Dear Ann Landers,
"CANCEL THE BLUSH, I WILL NOT PUT ON A SHOW FOR THESE JERKS." V

DEAR V-8,
In technical language your suggested approach is called "bio- feedback." If it can lower one's blood pressure (and it can), it certainly should be able to squelch a blush. THE ANN LANDERS ENCYCLOPEDIA 133 Body Odor Body odor is a very common problem. While there are many sources of nor-mal and abnormal odors which arise from the human body, the term "body odor" usually refers to the odors generated from perspiration. Some body odors come from human waste, such as fecal matter or urine which have soiled the skin or the clothing. Other body odors may be caused by various illnesses, such as the "fruit" odor emanating from patients with se-vere diabetes who have acetone on their breath or the "mouse" odor of pa-tients with advanced kidney disease and the accompanying accumulation of waste products in their blood, which produces an illness known as uremia. Other sources of abnormal odors due to illness are infections ranging from multiple boils to gangrene. However, patients with these severe illnesses are rarely able to carry out normal everyday activities and are usually confined to bed, frequently in a hospital. The normal type of perspiration is odorless. The usual type of body odor produced from perspiration is the result of the action of microorganisms, mainly bacteria, which live on everybody's skin and change the composition of the perspiration. It is the result of bacterial action that creates the odors. Under normal conditions, heat, physical exercise, and nervous tension, and less commonly, spicy foods, alcoholic or hot beverages, and a number of less common factors stimulate the activity of the glands which produce the perspi-ration. The perspiration due to warm weather is less commonly associated with body odor unless other factors are involved. There are two kinds of sweat glands. One, the eccrine glands, are distrib-uted all over the body surface. The less common apocrine sweat glands are abundant in the armpits, around the nipple of the breast, in the area of the genitals, and between the buttocks, particularly around the anal orifice. It is the latter type of gland that contributes a considerable part of the perspi-ration in these regions. Body odor which arises from perspiration originates predominantly in those areas where bacteria which cause the odors are most active. Those re-gions are the moist, warm areas where the perspiration is abundant, such as the armpits, the groin, the genital area, and the region between the buttocks. These are the same warm, moist areas in which the activity of the bacteria is increased. These anatomical areas are, therefore, commonly associated with undesirable body odors. In the anal-genital area, for obvious reasons, poor 134 THE ANN LANDERS ENCYCLOPEDIA hygiene can contribute sources of undesirable odor both from the genitals and from the anus. The development of the apocrine glands (in the armpits, the groin, and around the nipple) is closely associated with the development of hair in those regions. Both are under the control of sex hormones. Body odor, at least the major component which is associated with the apocrine perspiration, is there-fore rarely a problem in children before puberty or in people who have reached menopause. However, even in the young and older age groups, eccrine perspiration is present, can be abundant, and as a result of increased activity of bacteria in the underarm and anal-genital areas, can produce body odor of considerable significance. Both the anal and genital areas, at all ages, harbor large numbers of bacteria, which are normal inhabitants of the gas-trointestinal tract, and responsible for the production of odors usually as-sociated with those of bowel excretions. Various methods have been employed to control body odor. None of them are wholly satisfactory. The principal methods for controlling body odor fall primarily into three groups: Control of bacteria is probably the most effective method. Thorough washing and close attention to personal hygiene are the obvious way to re-duce the number of bacteria and the amount of perspiration. Women should use mild soap in the genital area to avoid irritation. Inhibiting the bacterial growth or action is the primary function of deodorants. These preparations range from such generally available agents as rubbing alcohol, soaps, and lo-tions to the commercial deodorants found in drugstores. Covering the body odor with a more acceptable and potent scented preparation, such as various perfumes, aromatic substances such as mentho-lated or camphorated preparations or pleasing plant odors, such as pine or other evergreen extracts, or odors associated with strong antiseptic agents, such as Lysol. Another widely attempted approach is to reduce the amount of per-spiration and thereby the amount of material available for the bacteria to create undesirable odors. While some antiperspirants inhibit the activities of the bacteria, their primary function is to reduce the flow of perspiration, pri-marily in the underarm region and the anal-genital areas. Almost every dermatologist has had at least one or two patients who come for help insisting that they have an offensive body odor and "no one can help them." They say they have a terrible odor which is mining their lives and they have been to several doctors but to no avail. Actually there is no offen-sive odor. The problem is imaginary. Such patients should seek psychiatric help. credit: Edmund Klein, M.D., Assistant Chief of Dermatology, Roswell Park Memorial Institute, Buffalo, New York, and Research Professor, School of Medi-cine, State University of New York. THE ANN LANDERS ENCYCLOPEDIA 135 Boredom, American Style Boredom afflicts the rich more than the poor, the adult more than the child, and the so-called healthy more than the neurotic. Boredom is often blamed on the external world ("I'm not bored-it's this lousy town ... my stupid friends . . . this miserable job . . . my dull hus-band [or wife]"). The mechanism of projection helps one feel that he is the victim and not the cause. There are, indeed, boring people and situations, but frequent and long periods of boredom, no matter what the cause, are an in-dication of an emotional problem. This becomes evident in people who, de-spite frequent changes of cities, husbands, wives, friends and jobs, remain bored. Let me try to define boredom. It is a state of dissatisfaction accompanied by a feeling of longing and an inability to identify what it is one longs for. There is a sense of emptiness, frustration and restlessness. The bored person waits for someone or something to provide the solution. Unfortunately, when someone does offer a plausible suggestion, it usually turns out to be little more than a time killer. There is another characteristic of boredom. Time seems to stand still. The German word for boredom is Langeweile, which means "long time." The sense of painful emptiness, characteristic of the bored, stems from the fact that most of his fantasy life is repressed or inhibited. His imagination is stultified or blacked out in the major areas of his life. He would rather feel empty than miserable. It is for this reason that he turns to the external world, hoping it will "guess" what he wants and provide it. A typical statement of a bored person is: "I can't get with it," or "I am no-where." His language indicates that he is out of touch with his fantasies and thoughts. People who are severely and chronically bored and are aware of it suffer great pain. Many years ago I treated a patient who made a serious suicide at-tempt because of her unbearable boredom. In the hospital and during treat-ment, she felt depressed, but her depression was a welcome relief from her intolerable boredom. In studying such patients it became apparent that chronic and severe bore-dom is a defense against an underlying deep-seated depression. They attempt to avoid the depression by plunging into a variety of intense activities or by lapsing into a state of lethargy. These solutions are never truly satisfactory. 136 THE ANN LANDERS ENCYCLOPEDIA As long as there is an inhibition and blocking of fantasy thought and imagi-nation, there are no connecting links between instinctual drives, emotions and human relations. These people may go through the motions of living and loving but it is essentially a charade, or a desperate search for something on the outside which can only be found on the inside, and then only after suffer-ing through their depression. Teenagers are an excellent example. They are usually filled with sexual and aggressive tensions-complain of having no friends-say they can't com-municate with their parents-lie around the house brooding, listening to rec-ords. Inevitably they say, "Gee, I'm bored." The best way to help a teenager move out of this condition is to recognize the cause of his boredom and then give him some direction to help him find activities that will offer him an op-portunity to release his tensions. Boredom also may serve an adaptive function, particularly when it is rec-ognized as boredom and is only temporary. It is a kind of local anesthetic dulling the pain in a particularly sensitive psychic area while natural healing takes place. Any change of routine, like a weekend away from home, a poker game, talking seriously with one's wife, or skiing, may be sufficient if the un-derlying conflicts can be faced consciously. Sometimes boredom may also serve as a period of germination before the birth of creative ideas. When the pathology is more serious, then boredom becomes a form of hibernation, a kind of self-preservative trance-like state, an attempt to wait out or ward off the stormy depression which howls below. I have seen such apathetic states in prisoners of war who survived years of imprisonment in World War II. Boredom is primarily an affliction of the successful and the affluent. There are millions of these people walking, or rather, running around the country attempting to conceal their boredom from themselves and the world. r's of boredom Bored people try to escape emptiness and loneliness by establishing rou-tines. Married couples who have blocked out their marital misery will sched-ule social events months in advance. They have a horror of free evenings be-cause they would then have to face each other and it would be intolerable. By issuing invitations long in advance they manage to ensnare people who would otherwise claim to be busy. Moreover, a full calendar proves to them that they are popular and "in demand" socially. They have long lists of people to choose from because they do not discrim-inate among friends, acquaintances, relatives, enemies, business contacts and strangers. Guests are chosen according to tested recipes containing various so-cial ingredients. One couple may be picked because they are, at the moment, socially prominent. Then come the couples they "owe" a dinner party to. To this group is added other couples who are "fillers"-people whose function is to add social bulk to the room. To this concoction one may add a dash of THE ANN LANDERS ENCYCLOPEDIA 137 "glamour" in the form of an entertainer, a foreign couple, or a psychoanalyst. When this collection of humanity is placed in a crowded room, served strong drinks and delicate hors d'oeuvres, the noise and confusion give the appear-ance of excitement. Before the dinner is served, everyone eats ravenously to keep from passing out from the alcohol or from sheer hunger. The food is praised because the guests can no longer taste, and are grateful for having been saved from paralysis. Having overeaten, everyone is too tired to leave, so they linger on until early morning, which proves the party was a smashing success. The hostess records the dates each person was invited because most of them belong to the "you remember good old what's-his-name" group. The guests are rotated regularly, new names added (after a few drinks at someone else's party), and no one is dropped unless he has committed a mortal sin like spilling red wine on an expensive tablecloth or vomiting on the hostess's new Bill Blass gown. The sex life of people who cannot stand not standing each other is also ruled by routine and recipe. One does not have intercourse on the spur of the moment-at least not with one's own husband or wife. Spontaneity and im-provisations might break through the protective wall and ward off the un-derlying miseries. Marital sex is carefully scheduled for a certain day. In this way, neither party has to take the initiative and run the risk of being rejected. If Sunday night is the night-that's it. Bored couples in desperate search for sexual excitement may resort to artificial aids such as marijuana or cocaine, pornographic magazines, or X- rated films. In recent years mechanical gadgets such as vibrators and Jacuzzi baths add spice to the agenda. Both partners may become so lost in their own fantasies that they are startled after orgasm to see who is actually in bed with them. Bored people are frequently promiscuous because they keep searching for ways to fill up their internal emptiness. They are not able to love because they cannot communicate either verbally or emotionally. They use physical contact and sensations as substitutes for meaningful human interaction. They are alienated from a vital part of themselves and hope that physical contact with a new person will give them the feeling of being whole or in touch. Un-fortunately, as marvelous as an orgasm may be, it is no substitute for love or intimacy. Such sexual affairs do not last long and have no important emotional im-pact. These people continue to remain on each other's guest lists, they meet as though nothing happened, and, sadly enough, they are right. THE PURSUIT OF TRIVIAL PLEASURES: FAVORITE PASTIMES OF THE BORED I refer here to vast numbers of people who spend a great deal of time seek-ing superficial satisfactions. There are women whose major delight is shop- 138 THE ANN LANDERS ENCYCLOPEDIA ping, without any specific need or objective. They may even accompany a friend on a shopping tour when they themselves have nothing to buy. They do this as other women might go for a walk or have a cup of coffee so they can talk. The advantage of shopping is that it makes it impossible to engage in any serious or meaningful conversation. These women are often dependent on beauty salons, which they visit with the same regularity that wealthier women go to their psychotherapists. They study their faces in the mirror every morning so they won't miss a wrinkle, blemish, or unwanted hair. They are equally scrupulous about their figures and are constantly weighing and measuring themselves. They get facials, hot packs, ice packs and massages. They spend several hours every week at the hairdresser's being shampooed and set, combed and curled, tinted, mani-cured, pedicured, tweezed, and getting their legs "waxed." All this is time- consuming and these ladies come home exhausted. At bedtime they put on a variety of skin creams and body oils, and end up donning hair nets and eye shades and applying skin de-wrinklers. If they would spend as much time looking inward instead of outward, their faces would undoubtedly look less artificial and strained. But to look inward means to be willing to suffer and perchance to cry, and this might produce bags under the eyes, so they stay with the beautician, the hairdresser, and the masseur. Bored ladies talk a lot, mostly trivia and gossip-and their phone bills are enormous. The male counterparts of the women described above are the country club addicts. The rich play golf, take a massage and a sauna bath, after which they play cards until they are late for dinner. They often dine at the Club, in fact, they spend more time at the Club than at home. They remain members of golf clubs long after they have given up golf. In a sense, many country clubs serve as a sanitarium for the rich. Those who must work for a living stop off at a bar for a few drinks with the boys. "Boys" refers to acquaintances of any age whom you never really get to know because you meet them only in crowded bars where the noise is so loud that conversation is impossible and the smoke is so thick you couldn't recognize your brother. Besides getting bombed, the major activity is verbal horseplay which is unrepeatable at home because it makes no sense when repeated sober. THE BORED PERSON'S SEARCH FOR MEANING There are people who never seem to have an ordinary experience. What-ever happens to them is the greatest, the best, the worst, the most horrible, or the most fantastic. In any case, it is the "most." Some of them work at creating these situations. They are the life of the party, or the death of it. They are cut-ups, jokesters, storytellers or confes- THE ANN LANDERS ENCYCLOPEDIA 139 sors. Interestingly, they can admit in a group what they cannot say in private. They laugh loud and long and cry easily and without shame. They often con-fuse loudness with sincerity, tearfulness with intimacy, and obscenity with passion. They love crowds because they give them the feeling they are "in"- that they belong. At parties they overdress, overeat, overdrink and overtalk. A recent addition to this forlorn group may be seen at encounter groups, and at touch therapy and nude therapy sessions. These sad souls are out of touch with their emotions and very lonely. They hunger for contact and warmth and hope they can be achieved by artificial togetherness. Their at-tempts are doomed to failure. If one is unable to make contact with his own feelings and thoughts, he cannot accomplish it with an outsider. THE DRUG takers: THE SEARCH FOR OBLIVION, MINDLESSNESS AND DEATH This subgroup is enormous and complex. In this limited space, I shall at-tempt to describe some outstanding characteristics because drug taking is on the increase at all age levels. Alcohol makes time pass. It is one of the greatest of all time killers. The elation produced by booze can temporarily relieve monotony and loneliness. Alcohol, however, can also break the defensive barrier around depression, and destructive brutality may emerge as well as terrible sadness. Sleeping pills block out a high percentage of night dreams. Tranquilizers and sedatives dull the imagination and produce peace of mind which is actu-ally more a piece of mindlessness. In recent times sedatives also have been used as "downers"-a means of counteracting the ill effects of such stimulants as amphetamines, such as Dex- edrine and Dexamyl. The latter are euphoriants, which means they produce a temporary mood of elation. If taken to excess they produce extreme rest-lessness, agitation, irritability, palpitations and insomnia-a vicious cycle. Marijuana is also a euphoriant, but it acts differently inasmuch as it stimu-lates the imagination and permits repressed fantasies to break through into consciousness. This is why marijuana is appealing to the bored. It also en-hances certain perceptions-sound, for example, and if taken with a group it gives a feeling of belonging and creates the illusion of closeness. The physical proximity and the communal use of pot do not break down the feeling of loneliness and isolation. While sexual capacity seems to be en-hanced, this too is an illusion. The number of orgasms in women may in-crease but the quality of the orgasms goes to pot with pot. The most outstanding difference between users of alcohol and marijuana is that alcohol tends to make people violent while pot makes people good-na-tured and lovers of loud music. Cocaine is now the "in" thing. "Coke" also produces a synthetic good mood but the high lasts only twenty or thirty minutes if sniffed-and another 140 THE ANN LANDERS ENCYCLOPEDIA rush is needed to sustain the "joy." Since cocaine is costly only the rich can afford to stay on it for long periods of time. LSD is the most dangerous drug of the lot. It can produce psychotic break-downs which may be irreversible. It is appealing to those who search for new and vivid sensations because the old ones have failed to give them pleasure and satisfaction. It also is a way of daring to face death or insanity, a form of playing "chicken." LSD attracts people who place little value on sanity or life. I put television in the category of drugs because TV is addictive. It dulls the intellect and artificially stimulates certain senses while it blurs one's own identity. All bored people are drawn to the tube and are prone to take over-doses. The fascination of television is complex, but it provides ready-made fantasies in living color for those with an inhibited fantasy life. They do not have to use their imaginations. TV does it for them. One of the most unfortu-nate side effects of television is that it makes real life seem even more drab for the person who is bored. BOREDOM AMONG THE YOUNG-UN-AMERICAN STYLE While large numbers of teenagers smoke pot to escape boredom, many more are attempting to escape the purposelessness of their lives. The majority are more depressed than bored. From 1968 to 1969, there was a rise of 100 percent in the suicide rate of people between the ages of thirteen and twenty- nine. Incidentally, the most prevalent instrument with which to end life was not drugs but guns. THE CURE AND CONCLUSIONS I hope that I have made it clear that boredom is a state of mind which is the result of blocking the thoughts and fantasies that would otherwise lead to the recognition of conflict, frustration and unhappiness and coping with them. On occasion we all may need some boredom as a respite from struggle and misery, but it can become a serious problem when distractions and diversions replace the basic elements of life. Life is to be lived and to live a life of meaning we must contend with the painful aspects of our existence. All people are full of loving and hateful impulses. That is the human con-dition. It is as true for the rich as the poor, the black and the white, the American and the Oriental. To know ourselves we must be willing to face and acknowledge our strengths and weaknesses. To form meaningful and en-during relationships we must be willing to share this awareness with those who matter to us. Honesty and humility are prerequisites for relating in a significant way. We change and the world changes too. It is painful to find oneself old, or out of step, or ignorant or weak. Yet, if we want to be part of THE ANN LANDERS ENCYCLOPEDIA 141 the world, we must face these eventualities. If we do and are willing to en-dure some suffering, we shall be able to love and work with our fellow man. We may be unhappy at times but we shall never be bored. credit; Ralph R. Greenson, M.D., Clinical Professor of Psychiatry, U.C.L.A. School of Medicine Training, and Supervising Analyst, Los Angeles Psycho-analytic Institute, Co-President, The Anna Freud Foundation, California Chapter. Bragging I have never sat on a bus, at a dinner party, by the pool or in a doctor's office in my entire life that I didn't find myself next to the parent of a college overachiever. You know the ones I mean. The parents whose son or daughter was the re-cipient of a four-year, all-expense-paid scholarship to one of the Big Ten schools that is recognizable by a single letter on a T-shirt. The kid who turned down twelve other schools because they didn't offer Conversational Arabic, didn't graduate one Secretary of State and discrim-inated against accepting thirteen-year-olds in the freshman class. I have the kid who, sometime during the last two weeks of August, rolls out of bed and announces, "Hey, college starts in another two or three weeks, I'd better get it on." After polite but firm refusals from Harvard, Yale, Duke and Dartmouth, they work their way across the country . . . Ohio State, Missouri, Colorado, Tulane and San Diego. As the time gets shorter, catalogues start coming in from places I never knew existed: Alpha Frisbee College (a free car tune-up for every sixteen credit hours); Eddie's Business School of Massage and Acupuncture; Guam School of Technology for Losers. One day I picked up a catalogue from a school in Hawaii. Under "Loca-tion of Campus" were explicit directions for jumping from a boat in a cork vest and swimming ashore with your luggage. "The trouble with you," I told my son, "is that you don't plan ahead. You knew you were going to graduate at least three hours before they awarded the diplomas. You should have . . ." "Don't worry, Mom. I have found a college. It's accredited, has absolutely no standards whatsoever, and is small enough to give individual attention." "When do classes begin?" 142 THE ANN LANDERS ENCYCLOPEDIA "Whenever I get there." "Is it in the Free World?" "Let me just say that it accepts five major credit cards." I don't mind wearing a T-shirt with a big D on it, but I feel like a fool driv-ing around with a bumper sticker reading, "send doo dah to the rose bowl!" credit: Erma Bombeck, Field Newspaper Syndicate. Brain Tumors Brain tumors are abnormal masses of tissue in which the cells grow and di-vide without restraint, apparently unregulated by the mechanisms that control normal cells. Customarily, tumors are considered either benign or malignant, but in a sense all brain tumors are potentially malignant because they may lead to death if not treated. Certain tumors occur almost exclusively during childhood and adolescence, whereas others are predominantly tumors of adult life. The age of the patient appears to correlate with the site where some tumors develop in the brain. Most of the primary tumors attack members of both sexes with equal fre-quency. Some, such as meningiomas (slow-growing benign tumors that may appear in many places throughout the head), occur more frequently in women; others, such as medulloblastomas (rapidly growing tumors, some of which are curable by surgery and radiation therapy), more commonly afflict boys and young men. Pathologists classify primary brain tumors into two groups: the gliomas, which invade the surrounding brain; and the non-glial tumors, which compress rather than invade the adjacent brain. Metastatic (or secondary) tumors arise when abnormal cells that have developed elsewhere in the body are carried to the brain by the blood flow. Lung cancer in men and breast cancer in women are the original sources of almost 70 percent of all brain tu-mors. By invading the neighboring structures, the tumor expands to produce in-creased pressure within the skull. Certain signs of a brain tumor reflect the pressure exerted on the brain by the tumor growth, and symptoms usually point to its location in the brain. The rate at which these symptoms progress is determined by the rate of tumor growth. Depending on the size of the tumor and the parts of the brain it affects, an THE ANN LANDERS ENCYCLOPEDIA 143 individual may suffer persistent headaches, paralysis, personality changes, loss of vision or visual hallucinations, speech difficulties, or behavioral disor-ders, at times accompanied by seizures. It is not surprising that individuals who have been confined to mental institutions occasionally turn out to harbor brain tumors. Unfortunately, symptoms of a brain tumor often mimic those of other dis-eases, causing a delay in diagnosis. Although the doctor may elicit from the patient's previous history symptoms suggesting the presence of a tumor, the diagnosis is often not suspected until it becomes apparent that, in spite of treatment, the patient's condition is becoming worse. Certain conditions resulting from head injuries also may pursue a course similar to that of brain tumors. If the patient's course leads the doctor to suspect a tumor, neurologic examination, skull X rays, an electroencephalogram (EEG), radioisotopic brain scans and a computerized tomographic (CT) scan are used to deter-mine if the patient should undergo more definitive procedures. Increased pressure has many causes and therefore does not always signify the presence of a brain tumor. Among children, certain diseases and, on very rare occasions, medical therapy for an illness can produce increased in-tracranial pressure. "Benign brain edema," which affects some adolescent and young women and also some women taking contraceptive pills, is a swelling of the brain that may produce pressure resembling that of a tumor. The patient's history, a neurologic exam and special neuroradiologic tests usually can distinguish between increased intracranial pressure caused by these other conditions and that caused by a brain tumor. The most accurate diagnosis of a brain tumor can be made by surgery that permits the neurosurgeon to see the tumor and obtain a specimen for exami-nation. However, diagnostic surgery is not without risk, and there are now several diagnostic procedures for detecting brain tumors without resorting to surgery. The CT scanner provides many X-ray views of thin sections of the brain, increasing the likelihood that a tumor can be detected at an early stage. Other diagnostic procedures may provide evidence of a brain tumor that might otherwise go undetected; these include angiography, in which con-trast material is injected into an artery, flows with the blood into the brain, and demonstrates on an X-ray picture the area where the tumor has devel-oped; and pneumoencephalography, in which air is injected into the spinal fluid that circulates around the brain and spinal cord. While CT scans have reduced the necessity for pneumography, in certain conditions, such as tu-mors around the pituitary gland, air contrast is the procedure that affords the best information. Many advances have been made in radiation therapy and chemotherapy for treating certain brain tumors, but these techniques are still of limited value. Both have side effects and, because they cannot be directed exclusively to the tumor, they have the potential to damage healthy as well as diseased tissues. Radiotherapy is used primarily for tumors that cannot be removed 144 THE ANN LANDERS ENCYCLOPEDIA completely, or for cases in which surgery involves a great risk to the patient. In general, radiation therapy and chemotherapy are used as secondary treat-ments for tumors that cannot be cured by surgery. Brain tumors that can be removed surgically lie just outside the brain or in parts of the brain that can be removed without causing significant neuro-logical damage. Because a tumor will recur if any tumor cells are left behind the surgeon's goal is to remove the total tumor whenever possible. If the loca-tion or size of the tumor, or its relationship to the blood supply within the brain, preclude a safe removal of the entire tumor, partial removal may be all that can be accomplished by surgery alone. One of the most important advances in the surgical treatment of brain tu-mors is the operating microscope, which can magnify the area to be surgically removed to many times its actual size. This instrument affords the neurosur-geon a clear view of the smallest area, and a greater precision in performing delicate operations. While the operating microscope and microsurgical techniques have afforded a greater chance that many tumors can be removed totally, most types of invasive tumors still cannot be cured by operation alone. However, using these techniques, the neurosurgeon can now approach and remove tu-mors that were formerly inoperable, and patients having certain types of tu-mors that were once considered incurable now have an excellent chance of recovery. One such case is the benign craniopharyngioma, which often at-tacks children. While this tumor was considered rarely curable by surgery only a decade ago, it now can be removed with minimal or no brain damage in many cases. Research into new methods of radiotherapy, chemotherapy, and the rela-tion of the body's immune system to tumor development is yielding new in-sights into the basis and treatment of this disease. In addition, because of new methods of diagnosis and a greater awareness of the symptoms of tumor de-velopment, people having brain tumors are being referred for proper treat-ment earlier in the course of their disease, when there is a greater chance of cure. Although brain tumors are a major cause of death, particularly among children, these diagnostic and therapeutic advances and the wide application of microsurgical techniques promise that surgeons, radiotherapists and chemotherapists may be able to control, if not cure, many more tumors at some time in the foreseeable future. credit: Charles B. Wilson, M.D., Department of Neurological Surgery, Univer- sity of California School of Medicine, San Francisco. THE ANN LANDERS ENCYCLOPEDIA 145 Breast Enlargement A SILICONE QUESTION DEAR MISS LANDERS: I'd appreci-ate it if you would tell me the names of the states where silicone shots to en-large a woman's breasts are legal. Also, will you please give me the name of a doctor who gives these shots? Thanks a lot. FLAT FAYE DEAR FLAT: There is no state in which silicone shots are legal for breast enlargement. This is a dangerous pro-cedure which can cause serious trou-ble. Silicone implants, however, are legal in every state. Sorry, I never recommend doctors. Call your County Medical Society and ask for the names of two or three plastic surgeons. Then take your pick. For many years, women who were self-conscious and felt unfeminine because of very small breasts did a variety of little tricks to camouflage their "inade-quacy." They stuffed cotton or toilet tissue into their brassieres, creating the illusion of larger breasts. Later, brassiere manufacturers produced padded bras and filler cups to slip inside the bra. While these techniques were satisfactory for some, many women longed for something more "real"-and the medical profession did indeed come up with the answer-the silicone bag enclosing a silicone gel. Following that major development, breast enlargement (augmentation) has been done in increasing numbers each year. The estimated number of breast enlargement procedures done in the United States is approximately 120,000 yearly. Confusion exists among lay persons in regard to injections of silicone to enlarge a breast and the use of a prosthesis or implant to accomplish the same effect. To date, the Food and Drug Administration has not permitted the sale or use of injectable silicone in the breast because of the pain, lumps, and a tendency of injected silicone to move around. Criminal indictments have been filed against people who have injected silicone, many of whom were not physicians. Following the major breakthrough of the development of a silicone bag en-casing a gel of silicone, variations in the type of prosthesis have evolved. To 146 THE ANN LANDERS ENCYCLOPEDIA date, no type of implant is superior. All the problems that will be noted below may occur with the use of any of the prostheses. The commonly used prostheses include one similar to that first developed but with a thinner bag encasing a gel of silicone. Another common prosthesis is a silicone bag with a valve which can be used to inflate the bag with salt water. A combination of these-an inner bag of silicone and an outer bag filled with salt water-may also be used. The implants are inserted by sur-gery. � The ideal candidate for surgery is a healthy, thin or moderately thin person who will not expect a miraculous change in her life as a result of the altera-tion in her figure. She should not be younger than eighteen and there is actu-ally no age limit on the other end of the age spectrum so long as the woman is in good health. Situations which may make breast enlargement surgery undesirable are: Prior existing breast problems such as frequent occurrences of breast cysts. The presence of scar tissue from previous biopsies. And most importantly, breasts that sag a great deal. In sagging breasts, the nipples are, of course, lower and often need to be transplanted. There is a chance that in the transplanting, the nipple may become perma-nently numb. To a younger woman, this loss of sensation can be important. In the case of an older woman, it may be of small significance. In any event, the woman should be aware of the risk. Occasionally women come in with one breast larger than the other. The surgeon can place an implant in the smaller breast, or he can place implants in both breasts, using a larger implant in the smaller one, so the result will be two breasts of the same size. Every woman who considers breast enlargement should be fully aware that the size of a woman's breasts will not change her life. It will not cause a philandering husband to stay home, nor will it attract eligible swains. No man worth having will suddenly take up with a woman because she is a 38-D cup. The ideal candidate for breast enlargement is the woman who is realistic and understands that after surgery the only thing that will change is the size of her brassiere cup. The usual change is one cup size-such as A to B, or B to C. The procedure itself may be done as an inpatient or, in increasing num-bers, as an outpatient with the basic reason being cost, to be discussed later. The surgery also may be done under general anesthesia or local anesthesia, again as an inpatient or outpatient. The risk of anesthesia is greater with gen-eral rather than local anesthesia. Several incision sites are available to the pa-tient and her surgeon. The choices basically are: in the armpit, in the pig-mented area surrounding the nipple, or in the fold beneath the breast. The most commonly used incision is the fold beneath the breast. Loss of nipple sensation may occur with any of these incisions. As in most THE ANN LANDERS ENCYCLOPEDIA 147 surgery, considerable time is spent controlling the bleeding. The implant is then put in and the wound is repaired in layers. Strap support is applied to the breast, or a brassiere is put on the patient. Most surgeons have instructed their patients to be on a limited activity regimen for ten to fourteen days after surgery avoiding the use of the shoulders for such things as lifting. The aver-age student or employed person would miss ten days of regular activity. No vigorous physical activity for six weeks is the recommendation of the major-ity of surgeons. Standard risks of all surgery are bleeding and infection. Profuse internal bleeding of the breast area may require reoperation. Infection is rare, and at worst, would cause removal of the prosthesis and eventual replacement after a few months. Rejection of a prosthesis because of allergy to silicone is ex-tremely rare. A scar is the aftermath of all surgery, but all three areas of standard incisions are favorable. Because of the development of the pocket and the stretch of the soft tissues, diminished or absent nipple sensation is thought to be a less than 1 percent risk. The rupture of a prosthesis is even more rare than this, as patients have incurred severe auto accidents, skiing injuries, etc. without that occurrence. Sagging of the breast is thought to be not increased as the weight of the prosthesis approximates that of normal breast tissue. Pain is not a significant feature of this operation. Many patients have pain medication the first day or two following surgery, and none thereafter. Most patients forget about die presence of the breast implants after a matter of weeks. The most common complication following breast implant surgery is the development of excessive firmness caused by the overdevelopment of scar by the tissue surrounding the implant. Because many of the patients are thin, this would result in a breast that is firm to touch, and to sculptors, too firm in appearance. This development usually occurs months after breast surgery. This situation can be remedied by the doctor using his hands to soften the area. This can be done with or without anesthesia depending on the threshold of pain of the patient. Breast feeding is possible after surgery because the prosthesis is placed behind the normal breast tissue and ducts. An almost unique aspect of breast enlargement surgery is that for any of these above complications, including the complication of being too large or too small or the appearance not fitting one's own body image, removal is possible. (The surgeon cuts along the same incision line and takes out the implants just as he put them in.) According to the statistics of the American Cancer Society, the incidence of breast cancer is one woman in fifteen. It is unknown if breast implant sur-gery alters that percentage risk. The insertion of prostheses does not interfere with the ability of the doctor to do a breast examination. The result of enlargement surgery is extremely gratifying to most patients. The expression of many patients after surgery is that they wish they had had the surgery several years earlier. With proper patient election, the good to ex- 148 THE ANN LANDERS ENCYCLOPEDIA cellent results estimated by the patients is about 95 percent, despite the com-plaint of excessive hardness present in 15 percent or more of the patients. The surgical fees involved may vary from $1,500 to $2,000. The outpa-tient hospital costs approximate $500, and the inpatient hospital costs ap-proximate $1,200 to $1,500. Generally the fees are higher in California and New York. The largest protesters against breast implant surgery are the women who are naturally endowed. For some reason they resent it when a "flat" sister suddenly appears with a beautiful figure. credit: Randall E. McNally, M.D., Associate Professor, Plastic Surgery, Rush- Presbyterian-St. Luke's Medical Center. A SENSITIVE SPOT