The symptoms of stage two stress breakdown: loss of emotional control and failure of self-motivation indicate an urgent need for rest and sleep.

The cause of the symptoms of stage two is the run-down of the body’s inhibitory reserve, just like an automobile battery which has run flat. The body’s reserves will therefore need to be regenerated. The treatment for second stage stress breakdown symptoms will require emphasis on relief of stress, rest, extra sleep and adequate nutrition. Sleep is the most important factor in the speed of regeneration of the body’s inhibitory reserve.

The person suffering from stage two stress breakdown can be thought of as a person experiencing a functional health crisis. The proper course of action in treating someone with second stage stress breakdown, should be:

1.   The person needs to be rescued from the stressful situation by someone who can step in and arrange for the over-stressed person to be relieved of responsibilities. In most cases, the rescuer role is performed by the family doctor, who has the authority to issue sickness certificates, as well as to influence his patient to rest.

2.   The patient should go to bed, hopefully to sleep. Meals should be regular, and problems and relatives should be kept away from the over-stressed person.

3.   Drugs should be avoided for two reasons. Firstly, the patient has already demonstrated loss 0f emotional control, hence the diagnosis of second stage, people suffering from stage two stress breakdown might be more likely to take impulsive mini-overdoses, and secondly, the over-stimulation of the cerebral cortex, which results from the body’s reaction to sedative drugs, would be theoretically likely to provoke stage three stress breakdown symptoms.

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The scientists maintain that a cure for many, but not all, now incurable breast cancers soon may be realized.

That’s because several hundred incredibly courageous women are putting their lives on the line for science. They also will be doing it for the 183,000 American women stricken with breast cancer each year. The disease, which often is discovered as a lump in the breast, kills 46,000 women annually in this country.

The women volunteering to test the promising cure all have advanced breast cancer. Some already have begun to take into their systems the strongest known combination   of   anticancer   chemicals.

And, if all goes as the scientists hope, the anticancer drugs being tested by these heroic women will rout the cancer while leaving all other organs mostly unharmed. The results will be known by 1997 or 1998.

Hazel Greaves, 39, mother of two young daughters in Delray Beach, Florida, stands on the front lines of the research. “I suppose I am a guinea pig,” she says, “but I am quite happy to be one – I feel a great deal better already.”

In the summer of 1989, Mrs. Greaves had lost 25 pounds for no known reason. Severe, constant fatigue laid her low. In October, physicians told her that a quickly growing cancer was spreading in her: breast. The doctors sent her to the National Cancer Institute (NCI) in Bethesda, Maryland.

There, in twelve 3- to 4-week cycles, medical scientists dispensed high doses of four chemicals known to kill cancers. Mrs. Greaves, however, could not tolerate the doses needed to kill the cancer. Those same drugs also destroy the bone marrow – the soft tissue in the bones that makes blood. And without bone marrow, she soon would have no red blood cells, no protection against germs.

“In between cycles, at home in Florida, I injected what doctors called a growth factor serum with a small insulin-type syringe,” she says. That growth factor, found naturally in tiny amounts in blood, safeguarded Mrs. Greaves’s bone marrow. Her chemotherapy has ended; doctors have found no sign of cancer.

Dr. Andrew Dorr, senior investigator at the NCI, reports that the kind of therapy given to Mrs. Greaves also partially or completely shrank the cancers in 20 other patients with advanced breast cancer. “This is all very preliminary,” Dr. Dorr says cautiously. “But this is the direction we are going in.”

Dr. Paul A. Marks, president of Memorial Sloan-Kettering Cancer Center in New York City, says, “We don’t need statistics to know we have the real thing, at last. Still, we do have to prove it.”

Dr. Marks and I were high school classmates 45 years ago and are still friends now. I do not doubt his estimate of the future of breast cancer. He credits the latest advance to other researchers at Memorial and around the world.

, Breast Cancer.-Is a Cure in Sight? 301

In particular, Dr. Marks cites the work of Drs. Janice Gabrilove and Malcolm Moore, the Memorial scientists who first identified and purified the growth factor. Called granulocyte colony stimulating factor (G-CSF), it stimulates blood cell growth. It protected the blood system for 20 women in Dr. Dorr’s care.

The next step is being planned by Dr. Larry Norton, also of Memorial Sloan-Kettering Cancer Center. He will enroll women with high-risk cases of breast cancer in a study of granulocyte macrophage CSF. The women first will get GM-CSF and high doses of anticancer drugs. Months later, half the women will get GM-CSF and anticancer drugs. The others will get drugs but no GM-CSF.

Since this was first written, however, the game plan has changed. GM-CSF has proved to be lifesaving on its own. So, all the women will get GM-CSF. But Dr. Norton’s patients will continue as planned. Dr. Norton is testing a one-two punch against breast cancer. That means that the women will get a big dose of combination therapy (i.e., several drugs at once). This is followed up at a later time with another treatment with a combination of different drugs.

Dr. Norton’s theory is that the cancer cells that survived the first set of cancer drugs will be picked off by the second treatment. Dr. Norton told me that 82 percent of the women in this group were still alive 3 years after the one-two punch treatment.

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Do patients with RA feel pain every day?

Not after your doctor places you on therapy; however, before that- you bet! Your days and nights may be filled with pain resulting from the inflammation and bone destruction taking place in your body. “Get thee to a specialist!”

What is a rheumatoid nodule?

A rheumatoid nodule is a small, firm bump that usually appears on the tendons but can occur anywhere. They are the result of inflammation. Nodules are sometimes biopsied to make sure that they are only rheumatoid nodules, but they are rarely surgically removed. They are not malignant and rarely cause dysfunction. As a rule, they do not cause pain or infection.

Scientists generally call these nodules foreign-body reactions. They are akin to what would happen after a large splinter lodged itself in your skin. The only problem with RA is that no apparent foreign body is evident that would produce these nodules.

Not everyone with rheumatoid arthritis gets rheumatoid nodules, but when they are present they can help confirm a diagnosis of RA.

Who gets rheumatoid nodules?

About one-fifth of RA patients get rheumatoid nodules. Other people with diseases like lupus can get nodules, but this is rare.

Will they go away?

The rheumatoid nodules generally go away with treatment of the disease. In fact, they are great indicators of disease activity and good barometers of clinical response to treatment.

Is it important to start therapy early?

Absolutely! The sooner the diagnosis is made, the sooner that we can prevent the joints from getting progressively inflamed and becoming destroyed. Remember that the process of destruction in rheumatoid arthritis is quite significant. Patients have actual erosions of the bones in their hands, feet, and other joints. Consequently, the earlier the disease can be diagnosed, the earlier it can be treated.

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