We are raised to think of death not as a necessity but as an enemy. When people who are still healthy are confronted with someone who is dying, they are intensely uncomfortable. They are frightened of losing the dying person, of their own deaths, and of death’s finality. “Death isn’t like breaking up with someone and time heals it,” said Helen. “Death is death, period, and no one wants to deal.” Sometimes their discomfort, their not wanting to “deal,” makes people appear insensitive. Alan was in a mall, shopping, and someone he knew came up and asked, “Why have you got all those shopping bags? Aren’t you dying soon?” Alan snapped back, “How soon are you dying?” but he was surprised and confused and hurt by his friend’s question. Dean had a friend who habitually made a joke of looking around at Dean’s furnishings and saying, “Oh, that’s new. Leave it to me in your will.” Dean finally replied, “Okay, that’s fine. Do you want the kitchen chairs too?” After that, the friend dropped the joke. Such remarks sound insensitive, as though as though the person is taunting you with life and health. But they are not; no one is this callous. Insensitivity is the method some people use to deal with their own pain and fear. The method is certainly inappropriate. Both Alan and Dean let their friends understand how inappropriate their remarks were and that they should be more careful in the future. Sometimes people’s discomfort with the reality of death isolates those who are dying. People facing death often find that other people are friendly and sympathetic but want to talk only about easy, comfortable subjects. When the subject of death comes up, they talk instead about what they’ve done recently, or about the future: “I can’t wait until we get you to a ballgame.” They also sugar-coat the subject: “Remember how sick you thought you were before, and a month later you were off on a trip.” This is hard on the person facing death. He or she may be happy enough to talk about the weather, the news, or sports, or to gossip about mutual friends. But being prohibited from talking about the things that are of most concern makes a person isolated and sad. On the other hand, everyone facing death knows some people who will “deal.” Perhaps it is someone who also faces death or someone who has lost a person they loved, or a professional who has had training in helping people handle the emotions and problems of dying. Often it is someone who loves the dying person and is less afraid than other people of the reality of death. These people tell the person who is dying that they will not leave, they will stay as long as they can. With Alan’s young nephew, that message is reversed. Alan’s nephew worries about Alan’s death, and Alan tries to help by telling him he won’t be abandoned: “My nephew cries when he thinks about it,” Alan said. “I tell him, ‘I’m not going to give up easily and I’m going to try to be there for your graduation. Don’t be disappointed if I can’t, but I’ll try.’”*224\191\2*
The first issue to settle is whether you can still drive your vehicle after spinal cord injury, with some type of adaptation. You may need to go through a driving evaluation and assessment for adaptive equipment. Driver education for persons with disabilities is usually available through rehabilitation centers. You can get more information from your state Department of Rehabilitation. Of course, private driver training programs are also available.Most states require drivers to report a physical disability that might significantly affect their driving status and require that these drivers be reexamined. If you do not report your disability, your automobile insurance carrier may not be obliged to cover you in the event of an accident. Check with your insurance company and state motor vehicles department before driving your adapted vehicle.After the proper driving training, you’ll need to make decisions about types of vehicles and special accommodations. There are various ways for a driver to get a wheelchair in and out of the car. Vans can be fitted with a wheelchair lift or a ramp that folds down so that you can wheel inside. Some people with power wheelchairs prefer to remove the driver’s seat and adapt the vehicle so they can drive while seated in the wheelchair. Others use full-size vans and stow the power chair between the front seats, transferring into the car seat to drive. Some people drive two-door cars with wide doors and more access to the back seat, which allows them to fold the chair and put it in the back. If you have some walking ability, you can put a chair or scooter on a lift on the back of the car and walk to the driver’s seat. Also available are lifts that put a wheelchair into the back seat of the car.Containers called chair toppers can be purchased to install on top of your vehicle. These ingenious contraptions automatically lower a hook from an overhead compartment, which resembles a car-top luggage carrier. The hook slips under the seat of the wheelchair (which is easily collapsed by pulling up on the seat) and carries it vertically upward until it flips on its side and slips into the open container. The container then closes, to store and protect the chair. An advantage of this device is that you can transfer from the chair to the car seat, hook the chair, and push the button in the car to raise it. This is helpful for those unable to walk or without sufficient strength to lift the wheelchair, and it protects the driver from the elements.When you are buying a new vehicle, check with the manufacturer about cash allowances for modifications. Ford, General Motors, and Chrysler all give some rebate toward hand controls, pedal adaptations, van conversions, or lifts. Dealers usually have brochures available on the dollar amounts their manufacturers grant. This allowance can be a major economic boost in these expensive purchases.If you do not drive, perhaps a personal care attendant or family member can drive your vehicle. Your personal safety is important, so make sure you have proper tie-downs for the wheelchair. A valid driver’s license and good driving record may need to be on your list of questions when you hire an attendant. Insurance covering the driver and passengers in the car is another essential.A note on technological aids in driving: Before investing in the latest technology to aid in your driving, talk with others who have used the device about pros and cons. Some items require sensitive care and frequent fine-tuning. If you know in advance that a technological device needs tender loving care, you may be less stressed about the time you spend taking your car or van to the shop.When considering hand controls, think about what type of driving you are likely to do. Some hand controls are permanently mounted in the vehicle. If you travel and rent cars often, or own more than one vehicle, you may want to buy portable hand controls. These can be switched from one car to another and are easily installed and removed, without permanently altering the car. They are also useful if another family member will sometimes be driving the same car, using the foot pedals.
*140/156/5*
Middle aged adults are the focus of most cholesterol research and recommendations. After all, they are the ones just entering the high-risk phase of life for coronary artery disease. But should lipids be a concern for children and older adults? Yes.Children. The process of developing atherosclerosis begins early in life, butusually it becomes severe enough to cause problems only later in life. Evidence suggests that high cholesterol levels in childhood promote an earlier development of atherosclerosis and, by extension, increase the chances for development of coronary artery disease in adulthood.However, the evidence is not clear enough to justify recommending cholesterol tests for all children. Certainly children older than 2 who come from “high-risk” families—one parent has a cholesterol level of 240 mg/dl or higher or a parent or grandparent had evidence of coronary artery disease before age 55—should have their blood cholesterol measured. (See Cholesterol levels in children and adolescents from high-risk families, this page, for an interpretation of test results.)If a child’s cholesterol value is elevated, dietary changes are the first course of action. Actually, all children older than 2, regardless of whether a cholesterol level is known, should follow the same eating strategies that are recommended for adults. These strategies focus on reducing fat and cholesterol in the diet, maintaining a healthful weight, and encouraging physical activity. If by 10 years of age a child’s cholesterol level remains elevated above 190 mg/dl (or above 1 70 mg/dl in children from high-risk families) despite the best dietary attempts, then one of the lipid-lowering medications may be required. Not every medication is suitable for children, however, so the pediatrician will prescribe the appropriate one.*247\252\8*
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.
Case-control Studies. In this method the group of people about whom information is collected are those who are already suffering from the particular cancer. They are then matched to another group of people who do not have the cancer but who are similar in other aspects such as age, sex and often social group. The group of patients with the cancer (the cases) are then compared to the group who do not have the cancer (the controls) in terms of their previous exposures to all sorts of factors. If the cases have had more exposure to a particular factor than the controls, it suggests that that particular factor is linked to the cancer. Again, it sounds easy bur collecting the information is a laborious task and choosing controls is full of pitfalls. If the groups are not properly matched then misleading links can be suggested. A particular pitfall is choosing groups of people when they come to hospital. Hospital-based control groups may be very unrepresentative of the general population.
*17\194\4*
“There are traffic lights longerthan my social life,” Jake said wearily when he met with me. “This problem is ruining my life. It’s like fighting demons.”‘
Jake was preoccupied with his arms and legs, which he thought were too skinny, and his “pale” skin. “I have no sex life or love life. I’m almost completely socially avoidant. I hardly ever go out. If I do go to a night club, I feel suicidal. … I’m still in shock that I look so horrible after all these years. It amazes me that no one faints when I get on the subway!”
Jake had been married to someone he hated and later divorced. “I married someone I felt no desire for. She was an awful person, but she was the only one who would accept me. She was probably the worst woman in the whole world, but I didn’t think anyone else would accept me because of how I look. I felt lucky to have anyone.”
Samantha avoided swimming or any activities requiring shorts. She, too, was concerned with pale skin and with freckles on her arms, legs, chest, and back. “The color of my skin is dead looking,” she said. “It causes problems in my social life. I miss parties sometimes, and if I go I can’t focus on conversations because I’m thinking about my freckles and pale skin. I’m constantly scrutinizing other people’s skin. I’m noticing what a nice color it is, or that they don’t have any freckles. The only time I really tune into the conversation is when I hear anything about freckles or skin. Then my ears perk up. “This problem also interferes with my sex life. My husband told me to make sure I told you. I feel very self-conscious, and I don’t want him to see my body. I can’t relax and enjoy anything. My husband can’t understand me. He tries but he can’t, and he gets angry about it.”
*119\204\8*
Improper diet, insufficient exercise, stress, overeating and ignoring the call of nature can all lead to bowel problems. Fibre-rich food is not the complete answer. Some people eat lots of bran (usually wheat bran, and 30 per cent of people are wheat intolerant); wheat scours the delicate lining of the bowel, and if the person is constipated it will make the condition worse by achieving nothing other than an irritable bowel and lots of flatulence.
Fibre is the bit that is left behind once the food is digested. It is considered good for us because it helps to provide bulk to otherwise watery wastes in the colon, and absorbs toxicity; but it is no good if the colon is already prone to blockage. Like the rest of the waste, some types of fibre will become stagnant and add to the congestion.
Better alternatives to bran are roughage from other vegetable bases, such as oats and rice. These tend not to be so abrasive and to swell into a mucilaginous gel which acts as a gentle detoxifier.
One common sign of trouble, dense sticky bowel movements, indicates an excess of mucus in the system. This is usually the product of mucus-producing foods such as dairy products, flour and meat. Meat is extremely contaminating to the bowel and prone to putrefaction, and in a short time creates a great strain on the elimination system.
Mucus stools are the most difficult to eliminate. They leave behind the glue-like coating on the wall of the colon which accumulates layer upon layer into a hard rubbery crust. This is carried for the duration of the person’s life as a toxic burden.
*170\326\8*
Joyce had been off her sleeping pills (temazepam) for eighteen months. During the early months she had suffered a lot of sleepless nights but had coped well. When she rang a tranquillizer support line she was embarrassed by how distressed she was, but as she explained, she felt she had gone back to square one, and was feeling as ill as she had in early withdrawal. To make matters worse she had some strange symptoms and her husband said she was being silly: she felt sick and dizzy when she was near strong perfumes; cleaning products she had always used made her feel ill. She had always enjoyed shopping but she now found she felt headachy and sick in
certain department stores. She had suffered panic attacks in early withdrawal and knew these feelings were different. Eating was also a problem; her pulse raced and she had hot flushes after certain foods. It was such an odd collection of symptoms she wondered if she was imagining them and was greatly reassured when she was told about Candida and food and chemical intolerance. Because she had lost a lot of weight and was by now confused about which foods upset her, she decided to see a clinical nutritionist. Here she had a cytotoxic test (a sample of blood is looked at under the microscope after it has been in contact with various foods to see whether the white blood cells react or not), and was then given an exclusion diet and supplements. The first three weeks were a struggle and she did not feel she was getting very far, then she started to feel stronger and gained two pounds in weight. Six months later she felt well and was working full time.
While the post-withdrawal problems of tranquillizer use are not yet widely medically accepted, particularly with regard to Candida and food intolerance, the dangers of long-term use of these drugs are well known.
*87\326\8*
Hypoglycaemia is preventable. Indeed, most attacks severe enough to require medical attention could have been avoided with a little forethought. Most people with diabetes have good warning symptoms that their blood glucose is falling. Learn what yours are as soon as possible. They may be more subtle than you realize. One way of considering the symptoms of hypoglycaemia is to divide them into changes in emotions, changes in thinking, changes in movement, and adrenaline symptoms. You are unlikely to notice changes in conscious level yourself until glucose wakes you up.
Changes in emotion are often inappropriate for the situation. You may be irritable, sad, excited, giggly, withdrawn, angry, frustrated, cheerful or feel you can conquer anything.
Changes in thinking occur before most people realize what is happening. Slowness or difficulty in making decisions is a characteristic feature of a falling glucose. Time seems to slow down. Your ability to calculate, think logically and plan can be impaired. This is why it is so dangerous to drive or operate machinery when you are hypoglycaemic.
Changes in movement may be late symptoms. They include problems with coordinating movement, whether of the throat and mouth to produce coherent speech; coordination of hand movements to draw or do up buttons; or coordination of legs and feet to walk straight, for example. Muscles may become weak and rarely if you have a bad hypoglycaemic episode it can seem as if you have had a stroke. Glucose cures it straightaway. While you might expect lack of glucose to make people slow down, occasionally people seem to have superhuman strength and do things which they would normally find difficult – lifting heavy objects, running up hill, for example.
Adrenaline symptoms are what many people rely on to warn them of hypoglycaemia. Unfortunately these can be late features of a low glucose and it is important to learn all your warning symptoms so as to identify the onset of a hypoglycaemic attack as soon as possible. We all know that adrenaline is the fright, flight and fight hormone, hence the pounding rapid heartbeat, the trembling hands and the drenching sweat.
Changes in conscious level are uncommon. You may simple feel sleepy, or rarely become unconscious. Although it is rare and the vast majority of people with diabetes treat their minor hypoglycaemic episodes quickly and efficiently with glucose, hypoglycaemic coma is what many non-diabetics associate with diabetes. After all, from the film producer’s point of view, it is much more dramatic for the heroine to collapse unconscious in the hero’s arms, than for her to say, “I feel a bit hypo”, eat some glucose and carry on dancing.
If you have good warning of hypoglycaemia and can learn to recognize your symptoms of a falling glucose, you should have few problems with hypoglycaemia. As the years pass some people on insulin lose their warning symptoms of hypoglycaemia. This happened to Dr Lawrence, the co-founder of the BDA – his junior doctors used to feed him glucose when they noticed that he was hypoglycaemic. Other factors which may reduce your warning are treatment with beta blocker drugs such as propranolol and the level at which your blood glucose concentrations run. If you habitually have a glucose of 10 mmol (180 mg/dl) or more, you are likely to have more intense warning symptoms of hypoglycaemia than someone whose glucose levels are usually between 4 and 8 mmol/1 (72-144 mg/dl). This is one reason why people whose blood glucose is persistently high may resist returning it to normal – an understandable reaction. However, the fear of failing to recognize hypoglycaemia must be weighed against the risk of developing the diabetic complications which are linked with persistently high blood glucose.
*23/102/5*
Atherosclerosis is the Latin word for “hard porridge”. It is a disease of the medium to large arteries and involves the life long accumulation of cholesterol inside the blood vessel walls. Over time the cholesterol plaque attracts calcium and platelets from the blood. Any major artery can become obstructed by this “hard porridge” and it is atherosclerosis that underlies the incidence of heart attacks, heart failure, strokes and Peripheral Vascular Disease.
Factors associated with a high risk of atherosclerosis are cigarette smoking, high blood pressure, high serum cholesterol, obesity and lack of exercise. Stress is still an unreliable indicator of the presence of atherosclerosis.
Until the 1980s, 60 to 70 per cent of all deaths in Australian society were caused by atherosclerosis. Middle aged men and women have halved their incidence of heart disease over the last decade, by giving up cigarette smoking. In spite of these encouraging statistics atherosclerosis is still public health enemy number one. Atherosclerosis causes more deaths in Australian society than any other form of disease, including cancer.
*1/131/5*
Shortness of breath accompanied by cough is a very common symptom of cancer, especially lung cancer. Bronchogenic tumours may also cause shortness of breath or cough resulting from partial or complete blockage of an airway.
Natural Remedies: The use of honey is considered valuable in treating shortness of breath. It is said that if a jug of honey is held under the nose of a person suffering from shortness of breath and he inhales the air that comes into contact with the honey, he starts breathing easily and deeply. The effect lasts for about an hour or so. This is because honey contains a mixture of ‘higher’ alcohol and ethereal oils and the vapours given off by them are beneficial and soothing. Honey, eaten or taken either in milk or water, will also be beneficial in shortness of breath. Relief from cough can be obtained by use of grapes. They tone up the lungs. A cup of grape juice mixed with a teaspoon of honey can be taken with beneficial results in treating this condition.
*10/355/5*