Childbirth is possible for a woman with spinal cord injury at any level. Healthy babies have even been born to women who were injured during their pregnancy. If you are emotionally ready to have a child and have considered the physical aspects of parenting, being pregnant and becoming a mother should be an exciting and fulfilling experience.You need to consider several potential complications of pregnancy, however, if you have a spinal cord injury. Pressure sores may occur more often during pregnancy because of increased body weight or anemia, and you need to do more frequent weight shifting or pressure releases. Urinary tract infection is more likely during pregnancy, but can generally be managed with antibiotic treatment. An increased risk of autonomic dysreflexia occurs as the pregnancy progresses. This can be caused by sexual activity, and it may be advisable to avoid sexual intercourse after the seventh month to reduce the risk of complications.The risk of autonomic dysreflexia increases during labor and requires close medical supervision. Other complications include the possibility of early delivery or the inability to feel contractions that indicate the start of labor. These problems can be managed by frequent medical checkups after the thirty-second week of pregnancy. Once dilation has begun, hospitalization and bed rest are usually advisable so the course of the labor can be closely monitored. Delivery may be vaginal or by cesarean section, depending on the individual needs of mother and baby. Episiotomy (surgical incision of the vulva to assist with delivery) may or may not be necessary. Finding an obstetrician, who has some experience with spinal cord injury, or coordinating care between your obstetrician and physiatrist, is the best way to ensure a healthy pregnancy and delivery.Breast-feeding your newborn may be possible, perhaps with some help in positioning. Consult with your doctor or a nurse lactation specialist if you want to breast-feed your baby. Keep in mind, too, that breast-feeding is not essential for the well-being of your child, and you and your infant can form a strong emotional bond through bottle-feeding, snuggling, and other forms of nurturing and closeness.
There are several therapeutic options that can help relieve the symptoms of narcolepsy. Such stimulant drugs as methylpheni-date (brand name Ritalin) or pemoline (Cylert) may help relieve feelings of drowsiness. Tricyclic antidepressants (such as protriptyline and imipramine) can alleviate cataplexy. It may be months, however, before the positive effects of drug therapy are fully experienced. Sometimes, unlike epileptic seizures, narcoleptic attacks can be arrested by stimulating the victim through talking or gentle shaking. In many cases maintaining a regular sleep-wake schedule and arranging periodic naps can help minimize the number of daytime attacks. Supportive counseling can work wonders in helping narcoleptics adjust to their situation, especially if situational depression is present. However, as I mentioned, many forms of psychotherapy, such as drug management for depression, are obviously inappropriate, since they do not address the cause of narcolepsy.*154\226\8*
Risk factors, as they pertain to coronary artery disease, are obviously different from the coronary artery disease itself.Treating or correcting a risk factor does not cure coronary artery disease; rather, it helps prevent it from occurring. Thus, modifying your risk factors can be thought of as preventive maintenance. Taking steps to reduce your risk factors before coronary artery disease develops is called primary prevention.Although improved treatments for heart disease are saving more lives, about half of all deaths occur before there is time to start treatment. Thus, treatment, no matter how sophisticated it may become, is not the ideal solution for reducing deaths from heart disease. Preventing heart attacks by reducing or eliminating risk factors undoubtedly can save lives.SECONDARY PREVENTION. What if you already have coronary artery disease and are experiencing angina or have even had a heart attack? Evidence shows that you can still reduce your chances of further complications if you reduce your risk factors. Secondary prevention is the attempt to reduce risk factors after you have documented coronary artery disease or a heart attack.When you treat risk factors aggressively, atherosclerosis can actually improve. By giving up smoking, exercising regularly, and developing healthful eating, living, and working habits, you can diminish the effects of existing cardiovascular disease.Cardiovascular rehabilitation programs after heart attacks are an example of secondary prevention. They try to help you reduce the risk of a second heart attack, compensate for the heart damage, decrease the extent of atherosclerosis, and resume as normal a lifestyle as possible.*226\252\8*
The adjuvant analgesics or co-analgesic drugs are not true analgesics in the pharmacological sense but may contribute substantially to pain relief when used either alone or in combination with analgesics. They can have an analgesic-sparing effect and should be considered in the treatment of all types of cancer-related pain. They are of particular use for opioid-insensitive pain, including neuropathic pain. Action-Corticosteroids inhibit prostaglandin production with reduction of inflammation and oedema associated with tumour deposits. They also have a central action, evidenced by their effect on mood and appetite. In patients with lymphoproliferative disorders, and a few with breast and prostate cancers, there is also an antitumour effect. Indications-Corticosteroids are particularly useful for pain related to raised intracranial pressure, extradural spinal cord compression and tumour compression and invasion of nerve roots or individual peripheral nerves. Corticosteroids are effective in treating the pain of bone metastases and that due to capsular stretching by metastases in the liver and other viscera. Pain associated with vena caval obstruction and lymphoedema may be reduced by the use of corticosteroids. The generalised bone and endosteal pain associated with haematological malignancies, as well as the pain related to hepato-splenomegaly or lymphadenopathy, frequently respond to corticosteroids. Contraindications-There are no absolute contraindications to corticosteroid therapy, but the presence or severity of some side effects may limit the dose. Preparations-The commonly used corticosteroid preparations are prednisolone, dexamethasone and hydrocortisone. Choice of preparation-If parenteral therapy is required, dexamethasone is cheaper than hydrocortisone and has less mineralocorticoid side effects. If continued oral therapy is anticipated, especially at moderate or high dosage, dexamethasone is preferable to prednisolone because of the lesser mineralocorticoid effects. Dose-Acute neurological problems, including spinal cord compression and raised intracranial pressure, are treated with dexamethasone 16-24 mg/day. The dose is weaned as soon as clinically feasible. For other indications, dexamethasone 2-4 mg/d or prednisolone 15-30 mg/d are frequently effective; however treatment can be initiated at a higher dose, in order not to miss a treatment effect, and the dose then weaned. At such time as patients taking corticosteroids lose the ability to swallow, consideration can be given as to the need to continue treatment. Dexamethasone can be mixed with morphine for SC infusion providing this is done at body temperature and not room temperature; others recommend dexamethasone be given as a separate infusion. Side effects-The side effects of corticosteroids relate to both the dose employed and the duration of treatment. For patients with cancer, the clinical importance of these side effects depends on their life expectancy. Patients taking corticosteroids for more than a few weeks will develop a Cushingoid facies and body habitus, to some degree, depending on the dose. Oropharyngeal candidiasis is common. Dyspepsia occurs relatively frequently, particularly in patients also receiving aspirin or NSAID, and treatment with antacids, an H2-receptor antagonist or misoprostol may be considered. There may be subjective improvement in muscle strength, which is often transient. Chronic administration of corticosteroids leads to proximal myopathy and weakness which can be debilitating. The production or aggravation of diabetes may require therapy. Fluid retention and oedema may occur with high doses. Abrupt withdrawal of steroids can produce hypoadrenalism and some patients suffer severe arthralgia. The neuropsychological side effects of corticosteroids are variable. There is frequently an improved sense of well-being, although many patients suffer insomnia. Less frequently, patients develop more serious side effects including frank psychosis.*59\55\2*
Stage OneNote: this is a clean-up diet rather than an elimination diet for allergies, but in fact some people have found that after cleansing the bowel, if they combine foods carefully they can tolerate foods which had previously caused trouble. Also note you are not going to feel good initially, in fact as you detoxify you could feel tired and heavy-limbed. Some people experience a furred tongue, nausea and joint pains. This is why cleaning out in stages has been suggested. Try to stay with it; the feelings pass in a few days and remember the worse you feel the cleaner you are becoming inside.Getting StartedThink about what you are putting in your mouth; has it been messed about? Does it contain chemicals? What has been lost in the processing? How is it packaged? Do you really want to eat dyes, or munch snacks covered with large quantities of salt to conceal the fact that they have been cooked in rancid fat? Your body is just not built to cope with this.GIVE UP:1 Regular consumption of junk foods2 All dairy products (except live yogurt), even for a month; these are the main cause of allergic problems in infants and adults so it makes sense to start here.This request usually brings cries of protest, ‘But how can I live without cheese or milk’ – you can, and you will be surprised how quickly the desire for these foods will go. You could substitute goat’s or sheep’s milk, yogurt and cheese. Some people use soya milk for drinking, cooking and making yogurt.CUT DOWN:3 Tea, coffee, chocolate and all soft drinks (see page 38).4 Alcohol. Make sure you eat fruit or drink fruit juice at the time you would normally have an alcoholic drink.Increase ‘Dredger Food’1 Wholegrains: oats, brown rice, barley, millet, rye2 Pulses: lentils, beans, peas3 Fruit and vegetables including sea vegetables (sounds better than seaweed)4 Fish, olive oil, sunflower oil5 Nuts (not peanuts) and seeds6 Take water, fruit juice, herb teas or coffee substitute at some of your tea breaks.Stage TwoYou might be ready for this after a week but if you are still struggling continue stage one for another week.CUT DOWN:1 Meat, eggs, and poultry2 Tea, coffee, soft drinks and alcohol more than in stage one.Increase Whole Clean FoodsMore vegetables, fruit, grains as in stage one.Stage ThreeOn paper this is going to look depressing, but when you are up to stage three you should be used to being deprived. (Although hearty bowls of lentil and vegetable soup, or baked potatoes with nut butter or yogurt and herbs, curried vegetables and rice or pasta tossed in olive oil with garlic mushrooms and tomatoes is not exactly starvation rations, is it?)EAT ONLY:Whole grains, vegetables, sea vegetables, fruit: fresh or dried, nuts, seeds, olive oil or sunflower oil, or products made from any of these if they do not contain additives.DRINK:Water, bottled or fdtered if possible, fruit juices preferably diluted, bancha tea, herb teas, coffee substitutes or, if you cannot make it without, one cup of weak tea or fdtered coffee per day.Your Hard Work Will Be RewardedBy now you might be ready to rush out for fish and chips to settle your nerves – don’t despair and think what you will gain:1 The bowel will work more efficiently, the absorption sites will be cleared, enzyme production will increase and as a result your bowel should be less irritable.2 Because you have eaten less concentrated protein you will have been eating better combinations of foods. Also your kidneys and liver will have been rested.3 Because of reducing your sugar intake your pancreas will be less strained and your blood sugar levels should be more stable.4 You will probably have lost some excess weight or puffmess.5 You will look healthier.*55\326\8*
The skin test reactions are graded from 0, 1, 2, 3, and 4 + depending upon the degree of swelling and redness produced, and are compared against control test site. The larger the size of the weal or the lump, (the positive reaction) the greater is the tendency to allergic reaction. A positive reaction of significance must be correlated with the clinical history of the patient.Negative reactions normally indicate the absence of antibody against the allergen tested, but sometimes the use of inadequate, weak or deteriorated extracts can also account for the negative reaction.A positive test may not necessarily mean that the child has symptoms at the time of testing, as skin tests may be positive years before symptoms begin and remain positive long after allergy symptoms subside.Skin tests are helpful in identifying an allergy to inhaled substances such as house dust mites, moulds, pollen, or animal saliva and dander. These tests are an accurate way of determining the presence of allergies and totally safe when carried out under the supervision of a doctor specialising in allergies.*52\260\8*
For clear conception of WEAKNESS Remedies remember:1. CENTAURY for weakness of will power; tires himself out doing others bidding with no strength left in the body to counter after-effects following recovery from ailments.2. OLIVE for physical weakness – inability to do physical work due to weakness or getting tired soon.3. HORN BEAM for mental weakness – feels unable to do the work without starting it, but can accomplish it after starting it.4. ELM for occasional feeling of inadequacy by very capable personsCase No.l : Manjit Singh was laid up with fever for 2 weeks. After the fever left him he was very weak, and could not get rid of the cough by allopathic treatment.Centaury given T.D.S for one week rid his system of both—weakness and cough.Case No.2 : The life of Mr. K.C. Roy resembled that of a door and mat lying outside a drawing room. Any body could step on it, a pass on without ever thinking of its pitiable condition. Anybody could use him for his personal ends. He was too weak-willed to protest or to say ‘No’ to others’ demands even if they were quite unjustified. He did not have time to think of ameliorating his own condition, as he was kept busy providing free service to others. He desperately needed physical and mental rest from overwork to recuperate his overstrained system. But selfish people would continue asking him to do some odd work, and he could not refuse.Result: Breakdown of health, weakness and jaundice when he was advised rest, he meekly asked ‘who would allow me to rest’.”Do you mean to say, anybody forces to do his work”?”No sir, I cannot say “no’ to anybody”.”Centaury” remedy for his weakness of will and “Olive’ for his physical weakness were prescribed T.D.S. He recovered with the above treatment in 4 weeks time. “Olive’ was then discontinued, and “Centaury’ alone was continued for another month to invigorate his will power. He was a changed man after this treatment, having inculcated in him the positive centaury qualities. His well-wishers were agreeably surprised at this metamorphosis. The self-seekers were dismayed.*65\308\8*
“Once you marry a woman, it’s the ball and chain for you!”"All women want is to tell men what to do until they have no mind of their own left.”"When you make a commitment to a woman, forget about your freedom—it’s history.”Here we have one of the most notorious of the seven myths about women, the one men grumble about when they’re together, the one they intone as the reason they’re not in a committed relationship, the one they use to explain their resistance to going along with what their partner wants. Women just want to enslave men, this myth says. Slowly, bit by bit, women will try to take away a man’s freedom until he is groveling at her feet. Naturally, this horrible fate must be avoided at all costs. How? By not giving in to her and her requests.You can hear the echoes of this myth in the kinds of statements men say to each other in commenting on their relationships with women:”She has you wrapped around her finger, buddy.”"Brother, you are whipped. That woman has her way with you.”"He can’t agree to go with us until he gets permission from his ‘boss,’ I mean his wife, isn’t that right?”All of these remarks send one message to men: If you aren’t careful, your woman will take away your freedom and you will end up weak and powerless.
How do men feel women try to rob them of their freedom? We want men to spend time with us. We want them to talk about their feelings. We want them to let us know they need us. We want them to communicate with us about their schedule and their plans. We want them to show us they love us. We want them to include us in their important decisions. We want them to receive our support and input. We want them to work on staying close and connected.What do all of these requests add up to? Are they tactics women use to manipulate the man we love? Are they secret methods for emasculating him? Are they sinister techniques for making him our slave? NO! They are simply the ways women want men to help us create a committed, intimate relationship.Myth: Women want to rob men of their freedom. Truth: Women want to create a committed, intimate relationship.Here’s the problem: Men often misinterpret a woman’s normal—and I believe reasonable—requests for participation in the relationship as her attempt to rob him of his freedom. They feel that in giving in to their mate on just about anything, even if it’s something as simple as agreeing to call her when he arrives at a destination, or talking about a topic she brings up, or implementing an idea she has, he will somehow be losing his independence. This fear of relinquishing his freedom and his consequential reactivity to her efforts sets up an adversarial and unhealthy dynamic in the relationship:What Women Want Men to Know:When a man has a big issue with proving to himself that he is free, every interaction with his mate becomes a power struggle in which he feels he must come out on top.It’s Sunday morning, and Patty and her husband, Matt, are lying in bed. “What do you want to do today, honey?” Patty asks.”I don’t know, let’s see how the day unfolds,” Matt answers.”But it’s already ten o’clock, Matt, and we agreed that this weekend we’d look for paint colors for the bathroom and check out the sale at the electronics store to see if we can pick up a new fax machine.”"I know how it works,” Matt replies sarcastically. “It starts with a few errands, and before I know it, you’re dragging me into a dozen stores and my day is shot.”"Gee, Matt, all I wanted was to do a few things together, and you make it sound like I’m kidnapping you or something,” Patty says in a hurt voice.”Well, that’s how it feels, like I’m a hostage in my own car, like I’m trapped into a day I didn’t choose.”The conversation ends, and Patty is frustrated and confused. She can’t understand why it’s so difficult for her husband to agree to a simple plan, and why he becomes so resistant to any little request she makes. And how is Matt feeling? He feels successful that he “won,” that he didn’t give in to Patty. Ironically, he actually did want to buy paint and check out the fax machine, but a part of him couldn’t say “yes” to his wife without feeling he would lose something in the process—his sense of freedom.
This is a perfect example of how Myth creates power struggles in relationships. For a man who buys into this myth, even the most insignificant interaction becomes about guarding against what he perceives as threats to his freedom, rather than about cooperating with the woman he loves. When his wife asks him a question, he feels he will lose his freedom if he answers on the spot. When she suggests an idea for how he can handle a situation, he feels he’ll lose his freedom if he goes along with her suggestion. When she tries to make plans, he feels he’ll lose his freedom if he commits.In deference to the women reading this section, we need to stop for a moment and answer the question that’s burning in all of our minds: What the heck is this “freedom” men are talking about? What do they mean when they say they “need their freedom”? Freedom to do what?I’ve spent many years, both personally and professionally, trying to understand this concern for freedom that men have, and I must admit I am continually amazed at how men actually define the experience of being free in regard to their intimate relationships. Guys, as I’ve analyzed it, I’ve come to the conclusion that when you say you want to maintain your freedom, you mean the following:Freedom not to have to answer to your partnerFreedom not to have to explain yourself or your behaviorFreedom not to have to be anywhere or do anything you don’t want to doFreedom not to have to talk to your mate when you aren’t in the mood to discuss anythingFreedom not to have to make plans or commitmentsFreedom not to feel obligated to take care of your woman’s needs if you don’t feel like itFreedom not to have to deal with your partner’s issuesFreedom not to have to explain why you need so much freedom
I must confess that when I read this list, I feel like saying to men: “You want all of those freedoms? Fine—then go be alone! You can have all the freedom you want by yourself.” All right, so I’m reacting a little dramatically, but isn’t that what this list amounts to—a description of being single? When you’re not in a relationship, you don’t have to answer to anyone or do anything you don’t want to do, or make plans, or deal with another person’s needs. But when you fall in love, you trade some of these “freedoms” for the joy of sharing your life with another human being. It’s the price you pay for the gift of love.This is what perplexes women about men: You want to be with us and love us and have us love you, but you don’t want to feel obligated to do anything that would take away your freedom. My answer to this is that the kind of freedom some men are so terrified of losing is really an illusion, a freedom they never had in the first place.In this same way, the moment you enter into an intimate relationship with another person, you are relinquishing a certain amount of your freedom. From that point on, someone else is going to react to what you say and do, have expectations of you, need things from you, project her issues onto you, and affect you with her moods, energies, personality, and desires. That’s what a relationship is—letting yourself be affected by someone else.True freedom in a relationship is not about what you get to do or not do now that you’re with someone else— it’s being free to love without fear, to receive without resistance, and to give without holding back.What happens when men believe Myth?Men use this myth as an excuse to avoid making a commitment.”Sure, I’d love to have a steady girlfriend, but I’m not the type of guy who can give up my freedom, know what I mean?”"When I realized Sue wanted to get married, I broke off the relationship. She was trying to chain me, and I’m the kind of guy who needs a lot of space and freedom.”In spite of what these men are saying, it’s not losing their freedom that they’re afraid of—it’s making a commitment to an intimate relationship. Committing to love another person is scary. You open yourself up to being hurt, to being rejected, to the possibility of loss. For some men, the fear of this kind of pain is so strong that they avoid getting too close or making a commitment to a woman. However, they’re not about to say, “Look, I’m terrified of commitment, so I can’t open my heart to you,” or “My last girlfriend cheated on me, and I’m too scared to trust love again.” These sentiments would make them appear weak and not in control—and this wouldn’t be very manly! Instead, they use Myth #7 as an excuse: “I’d love to be with a woman if I could find one who wouldn’t try to take away my freedom,” they insist. In other words, the reason they aren’t in a committed relationship is because all the women they meet are too demanding and controlling.The problem with a man who stereotypes a woman as wanting to rob him of his freedom is that he’ll overreact to even her slightest attempt to create closeness, and miss the very love that could heal his heart of the pain that caused it to close down in the first place.The Truth About MythWomen aren’t trying to rob men of anything. On the contrary, we’re trying to give you something—our love, our devotion, our loyalty. All of our efforts to communicate with you, spend time with you, be intimate with you, and work things out with you are not attempts to take away your freedom, but to create the best relationship possible.*44\289\2*
In the early 1970s, a team of researchers at Stanford University in California began tinkering with bovine (cow-based) collagen. The results were very promising and finally, in 1977, the first bovine collagen injection with the trade name Zyderm hit the market. Its approval for use in the UK followed and today it maintains a level of unrivalled popularity. Two other versions of bovine collagen. Zyderm II and Zyplast, soon followed and, depending on the patient’s needs, any of the three can be used, either exclusively or in combination.By now you’re probably asking yourself. Why from cows? First, the collagen found in cows is very similar to human collagen and as a result, only an estimated 3% of the population is allergic to it. Before any treatment, a series of skin tests paced over a four-week period usually rule out the possibility of an allergic reaction, but even so, it’s been found that 1 in 1.000 patients will experience the redness and swelling at the site of the injection associated with an allergic reaction. Fortunately, the reaction always clears up on its own and doesn’t’ affect your general health. Secondly, and perhaps most importantly, bovine collagen delivers an extremely natural result that so far has proven difficult to replicate with a synthetic substance or even a human one.*59\82\8*
Many fears do not hold up in the cold light of reality. If you fear sickness, find out which symptoms you should see your doctor about and which you should ignore. “I found out what’s what,” said Alan, “and now I don’t worry about every little cough.” If you fear medications, tests, and procedures, educate yourself about them. Read what you can find, ask your doctor, ask people who have had the experience. Learn about drugs like AZT and their side effects. Talk to someone who’s had a bronchoscopy, who’s gone through a scanner, who’s had a lumbar puncture. The fear of such things is often much worse than the things themselves. If you fear dying, talk to a therapist or pastor or other people in your situation or someone you love. Death, whether your own or that of someone you are caring for, seems like a dark thing we cannot talk about. Talking makes the unknown much less frightening. Talk as openly as you can. If you fear rejection and desertion, find out if those you love will in fact stand by you. Try saying, “This is what will happen to me. Can you deal with that?” As it turns out, people are rarely completely abandoned by the people they love. “I know,” said Dean, “that given my resources in life, which are my relatives, I will always have a roof. That’s helped me with anxiety.” Steven said that he quit being afraid when his cousin said she’d come stay with him. Sometimes those people you love cannot offer unqualified support. In that case, you and they will need to negotiate what they feel able to give. People usually know and can be specific about what they can and cannot provide. If you fear what the disease might do to you, ask your doctor, hospital mental health professional, or other people with HIV infection. During a stay in the hospital, Dean roomed with a man who was dying and, like June, Dean was full of fears for the future: “My roommate in the hospital was dying. I asked him lots of specific questions. I asked him, Could he care for himself? He told me that when he got too tired to follow a routine, he didn’t. I wondered, Was he lucid? I found out that things didn’t get bad for him until right before. He was religious—so am I—and that was reassuring to me. His lover was very attentive, and that was reassuring, too.” If you are a caregiver afraid of contagion, inform yourself about how to take the precautions that avoid infection—June said she had “learned to be precautious”. While you are doing this, try not to communicate your fear to the person you are caring for. Make that person feel you are comfortable being around him or her. Put the fear into perspective. Alan said, “I went to a therapist for a while. Then I had a big gigantic turning point. I was taking a shower and realized that all my problems were coming from the fear itself. Fear was creating all the problems, even the fear. Realizing that made the fear dissipate in a gush. Of course, it came back again, but it kept going away again too.”