RHEUMATOID ARTHRITIS (RA) AND EMOTIONS: MANAGING ANGER

The first step in dealing with any emotion is to recognize it. Once you recognize that you’re angry, you’ll have an easier time managing it. The coping strategies can help you deal with anger. First, define and assess the source of anger. The people in the following stories have recognized that they are angry, and they have identified the source of their anger.
Janice is angry because arthritis is interfering with her work. She’s always been a competent and respected employee, and she hates the way her arthritis has changed her previously successful work routine.
Margaret is angry because her family doesn’t understand the emotional and physical chaos she is going through. She feels that there is a lack of help and encouragement in her home. She works all day and comes home feeling too tired to perform simple household tasks.
Ken is frustrated and angry about the unfairness of having RA. He has always exercised, eaten right, and kept himself in excellent physical condition. He is angry that despite his good habits, he has arthritis. Friends who were not nearly as health conscious as he remain unscathed. “Why me? What did I do wrong?” he continues to ask himself.
Second, set realistic goals and expectations. Arthritis is interfering with Janice’s work, and she’s angry. Why? Is it possible that she’s expecting too much from herself? Or are other people expecting more from her than she can provide at this time? It seems that Janice expects to be able to continue performing her job exactly as she’s always done it, and she’s frustrated because she can’t. It also seems that she is stubbornly attached to her routine and has not accepted the changes in her capabilities. Janice needs to redefine her expectations. She needs to consider whether her routine is really that important and whether her schedules are really that rigidly defined.
Does Margaret expect her family to know automatically how she is feeling simply because they love her? Do they even have any idea of how they can best help her? Should they be able to sense that she is really angry about having arthritis, or are they receiving signals that she is angry at them? Are Margaret’s expectations of her family reasonable?
People with RA have done nothing to bring this condition upon themselves, and so a person with RA might easily view the situation as being unfair. Two facts are significant here. First, RA, like many other conditions, is neither fair nor just. Second, unfairness as a source of anger is difficult to resolve. It will never be possible for Ken to view his condition as being fair to him, for example. He may try to “make things even” by making his friends feel as badly as he does. But he won’t ever be able to make things fair in his own estimation. Any expectation of fairness is likely to result in frustration and anger. It seems that the only way around this, again, is to change your expectations. Don’t expect things to be fair. Develop more realistic expectations.
Third, resolve your anger through problem solving and negotiation. Janice will have to break free of the ritual of doing it like she’s always done. She must be willing to accept changes in her capabilities, at this time, and adjust accordingly. Can she make changes in her work environment which will help her work more efficiently? Can she improve other skills to compensate for the increased time required to perform what were once easily completed tasks? Becoming more efficient and better organized and setting priorities will help Janice make it through her workday. Honest and open communication with her co-workers and employer will ease bad feelings. Being open to change and learning to adapt to her new physical limitations are the answers to Janice’s dilemma.
How can Margaret get her family to understand the torment she is going through? Just expecting them to understand is unreasonable, particularly with all of the mixed messages she’s sending to her family. She must talk candidly to them. She must learn ways to let them know her feelings before the anger and resentment build up and complicate what is already a difficult situation. Thoughtful communication-letting her family know how to help her – will settle Margaret’s problem.
Ken must work around the obstacles that make him feel cheated. Moving forward through these problems will increase his feelings of strength and competence. Triumph over adversity will help eliminate his feelings of being victimized by RA. He must aim to overcome the inequities of having RA by using his energies to seek improvement. But most importantly, he must understand the indiscriminate nature of RA. Nothing he did or did not do caused his condition, and to view it as some form of punishment merely compounds the problem.
Finally, redirect negative energy by modifying negative thoughts and behaviors. If it is directed positively, anger can sometimes be useful. Janice, for example, can direct her energies toward finding the possibilities instead of clinging to the impossibilities. Margaret can trade misdirected anger for her family’s help and encouragement. And Ken can exchange resentment for the personal challenge of recovery. They all will feel relieved when they redirect their anger into positive actions.
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COMING OFF DRUGS: A HEALTHY BODY-FINDING A PARTNER

Most young and single people probably want to find a partner they can live with in a loving relationship. And there is absolutely no reason why recovering addicts and alcoholics, once they have developed some emotional balance, should not love others, marry them and have children.
This will probably involve re-learning the places of getting acquainted, because recovering addicts and alcoholics are not usually at ease in drinking spots like pubs and clubs. Yet there are other places where boys meet girls. There are swimming pools, dances, beaches, holidays, evening classes, offices, launderettes, restaurants, concerts (pop and classical), libraries, church and synagogue groups. But the most obvious place to meet people is at work.
How to make contact with strangers is something most young people learn in their teenage years. Those who have turned to drugs may never have learned this. So be prepared to feel a little shyness as you begin to lead a normal social life.
‘The first time I made a date in sobriety, I worried about it for days beforehand – what I should wear, what I should do, whether I could kiss her,’ says Michael, a thirty-eight-year-old recovering alcoholic with three years’ sobriety. ‘I was full of panic. Imagine it! Worrying about a little kiss. I had screwed my way round the world in my drinking, but now I was full of anxiety about a date!’
Of course, you will also meet others at NA and AA meetings, and many NAs or AAs do marry each other successfully. However, it is risky taking up with an addict or an alcoholic who has been continuously clean and sober for less than two years. You might find yourself involved with a drug-using addict or a drinking alcoholic – and that will be no fun at all.
Some addiction counsellors take the view that even clean and sober addicts should think carefully about marrying each other and having their own children. As addiction seems to be passed on genetically, they may be giving their children a double dose of the addiction gene.
Sometimes the search for a partner becomes an obsession. ‘If only I can find the right person, then all my troubles will be over . . .’ thinks the addict. They are hunting for a partner to solve their problems, just as they used drugs to do so.
This kind of substitution is an extraordinarily bad start to any relationship and is likely to end in unhappiness. It is important to remember that depending on any person for your happiness is unhealthy – no matter how reliable, kind and competent that person is. Only when you can live happily alone, and your self-worth comes from within, are you fit to live happily with another.

*111\116\2*

TO THE BIOMEDICALLY ORIENTED PSYCHIATRIST: PARADIGM REVOLUTION

What are our basic assumptions behind ameliorating psychotic effects? We should check our desire to medicate all extreme states, otherwise we propagate an inadvertent form of communism, a collective ban on abnormality. We know that there are many individuals suffering in extreme states whose processes are potentially mind expanding, whose behavior is highly critical of western technological society and who, given the proper help, could be constructive culture changers. Some may even become future therapists.
If we medicate such people, we may be avoiding our own myth of truly helping. Are we giving medication because it is really the process of the individual or are we sometimes giving it because we no longer want to think about the complex situation of our patient or about the basic premises of our profession?
Paradigm Revolution
Being a psychiatrist today means being part of a revolution in medicine. Psychiatry, more than any other branch of medicine, is faced with the limitations of causality. As a student you once challenged the basis of your profession; its flaws confront you no less glaringly today.
A central term in psychiatry is ‘psychosis.’ In this text psychosis is defined as a process reversal without a metacommunicator. The primary process which was originally adapted to a given family or community is, for a number of reasons, reversed with the secondary process long enough to change the way in which the individual experiencing the reversal is observed by others. Instead of a primary process which is adapted to the reality in which one lives and which is periodically disturbed by a secondary process, we have a new and surprising primary process which is unrelated to the consensual reality and disturbed by reality orientation.
The definition assumes that the individual in an extreme state experiences a highly patterned process and that psychosis is one of many processes characterized by temporary process reversal. This definition requires you to be aware of your own state of awareness and that of your city. It also demands knowledge of the individual client’s idiosyncratic messages and signals.
This definition has cross-cultural applications as well, since it examines the individual’s feeling, thinking and relationship to the world independently of their cause. Specific western terms for an extreme process such as schizophrenia may now be compared with apparently analogous disease entities defined in other cultures, since all psychoses are reversals of a culture’s primary process.
Thus, if law and order, cleanliness, tidiness and hard work are characteristic of a given culture, a person will be psychotic if he tends, for a long period of time, to be unlawful, disorderly, unclean, untidy and lazy. In a culture where intuitiveness is accepted, fantasy is not likely to be considered a symptom of disease.
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COMMON CONCERNS ABOUT COLDS AND FLU: CAN I EXERCISE WITH A COLD?

Good news for those addicted to regular exercise routines: there is no evidence that physical activity prolongs the duration or severity of a cold, or that inactivity will cure you faster. In fact, there is some evidence that moderate exercise can boost the immune system and help to relieve nasal and sinus congestion. It makes sense, however, not to overdo exercise when you feel less than par, since excessive exercise can be an immune suppressant and may increase the fatigue that usually accompanies viral infections. It also makes sense to put your activities on hold if you are running a fever, since vigorous exercise will only further raise your body temperature. If you are contemplating exercise while fighting off a cold, listen to your body and do only as much as it seems to tolerate easily And try to avoid getting chilled. Those who swim should take extra care to keep water out of their nose, eyes, and ears.
*29\296\2*

DISABILITY LIVING ALLOWANCE (MOBILITY AND CARE COMPONENTS)

The benefits to severely disabled people were reorganized in April 1992. The disability living allowance is divided into two parts, payable at different rates. The old mobility allowance and attendance allowance for those under 65 were incorporated into this new benefit: the mobility part has been extended and replaced mobility allowance and the care component was extended and replaced attendance allowance for those under 65 years of age.
Claimants now complete extensive self-assessment claim forms and most claims are decided without any medical examination. Decision making is by an adjudication officer, not doctors as in the past. There is a right to review by a different officer and ultimately to an independent disability appeal tribunal.
The upper age for claiming either rate of the disability living allowance mobility component is normally 65. Those who are aged 65 but who have not reached 66 are able to claim if they can show that they had met the criteria and their disability had begun on the day before their 65th birthday. You cannot claim the mobility component for the first time once you have reached the age of 66, however once entitled it can be paid for life. The same age rules apply for the care component. The entry requirement to the lower level of this allowance is the ‘cooking test’, i.e. a person is so disabled physically or mentally that they cannot prepare a cooked meal for themselves.
The rules for all the benefits are very complicated. This should not put people off from obtaining their rightful benefits as help can be obtained (from DSS or social services to help fill the forms in). In addition a rejection should not be accepted if a genuine need is present (and the assessment process was either thought to be unfair or there was a variation on the day).
*62/128/5*

FDA Approved Prescription Drugs.

HOW TO SURVIVE YOUR DOCTOR: FURUNCULOSIS AND GALLSTONES

Furunculosis
A furuncle is a small abscess that occurs anywhere on the body. They are painful and diagnosis is particularly difficult when furuncles occur towards the outer end of the external ear canal. Treatment consists of incision where possible and doses of Flucloxacillin.
Home Remedies
As is the case with boils, furuncles demand the eradication of virulent bacteria living on the skin’s surface. Sometimes they live up the nose and can be found in and around the anal canal. Put antiseptic in the bath for a fortnight. If infections persist apply antibiotic ointment inside both nasal openings and around the anal verge.
Gallstones
Nausea and severe cramping pain under the right lower rib cage triggered by a fatty meal are the first signs that cholesterol or pigment stones have triggered an attack of gall bladder pain. Surgeons believe that removing gall bladders somehow constitutes a cure for gall stones. Why this is so remains something of a mystery; because taking out the gall bladder doesn’t prevent the formation of further stones. Gall stones live just as happily in the common bile duct as they do in a gall bladder.
Much is made of the new technology which allows stones or gall bladders to be removed through small incisions. As awesome and fascinating as the new technology may be it doesn’t alter the fact the 50 per cent of gall stones are dissolvable using a low cholesterol diet or the prescription of a bile salt called Chendol.
Ten per cent of men and fifteen per cent of women develop gall stones sometime in their lives. One in five of them develop symptoms over a period of 20 years.
Home Remedies
People that possess gall stones and no symptoms don’t need surgery. A low fat, high fibre diet is helpful if symptoms supervene. As long as circumstances are not overtaken by complications such as severe infection, perforation and peritonitis, try bile salt therapy before opting for surgery.
*61/131/5*

Discount medications online

ENJOYING A HEART-HEALTHY DIET: ELIMINATING THE CHOLESTEROL CONFUSION

Just a few years ago, cholesterol was a word that few could pronounce or spell, much less have any regard for in their own lives. Today that’s all changed. So much so that when Vanna White spelled out CHOLESTEROL on Wheel of Fortune the category was “common household term”. And my wife and children were delighted when the question for “Best-selling health book of 1988″ on jeopardy! was “What is The 8-Week Cholesterol Cure?”
A tremendous amount of publicity aimed at both doctors and their patients resulted in massive public awareness of the need for cholesterol testing and control. Still, the average Westerner doesn’t completely understand what all the terms really mean. Now that you’re on the road to recovery from heart disease, it’s particularly important that you fully understand cholesterol and what you can do about it.
Actually cholesterol isn’t all bad. We need some of it for a number of the body’s functions: to manufacture adrenal and sex hormones, to produce bile acids used in digestion, to build cell walls and to form the protective sheath around nerves. Because cholesterol is so important, the body makes its own supply in the liver. In fact, if we never ate a single bit of cholesterol, we’d make all we need. Unfortunately some of us make more than we need, and we add fuel to the fire by eating a high-fat, high-cholesterol diet.
The result is an elevated cholesterol level in the blood. We’d like to see levels at no more than 5.2 mmol/1, and more ideally at between 4.1 and 4.6. The “mmol/1″ stands for millimoles of cholesterol per litre of blood. From now on, I’ll drop that designation and just provide numbers.
While the total amount of cholesterol in the blood is important, it’s also essential to know about individual constituents. A number of years ago, researchers found that the total cholesterol in the blood could be broken down into a number of fractions, determined by the lipoproteins which carry cholesterol through the blood. These lipoproteins can be likened to transport ships, since cholesterol itself does not dissolve in blood and needs to be shuttled around.
Low-density lipoprotein cholesterol (LDL) is the real culprit in heart disease. This is the “bad” cholesterol we hear about. For those who have had a cardiac event and hope for disease regression, LDL should be no more than 2.59. LDL carries cholesterol through the blood and deposits it in the arteries in a solid mixture of calcium, fibres and other substances collectively referred to as plaque. The formation of such plaque is called atheroma, and the disease is atherosclerosis. It is this atherosclerosis that we commonly call heart disease. Actually, the heart is usually healthy, but the arteries are blocked. So a more proper term is “coronary heart disease” (CHD), with the word coronary referring to the coronary arteries supplying the heart with blood. The higher the level of LDL in the blood, the greater the risk of heart disease.
Very-low-density lipoprotein cholesterol (VLDL) is the substance that the liver uses to manufacture LDL. Scientists refer to VLDL as a precursor of LDL. In other words, the higher the level of VLDL, the more LDL can be produced by the liver.
High-density lipoprotein cholesterol (HDL) is the protective fraction of cholesterol. HDL actually acts to draw cholesterol away from the linings of arteries. The higher the level of this “good” HDL cholesterol, the more protection against heart disease. Levels of HDL should be no lower than 1.3 to 1.4 in women and 1.2 to 1.3 in men. Levels of less than 0.9 are considered to be an independent risk factor for heart disease. That is to say, even if total cholesterol levels are in the desirable range, if the level of HDL is less than 0.9, heart disease can occur. In fact, it is estimated that about 20 per cent of all men suffering a heart attack have a perfectly normal cholesterol level of
5.2 or less, but their HDL falls under 0.9. Conversely, women tend to have a higher level of HDL, and even if their total cholesterol counts are high, they can be completely free of heart disease risk.
You may hear your doctor talk about a cholesterol risk ratio. He’s referring to the ratio between either total cholesterol or LDL cholesterol and HDL cholesterol. This is an excellent index of heart disease risk. Let’s look at some examples.
If total cholesterol is 5.2 and HDL cholesterol is 1.3, the ratio is 4:1 or 4.0. A total of 6.5 with an HDL of 1 gives a ratio of 6.25. Ideally that ratio should be no more than 4.0 for women and 4.5 for men. The difference reflects women’s greater production of HDL as a rule.
If using the LDL to HDL ratio, the numbers should be no more than 3.0. As an example, if the LDL were 3.6 and the HDL 0.9, the ratio would be 4.0. In this case we’d like to see the LDL come down and the HDL go up. We’ll discuss just how to achieve those changes in this chapter.
Blood tests prescribed by doctors will usually include information about levels of triglycerides. These are another category of fats in the blood, although their involvement in heart disease remains in question. Some doctors feel that elevated triglyceride levels have nothing to do with heart disease. Others believe that levels should not exceed 6.5. Still others are more stringent, calling for triglyceride counts of no more than 3.9. The concern here is that triglycerides are the major components of VLDL, which in turn can lead to increased LDL in the blood. An international expert panel upgraded the risk of elevated triglyceride levels at a 1991 meeting in New York. Those with levels of 5.2 or more are now considered to be at increased risk, especially when other risk factors are present.
Dietary fat, especially saturated fat and cholesterol, raise levels of cholesterol in the blood. Triglycerides are influenced by simple sugars and alcohol. The ideal dietary prescription, as we’ll see in more detail, calls for reduced amounts of fat, cholesterol, refined sugars and alcohol. But you’ve heard that before! Now it’s a matter of putting it to practice as you make your recovery.
*105\85\2*
Cardio & Blood/ Cholesterol

QUITTING THOSE CIGARETTES FOR A HEALTHY HEART: WHEN THE SMOKE CLEARS

You and I and everyone else who calls himself an ex-smoker is really nothing more than a smoker under control. We’re just like the alcoholics who are “recovering” rather than “recovered”. Once a smoker, always a smoker. The worst thing you can do is falsely believe that you’ve “beaten” the cigarettes and that you can have one once in a while.
Recognise the mind’s ability to rationalise a return to old habits. Having one cigarette can lead to another, and another and another until you’re hooked again. Don’t allow yourself to light that first cigarette, regardless of the situation, either good or bad.
A good friend of mine had been off cigarettes for a full six years. Then one day he was on a long-distance trip through the desert and his car’s engine broke down in the middle of nowhere. Angry and frustrated when he finally got to a service station, he bought a pack of cigarettes which led to another three years of smoking.
Then there was the actor who landed a role that required him to smoke a cigarette. Of course that scene had to be reshot several times. After ten smoke-free years, he was hooked all over again.
When tempted to smoke, try to remember just how hard it was to quit in the first place. You don’t want to have to go through all that again.
Concentrate, too, on all the reasons you wanted to quit. Focus on how much better you feel now. Recall the frustrations of wanting to quit but being unable to do so.
In my own case, I remember how I used to smoke during meetings. There was nothing else to do with my hands, and I’d light one after another. Now when I attend such meetings I call to mind how my lungs used to feel and how powerless I felt to keep from lighting the next one.
Every former smoker has a recurring dream with just a variation or two. You dream that you reach for your pocket and discover a pack of cigarettes there, realising that you’ve started in again. There’s a sense of panic. When did I start? How did this happen? How am I going to quit again? You wake up in a sweat, eminently thankful that it was just a dream. Talk with some former smokers and you’ll find that almost everyone has had that dream. 1 think it expresses the strong psychological hold cigarettes can exert over us.
During the first days and weeks, the desire to have a smoke seems to strike every few minutes. As time goes on, those cravings will be spaced further and further apart. Moreover, the intensity of the craving will lessen.
But don’t be surprised when, months later, you find that you’d really like a cigarette. Beat in mind that it’s been quite a while since such a craving struck, and realise that the desire will pass quickly. Speed it along by doing a few deep breaths.
Sometimes those cravings will strike, it seems, out of the blue. Often that’s because you find yourself in a situation in which you used to smoke but which you haven’t learned to deal with as a non-smoker. My wife Dawn had that happen to her just recently.
When we first met, Dawn and I were heavy smokers. At the time, I had an apartment in Chicago with a commanding view of the city. We loved to have dinner together, the electric canyon of lights spread out for miles below us, and to finish off the meal with a cigarette.
Fast forward many years. We’d moved to California, both of us had quit smoking for years, and we lived far from the high-rise lifestyle we’d enjoyed before having our children. Then one day we had dinner in one of LA’s few hotel-top restaurants. Dawn fidgeted in her chair, nervously toying with her glass of wine. She said, “Bob, I can’t believe it. I want a cigarette so badly I can hardly stand it!” I explained to her that this was a kind of “flashback” to out high-rise dinners during our smoking days. Understanding this made it easier, the craving passed, and neither of us is tempted to smoke in that situation any more.
Even if you started smoking at a very young age, you spent many years without cigarettes. You lived without them quite well. Then you spent years learning how to live with cigarettes, one situation, one setting, one cue at a time. It will take some time, but you’ll learn how to not smoke in those same situations and settings.
No one will tell you that quitting is easy. It can be one of the most challenging things you can do. But it’s worth the effort. Millions of people have quit. Welcome to the “in” crowd of the Smoke-free Society! And congratulations!
*104\85\2*
Cardio & Blood/ Cholesterol

SUDDEN INFANT DEATH SYNDROME (SIDS): IMPACT

Impact

Parents and other family members are understandably devastated by SIDS. They feel anger, guilt, frustration and above all, grief. Anger is often directed towards health professionals, for somehow not preventing this from happening, or towards family or friends. Parents will re-examine every moment over the last few hours or days of their child’s life, searching for some clue as to what may have contributed to the death. They will also feel guilty, wondering whether, if they had done things a little differently, the baby might still be alive. They may feel guilty that they did not check on the baby before going to sleep themselves, or that the cot was not in their room, or that they did not wake the baby for a midnight feed. Some of these thoughts are rational, others are not. They are a normal part of the grieving process, and will come up irrespective of any reassurances.

The parents can be reassured that there is absolutely nothing that could have predicted the death of the baby, and nothing that could have been done to prevent it. In each state there now exist branches of the SIDS Foundation, which provides counselling for bereaved families, as well as funding SIDS research and conducting community education about SIDS. It is frequently of enormous assistance to families to talk with trained counsellors from this organisation. The tragedy will also have a devastating effect on siblings, as well as on members of the extended family such as grandparents, and counselling should be considered for these family members too.

Some parents form even closer attachments to surviving children, or to subsequent babies. While this is understandable in the short term, it can be problematic for both those children and the parents in the longer term. Alternatively, pare it may grieve for the dead child to the extent that they neglect the emotional needs of surviving children. There is considerable variation in the way families handle the grieving process. Some may feel the need to talk about their sorrow, while others bottle up their emotions. Others will concentrate on ‘getting on with life’, making themselves very busy, as if to avoid having time to think about their feelings.

Sometimes the death results in increased tension between the parents. This can be due to a number of reasons, from different ways of handling their emotions, to disagreements about having future children. It is very important that families be supported through these times in ways that are appropriate to them, taking into account and respecting the fact that all individuals will have differing needs. Sometimes referral to a trained professional such as a psychologist, social worker, grief counsellor, or seeing a sympathetic family doctor is of immense help, while others may be helped by a minister of religion.

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WHAT THESE SUBSTANCES MAY DO TO YOUR BABY

Alcohol Daily consumption of alcohol during pregnancy, as few as two or three drinks a day, can lead to problems with your baby’s development and growth, the risk of prematurity and even congenital abnormalities including heart problems. Babies of alcoholic mothers are at increased risk of suffering from foetal alcohol syndrome. Babies affected by this have stunted growth, mental retardation and abnormal facial features. Alcohol is best avoided entirely during pregnancy. If you drink more than 2-3 glasses of alcohol per day and are unable to cut down during pregnancy, we suggest you discuss this with your doctor.

Smoking Women who smoke during pregnancy tend to have smaller babies. The chemicals breathed in include nicotine, and interfere with the baby’s growth. Statistics show that, on average, the baby of a mother who smokes during pregnancy weighs around 200 g less than average. (If a baby is significantly underweight when it is born, it is less likely to thrive and remain healthy.) It is also at a higher risk of developing complications at birth, and there is a significant risk of it being born prematurely. Passive smoking may also affect the baby before it is born, so it is advisable for the mother’s partner to refrain from smoking in the house. If you are unable to stop smoking during pregnancy, we suggest you discuss this with your doctor.

Painkillers Check with your doctor before taking any medication during pregnancy. Painkillers in particular can be harmful to the baby in many different ways. Try relaxation techniques, yoga or massage as an alternative for pain relief.

Drugs of addiction These can cause severe problems during pregnancy and birth, and the baby may also be ‘addicted’ and suffer severe withdrawal symptoms after birth. The baby is usually underdeveloped and may become severely ill. It is important that you let your health professional know if you are using any drug of addiction during your pregnancy.

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