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ISD AND THE MIND: YOUR SEXUAL HISTORY AND ISD – ANNE AND PHIL’S CASE HISTORY

Your past sexual experiences also helped you discover what excites you sexually. Unfortunately, some people learn to respond to only a limited number of cues and others never learn to identify feelings of sexual desire as such.”I didn’t even know what sexual desire was until I was almost forty,” says Anne, the housewife-turned-real-estate-saleswoman whose marriage is floundering as a result of her transition from caretaker to career woman. “It took me that long to figure out that I could want sex—for myself, because I enjoyed it and it made me feel good.”Raised in a very traditional and unemotional family, Anne cannot recall either of her parents ever mentioning sex, never mind teaching her anything about it. Yet during her youth, Anne got the impression that when it came to sex, “men were in the driver’s seat. They made all the moves, all the decisions. They felt the urges and we girls put on the brakes if the boy was going too fast for us.”As Anne recalls, what girls decided was too much or too fast had nothing to do with their own sexual feelings. Determining what was “allowed” was based on beliefs and values about what was right or wrong, good or bad, too soon to try or about time to permit. “It never dawned on me that I could feel interested in sex ahead of time,” she claims.Phil, whom Anne married when she was twenty-three, was the first and only man with whom she ever had intercourse. They had sex frequently during the early years of their marriage and, until recently, made love at least twice a week. “I’ve always kind of enjoyed sex,” Anne says, and indeed, Anne was—and still is—easily aroused and usually orgasmic. Yet, until she was in her late thirties, Anne never recognized her own feelings of sexual desire. “I guess I never got a chance to”—she gropes for an explanation that turns out to be close to the truth. Because Phil’s sex drive was a bit higher than her own and since Anne always accepted his sexual invitations, her sexual needs were met before she consciously experienced them. What’s more, since the only cue to which Anne gave sexual meaning was Phil’s interest in being sexual with her, she did feel sexual desire at times, but labeled it as something else. “When I would get all flushed and feel my pulse racing while watching a movie or reading a novel, I thought I was just upset or embarrassed,” she explains.Then, several years ago Phil became preoccupied with problems in his business and was sometimes too tired or tense to have sex. Gradually, they began having sex less and less often. Anne started feeling “keyed up” and restless, as well as distanced from Phil. “I found myself thinking about sex at odd moments early in the morning, in the middle of the day, while driving the car,” she recalls. She mentioned it to a friend who chuckled and asked, “Do you mean to tell me you never felt horny before?” Anne had not. What’s more, once she did, she had to learn what to do about it, including letting Phil know when she was interested in having sex. The fact that she was still uncomfortable doing that played a supporting role in escalating their sexual desire discrepancy.As you can see, any element of your sexual history can have an impact on sexual satisfaction and desire. And as you might expect, the most damaging sexual experiences of all are traumatic ones—including incest, child molestation, rape, and other sexual assaults.*103\261\8*

REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: HIGH BLOOD PRESSURE

High blood pressure is called the “silent killer.” You can have it and not know it, because it seldom causes symptoms to warn you that there is a problem. However, it is the most common cardiovascular disease, affecting about one of every four Americans. Fifty-four percent of people older than 60 have high blood pressure. By age 70, 64 percent of all Americans have high blood pressure. High blood pressure is not a condition to take lightly, because it can damage components of the circulatory system, including blood vessels of the heart, the brain, the eyes, and the kidneys. The higher the pressure or the longer it goes undiagnosed or uncontrolled, the worse the outlook.The medical term for high blood pressure is hypertension (hyper means “high,” tension refers to the pressure inside your arteries). Hypertension killed almost 33,000 Americans in 1990 (the latest figure available) and this number does not include deaths from heart attacks and strokes caused by hypertension. The good news is that improved detection and treatment of high blood pressure have contributed to a dramatic reduction in strokes and heart attacks during the past 20 years.*252\252\8*

WOMEN AND ABORTION: EMOTIONAL ASPECTS

The emotional aftereffects of abortion have been the subject of much interest. Do women who have had abortions exhibit symptoms similar to those of posttraumatic stress syndrome? Are they forever haunted by the experience of having had an abortion?Although a variety of feelings, such as regret, guilt, sadness, relief, and happiness, are normal, no evidence has shown that having an abortion causes long-term psychological trauma for a woman. In a longitudinal study, by Russon and Dabul, of over 5,000 women who had had abortions, they found that the best predictor of a woman’s emotional well-being following an abortion was her emotional well-being prior to the abortion. Even factors such as marital status or affiliation with a religion that is strongly anti-abortion were found to have no effect on a woman’s post-abortion sense of self-esteem and well-being.A small percentage of women who have abortions experience depressive symptoms similar to postpartum blues but the vast majority expresses no regrets about their decision and state they would make the choice again if they found themselves in similar circumstances. Certainly the presence of a support network and the assistance of mental health professionals would be helpful to any woman who is struggling with the emotional aspects of the abortion decision in her own life.*16/277/5*

BACH FLOWER REMEDIES:CENTAURY REMEDY

This is a unique remedy for the imbecile, the weak-willed people who have no individuality of their own, who are easily influenced by others and are used as willing slaves to do their bidding, who are used only as door-mat. They spend all of their time in serving others, but there is no grace attached to such service, just as there is no grace attached to the service of a slave to his master. A slave cannot refuse to obey his master, and he gets something in return by way of food or some sustenance allowance.A centaury person does not get anything in return for his services and he is not bound to do the bidding of the other person, and yet he submissively works for others.He provides the cheapest labour rather free labour to the unscrupulous persons around. He does the work of his colleagues in the office, while they loitre around gossiping, while he has to carry his office-files home in the evening to finish his work. He unduly tires himself out by over-work thus doing injustice to himself, and he contributes unconsciously to an evil in the society by encouraging people to shirk their duty and waste their time. We have said, there is no grace attached to the service done by centaury person, and yet service of fellow men as a very noble ideal is an accepted fact. It is the intention behind the service, much less the actual act of service, which earns grace or condemnation. Service to be commendable has to be voluntary, for the benefit of a fellow being, without any ulterior motive, and to inculcate humility in ones’ own-self. On the touch-stone of the above qualifications, the servile bidding by unscrupulous persons executed by centaury person cannot be named service of mankind. Yet centaury type is a good person-honest, meek, yielding type, never wants confrontation and always ready to help. But he is only good to others and good for others. He does not have an individuality. He has all the mental faculties intact but because of a very weak willpower, he always says yes’ to others’ bidding. He simply cannot say ‘No’ even if he knows that the other man’s demand is unjustified and even beyond his power to meet.*61\308\8*

MEDICAL TREATMENT OF SEIZURES: CHOOSING THE BEST MEDICATION

All drugs do not work equally well for every seizure-type. Therefore it is necessary to classify the child’s seizure. For each seizure-type there are several drugs that are usually equally effective. The choice between the drugs is then made on the basis of the drug’s side effects and cost, the child’s age, and any previous drug allergies. Some medications are more effective for partial and tonic-clonic seizures, others for absence seizures. We will discuss them in those groupings and the order in which they were discovered.A large number of anticonvulsant medications are available. The following are those most commonly used.Drugs for Partial Seizures and Tonic-Clonic Seizures –  PhenobarbitalPhenobarbital is one of the oldest, cheapest, and safest of the anticonvulsants. Since phenobarbital is slowly metabolized by the body (has a long half-life), it usually can be taken only once per day. As with any drug, it can lead to occasional allergic reactions.Phenobarbital, like its two close barbiturate cousins, mephobarbital (Mebaral) and primidone (Mysoline), is effective in partial and generalized tonic-clonic seizures but ineffective in absence seizures (and, indeed, may even cause them to increase).*117\208\8*

EXERCISE FOR PEOPLE WITH TYPE II DIABETES: TYPES OF EXERCISE

•   Aerobic: Walking, biking and swimming are types of exercise that are called aerobic. These exercises help you improve your cardiovascular fitness (heart, blood vessels and lungs).•   Strength training: Weightlifting is a form of strength training. This type of exercise helps you improve your muscle fitness and will also help you fight fatigue and lower your risk for exercise-related injuries.•   Flexibility exercise: Stretching and bending activities are flexibility-improving activities. Such activities are recommended as part of the warm-up and cool-down sessions you should have before and after you do your regular exercise programme. Flexibility exercises help you develop a good range of motion in your joints and muscles.Your doctor can advise you as to what type of exercise might be good for you and what may be harmful.If your blood glucose is in poor control, your doctor may tell you to try to get the blood glucose into the normal range before you start on an exercise programme. When blood glucose is high, certain types of exercise tend to make it go even higher – the opposite effect of what happens as the result of exercise when the glucose is in the normal range.Your doctor also may suggest that you take an exercise stress test. The results of this test will help him or her prescribe specific activities that will be safe for your heart.Once you get your doctor’s okay and recommendations, the world of exercise is open to you. You can choose from a number of exercises that can help make your life better. You can choose bicycling (outdoor or stationary indoor), walking, aerobic, dancing, low-impact aerobic exercising, jogging, running, swimming, skipping, or a combination of these.The main thing to keep in mind is to choose exercises you like to do and one you feel you can do on a regular basis. You can alternate exercises – walk one day, bicycle the next – to put variety into your exercise programme. You can vary exercise by the season, doing outdoor things during the good weather months and indoor things during inclement weather.Some types of exercise are sort of solitary activities; others are group events that are social as well as physical. Jogging is solitary. Aerobic dancing is group. You need to choose how and with whom you want to exercise. Some types of exercise require investment in special equipment such as exercise machines or stationary bikes, or use of this equipment in a health club, which could involves fees. Most exercise requires the purchase of exercise clothing. You do need the right kind of shoes when you walk, jog, play tennis, or cycle. You do need loose-fitting, protective clothing for hot or cold temperatures and sun.Most exercise requires that you know the basics about firs aid. Sooner or later you will develop a muscle cramp or ache a bruise, or a strain. Learn how to treat these and when to seek professional help before you start to exercise.Most people with Type II diabetes don’t have to be concerned with exercise-related low blood glucose attacks as does a person with Type I diabetes. But if you take an oral anti-diabetes medication or inject insulin, you should be prepared for the possibility that exercise will send your blood glucose levels down and you may need to have a sugar source available to handle this emergency.*24/210/5*

WHAT IS HYPERTENSION?

Essential hypertension is a persistently elevated blood pressure – specifically, a diastolic pressure exceeding 95 millimeters of mercury – that cannot be attributed to any specific organic cause. Approximately 85 percent of all hypertension fits this definition. The other 15 percent is accounted for by various forms of secondary hypertension, which may result from:Arteriosclerosis, or “hardening of the arteries”. This ailment reduces the elasticity of affected arteries. Characteristic fatty deposits obstruct the blood flow through them. Both of these factors tend to increase arterial blood pressure. Arteriosclerosis is often responsible for elevated blood pressure in elderly people.Kidney diseases or obstructions to normal kidney blood flow. These may cause the kidney to release renin into the blood. This enzyme catalyses the formation of angiotensin from a plasma protein. A powerful blood-vessel constrictor, angiotensin is the most potent agent known for raising blood pressure.Aldosteronism. This is a hormone that promotes the retention of salt and water by the kidneys and thus tends to expand plasma volume. Excessive secretion of this hormone may cause an increase in blood pressure.Pheochromocytoma. This is a tumor associated with the adrenal glands. It is usually benign and seldom spreads to other parts of the body. But it produces and releases into the blood large quantities of the hormones norepinephrine and epinephrine. They raise blood pressure by stimulating the heart and constricting blood vessels.Unlike essential hypertension, which can be controlled but not cured, secondary hypertension can often be cured if the underlying cause can be eliminated.
*3/151/5*

THE CAUSE OF CANCER: ANALYTICAL STUDIES

In the performance of analytical studies epidemiologists move from the demanding chores of collecting accurate information into the realms of designing studies that seek to answer important individual questions about the causes of cancer. In this area they will usually have an idea to test – a hypothesis about some possible causative factor. The focus shifts from whole nations or whole regions to a much more closely defined group of individuals. By collecting a great deal more information about a rather smaller number of people (but not so small that our conclusions might be based on pure chance), it is possible not only to demonstrate links between particular factors and particular cancers but also to look carefully to see if there are any possible alternative links which have to be considered or excluded by careful work. A number of methods of performing analytical epidemiology are recognized and are worth mentioning to give the general flavour of this sort of work: cohort studies, case-control studies and intervention or experimental studies.Intervention or Experimental Studies. These studies represent the most difficult but in many ways the most informative of all forms of analytic epidemiology.Here, two very similar groups of people are identified, often by computer-generated methods, randomly allocating people into one or other of the groups. With the consent of the people involved, one half are asked to undertake a change in their lifestyle. Perhaps a particular dietary clement may be changed for that group alone, on the theory that that dietary element may be related to cancer. The people are then studied for a long period of rime to see if there is any difference in the medical outcomes between the two groups. Since the groups of people were essentially identical at the beginning, any differences that emerge arc very likely to be linked directly to the change that was introduced for one group alone. This it precise science which can give accurate answers, but it is fraught with many human problems. The first of these is ethical. If there is a strong and genuine suspicion that the intervention may be helpful, and that only one group will benefit from it, many physicians would feel it morally wrong to perform such studies. Equally, if, as is essential in all medical research, the people involved are fully informed of the experiment being undertaken, many may feel unwilling to join. This means that accruing numbers of people into these studies may prove difficult. It is also extremely difficult to choose the right point in time at which to undertake an intervention study. If the risk factor being studied is very likely to be associated with cancer, then the ethical constraints will make at too difficult to perform the study, since no researcher will want just one group of people to benefit from an intervention study which leaves the other group exposed to a highly probable risk. If, on the other hand, the information . about the risk factor is very preliminary and perhaps weak, then there may not be sufficient reason to deploy the resources required for an intervention study in order to evaluate it fully. In a few circumstances the right point has been identified and there are currently major debates about whether intervention studies to test 9 number of other important theories are appropriate.*18\194\4*

HISTORY AND CLINICAL FEATURES OF CHRONIC HEPATITIS С: CHRONIC INFECTION

Hepatitis С virus infection becomes chronic in the majority of cases, manifested by the persistence of detectable virus in the serum. Chronic infection is usually characterized by a prolonged period in which there are no symptoms or only fatigue. No clinical features of acute disease or risk factors for infection have been found to be predictive of chronicity. Patients are often incidentally found to have elevated ALT levels on “routine” biochemical tests or a positive anti-HCV antibody result at the time of blood donation. Serum ALT levels typically fluctuate over time and may even be normal on occasion. The major complication of chronic HCV infection is progressive hepatic fibrosis leading to cirrhosis, which develops in approximately 15% to 20% of those infected with HCV.Progression of chronic liver disease is insidious in most patients. The average time from viral acquisition to the development of clinically significant hepatitis, cirrhosis, or hepatocellular carcinoma is 10 to 18 years, 21 years, and 29 years, respectively. Patients with persistently normal levels of serum ALT have a lower risk for fibrotic progression. However, a number of factors can accelerate progression to advanced liver disease, most notably alcohol consumption, co-infection with HIV or hepatitis В virus, and older age at the time of infection. In particular, excessive alcohol use has an additive effect on liver injury and can significantly promote the development of progressive liver disease. Even lower amounts may increase the risk of liver damage associated with HCV. Death from HCV typically occurs because of decompensated cirrhosis but may also be due to hepatocellular carcinoma.*80/348/5*

BDD BEHAVIOURS: TOUCHING

Rosa frequently touched her hair to make sure it was puffed up. If it didn’t feel right, she rushed to the mirror to fix it. Another woman constantly touched her face to “cool it off so it didn’t look so red. Zach frequently touched his lips, which he thought were too small, tense, and “never in the right position,” trying to make them look more relaxed and natural. He also compulsively licked them hundreds—perhaps even thousands—of times a day. “I have to lick them to check them, and so they’re not so dry and to make them look better. I try to resist, but I get more nervous and upset, and I can’t talk to people unless I lick them. But when I do it I usually feel worse, because it looks so strange, and other people must think I’m really weird.”Frequently touching the disliked body part is another form of body checking, which about half of people with BDD do. Touching may also take the form of manipulating the body part to make it look better. A nose may be pushed up to look shorter or sideways to seem less crooked. Judy frequently pressed on her eye to make it more symmetrical with her other eye. She put so much pressure on it that she gave herself a black eye.Touching, like mirror checking and many other BDD behaviors, can actually fuel the obsession and is best avoided. One woman said, “Touching my face confirms that the defect is there and I feel worse, so I try not to do it.” Sometimes it’s a trigger for skin picking. Touching often increases emotional distress and may lead to more time-consuming and futile attempts to remove or improve the flaw.*115\204\8*