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HEART DISEASE: FORUM (FINDING THE PATH OF HEALING)
Mary is a fifty-three-year-old single mother of two teenagers whom she had raised alone since early childhood. Mary had recently become more involved with a new boyfriend. There is a strong family history of heart disease on Mary’s father’s side; she, however, was a nonsmoker, had exercised regularly and had always been well, before she suffered a small heart attack.
Mary was discharged from the hospital without overt complaints, but in the next few weeks she began to experience mild chest tightness and shortness of breath when she was active, which she was almost immediately upon returning home. Activities included her previous exercise routine, work and sex. She was surprised, disappointed and frightened by not being able to “get over it.”
Mary was increasingly perplexed that her physical symptoms could not be “solved.” She continued trying to go back to work, but kept having a tightness in her chest and shortness of breath climbing stairs at work, and even during meetings. Eventually, she called her cardiologist, complaining, “I’m not getting better and I cannot go on like this.” She underwent an exercise test, which showed that her heart muscle was getting insufficient blood supply; and a subsequent angiogram revealed that the blood vessel that had been temporarily blocked, causing her original heart attack, was now quite narrow and almost fully blocked. Angioplasty was recommended and, despite apprehensions and the difficulty of losing further time from her work, she underwent the procedure successfully and was left with moderate heart scarring but no further shortness of breath or chest tightness. She was told to monitor this carefully, and she was placed on drug therapy to lower cholesterol and blood pressure, which she found somewhat of a nuisance. She was also started on an exercise program but was counseled to not overdo physical activities initially, advice which “was against the grain” for somebody who likes to live life at full speed.
In this forum, one year after her heart attack, we invited Mary, her boyfriend and her eighteen-year-old son to discuss this phase of her recovery.
Mary: I’m still confused as to what exactly led to me feeling that I had hit a brick wall after my heart attack. Was it only that my heart was not good, or did I bring it on myself by getting into activities too soon?
Dr Dorian: Your symptoms were not directly caused by overdoing it. Rather, your first heart attack was incomplete, and left you at risk for another one. The activity that you tried to do, however, did bring on your chest tightness and shortness of breath, which were signals from your body that your heart was getting insufficient blood and, in turn, meant that you needed further testing and treatment. Although rushing back to your previous life is usually not dangerous, what happened to you highlights the fact that the return to activity needs to be measured, and done in close cooperation with your physician.
Mary: When I think back, it was an unsettled time for me. Strange to say, but once I had been discharged, I just shut my heart out of my mind. I was more concerned that my boyfriend would leave me than anything else.
Boyfriend: Well, I hope you have been reassured about that. I was surprised that you could even think that I would somehow just abandon you.
Mary: It’s easy to look back and say that now, but I didn’t know what was going to happen next, especially after my life was so rudely interrupted by my heart. Before that, I had thought I could control everything. After the heart attack, things seemed beyond my control. It was such a relief to know that you were there for me.
Son: You haven’t mentioned my sister or me yet. That was a scary time for us too. You weren’t well, my dad’s been out of the picture for so long now, and we were left to fend for ourselves.
Mary: Yes, those were difficult times for the family.
Son: When you came home the first time, we weren’t sure how to handle you, but after only a few days you got busy again.
Mary: You know, I’ve always solved things that way; only this time, I got a rude shock.
Boyfriend: Yes, you found you couldn’t do those things you had always done with ease.
Mary: It was a shock when I kept trying and I just couldn’t…
Son: Now, Mom, don’t get upset.
Mary: Well, I just seemed to hit a brick wall.
Boyfriend: That was when she started to feel down. I had never seen her like that before. You were always such a happy person? so full of energy.
Dr Baker: Yes, Mary, you illustrate well the link between not being able to do something and low mood. When there is the feeling of incapacity, of not feeling capable, which was always so important to you, then instead of feeling on top of the world, the world felt on top of you.
Dr Dorian: Let me jump in here. I can see why you became depressed when you couldn’t go back to work or resume your physical activity. However, I think originally this came about because you wanted to deny the fact that you had heart disease. Although dwelling too much on one’s heart may not be a good thing, pretending the heart is perfect when it isn’t is also not healthy. Many of my patients with a strong family history pretend to ignore (and are sometimes successful at it!) the fact that deep down they are afraid that the same thing that happened to their family members will happen to them. This can result in not seeking or pursuing medical care, and especially not taking medications that are offered or prescribed.
Mary: Well, I can now certainly agree with that. For all those years I didn’t want to look at the fact of my family history and I didn’t pay much attention to what the doctors told me.
Boyfriend: You mean they found something wrong with you?
Mary: At my regular health checkups I was told that my cholesterol was on the high side. Also, my blood pressure was slightly elevated, but I never pursued any treatment for this.
Son: Mom also never wanted to talk about what had happened with her family…
Mary: I didn’t tell you that my father, his brother and my uncle all had heart attacks in their fifties, and my brother has already had bypass surgery.
Son: And that’s why, when she had her first attack, my sister and I were very upset.
Mary: I feel now as if I neglected the two of you.
Dr Baker: It looks like you neglected yourself.
Son: Mom, you were the one who was ill.
Boyfriend: You know, when you first came home from the hospital, you tried to pretend that everything was completely normal, although, of course, I knew it wasn’t true. You have always pretended you were invincible, but this time I think you knew that you were in a desperate fight that you thought you could not win. It took you some time to allow me to help you, since I think you felt that this showed that you were weak in some way. I am glad you were eventually able to reach out to me and to your children, who were happy to help you.
Dr Dorian: We find that patients who “bottle up” all of their fears and emotions seem to have more trouble coping than do those who can express their fears and their feelings. In addition, facing up to your fears and recognizing the need for treatment will make it easier for you to follow through with recommendations for medications, tests, and so on, all of which involve a certain amount of nuisance, hassle and possibly discomfort.
Mary: You know, in a sense I think the angioplasty saved my life That, and that frank discussion I had with my doctor, which made me realize that I was really overdoing things and I needed to slow down and pace myself much better, because things have gone quite smoothly since then.
Dr Dorian: Again, I must point out that “overdoing things” is emotionally unhealthy. However, excessive physical activity is rarely dangerous and simply increases the chance that you develop symptoms such as shortness of breath or chest discomfort. All heart patients have to learn to live within their limitations.
Dr Baker: I gather there have been a number of changes in the family over this time.
Son: Mom was always Supermom until the heart attack. Then, she didn’t want us to look after her. But when she found she couldn’t do what she wanted to do and she was getting short of breath, she just slowed down; she couldn’t help it until she had that procedure.
Dr Baker: What has happened since then?
Son: Mom’s different now.
Mary: Also, my healing has turned me around. I’m more open with myself. I don’t shut out my problems and I have started to learn to accept help from others. I try to be open with others. I am paying more attention to my children than before. I suppose the family has grown up.
Boyfriend: It has changed as well.
Mary: He means that he is also a part of it.
Boyfriend: I know that it will take time for me to be fully accepted.
Son: We talked about it and I’ve told him that we do like him, and we know he’s good for Mom.
Dr Baker: A balance is achieved by the end of recuperation, not only in the body and in the mind, but in the family system as well.
Mary: I reckon we are on the way to getting there. Now, I feel more confident, and there is more harmony in the family.
*21/214/2*

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BEAT HEART DISEASE WITHOUT SURGERY: INTRODUCING EDTA CHELATION THERAPY-IT SEEMS GOOD BUT IS IT SAFE
Possibly the most important consideration to anyone thinking of embarking on chelation therapy is its safety. The Scientific Basis for Chelation Therapy, Bruce Halstead MD devotes an entire chapter to the safety aspect of EDTA, meticulously examining its toxidity in relation to its benefits and in relation to other substances such as aspirin and nicotine.
He concludes, ‘When EDTA chelation therapy is properly administered by a well-trained physician and nursing staff, it is one of the safest major therapeutic modalities available in the chronic degenerative disease armentarium. It is also one of the most rewarding therapies for both the patient and medical staff because of the beneficial results produced. It is encouraging to note that in the combined experience of the chelating physicians in the United States after almost 3 decades (NB written in the late 1970s) of using EDTA, involving in excess of 100,000 patients and more than 2 million treatments, the number of significant untoward reactions is probably less than in any other therapeutic modality.’
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STRESS IS . . . HOW YOU THINK, FEEL AND BEHAVE
Think back to the last time you had a real fright; you nearly crashed the car, got an outsized bill, heard bad news about a relative or your work. How did you feel? What thoughts went through your mind? What action did you take? Answers to these questions will help you to describe your typical acute or immediate response to stress.
You may be aware of a whole range of physical effects in your body; tension in your muscles of your face, neck, arms, chest, stomach and legs. You may notice your mouth drying up, your heartbeat and breathing quickening, your face flushing or going pale, your stomach churning, your bowel and bladder feeling full. Your sight and hearing may seem very sharp. Your thoughts may race, time seeming to stretch, then immediately afterwards events seem to have taken place in a flash. Your behaviour may include speaking loudly, making hurried movements, physically bracing yourself into a self-protective or aggressive stance.
In a matter of hours, if you try to sustain this level of response, you will tire. Your bodily responses will include aches and fatigue, nausea and poor appetite, your senses will seem less sharp. You may also get angina. Your thoughts will be less clear, and you may even think irrationally, taking events out of context and blowing them out of all proportion. Your behaviour will probably be more clumsy, your actions less strong and decisive.
In the much longer term, with stressful events adding up over a period of years, people become more prone to stress-related disorders. Each person inherits tendencies to develop particular disorders, but these only emerge when the person is put under extensive and intensive stress. No single disorder can be produced solely by stress, each depends to an extent on what is inherited, and what environmental hazards (such as heavy lifting jobs for back pain, airborne pollutants for breathing disorders such as asthma or bronchitis) you are exposed to.
Also, in a person who has developed the disorder, periods of severe symptoms may coincide with stressful periods in their life. For example, a person who is prone to headache pain may only get headaches at the end of a working week, and seldom during holidays or a weekend. Whether you develop a habit of being stressed depends on the amount of demands or stressful events in your life.
Stress is . . . the demands put on you
Air crashes, motorway pile-ups, hurricanes, wars and other major disasters seem pretty strong bets as events that would stress anyone. There is plenty of evidence that people show very strong reactions of shock, emotional distress, and disturbance of their ability to do everyday tasks for days and sometimes months afterwards, and their health suffers. There is a higher rate of heart attacks in communities exposed to sudden disaster.
At a more everyday level, we know that some commoner events such as the death of a close relative, divorce, and bankruptcy are distressing to most people. Research on naval recruits also showed that mainly positive events are also stressful; going on | vacation can be as stressful as getting caught for a traffic offence. This is because stress occurs when a demand is made on the person and he or she believes they may be unable to meet the challenge and may suffer unpleasant consequences. So, while planning a holiday, you may be worried about getting ill while abroad or the possible hidden costs which will take you over | your budget.
Some events are given much the same rating by groups of people taken on average. That is, if you asked a group of car assemblers at a local factory and a group of managers at the same plant, they might all rate bankruptcy, pregnancy in the family and holidays in the same order from worst to best.
But this glosses over the impact that one event such as pregnancy might have for your family. It could be a wonderful gift long sought after, or an unwanted emotional and financial burden.
Similarly, redundancy can be a blessing with a large pay cheque to be used to start up a new business, or a frustrating end to a promising career. This is true even for really devastating events like a heart attack, which can have some inescapably distressing effects. But these effects can be partly remedied by small positive gains such as the perhaps unexpected experience of real warmth and support from the family. And surprisingly, j this fact goes for people who have survived really large-scale disasters such as the Bradford City Football Club fire, the Zeebrugge ferry disaster, the Piper Alpha oil platform disaster, the Lockerbie and Ml air disasters, and the experience of hijack victims in the Middle East. Not everyone who suffers a major disaster is lastingly scarred by it. Those who recover and put the experience behind them seem to be those who are able to find some positive aspects of the event, and to feel they have learnt something useful about themselves.
One survivor of a motorway pile-up who was badly burned and treated at the Birmingham Accident Hospital said to me: ‘OK, I’m physically scarred. I have mottled skin on my neck and hands, and I don’t look so handsome now, I guess! But I got out of the car, and I’m still not sure how, when I saw it catch fire. I knew only I could save myself, and I did it. That feels good. And I’m much closer to my wife now, we really appreciate the time we have together now, and that has to be good.’
Freda had a heart attack at 55 years old. She was a successful businesswoman, with her own secretarial agency, and two grown-up children by her first husband. She developed severe angina after her heart attack, and was advised to sell her business. She felt it was too soon to retire fully. But on the other hand, she looks back two years later with some relief, since she felt worried before the heart attack that she had not allowed herself to develop new personal relationships. She is now lemarried and has a smaller agency which she feels keeps her mind ticking over, but allows her more time for her family.
So, stress is not simply a direct result of the amount of demand put on a person. Rather, each person responds differently to the same events, and every event has both distressing and positive effects depending upon how the person assesses the likely impact of the event on their unique personal circumstances.
*19/108/2*

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ATHEROSCLEROSIS AND BLOOD-CHOLESTEROL LEVEL
An exciting new finding by Dr Mark Armstrong in the United States was that the atherosclerosis in these animals gradually diminished when the abnormal diet was replaced by a low-fat diet which caused the blood cholesterol to fall. Over three to four painstaking years of observation, the narrowed arteries showed improvement in their bore, and the amount of cholesterol and even of scar tissue in their walls lessened. They did not revert entirely to normal, but the changes were remarkable. Similar studies by Dr Robert Wissler and his colleagues have shown that reduction of blood-cholesterol levels by a drug also results in slow but impressive regression of atherosclerosis caused by diet.
Hence atherosclerosis in animals can be induced by high-fat diets which raise the blood-cholesterol level, and can be lessened by diets which reduce the cholesterol level. This suggests that the association in man between a high saturated-fat diet, high blood cholesterol and coronary heart disease may indeed be cause and effect.
The evidence in man is at present incomplete. One early hint came from wartime experiences in several European countries. In Holland, Finland, Norway and Greece, coronary heart disease mortality fell during the Second World War, and this was seen in some age-groups in Great Britain too. During this period there was a sharp reduction in fat intake, and of course in cigarette smoking. In some countries the drop in heart-attack mortality was quite marked. But we cannot say with certainty which of the wartime changes in life style were responsible.
Another approach has been to study in detail small numbers of patients who have inherited conditions producing very high levels of cholesterol and fat in the blood, with consequent atherosclerosis of major arteries. Research workers have compared the arteries before and during treatment of the high cholesterol and triglyceride levels, either by taking repeated X-ray pictures of affected arteries, or by measuring blood flow. Drugs and diet, and in some instances operations, have been used to produce a steep fall in the blood cholesterol and fat levels. Drs Zelis, Buchwald, Starzl and Blankenhorn and their colleagues have independently shown that atherosclerosis in man can be lessened by such treatment.
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HEART DISEASE: FAMILY MATTERS
Recuperation can be a bumpy ride for a patient’s spouse, family and social and collegial network. The patient who is recuperating from a cardiac event is particularly changeable emotionally in terms of anxiety, sadness, low mood and anger. We have to remember that the mood of the significant other is changeable as well, but usually for a shorter time and less severely. But not all get off so lightly. There will be a stronger emotional response if the spouse or any family member is the “symptom bearer” on behalf of the patient. This means that it is not the patient but the family member who takes the brunt of being emotionally reactive in the family. Of course, much will depend on the actual physical state of the patient. Things go more smoothly if the patient is medically stable, or at least “stably unstable,” which means that symptoms do occur but are recognizable and are deemed not serious by the physician. As well, a lot depends on the people involved?the patient and family members?and the relationships between them. Many relationships are not flexible enough; they function well when things go relatively smoothly, but a cardiac event can disturb the emotional equilibrium of a relationship. As we pointed out in spouses can become overly involved with the patient’s situation, which can be manifested as overconcern, or “hovering over” the patient (“hypervigilance”). This situation can be highly distressing to the patient, robbing him or her of privacy and independence as the spouse or other family members watch every step and limit every activity. Following the aftermath stage, this behavior pattern usually subsides, but in certain cases it can continue, to the detriment of both patient and caregiver. If both spouses are symptomatic or troubled, a potentially dangerous “spiral” can occur, with each person feeding off the negativity of the other and making things worse. Almost all patients will go through the bumpiness of emotional reaction. However, significant others may experience a rough ride as well, especially if acceptable reliance of the patient on the spouse at the start becomes unacceptable dependence, continuing into the weeks, and especially the months, following the cardiac event.
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Other names: Benicor
TRIED AND TRUE RELAXATION TECHNIQUES FOR A BETTER HEART: VISUALISATION/IMAGERY
Imagine a cool, refreshing drink you enjoyed on a hot, muggy day last summer. Picture the glass in your mind’s eye. See the condensation on the glass, feel the coolness in your hand, taste the first drenching sensations on your parched tongue as you drink that delicious liquid refreshment. As the image fades, what remains? The inside of your mouth is probably primed with saliva and you may even be wondering what’s in the refrigerator that you could drink.
This is a simple demonstration of the powers of visualisation. Some people get so good at such imagery that they can tell their minds that they are seeing one thing when in fact they’re looking at another.
In cancer wards, professionals guide patients as they visualise wonderful scenes and experiences while undergoing chemotherapy. Incidence of side effects plunges. The mind is a wonderful thing.
One way to use visualisation in relaxation is to imagine a moment in time when you were absolutely at ease. Recall that experience with as much detail as you can. Were you in sunlight or shade? Inside or out? Alone or with someone else? Was there grass, blue sky, furniture, or carpeting? Were you inside with a fire blazing in the fireplace while it rained outside? Were any sounds associated with your memory? The soothing rhythms of breaking ocean waves, perhaps, or the distant sounds of children laughing? What did your body feel like? Could you touch anything, or was anything touching you? Recall every sensation associated with this relaxed moment. If it wasn’t perfect, make it so. If you were walking along a beach in full dress, imagine yourself barefoot in the most comfortable attire. If the sky was a bit overcast, make it sunny. You’re the author of that moment in time.
The approach isn’t limited to cancer or heart patients. Psychologists working in human performance laboratories use visualisation with athletes who want to improve their performance. They’ve been able to measure changes in breathing patterns and lessened muscle tension.
How can you apply those techniques to your personal recovery efforts? I remember very well the images I brought to mind during the years following my second bypass. I pictured my cholesterol going down, visualising the numbers like degrees of temperature on a thermometer. I saw myself running through a field, without strain, effort, or pain. And ultimately I visualised myself getting that momentous angiogram, the day I’d be told that my heart’s vessels were clear as a bell. How much did visualisation contribute to the eventual reality? I really can’t say. But I can tell you with no hesitation that every time I brought one of those thoughts to mind, it made me feel better. Give it a try yourself. You have nothing to lose.
*20/85/2*

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STRESS: WHAT DOES IT MEAN TO YOU?
Everyone knows what stress is. Stress is . . .
Overwork, boredom, dissatisfaction, conflict
Butterflies, aches and strains
Crises, disasters, panic.
But if you pin people down, they will tell you some puzzling, paradoxical, things about stress:
It is bad for you sometimes, but some people thrive on it.
Not everyone feels stressed by the same situation: some people like crowds and head for the busiest part of the room at parties, others prefer to be on their own or with a few good friends.
You can feel stressed by one situation today, like arranging a hospital appointment, but not be bothered about it next time.
Some people become ill with stress. They have rashes, headaches, panic attacks and chest pains, while others seem to remain fairly healthy.
So although stress is a common word, we need to tease out these paradoxes which hold the clue to how you can understand your stress response and learn to manage your stress – to unlock your own potential to win.
Part of the paradox can be unravelled by looking at some different models of stress or ways of thinking about stress which you may be using.
A model is only useful if it helps us explain how you react in as many situations as possible. This allows you to predict and decide if you want to control how you will respond in future.
*18/108/2*

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HIGH CHOLESTEROL: RESEARCH ON ANIMALS
But these associations on their own do not prove that the high cholesterol level causes the heart disease. To decide whether high blood cholesterol is one of the causes of heart attack we require other kinds of evidence. We need to know whether changes in cholesterol level influence the frequency and severity of atherosclerosis, and the frequency of coronary heart disease. In the same way, in order to know whether a high intake of saturated fat causes coronary heart disease we must study the effect of altering the diet on the frequency of this disease.
Despite the extreme difficulties of this kind of research, some answers are beginning to appear.
Research on Animals
Some information, referred to earlier, comes from observing the effects of a high saturated-fat or high-cholesterol diet on animals, especially in certain monkeys which are closely related to man. The diet rapidly leads to very high blood-cholesterol levels, and within a few months the body’s cholesterol stores become greatly increased. This has been confirmed repeatedly over the past seventy years. The animal’s arteries develop changes similar to those in severe human atherosclerosis.
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TRIED AND TRUE RELAXATION TECHNIQUES FOR A BETTER HEART: BREATHING
As a first step, think about this: when you’re about to do something special, you take a deep breath. When you finish a major task, you take a deep breath. When you feel a bit of anxiety, you sigh, that is, you take a deep breath. All that proves that your body automatically takes advantage of such breathing. Now it’s a matter of taking this natural activity to its ultimate benefit.
I was first introduced to the idea of deep breathing as a specific relaxation technique in 1971 when I took a course in yoga at a Chicago YMCA. 1 must admit that back then 1 did it really as a lark, and taking courses like that was a good way to meet women. But I soon learned that I’d stumbled on to something quite valuable.
The instructor, who had travelled a number of times to India to become expert in yoga, tried to explain how this ancient discipline was not only another way of getting exercise and increasing flexibility, although it was quite effective in that vein as well. Yoga, she maintained, was able to effect significant changes in the body’s physiologic functioning. “Sure,” I thought, “and next you’ll tell us about levitating.” I didn’t take it very seriously at all. Yet I did begin to feel the benefits.
Interestingly, as I’ve looked at some of the handout materials she gave us, I’m amazed at how on target that yoga instructor was. She wrote, for example, about how yoga could diminish the activity of the sympathetic nervous system. At the time, I dismissed such claims out of hand, thinking that the only “truth” possible came out of a scientific laboratory. Well, two decades later we’re getting affirmation of what she knew to be true and, Doubting Thomas that I am, I’m accepting the research data coming from prestigious universities and medical centres showing the benefits of yoga and other relaxation techniques which utilise deep breathing.
Don’t jump to the conclusion that I’ve become some sort of swami or a zealot chanting in the streets. Far from it; I remain a hard-nosed science writer, quite conservative in my professional and personal life. But when someone gives you a valuable gift, the best thing you can do is accept it and say thank you.
Let me share with you, now, how you can start to immediately benefit from deep breathing therapy. There are five different methods of breathing, each with its own advantage. Try them all.
Alternate breathing allows you to learn to concentrate on your breathing. Sit in a comfortable position with your eyes closed and rolled slightly upward. Close your right nostril with the right thumb, and inhale slowly, very slowly, through the left nostril. Do so noiselessly and in a relaxed manner. Now close the left nostril with the index finger of the right hand and exhale slowly through the right nostril.
Keeping the index finger pressed to the left nostril, inhale, again very slowly, through the right nostril; close with the thumb and exhale through the left nostril. Continue for 12 breathing cycles. Don’t hold your breath between inhalations and exhalations. Try to balance by keeping a slow count as you breathe in and out.
The main purpose of this exercise is to make you become aware of your breathing. You’ve taken it for granted until now. Concentrate on that breathing and feel the relaxation spreading through your body. After a few sessions the matter of closing off the nostrils will become second nature and you won’t have to pay as much attention to it.
Diaphragmatic breathing is a great way to relax and take a break during a hectic day. You’ll want to take advantage of this soothing exercise when you return to work. In the meantime, try to practise a few times each day.
Lie on the floor with your hand on your abdomen. Feel the stomach muscles lift as you inhale and fall as you exhale. Try to keep your shoulders and chest still. This is actually the reverse of the high, shallow chest breathing most adults use. Using the abdominal muscles helps us fully expand the lungs. You may find this feels strange at first because we have to relearn a process we’ve performed unconsciously for many years. Watch a very young child breathe and you’ll notice how the tummy rises and falls. Perhaps adults breathe the way we do because we want to keep our stomachs flat. Try as much as possible to breathe using the abdominal muscles. By all means, practise this technique a few times daily. It’s the basis of breathing exercises to come.
Three-part breathing builds on diaphragmatic breathing, and is the first step in this complete breathing cycle. First inhale as fully as possible via the abdominal muscles. Next expand your rib cage to further fill your lungs. Finally take a few “sips” of air through your nose, feeling the throat area fill with air. Practise following those three steps in a smooth, unrushed fashion.
Exhale in the same, not the reverse, order. First depress the abdominal muscles, next deflate the lungs by pressing down on the rib cage, and finally feel the air leave the throat through the nostrils. To fully expel all the air, do three reverse sniffs through the nose, pushing the very last bit of air from the body.
This, I think, is one of the easiest and best ways to relax. You can do it any time and any place. It should be a part of your routine day.
At the beginning it’s best to do this while lying on the floor with your back firmly pressed down. Try to imagine that gravity is pulling your body, especially the buttocks and lower back, down. After you master the process, and it does take some practice to perfect, you can try it while in a seated position. I personally don’t like to sit in a chair; I prefer to sit cross-legged with my back as straight as possible, hands on the tops of my thighs.
Concentrate on the process. Breathe the air in slowly and fully, then release the air in a similarly slow fashion. Be sure to “sniff that last bit of air out. Think of nothing but your breathing, putting all your attention on the air rhythmically entering and leaving your body.
I know that you’re reading all this with your eyebrows lifted in scepticism. You can’t picture yourself doing anything like this, so foreign to your normal way of thinking. But I can assure you that this breathing exercise can work for anyone.
Everyone has a favourite trick for getting rid of hiccups. But none of them works for everyone all the time. At parties, I’ve encountered many a person with hiccups that just won’t go away. I invite them into a darkened room away from the hustle and bustle of the party, instruct them to take a seated position on the floor, and talk them through the breathing exercise I just gave you.
With a gentle, muted voice I walk them through their inhalations and exhalations. As they fill their lungs with air, I ask them to hold their breath for a few seconds, remaining conscious of the air in their bodies, and then instruct them to slowly release that air, down to the last few sniffs. After just a few minutes, I ask them if their hiccups are gone. Amazingly most have forgotten they ever had the hiccups at all. Many have elected to remain in the room for a few minutes more, so they could fully relax because the breathing made them feel so good.
When my son Ross was just eight years old, he got a nasty case of the hiccups. I took him into a room, just as I’ve done so many times with adults, and walked him through the procedure. Sure enough, the hiccups were soon gone. Moreover, Ross discovered a great way to relax. Now, when he’s having some particularly tough times in school he’ll go off to do his breathing because, in Ross’s own words, it makes him feel as though he’d had a nap.
Rapid abdominal exhalation is the fourth type of deep breathing, and is particularly suited for dealing with those moments of stress and anger. To start, inhale and exhale rapidly, forcing in the abdominal muscles vigorously on the exhalation. Then relax the abdominals, letting the air rush in. Continue, stressing the exhalation. As compared with the breathing exercise with three parts, here we concentrate on the abdominals.
Think about it this way. If you normally take a deep breath and blow it out when under stress, think how much more effective a series of rapid breaths would be.
After the initial series of rapid breathing through the abdominals, switch to a more relaxing three-part breathing. Continue that relaxing breathing until you’re calm and feeling refreshed.
I must caution you here not to do that rapid breathing while standing up and inhaling and exhaling through your nose. That might result in a state of hyperventilation and cause you to feel a bit dizzy.
Instead of getting angry at your spouse or boss, do some breathing. When the Taxation Department wants its pound of flesh at tax time, do some breathing. When someone cuts you off in traffic or a policeman writes a ticket, do some breathing. There are numerous provocations in everyone’s life. You’ll find that deep breathing is as addictive, and a lot more healthful, than drugs such as Valium.
Cooling breath is the fifth yoga deep breathing technique. It’s not one of my favourites, but I pass it along as some people find it very rewarding.
Protrude your tongue beyond the lips and curl it upward. Inhale through the mouth along the path of the curled tongue. Feel the coolness in your mouth. Hold the breath for a few seconds, and slowly exhale through the nostrils. Repeat six to fifteen times.
Deep breathing is a basic concept of yoga. If you were to take a course at the YMCA or elsewhere as I did, you’d no doubt get a lot of the mystical jargon thrown in to the bargain. I don’t take that very seriously, but I do enjoy the rather rhythmic cadences of the instructor as he or she soothingly goes through the instructions of the breathing and the various stretching poses. Of course you’ll need to be a bit further along in your recovery before then, especially if you’ve had surgery.
One of the first poses you’d learn is called the “savasna” or the corpse pose. This is one way to get really relaxed, back to life as it were, by playing dead. Here’s how it goes.
Lie flat on your back, relaxing the arms at your sides but not touching the body, with your palms up, the fingers curled slightly, naturally. Separate the legs a bit, and consciously relax the knees. Let your feet fall away from each other. Unclench your teeth, and let the tongue and jaw relax. Close your eyes, but lightly so, with the gaze through the lids slightly upward.
Feel your body becoming very relaxed, with the entire length of the spine on the floor. You feel the weight of your body pressing into the floor as gravity pulls you down. Give no resistance, allowing yourself to fall, as it were, toward the centre of the earth.
Begin to consciously relax your body by concentrating on one part at a time. Give your feet the command to relax, relax, relax. Notice how your feet, first the right, then the left, begin to feel heavier and heavier as you tell them to relax. Work your way up the body to your calves, your knees, your thighs, and on and on. All the while, breathe slowly through the mouth and exhale through the nose.
As you feel yourself approaching total relaxation and contentment, begin to concentrate more completely on your breathing. Perform the three-part breathing, but don’t push the last “sniffs” too hard.
Certainly you can achieve relaxation all by yourself in this way. To assist yourself you might want to make a tape of instructions. Play some soft music as a background and soothingly give yourself instructions, using the paragraphs above as a guide. There are also tapes on the market which can assist you in your deep breathing exercises.
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HOW EVENING PRIMROSE OIL HELPS TO LOWER CHOLESTEROL
Having high cholesterol levels in the blood is one of the broadly accepted risk factors for cardiovascular disease. Total plasma cholesterol remains the best single predictor of coronary heart disease.
Ever since the 1950s it has been known that linoleic acid is able to reduce cholesterol levels. However, this would mean taking large quantities of linoleic acid, which would be very high in calories as well as relatively unpalatable.
It is now becoming clear that the power to reduce cholesterol levels is not so much vested in the linoleic acid itself, but in its metabolites dihomo-gammalinolenic acid (DGLA), and also arachidonic acid.
There is a strong association between the incidence of cardiovascular disease and reduced levels of DGLA. A study in Scotland showed that among symptomless middle-aged men, the 10% with the lowest DGLA levels in adipose tissue had an almost 25% chance of developing coronary heart disease over a four year period. Similar results have been obtained in Finland.
In the metabolic pathway of linoleic acid, DGLA is formed from gammalinolenic acid (GLA), the active ingredient of evening primrose oil. Evening primrose oil converts into DGLA very simply. You only need to take six capsules (3g) of evening primrose oil a day to achieve the same effect as taking between 30-100g of linoleic acid! On average, evening primrose oil is over 100 times more potent than linoleic acid in reducing cholesterol.
Research on evening primrose oil and heart disease has recently been done at the University of Edinburgh. Dr Rudolph Riemersma of the Department of Cardiology did a study in which he compared the ability of Scottish men to convert linoleic acid to DGLA, and to convert the GLA from Efamol evening primrose oil to DGLA.
On average, the men he studied were not able to convert linoleic acid to its metabolite DGLA. But there was no problem for them converting the GLA in Efamol into DGLA. Since low levels of DGLA seem to be a strong predictor of heart disease, it is possible that this inability to convert linoleic acid may be an important factor.
DGLA seems to be the key substance in reducing cholesterol. Also, PGEl, which is derived directly from DGLA, has many desirable actions in the sphere of cardiovascular disorders, of which inhibiting cholesterol biosynthesis is only one. PGE1also lowers blood pressure, and inhibits platelet aggregation and smooth muscle proliferation.
High cholesterol levels are particularly dangerous because cholesterol not only furs up the blood vessels, but also acts as a blocking agent in the linoleic acid metabolic pathway. Cholesterol interferes with the actions of the delta-6-desaturase enzyme, which helps convert linoleic acid into GLA. This means that people with high cholesterol levels may take a diet high in linoleic acid in the hope of reducing the high cholesterol levels in their blood, but they won’t be able to make use of this linoleic acid because of the high cholesterol levels which block its conversion. So they are caught in a catch 22 situation.
However, there are no such problems taking evening primrose oil, as it by-passes this block by starting at the next stage in the metabolic pathway (GLA).
Interestingly, some other blocking agents are also well known risk factors for cardiovascular diseases, such as ageing, diabetes, trans fatty acids, saturated fats and catecholamine released during stress. Perhaps these factors are risk factors for cardiovascular diseases precisely because they block the pathway of linoleic acid. Once again, evening primrose oil circumvents all these blocking agents by starting at the next step, GLA.
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CHOLESTEROL AND ITS REMEDIES
Recent scepticism to one side, there is little doubt that hardening of the arteries with resultant heart attacks and strokes owe their prevalence to elevated levels of serum cholesterol. People with a total cholesterol below four units never succumb to heart attacks and the risk of heart disease doubles with every single increase in the level of cholesterol. It has also been shown by world experts that people with cholesterol below four units can smoke and have high blood pressure without increasing their risk of heart disease.
Home Remedies
Cholesterol is broken down into sub units, two of which are known as HDL and LDL respectively. HDL cholesterol is the good or cleaning cholesterol. LDL is the bad or clogging variety. Vegetarians who eat no animal fat run total cholesterols at or below the level of three units. No wonder they live ten years longer than lovers of animal fat. As a general rule, if it lives on land and walks on two to four legs the food item is a good source of cholesterol. Prawns, crabs, lobsters, and other things that live in seas or rivers are in the clear as far as dietary restriction is concerned. Evidently any cholesterol so contained is balanced by high levels of Omega Three Fatty Acids which have a beneficial effect on HDL or the cleaning cholesterol.
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STUDIES ON EVENING PRIMROSE OIL AND CHOLESTEROL
Evening primrose oil has an interesting effect on cholesterol levels. It will only bring down cholesterol levels if they are high, but it will have no effect on cholesterol levels if they are normal or low. As the starting cholesterol levels rise, so the relative potency of the GLA in evening primrose oil increases.
Evening primrose oil is clearly an effective cholesterol-lowering agent in those people with plasma cholesterol values above 5 mmol/1, in other words, in all but the lowest 20% of cholesterol levels.
Like other PUFAs, evening primrose oil either has no effect on HDL (high density lipoprotein) cholesterol or actually increases it. The cholesterol-lowering action of evening primrose oil is entirely because it is able to lower LDL (low density lipoprotein) cholesterol. It is the LDL cholesterol which is harmful and which needs to be lowered in order to reduce the risk of a heart attack. HDL cholesterol is desirable because it actually helps to transport cholesterol away from places where it may be harmful. Evening primrose oil has the very beneficial effect of raising the HDL/LDL ratio.
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Other names: Urso

DIGESTION: SALIVARY GLANDS
The ones which force themselves most on our attention are the salivary glands of the mouth. You know that they are big enough to make a lot of fluid. But all along the canal are innumerable minute ones. Many of these secrete mucus, which lubricates. The others secrete “enzymes.” Enzymes are substances indispensable to the chemical reactions of the body. They would seem to be practically infinite in number and we know of most of them only by the results which they accomplish. They will be discussed later when we come to vitamins and hormones, the three being said to be one family.
Some of these enzymes have been identified and collected and occur in large amounts. The digestive enzymes, of which I have seen eighteen listed, are in this class. A few are well known: ptyalin of the saliva which changes starch to sugar is one. Perhaps the best known is pepsin of the gastric juice which certainly in my younger days everybody knew about. Every family bought it at the drugstore or got it in chewing gum. We were told that it came from the stomachs of hogs and digested protein. All of us medical students knew of the euphonious trio, trypsin, steapsin, and amylopsin, which comes from the pancreas and which transforms proteins, fats, and starches, respectively.
Although there is ptyalin in the saliva and it helps to digest starch, the chief use of the saliva is undoubtedly to soften food and make it easy to swallow. Several pints may be secreted daily. Americans apparently have plenty of saliva – at any rate, they have led the world in spitting, as has been commented on by English travelers. Mrs. Trollope in 1830 was disgusted with this habit; and later Charles Dickens, in his notes on his American tours, complained that Americans spat before him. Nowadays our supremacy in gum chewing, which, of course, keeps saliva flowing, makes several pints seem a reasonable figure.
Saliva is secreted by several sets of glands, the parotids in front of the ears being much the larger. I know not why mumps, or epidemic parotitis, which is so remarkably infectious, has a predilection for these glands. Neither do I know why in adult males the disease so often jumps to the testicles, often causing atrophy here. One of my internist friends told me that in the First World War the sickest patients he saw were those with mumps. For these reasons, I am inclined to think that one might find it the course of wisdom to let one’s children have the mumps, as the disease is mild in youth.
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CHOLESTEROL: HDL CHOLESTEROL, HOME REMEDIES
Cholesterol is divided into two fractions labeled the “good” and the “bad”. HDL is the good cholesterol, which mobilizes cholesterol from the tissues and transports it to the liver. High levels of HDL correlate very well with a low risk, of heart disease and strokes. Doctors use drugs to lower the bad cholesterol and raise the HDL. Examples of such drugs are Niacin, Simvastatin, Gemfibrozil and Atromid.
Home Remedies
Alcohol elevates HDL cholesterol and is therefore considered protective in terms of coronary artery disease. A stubby of beer or two glasses of wine a day, with meals, is considered an ample sufficiency.
Exercise is also a well known elevator of HDL. No male over 40 and no woman over 45 should embark upon an unaccustomed program of exercise without first being assessed by a medical practitioner. Other factors capable of increasing HDL cholesterol are cold water fish, Vitamin B3, Vitamin C, garlic, brewers yeast, ginseng and chromium.
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Other names: Afeditab Er, Procardia

LDL CHOLESTEROL
LDL cholesterol is the component of the body?s cholesterol management system that has earned the description of “bad cholesterol”. It is LDL cholesterol that comes from animal fats, crystallizing into artery walls to attract calcium and cause hardening of the arteries.
To lower LDL cholesterol and decrease chances of heart disease and strokes it is necessary to avoid milk and fatty cuts of meat and poultry. The old adage that says if it lives, walks on land and ends up in the diet it should be largely avoided, still holds true.
It is possible to have a low animal fat diet and still eat meat if such meats are lean and poultry is eaten without its skin. Wisdom dictates that all offal be avoided including sausages, brain, liver, kidneys and mince meat. Tea bone steaks are rich in fat and are not missed if excluded from the diet. Dairy products can be consumed via skim milk plus cheese, yoghurt and even ice cream come in reduced fat varieties. Prawns and avocadoes are back on the list of foods that can be eaten without fear of promoting cardiovascular disease.
Home Remedies
A very senior cholesterol authority in the form of the Framingham studies, Dr. Castelli says that the average family has a staple menu that consists of only 11 recipes. All a family needs to do for its members to live an extra ten years is to change those ten recipes. Cuisines that are low in LDL cholesterol and relate to a lower incidence of heart disease in their home countries are Chinese, Japanese, Italian, Greek and seafood. The change of one recipe a month selected from these cuisines after due deliberation is worth an extra ten years of healthy lifespan.
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