Dear Ann Landers,
y boy-friend, Buzzy, is a sweet guy, but now and then I see signs of a terrible temper. Last Friday night when we were horsing around on the floor, I got a toe-hold on him. (I learned it from watching wrestling on TV.) I think he went a little crazy, Ann. The guy actu-ally bit me on the hand. I don't mean just a nibble, I mean a real bite that broke the skin. When I saw the blood I nearly fainted. Buzzy said he was sorry-that he lost his head, and promised never to do such a thing again. I forgave him. The next day my mother saw the teethmarks and asked what happened. I was going to put the blame on Tufty (our dog), but decided I'd better tell the truth. When I told Mom Buzzy bit me she was horrified-said a human bite can be very dangerous. Is this true? So far I am O.K. Please tell me if Mom is right. NIPPED BY NICK

DEAR NIPPED,
Yes, she is right. You were lucky. Every human mouth has a good bit of bacteria. You could have gotten a bad infection. If that clown ever bites you again, wash the wound with soap and water and see a doctor promptly. Insect Bites If you are stung by a bee, promptly and carefully remove the stinger, getting root and all. For other insect bites-spiders, scorpions-or unusual reactions to other stinging insects such as bees, wasps, hornets, etc.: Do not allow the victim to walk. He should be kept quiet and inac-tive. Place cold compresses on the bite to reduce swelling. Use calamine lo-tion to relieve itching. Also, a paste made of Adolph's Meat Tenderizer ap-plied to the bite will often reduce the swelling and itching. If the victim stops breathing, use artificial respiration. Call a physician, hospital, poison control center, or rescue unit and take the victim promptly to a medical facility. Persons with known unusual reactions to insect stings should carry emergency treatment kits and an emer-gency identity card at all times. credit: Jay Arena, M.D., Chief of Pediatrics, Duke University, Durham, North Carolina, author of Safety Is No Accident; A Parents' Handbook, Durham, North Carolina: Duke University Press. Bleeding NOSEBLEEDS Nosebleeds are usually easy to control by pressure. Bend over the washbasin and blow your nose to remove all clots and blood. Immediately insert into the bleeding side of the nose a piece of cotton which has been wrapped around itself several times to make it firm. Insert the cotton with a twisting motion. Put one of your fingers against the outside of the nostril, pressing on the cotton. Hold your finger there for five to ten minutes. Do not lie on your back. In that position it is impossible to tell if your nose is still bleeding. Ei-ther sit with your face toward the ground or lie on your stomach so that you can see if your nose continues to bleed. If it persists, call a doctor. BLEEDING FROM THE EAR Following a head injury, blood or watery fluid running from an ear is a dangerous sign. If these symptoms develop, go at once to the emergency room of the nearest hospital. Never put any fluid or medicine of any kind into your ear unless directed to do so by your doctor. Cover the ear with a clean handkerchief or cloth to absorb the fluid or blood until you get medical attention. BLEEDING FROM CUTS AND SCRATCHES Bleeding from minor cuts will usually stop without first aid. However, to help clotting and prevent infection, wash the cut thoroughly with soap and water and apply a sterile and tight dressing and bandage. Do not apply a tourniquet. SEVERE EXTERNAL BLEEDING The sight of spurting or fast-flowing blood is, of course, frightening for both the person who is injured and the person who is with him. If you remember that even extremely severe bleeding (hemorrhaging) can almost always be controlled, it will be easier to stay calm. First, place a sterile compress or a clean cloth directly on the wound. Press your hand firmly on top of the cloth, directly over the wound. When applying pressure to the injury, do not let up; keep the pressure firm and steady. Con-tinue firm and unrelenting pressure for ten minutes. If the bleeding saturates the dressing, apply additional layers of cloth but do not remove the original layer of dressing. Watch for signs of shock. They are: (1) a general weakness-inability to stand; (2) cold, pale, moist skin-perspiration often appears on forehead and above the lips; the palms of the hands are likely to become clammy and wet; (3) nausea, sometimes vomiting; (4) thirst; (5) dull, vacant eyes; (6) irregular, shallow breathing; (7) weak but rapid pulse. If you believe shock is setting in, take the person to a hospital emergency room at once. INTERNAL BLEEDING Internal bleeding requires urgent medical care and must be suspected if you notice any of the following symptoms: (1) coughed-up blood; (2) vomited blood-it may be bright red or the color of coffee grounds; (3) stools that are streaked with bright red blood; (4) stools that are jetblack- the color of tar; or (5) all or most of the symptoms of shock. If any of these symptoms are present, take the person to the nearest doctor or hospital im-mediately. credit: Accident Handbook, Department of Health Education, the Children's Hospital Medical Center, Boston, Massachusetts. Blindness PROBLEMS OF THE BLIND DEAR ANN: When my blind friend asked how she could wage a campaign to educate people about problems a handicapped person must face, I told her I'd write to you. Will you help? These facts need to be known: Blind people carry a white cane with a red tip. (She is certain many people don't know this because she didn't know it until she became handi-capped. ) If you see a blind person stand-ing somewhere, looking bewildered, chances are he is lost. Ask if you can help. Generally all he needs to know is where he is. Guide dogs are allowed in areas other dogs aren't. Recently, a woman came up to my friend complaining be-cause the management had allowed her guide dog into the grocery store, "And they wouldn't let me in with my poodle. I was carrying him." Guide dogs are highly trained animals with a job to do. PLEASE DONT PET OR TALK TO THEM. THIS IS VERY IMPORTANT. The owner's life depends on the dog's con-centration. Smoke bothers many blind peo-ple. If you are going to smoke and are near a blind person, tell him. He will be glad to move. Thanks for your help. CALIFORNIA DEAR CAL: Thanks for your letter. We educated a few million people today. BLINDNESS AND VISUAL IMPAIRMENT Government estimates indicate that at least ten million (one out of twenty) Americans have a serious problem with eyesight. Fifteen percent of these people are unable to see well enough to read a newspaper. Seven percent are legally blind. While most eye problems are not life-threatening, they create stress and frustration. In fact, among chronic diseases that prevent people from leading a normal life, blindness ranks third after heart disease and arthritis. The cost of treatment and rehabilitation of the visually handicapped is staggering. The National Eye Institute reports that in 1972, direct costs of eye care (visits to ophthalmologists, eye surgery, optometric services, hospi-tal and nursing home care, etc.) came to $3.6 billion. Indirect costs (loss of earnings) added up to a whopping $5.1 billion. While a great deal of progress has been made in both the prevention and treatment of eye disorders over the past twenty years, cataracts, glaucoma, diabetes, and vascular diseases are still the major causes of blindness. This is true even though cataract surgery is one of the most successful operations performed, and glaucoma, if detected early, can be controlled. Blindness from diabetes still baffles the experts because they lack the knowledge of the fundamental processes underlying retinal function. Many eye diseases are as-sociated with the aging and since more people are living longer we must ex-pect these figures to increase. Public health and safety measures, industrial as well as school safety pro-grams have sharply curtailed the incidence of blindness due to accidents. Still, the problem of eye injuries is a major one. Since World War II, there has been a dramatic change in the composition of the blind population. This is the result of medical research zeroing in on the high death rate of newborn babies and concentrated efforts to help people live longer. Some of the best work was done at the Lighthouse, the New York Associa-tion for the Blind, 111 East 59th Street, New York, New York 10022. They pioneered a new approach for training and educating blind youngsters. This involved a team of medical and paramedical specialists and consultants who joined teachers and social workers in developing a new concept of education for the handicapped and sightless. AGENCIES SERVING THE VISUALLY IMPAIRED A wide variety of direct services to blind persons is provided in all large cities (and many smaller ones). Local voluntary agencies (usually financed through contributions by pri-vate groups or individuals and United Funds) offer a wide range of services. All states and U.S. territories have established a separate unit to help the blind. In addition to the direct services available on a local level, there are na-tional agencies, both federal and voluntary, which also offer a variety of serv-ices to the blind. The Library of Congress, through its Division for the Blind and Physically Handicapped, conducts a national program (Talking Books) to bring free reading materials to those who cannot use ordinary printed ma-terials. The Veterans Administration provides non-vocational rehabilitation services for blind veterans and members of the Armed Forces as well as dog guides for eligible blinded veterans. Some of the better-known national voluntary agencies are: The American Foundation for the Blind, 15 West 16th Street, New York, New York 10011, which serves as a national clearinghouse for information about blindness and conducts and stimulates research to determine the most effective methods of serving visually handicapped persons. The National Society for the Prevention of Blindness, Inc., 79 Madison Avenue, New York, New York 10016, which conducts educational programs and research into the prevention of blindness. Recording for the Blind, Inc., 215 East 55th Street, New York, New York 10022, which tapes and loans educational books to visually and physically handicapped students and professionals. National Industries for the Blind, 1455 Broad Street, Bloomfield, New Jer-sey 07003, which co-ordinates the production of eighty-nine associated work-shops for the blind in thirty-six states and allocates federal purchase orders among them. In the area of medical research there are such institutions as National Eye Institute of the National Institutes of Health; Eye-Bank Association of America, Inc., which supplies corneas for transplantation free of charge throughout the United States (the surgeon must be paid, however); Fight for Sight, Inc., which finances eye research; and Research to Prevent Blindness, which supports clinical and basic eye research. Dog guide schools which provide dogs to blind people who can use this mobility aid are located throughout the country. The oldest is the Seeing Eye, Inc., in Morristown, New Jersey. A number of associations of professional workers, agencies and blind peo-ple have formed consumer groups. These include the American Association of Workers for the Blind, the Association for Education of the Visually Handicapped, the American Council of the Blind, Blinded Veterans Associa-tion, National Federation of the Blind, etc. HOW TO FIND SERVICES FOR THE BLIND IN YOUR COMMUNITY Consult your local Health and Welfare Council or the United Fund, listed in the telephone directory. The American Foundation for the Blind has two publications that would be helpful: Directory of Agencies Serving the Visually Handicapped in the United States, revised and updated every two years, which contains state- by-state listings of federal, state and local services with names, addresses and telephone numbers, $6; and Where to Find Help for the Blind, a free flyer listing names, addresses and telephone numbers of all state and territo-rial agencies for the blind. credit: Mrs. Mary Jane O'Neill, Lighthouse for the Blind, New York, New York. Blood Pressure (High) Myths versus the facts: Myth: Control equals cure. Fact: Control requires daily regimen; there is no permanent cure. Myth: Hypertension is nervous tension, so pills only need be taken when the patient feels nervous. Fact: Feeling tense is not a symptom; medicine must be taken every day. Myth: Patients may select their treatment (medicine or careful diet or healthier lifestyle). Fact: Treatment requires a regular daily regimen of medication and dietary and smoking modification, depending on the individual. People who have high blood pressure must consult their doctors and get on a program of daily medication. Medicines should be taken as prescribed. As yet, high blood pressure cannot be cured, but it can be controlled. High blood pressure (hypertension) is a major public health problem in the United States atid throughout the world. About twenty-four million Americans with high blood pressure is the current estimate. It is a major cause of sickness, disability and death-among the young and middle-aged as well as the elderly. It is a disease that is easily detected, yet at the start of the seventies, sur-veys noted that about half of those with hypertension had no idea they had it. It is a treatable disease, yet at least half of the known hypertensives were found to be without any treatment. BLACK-WHITE DIFFERENCES IN HIGH BLOOD PRESSURE The toll of hypertension is not equally shared in the U.S. population. For reasons that are not understood, blacks have a much heavier burden of the disease, so that it looms as the number one health problem in the black com-munity. They have more hypertension, they develop it younger, it is more se-vere, and they die from it more frequently and at an earlier age. Controlling hypertension, once it is discovered, involves a lifetime commit-ment. But if you and your doctor work together, the prospects for controlling your blood pressure are excellent. Your faithfulness in following his advice will pay big dividends in terms of a longer and healthier life. WHAT CAUSES HIGH BLOOD PRESSURE? To pin down the cause of high blood pressure is not easy. Most people agree that the insurance companies know their business. Their fortunes have been built on actuarial record-keeping and evaluation over decades, all aimed at finding out who is more likely to die and who is a good risk for life insur-ance. They have had records of millions of people to look at, to determine what medical findings, recorded at the time people applied for their policies, were good predictors of future life expectancy. The most recent report by the Society of Actuaries compared twenty-year survival rates for persons classified according to blood pressure level when first examined at various ages. It is clear that each step upward in diastolic or systolic blood pressure means less chance for survival. If your doctor cannot find an underlying cause for your high blood pres-sure (such as kidney infection or disorders of the adrenal glands or nervous system), then you are considered to have essential hypertension. You have a lot of company. About 90 percent of people with high blood pressure have essential hypertension. While the cause of essential hypertension is unknown, certain factors-emotional stress, obesity, salt, and cigarette smoking-may aggravate blood pressure. WHY HYPERTENSION CAN BE DANGEROUS If your doctor discovered your hypertension during a regular checkup, and you felt fine when you came to see him, you may be tempted to ignore his findings. But remember that uncontrolled elevated blood pressure will harm your vital organs. High blood pressure and hypertensive heart disease cause about sixty thousand deaths annually in the United States and contribute to strokes, heart attacks and kidney failure. In untreated hypertension, the course from onset to death is about twenty years. Yet, except for elevated blood pressure readings, no warning signs or symptoms are likely to appear for the first two thirds of this time, after which failure of one or more vital organs begins. Once organ failure starts, the aver-age survival time of the untreated patient is only about six years. However, even after organ failure begins, effective treatment can add years to a patient's life. HIGH BLOOD PRESSURE AND THE HEART The heart is the organ most commonly damaged by hypertension. When blood pressure is high, the heart must expend more energy to pump the blood through the body. In response to this increased effort, the heart muscle itself increases in size and needs more oxygen and nutrients. If the blood pressure rise is uncontrolled and the strain on the heart muscle continues for a long time, the heart eventually is unable to meet the extra demands and heart fail-ure results. In some patients the burden on the heart is so great that the need for oxy-gen and nutrients to nourish the heart muscle itself cannot be met. As a re-sult, coronary insufficiency with chest pain (angina pectoris), or damage to some tissues in an area of heart muscle, or even death may occur. HIGH BLOOD PRESSURE AND THE BRAIN Brain: A cerebral vascular accident (stroke), a disruption of the brain's blood supply, may occur as a result of continued blood pressure elevation. The severe strain, which has been imposed on the arteries in the brain by persistent increased pressure within them, finally ruptures a weakened artery and produces brain hemorrhage. A stroke may also be caused by a blood clot disrupting the blood supply of the brain. Paralysis or death may follow. HIGH BLOOD PRESSURE AND THE KIDNEYS The kidneys are another prime target of hypertension. The principal site of damage is in the arterioles that supply the kidneys. Increased pressure from hypertension causes damage to these arterioles and the blood supply to the kidneys is gradually reduced. They can no longer function at full capacity. If the remaining work capacity of the kidneys is not enough to meet the needs of the body for removal of waste, kidney failure results. TREATMENT Some of your doctor's most important advice will concern drugs that con-trol hypertension. Even if your physician does not know the cause of your high blood pressure, he can recommend specific drugs that, combined with moderation in your lifestyle, can reduce your blood pressure virtually to nor-mal. A number of drugs have been developed in the last twenty years that are effective in controlling blood pressure. But remember that each patient re-sponds to the various drugs in different ways; and few drugs of any type have only one action. The drugs used in the treatment of hypertension act prima-rily to reduce blood pressure, but in some patients other actions may also be-come apparent because of individual responses to a particular agent. These other actions are called side effects. While your physician knows they are possible, he usually cannot know beforehand if you will experience any of the side effects (or how severe they might be). For these reasons your doctor needs your help to develop a drug program that is tailored specifically for you. His object is to control your hypertension with the fewest and mildest adverse reactions. You can help by taking your medication exactly as directed and reporting your reactions to your doctor. He may have to try different dose levels of one drug or combinations of several drugs at different dose levels before he finds the program that works best for you. A suitable drug program with very minimal adverse reactions is possible for most patients. If your hypertension is considered mild to moderate, your doctor may begin treatment by prescribing an oral diuretic drug. The diuretic drugs help rid the body of salt and water and appear to have other useful actions as well. Diuretic drugs have a low incidence of side effects so they are often given in conjunction with other antihypertensive drugs to help reduce the dose requirements of drugs that are more likely to cause adverse reactions in patients. Patients who are taking diuretics find that they have to urinate more fre-quently than usual. Some may also experience weakness, fatigue and gas-trointestinal irritation. The doctor will want to know about these reactions if they occur. A diuretic may be combined with reserpine, which, in addition to lowering blood pressure, has a tranquilizing effect that is sometimes desirable. But reserpine can cause an undesirable depression in some patients, first notice-able as early morning insomnia. Other possible side effects include a stuffy nose, drowsiness and lethargy. Methyldopa is another drug that may be combined with a diuretic to treat hypertension. It is usually well tolerated, although a patient may notice signs of drowsiness and dryness of the mouth. These side effects rarely persist for more than three or four days. Another drug usually used in combination with other agents is hydralazine, which directly dilates the blood vessels and increases blood flow in the kid-neys while increasing the volume of blood pumped by the heart. Adverse side effects possible with this drug include headaches and rapid heartbeat. Propranolol is still another drug that has effective antihypertensive proper-ties. Originally developed for its actions on the heart, this drug now is used alone or in combination with other drugs to treat hypertension. If you have severe high blood pressure your doctor may prescribe guanethidine in addition to one or more of the less potent drugs already men-tioned. The dose level of this powerful drug must be carefully regulated be-cause as part of its action it causes orthostatic hypotension, which results in dizziness and nausea when a patient stands up. This effect can be especially troublesome in the morning when getting out of bed. Diarrhea is also a side effect of guanethidine experienced by some patients. Many other drugs useful in treating hypertension have not been mentioned. However, your doctor knows them and if he feels that they are better for your situation he will, of course, prescribe them for you. You can help your physician by following his advice and reporting the effects of the drugs you are taking. You may have to tolerate some an-noying side effects but usually these can be minimized. These discomforts are the small price paid for extra years of living because you have brought your blood pressure under control and spared vital organs from further damage. YOUR LIFESTYLE CAN MAKE A BIG DIFFERENCE Your daily living habits can aggravate your hypertension. In addition to the drugs he prescribes for you, your doctor may suggest some modifications in your lifestyle in order to bring down your blood pressure. Anxiety, frustration and anger aggravate hypertension. Your doctor knows that it is impossible for you to avoid emotional tension completely, but it is advantageous for you to avoid situations that put you under an emotional strain. Some adjustments in your way of life, perhaps in your job, may be in-dicated. A recent study showed that persons in certain occupations are four times as likely to develop high blood pressure as individuals in less stressful jobs. DIET Obesity tends to exaggerate high blood pressure. Your doctor is aware that sticking to a low-calorie diet is not always easy, but the benefits gained from having normal weight and lower blood pressure are considerable. Long before medical science had developed effective antihypertensive drugs, restriction of salt intake was a useful method of reducing high blood pressure. Since introduction of effective drugs to combat hypertension, it gen-erally is not necessary to reduce salt intake severely. Your doctor will tell you how much salt is allowable in your diet. SMOKING Cigarette smoking can elevate the blood pressure of some hypertensive pa-tients. Your doctor may suggest that you quit smoking to see if your blood pressure goes down. In most cases it will go down. If it does in your case, stop smoking at once. EXERCISE Exercise can add tone to the mind's outlook and spice to living. If exercise gives you an opportunity to act out the many internal forces that would not be released otherwise, it may be extremely valuable. Your doctor can advise you about how much exercise is appropriate. MEASURING YOUR BLOOD PRESSURE Blood pressure is the force exerted by blood against the walls of the vessels that carry it. Generally, the blood pressure in the arteries varies as the heart pumps: (1) when the heart contracts the pressure is increased (systolic pres-sure)-, (2) when the heart relaxes between contractions, the pressure is decreased (diastolic pressure). The difference between the systolic pressure and the diastolic pressure is termed the pulse pressure. A pressure measure-ment from!!�. to -.1-is usually considered within normal limits, depend- 60 90 ing on certain other factors, such as age. CAN HIGH BLOOD PRESSURE BE PREVENTED? Even though, in most cases, the causes of high blood pressure are unknown, it has been learned that certain people are more vulnerable than others. Traits found to be related to hypertension are: Family history of hypertension. High normal blood pressure in youth and young adulthood or the oc-casional "spike" of abnormal pressure in a young person who is usually nor-mal. Overweight in youth, young adulthood, or middle age, or a sizable gain in weight in the years from young adulthood into middle age. Rapid resting heart rate. In addition, three other traits-tendency to elevated blood glucose, ele-vated blood uric acid, and elevated blood cholesterol-may be associated with increased proneness to high blood pressure. All of these are in turn more likely to occur in overweight people. CONCLUSION The joy of finding, evaluating and treating over twenty million hyper-tensives is a huge and challenging one which needs doing. But the challenge should not blind us to a basic fact: in the long run, the ultimate solution of the hypertension problem is prevention, not case finding and drug treatment, as important as they are at present. It is clear that the whole program-the education of the doctor and the public, the finding of new cases, the effective treatment of elevated pressure, the reduction of other cardiovascular risk factors-needs to be developed side by side with continued research to clarify the causes of essential hyper-tension. Such an extensive program requires a system of medical care delivery that ensures every American equal access to the best care for hypertension cur-rently available. This in turn requires a commitment-especially a govern-ment commitment-to a program, to planning, to funding. The challenge of hypertension is a very great one in the country. If it is met successfully, it will be one of the biggest contributions in this century to the better health and longer life of Americans. credit: Rose Stamler, M.A., Assistant Professor, and Jeremiah Stamler, M.D., Professor and Chairman, Department of Community Health and Preventive Med-icine, Northwestern University Medical School, Chicago, Illinois. BLUSHING