European Stars and Stripes (Newspaper) - July 23, 1991, Darmstadt, Hesse                                Patients Are discovering that Medicine rarely offers Cut and dried answers. Some doctors May vote for operating while others . Deal with that Quot said or. James Halper a psychiatrist at North Shore University Hospital in new York. Quot there s something comforting about someone saying we re going to open your belly and take out this or that Quot he said. Manevitz speaking from personal experience said. Quot if there Are too Many opinions the situation can get out of control and the patient can become paralysed by the  last year he contracted Lyme disease a tick borne illness that can cause distressing neurological symptoms like numbness and paralysis. Because the proper treatment of the disease is still controversial he sought out Quot second third fourth fifth opinions. Quot at one place they a say 12 weeks of antibiotics by vein Quot he said. Quot at another they a say two weeks. At a third they a say four weeks of another Antibiotic by Mouth. As a doctor i understood that these were complicated decisions but As a patient it was very frustrating. I wanted to Trust someone. You get an angry feeling when your doctors done to have Clear . In the end he discussed the options with his regular physician and chose a longer More cautious course of treatment. Health experts say that patients differ in How much decision making Power they desire. But Mulley says that Many people Are hesitant to make medical decisions largely because they Are not Given enough information to do so. A a doctor s asking his patient whether he wants to choose his High blood pressure treatment is like a flight attendant asking me do you want to Fly this As i get on a plane Quot Mulley said. Quot of course i m going to panic and say absolutely  but if i had some flying lessons my answer might be  he said his studies suggest that when patients Are Given the necessary background they Are More inclined to make their own decisions about medical treatments from prostate surgery to High blood pressure rather than simply relying on the advice of their doctors. The video programs contain Basic information about the Side effects and Success rates of various. Treatment options As Well As interviews with patients who have chosen either the surgical or non surgical route. Quot the patients describe Oyhat its been like to have Good outcomes and bad outcomes Quot Mulley said. Quot the videos let the patient kind of live vicariously with the different  eighty five percent of the 700 men who have used the program Felt it helped them make a decision and thought that All men contemplating prostate surgery should use it he said. In Light of these results Mulley is concerned about the trend among insurers to create Quot practice guidelines Quot strict rules governing which patients should have which treatment. Quot you la be withholding the procedure from some people who would want it and giving it to others who Don to Quot he said. When Manevitz helps patients sort out these decisions he tries to clarify their priorities and work out the Best Way to achieve them. At the very least the session acknowledges to the patient that it is a difficult decision which the surgeon May have  Brook predicts that Over time doctors and patients will learn new ways to collaborate in medical decisions. A Hen i was trained we never told patients they had cancer because we were scared they would lose Hope open win cow Ancy themselves Quot he said. But then we Learned How to Tell people and it worked Fine. In the same Way we have to learn better a ways to share with patients the options and uncertainty in Medicine. I m sure once we be done that things will get  the family that smokes together by Lois Kaplan Cox news service when Shirley Graham lights up her Benson amp Hedges menthol cigarettes her daughter kayak s voice is never far behind. Quot you re killing yourself and us too Quot says the 12-year-old seventh grader from Riviera Beach Fla. Quot i m going to throw All those cigarettes in the garbage  she never does. But her pleas plague her Mother who admits her 20-year addiction is harming her body a and her family. Graham quit in april started again last month and quit again two weeks ago. Quot you want to reflect Gooc values for your children but it is so difficult if you be been smoking 20 years Quot said Graham 36, a Mother of three who works in West Palm Beach s building department. Her father died five years ago of lung cancer and emphysema from smoking. Kayak is reflecting what she Learned in her Washington elementary school health class. Children who live in households with adult smokers Are More Likely to be in worse health than. Those in smoke free Homes according to a National Center for health statistics study released last month. Quot when she smokes i leave the room because i Start to cough a kayak said. Coughing Isnit the Only health problem smokers Force on their children. The polluted indoor air causes 30 percent More lower respiratory problems in children whose parents smoke than in nonsmoking families according to the american lung association. The children of parents who smoke Are hospitalized More frequently for bronchitis and pneumonia during the first year of life compared with the children of non smokers. Secondhand smoke also causes Eye and sinus irritation. Pregnant women who smoke Are More Likely to have babies who Are underweight born prematurely die in their first year or have breathing and heart problems says a report from the . Public health service. About 25 percent of All pregnant women smoke throughout their pregnancies according to a surgeon general s report. About 30 percent of women who smoke quit when they find out they Are pregnant. Health professionals who warn parents of the risks get mixed reactions. Quot some will do anything to help their kids while others Are not willing to give it up Quot said or. Mark Stein a North Palm Beach allergist who often deals with asthmatic children. Quot first i encourage the parents to Stop. If they can to i ask them to smoke outside the Home away from the  family fights Over smoking Are virulent and often bitter. Quot in be had people Call on the verge of tears because they be been trying to get someone in their family to  said Suzanne Norton Davis program administrator for the american lung association of Southeast Florida. Quot usually there Are Small children in the House and they Don t want them to inhale the. Secondhand  when he wants to take a puff Samuel Bestjr. Locks himself in the bathroom with the window open. His Lake Park family insisted he Stop exposing thereto his smoke. His wife Everlee quit two years ago their sons Samuel Iii 8, and Christopher 4, have asthma. Quot it s upsetting to him that we Don t want him anywhere near us Quot Everlee Best said. Quot the boys say dad we can to stand the smell of  they won t go in the bathroom until its cleared of  mrs. Best quit smoking each time she became pregnant but began again a few months after each son was born. Pregnant mothers often try to quit to protect their unborn babies. But the habit can return when the Mother seeks an outlet from the burdens of daily life. Linda a 29-year-old homemaker from West Palm Beach quit smoking when she was a month pregnant with her 2-year-old son  when he was born prematurely and weighed Only 3 pounds she started smoking again. Quot it was incredibly stressful Quot said Linda who asked that her last name not be used. Quot my Job was also very stressful at the time and my husband and i were fighting a  aggravating the tension Linda s non smoking husband continually harassed her about her habit. Quot he told me i smelled like an ashtray Quot she said. Quot at first i tuned it out. Then head tear up my cigarettes. But i never smoked around the  finally Linda quit March 11 after attending a lung association support group. She still feels tempted to smoke especially after eating. Quot its not the easiest thing to quit smoking Quot she said. Quot in fact it s one of the most difficult things i be Ever  a amps gut Sichuan hear How to nag mom and dad to quit smoking Here s How the american lung association suggests children and health professionals can urge parents to quit smoking ask whether they Are interested in quitting. Ask them to set a target Date for quitting. If they Arentt ready ask them each time you see them. If they Are not ready to quit ask them to protect their children from the effects of passive smoke.  Stop smoking around thei children or remove the children from an area with smoke. Rally older children to the cause. They can Tell parents about the consequences of smoking on younger children and infants. New mothers who quit while pregnant should be reminded of the effects of passive smoke on babies. If she Wasny table to quit while pregnant Teller ils essential to do i now a tuesday july 23t 1991 the stars and stripes a Page 15