectation? Or are you blase to the point of indifference about your child’s toilet habits, failing to reinforce certain basic toilet teaching behavior? Either way your children’s voiding performance may be directly related to the signals you are giving about what is expected of them. If your child is a problem bed-wetter, I suggest you first examine your own attitudes about toilet teaching to see if you may be applying undue or premature pressure. A conversation with your family physician, a urologist, or a psychologist may help correct bad or harmful habits.
If bed-wetting persists into adolescence, a psychological evaluation is necessary to determine the possible cause; nocturnal incontinence is a factor in about 3.6 percent of cases of psychosis. In middle-aged or elderly patients, I would also order neurological tests in order to rule out certain conditions, including epilepsy and other seizure disorders, which may be robbing them of bladder control. I would also look for signs of excessive daytime sleepiness, since one consequence of a DOES complaint may be the inability to rouse oneself sufficiently during the night.
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DRUGS TO PREVENT ALLERGIC REACTIONS: HISTAMINE, ANTIHISTAMINES AND OTHERS

More than 20 years ago, scientists realized that if they could block histamine, they could relieve the symptoms of hay fever. Chemists developed several antihistamines, which relieve the itching and liquid discharge. Nonprescription antihistamines   such   as   Benadryl   and ChlorTrimeton are sold for a few cents a pill.
“With most antihistamines, since people develop tolerance,” Dr. Shepherd notes, “they need to switch to another one with a different chemical formula.”
These drugs also make people sleepy. They interfere with thinking and judgment. A few years ago, the Merrell Dow Company developed Seldane, a prescription drug. An antihistamine, Seldane doesn’t reach the brain, so it cannot make you drowsy. Janssen Pharmaceutical brought out Hismanal, also a prescription antihistamine that does not cause drowsiness. It is taken once a day.
Doris Palazzo, 31, an office manager for a Manhattan allergist, gets hit hard by allergy discomfort each June. She takes Seldane. “Seldane has helped a lot,” she says. “It’s the one thing that doesn’t make me fall asleep.”
Another drug, cromolyn sodium, has given doctors a powerful tool to prevent allergic reaction. This chemical stops the pollen (and any other allergy trigger) from reaching the mast cells. It can be sprayed into the nose up to five times a day.
A few years ago, cortisone, a hormone that your body makes, was produced in spray form. “Cortisone has been a huge boon to the treatment of local allergic problems in the nose and of asthma,” Dr. Shepherd says. “It is the single most effective medication. In spray form, you get it just where you need it – on the surface.”
Although cortisone is not safe in pill form – it induces fluid retention, weight gain, and loss of calcium from the bone – it does not cause these side effects in spray form. The amount in the blood-stream is so small that it causes no problem.
The latest research shows how the foreign protein (such as pollen) cripples the mast cell.
When the ragweed pollen comes to rest on your nose tissue, white cells – В cells – gather around and make a protein called IgE. The IgE and the ragweed protein fit together like a key in a lock.
Here is the first of three major scientific discoveries: For every foreign protein, your body’s В cells join to make a special IgE that fits only that protein. So if you’re allergic to grass pollen, you have an IgE that fits grass protein.
The second discovery is that the surface of each mast cell contains thousands of protein molecules that fit the ends of the IgE molecules. These are called IgE receptors. So you have a sandwich: the IgE attaches to the mast cell, the ragweed protein to the IgE. When that happens, the histamine and other chemicals gush forth.
The third discovery: Scientists have been able to create in the test tube unlimited amounts of IgE receptors. It will be possible to find a substance that will fill the receptor so that the IgE can’t attach to and cripple the mast cell. The mast cell’s allergic reaction won’t happen. The allergic chain of events will be stopped!
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FOOD ALLERGIES: NATURE OF ALLERGIES

A homemaker ate a piece of chocolate cake and a few hours later developed a migraine-type headache. A 10-year old boy began to wheeze while eating in a restaurant; his fork had a tiny trace of egg on it. A girl ordered a seafood casserole in a restaurant and almost immediately after tasting it began to tremble, perspire, and later had severe vomiting and diarrhea. A newborn baby developed severe eczema within a few days after starting his milk formula. All of these individuals were allergic to some food. About one in every 6 persons or roughly 32 million Americans has an allergy to some substance. Less than one third of these are caused by foods.
Allergy is an abnormal reaction of the body’s antibody-antigen defense mechanism. There appears to be an excessive production of immunoglobulin E (IgE) which in turn over-reacts with the allergen (antigen) to produce the symptoms. An allergen is the substance that sets off the reaction. In most instances the allergen is protein in nature, but non-protein substances such as aspirin can also cause reactions.
The tendency to allergy is inherited. If one parent is allergic, there is a 50 per cent chance that the child will be allergic. If both parents are allergic, the change of allergy in the child increases to 75 per cent. The child does not inherit allergy to the same substances, nor does he have the same symptoms as his parents.
Allergies are initiated in four ways: (1) by contact with foods, drugs, aerosol sprays, pesticides, poison ivy, hair, molds; (2) by ingestion of foods, drugs; (3) by inhalation of pollens, dust, cosmetics, sprays, molds, perfumes; (4) by injection of vaccines, serums, hormones, antibiotics, insect bites.

Food allergens
The most frequent food allergens are milk, wheat, eggs, fish, shellfish, citrus fruits, strawberries, tomatoes, and chocolate. Milk is the most frequent allergen in infants. Other foods to which people are sometimes sensitive are pork, nuts, peanut butter, peas, corn, onion, garlic, cabbage, and potatoes. Foods that belong to the same botanic class are likely to produce reactions; for example, oranges, grapefruit, and lemons, or cabbage, cauliflower, and broccoli.
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IRRITABLE BOWEL SYNDROME: WHY ARE THERE SO MANY SUFFERERS?

The short answer is that living in the twentieth century has become a health hazard. People who don’t want to accept this often declare we have become a society of malingerers or that the root causes of Irritable Bowel Syndrome are all psychosomatic. It cannot be denied that nervous tension is often part of the picture, but there are great dangers in always focusing solely on this as a cause.
History has shown that non life-threatening illnesses are often fashionable for a while then disappear; like the bustle or flared trousers, the vapours and grumbling appendices came and went. Unfortunately it seems unlikely that the Irritable Bowel Syndrome will become outmoded until we listen to the cries of our overburdened immune systems and harken to the groaning of our gut. We cannot expect our bodies to behave normally when they have to cope with the pace of modern life, prescribed drug damage, antibiotics and hormones in meat, environmental pollution and careless nutrition. The human body is a wonderful creation but even the best biological systems have their breaking point.
Before the causes of Irritable Bowel Syndrome are looked at in more detail, and you discover what is causing your symptoms, it would be useful to look briefly at how the digestive system works and what the bowel needs to keep it healthy.
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WHAT CAUSES THE IRRITABLE BOWEL SYNDROME?

Anything which depresses the immune system, the body’s defence against disease and foreign proteins, or anything which disturbs the balance of the gut flora allowing the ‘bad’ bacteria to take over can cause IBS. This could be:
When we are physically run down:
After infections, particularly bowel infections; after surgery; after childbirth; living with chronic physical pain; during hormonal upsets.
When we are emotionally low:
Coping with life situations such as illness, bereavement, overwork and relationship difficulties.
When we have an overgrowth of Candida Albicans (Thrush) in our gut:
Often characterized by craving for sweet foods.
When we have food allergies or intolerances:
These are becoming increasingly common and are often associated with Candida.
When prescribed drugs have affected the bowel:
It has been known for some time that antibiotics can upset the bowel long term; other drugs are implicated too (page 92).
When we are lacking in essential nutrients:
For example some of the B vitamins are essential for the health of the bowel.
When we are not producing enough digestive enzymes:
Why this happens is discussed in the problems of the toxic colon on
When our blood sugar levels are unstable:
This can cause carbohydrate craving and lead to poor nutrition and a toxic colon.
When we hyperventilate:
Overbreathing can lead to abdominal troubles through air-swallowing and tension, and could possibly be a factor in allergies.
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DIABETES THROUGH THE AGES

The oldest written reference to diabetes is found in the Ebers papyrus, which was written in ancient Egypt about 1500 B.C. The Egyptian physicians suggested treatments for polyuria (frequent urination—one of the most obvious signs of diabetes) that included eating wheat grains, grapes, honey, and berries.
The ancient Greek physician Aretaeus of Cappadocia gave diabetes its name, which is the Greek word for “siphon.” About a.d. 100 he described the disease as “a melting down of the flesh and limbs into urine.” Diabetes was rare in his time, and for its sufferers, he wrote, “Life is short, disgusting, and painful.” Listing such symptoms as burning thirst and incessant urination, he suggested a diet of milk, gruel, cereal, and wine.
Diabetes was also well known to medical specialists in ancient China, Japan and India. For example, Susruta, a doctor in India around 400 B.C., wrote about a disease in which people produced “honey urine,” “like an elephant’s in quantity.” He noted that the urine of a person with diabetes attracts flies. Other ancient Indian writers described such symptoms as thirst, fatigue, and skin boils. They reported that diabetes is a disease most often found among the rich and self-indulgent, who are fond of eating to excess; they also suggested that the disease might be hereditary. But they had no cures to offer.
In the West, Roman physicians added the Latin word mellitus (meaning “sweet” or “honeyed”) to the name of the disease. But then came the Dark Ages, when much of the old knowledge was lost.
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