HIV: ON DYING-DEATHBecause we have to, we accept the conditions of mortality: having means losing, being here means leaving. Seneca, a Roman philosopher, wrote to his old friend Lucilius, in Moral Letters to Lucilius: “You will die, not because you are ill, but because you are alive.” The idea, though people have known it forever, always comes as a surprise. We want life never to end; we want those we love never to die. But we have never been able to have everything we want. The fact that we want what we cannot have is only a fact, not a surprise, not cause for despair. Sooner or later, we find ways to accept it. Dean’s way is to think about his friends’ future: “Each person who has fought this disease does it with his own weapons. When the people die, they leave their weapons behind. When I die, my friends are going to pick up my weapons.” Like Dean, people who are dying are often calm and talk quietly about death and their lives. For the caregiver, this hurts badly. Caregivers want to resist the pain by trying to keep the dying person alive as long as possible. Lisa said, “I was fighting to keep my husband alive. I just didn’t want to give up. He said to me, ‘Don’t you know. Lisa, it’s just one sickness after another.’ I said, ‘Never mind. Just keep fighting.’ ” After a time, caregivers become a little better used to the death, and know they must let go. Lisa said, “I stopped fighting about two weeks before he died. I finally let him go, said to myself if he had to die, that would be okay. I didn’t want him to die. But I would not cling to him.” At the end, people who are dying should be able to have with them the people they love. People who love someone who is dying should be able to be with that person. Lisa sat with her husband while he was dying: “I held his hands and talked to him. I think he could hear, even though he seemed unconscious. I told him who I was and that I wouldn’t leave. I just kept talking. I said, ‘I love you. I don’t want you to suffer any more. I’ll take care of the kids. It’ll be fine. Let go if you want.’ I did all I could. I think I helped him die.” People tell those who are dying, “I won’t leave you. If I go away, I’ll come back soon.” They say prayers. They read aloud, often the holy books of their religions. Some sing: a woman June knew sang gospel songs to her son while he died. Some, like Lisa, just talk, lovingly and reassuringly. When they find nothing to say, they sit quietly. Most importantly, they hold, touch, caress, hold hands. For both the dying and those left behind, the physical presence of another person eases loss and loneliness. One hospital clergyman said that at death, the physical presence of another person amounts to a sacrament. Maybe death is not so bad. We know so little about it. Why should it be worse than sleep? Socrates, a Greek philosopher who lived in the fifth century B.C., was ordered by the leaders of his state to kill himself for insubordination. Socrates acquiesced, and he died after drinking poison. Before he died, he talked about death: “Perhaps death is something indifferent, perhaps desirable. It is likely, however, that if it is a transmigration from one place to another, it is an improvement to go and live with so many great persons who have passed on and to be exempt from having any more to do with unjust and corrupt judges. “If it is an annihilation of our being,” Socrates continued, “it is still an improvement to enter upon a long and peaceful night. We feel nothing sweeter in life than a deep and tranquil rest and sleep, without dreams.”*227\191\2*
WHAT IS THE EVENING PRIMROSE?
In its natural habitat, the evening primrose is an unassuming little plant with pretty yellow flowers which likes to grow wild along waysides. It’s happiest in sand dunes, along railway sidings, waste sites, and country roadsides. And although you can still easily spot the evening primrose in its natural state, there are now whole fields of it being grown by farmers as a cash crop. For it is from this crop that the millions of tiny seeds which make the precious oil are harvested.Strictly speaking, the evening primrose is not a primrose at all. It is related to the rose bay willow herb family, and to the popular garden flowers clarkia and godetia.It acquired its name because its bright yellow flowers look like the colour of real primroses, and because its flowers open in the evening. It has the curious habit of blooming between 6 and 7 o’clock in the evening, when eight or ten of the largest fragrant flowers can burst open every minute. The flower usually lasts for the whole of the next day, particularly in dull weather, but in bright sunlight the flowers fade quite quickly. In England, the plant flowers from the end of June to mid August.Experts who classify plants (taxonomists) will tell you that the evening primrose belongs to the order Myrtiflorae, family Onagraceae, genus Oenotherae. The generic name comes from the Greek oinos (wine) and thera (hunt). According to herbals, this described a plant – probably a willow herb – which gave one a relish for wine if the roots were eaten. Another interpretation is that the plant dispelled the ill effects of wine, and this fits in better with modern research. Herbals describe the evening primrose as being astringent and sedative, and the oil helpful in treating gastro-intestinal disorders, asthma, whooping cough, female complaints, and wound healing.
ARTHRITIS: LEARNING ABOUT DISEASEThe Greek word for “joint” is arthro, and itis means “inflammation”- hence arthritis. Although the disease takes many forms, in general it causes aching pain, stiffness, swelling, and often limitation of movement of one or more joints. Inflammation or erosion (or both) of the joints’ inner structures, the ligaments that surround them, and nearby tendons and muscles creates the discomfort.Arthritis primarily attacks synovial joints; these are the joints that have closed bursal sacs (also the sites of bursitis in other parts of the body) in which movement of the adjacent bones occurs. The fluid inside the bursal sac is called synovia, or synovial fluid. As a joint is developing, two or more parts of the wall of the bursa become cartilage prior to birth, and in time these areas of cartilage become attached to the bones that come together (articulate) in the joint. The strands of fibrous tissue in the outer wall of the bursal sac blend with the fibrous tissue (periostium) that covers the outer surfaces of the bones, and the connective-tissue capsule of the joint is formed. Additional bands of connective tissue are formed in this area, and they are the ligaments that reinforce the joint-capsule wall and also help keep the ends of the articulating bones in position.The following simplified drawings show some details of the development and structure of a typical joint. Look at them for a few minutes and it will be easier for you to understand the changes that occur in arthritis.Arthritis can be excruciatingly painful. The usual prognosis is that it will become progressively worse. Patients often develop crippling deformities resulting in more and more severe limitations on bodily movement. And the frequent accompaniments of the disease – headache (often migraine), colitis, asthma, restlessness, fatigue, and depression, among others – bring additional discomfort to its sufferers. But the term arthritis encompasses several different disorders, which share many but not all symptoms.*2/295/5*
WHY DO SEIZURES OCCUR? WE DON’T REALLY KNOW WHY A SEIZURE OCCURSThe truth is that we don’t really know why a seizure occurs. We understand much about how the brain works and what a seizure is, how it happens, but not always why. We can explain how single cells fire, how they communicate with other cells, and a lot about the chemical and electrical makeup of neurons. We know that a cell’s function is affected by its chemical environment. We know, for example, that oxygen and glucose (sugar) are required to keep neurons healthy and working; with insufficient oxygen or glucose cells may fire abnormally and cause a seizure. Lack of blood supply to a part of the brain, such as after a stroke, can cause seizures by reducing the oxygen and chemicals necessary to keep these nerve cells functioning normally. Significant changes in important body chemicals such as calcium and magnesium can cause seizures; so can a lack of certain vitamins. These chemical changes may provoke a disturbance in the brain, or a single seizure, by influencing the threshold for firing, but they rarely cause epilepsy.A high fever, a blow to the head, or an infection of the brain such as meningitis or encephalitis, can provoke an isolated seizure by causing sufficient disruption of surrounding cells. But most seizures are the result of the interaction between the fiery speaker and the crowd, between the provocation to the brain and the surrounding neurons.*13\208\8*
DIET FOR DIABETES MELLITUSMedical nutrition therapy for diabetes requires the application of nutritional, medical and behaviour sciences. This can be accomplished using a four-pronged approach. The first step is a comprehensive nutrition assessment that includes metabolic, nutrition and lifestyle parameters. The second step is setting goals with the patient and these goals must be practical, achievable and acceptable for the patient with diabetes. The third step, nutrition intervention, must incorporate a variety of meal planning and nutrition education resources that the patients can easily understand and use. The fourth step is evaluation, which reassesses how the goals have been accomplished and indicates area for future self-management education. The goals of diet therapy are:1. To maintain and prolong a healthy, productive and a satisfying life.2. To improve health through optimum nutrition.3. To provide calories for reasonable body weight, normal growth and development.4. To maintain glycemic control.5. To achieve optimal blood lipid levels.6. To minimize nutrition-related, chronic, degenerative complication.Adapting diet therapy to the specific needs of an individual patient is most essential; however, there are a few basic principles to be followed.The basic principles for planning diet for diabetics are:1. Age, sex, activity, height, body weight, cultural factors.2. Type of diabetes, mode of treatment, control of diabetes.3. Aggravating factors: infections, gastrointestinal disorders, cardiovascular disorders, pregnancy.Based on these factors, the primary consideration is of calorie requirements, to achieve one’s ideal body weight with a balanced wholesome meal.*1/356/5*
REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: SMOKING- WHY IS SMOKING HARMFUL?Tobacco smoke contains about 4,000 substances, and many of them, such as nicotine, tars, nitrosamines, and polycyclic aromatic hydrocarbons, are known to produce adverse effects.The main cardiovascular risk from smoking is the development of atherosclerosis in blood vessels. The mechanisms by which this occurs remain elusive, despite the clear-cut association with tobacco use. Several potential links have been identified: smoking reduces the proportion of HDL (“good”) cholesterol to LDL (“bad”) cholesterol in the blood and increases the tendency for blood to clot inside the blood vessels and obstruct blood flow. Constituents of tobacco smoke may also directly damage the internal protective lining of blood vessels (endothelium).Inhaling cigarette smoke also produces several temporary adverse effects on your heart and blood vessels, and these may provoke serious consequences such as heart attacks. The nicotine in the smoke increases your blood pressure and heart rate. Carbon monoxide (a gas produced by smoking—the same gas in car exhaust that is lethal in an enclosed space) gets into your blood and reduces the amount of oxygen that your blood can carry to your heart and the rest of your body. It causes the arteries in your arms and legs to constrict.*229\252\8*
CAFFEINE AND CANCERCaffeine is the most popular drug in North America and in many other parts of the world. It is found in coffee, tea, cola beverages, and chocolate.Coffee drinking may be related to cancer of the lower urinary tract, including the bladder. Studies show that the risk for these cancers is independent of other factors like tobacco smoking, and these cancer rates are very high in persons who drink more than three cups of coffee a day. This risk is probably related to other compounds in coffee as well as caffeine.It is well known that caffeine can cause damage to genetic material and thereby potentially lead to the development of cancer by altering DNA. It also interferes with the normal repair mechanisms of DNA and other genetic material. Caffeine can act as a teratogen, which is an agent that causes mistakes in gene production leading to malformations of a fetus.Excessive coffee consumption by pregnant mothers can lead to lower infant birth weights. Pregnant women who consumed 600 milligrams or more of caffeine per day have a higher incidence of abortion and prematurity.In a study of coffee consumption in 1,130 male college graduates for nineteen to thirty-five years after graduation, it was found that those who drank five or more cups of coffee a day had a 2.8 times higher risk of developing heart disease. This study also showed coffee to be an independent risk factor for the development of heart disease.Although alcohol and caffeine are two important risk factors for cancer, the decision to consume them is yours. You can again decide about the status of your health!*78\360\2*
DIAGNOSING RHEUMATOID ARTHRITIS: PHYSICAL EXAMINATIONAfter the clinical history is taken, the physician will perform a physical examination. Your physician will examine all of your joints, looking for evidence of tenderness, heat, swelling, and decreased motion. Your doctor will pay particular attention to the pattern of joint involvement because one of the distinguishing characteristics of RA is the particular pattern of joints that can be affected. Often the physician will perform a complete physical examination (including taking your blood pressure; feeling your glands; examining your eyes, ears, nose, throat, and skin; listening to your heart and lungs; examining your abdomen; and checking your reflexes and muscle strength) to uncover clues to help him or her identify the type of arthritis you have.Sometimes, in the early stages of RA, people find the results of the physical examination frustrating because they are experiencing significant pain or stiffness in their joints, and the physician may not be able to detect outward signs of joint inflammation. In these cases the physician has to proceed on the basis of the patient’s description of the pain or stiffness he or she is experiencing. Again, the accuracy of the clinical history provided to the physician is extremely important.*16/209/5*
JUST WHAT IS PSYCHOTHERAPY?Psychotherapy is a treatment method, sometimes referred to as talking therapy, that involves a patient speaking with a therapist about his problems. The goals of psychotherapy include gaining insight and knowledge about the self and its emotional states and personal life history. The ultimate goal is to change ways of reacting to and dealing with situations that have caused trouble previously. So the goal is not just one of changing behavior, but rather of changing emotional responses, thinking patterns, and coping strategies. Behavioral change will follow on from that.As long as people have had the gift of language and have lived in communities, they have undoubtedly found it helpful to share their thoughts and worries with a person whom they trust and esteem. While a sympathetic ear and supporting friend can go a long way, people seek therapy when, in spite of such support, they are not able to change their emotional state or recurring maladaptive behaviors and when they are not able to carry out the advice that friends and advisors may give. The particular techniques used in psychotherapy and the understanding of the human mind upon which they are based have only developed over the last hundred years, starting in Europe with the work of people like Freud, Jung, and their associates.In psychotherapy, the therapist is a supportive, intent listener who tries to remain neutral toward the patient, especially in terms of opinions about actions the patient should take and in terms of morally judging the patient. In this way the therapist differs from a friend, who may have very strong opinions and may try to persuade or coerce the person to do certain things. Another important skill of the therapist is to not only listen very carefully to the patient, but to listen very carefully to her own reactions to the patient and to make sure that her interventions are in the patient’s interest only and not entangled with her own needs or desires. This is much harder for family members or friends to do, partly because their lives are necessarily entangled with the patient’s.The intent, trained listening of the therapist makes it possible for her to hear patterns, underlying issues, hidden emotions, and conflicting feelings that the patient may be unaware of and to begin to bring her observations to the patient for his own conscious examination. To have such a trained, objective, sympathetic outsider focusing all her attention on just what one is experiencing and why can open up a whole universe of understanding and make it possible for the patient to begin to see, feel, and do things very differently.Psychotherapy differs from the other treatments discussed in this book (i.e., medication and behavior therapy techniques) in two significant ways: First, its efficacy depends on the development of a trusting, consistent, and ongoing relationship between the therapist and the patient. Second, it is a talking therapy, and the role of language is crucial not only to the process of communication in therapy, but also to the healing mechanisms themselves.*78\173\2*
STAPHYLOCOCCUS INFECTIONSStaphylococci used to be among the most feared of all the germs that attack mankind. In their various forms they could attack mucous membranes, the tissues of the heart, even the entire blood. Boils, carbuncles, and similar manifestations of staphylococcus infection were frequent. The germs would get into the centers of bones and cause the condition called osteomyelitis. Many a child was crippled for life by the inability of medicine to control this infection.Occasionally staphylococci attack the bowel through entrance with food. Staphylococcus food poisoning results from the absorption of the toxin given off by the germ. The response is cramping pain, usually coming on two to four hours after the food is taken, with nausea, vomiting, and diarrhea. This lasts for a few hours, seldom more than a day. After twenty-four hours, the attack subsides, leaving the patient weak. The best treatment is to go right to bed and stop taking food for at least twenty-four hours. Paregoric is usually given to relieve the diarrhea and the cramping. Of course, a doctor has to make sure that the condition is not appendicitis or some similar disturbance.Penicillin is the drag that is most frequently recommended for treating staphylococcal infections. When the germs are resistant to penicillin some of the other antibiotic drugs may be used, including the sulfonamides. Mixtures of several sulfonamides, such as streptomycin, aureomycin, or terramycin, are sometimes successfully used. The sulfonamides and the antibiotics are so effective in combating staphylococci that the only additional treatment usually required is good nursing. Surgery helps by opening accumulations of pus and draining away infected material, after which healing occurs promptly. A recent discovery is an antibiotic called staphcillin effective against staphylococci resistant to penicillin.*16/318/5*