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Many chronically ill and severely disabled individuals will do or pay almost anything for the chance of a cure. These desperate people are extremely vulnerable to unscrupulous individuals who profit by taking” advantage of them. You’ll find practitioners offering a wide variety of unproven therapies to cure spinal cord injury: medications, vitamins, herbal remedies, electrical stimulation, hydrotherapy and specialized intensive physical therapy programs. Some of these “treatments” may be offered through advertisements in magazines for people with disabilities or popularized through Internet chat rooms. Others may be offered by health practitioners of “alternative medicine” in your neighborhood, who may not be familiar with spinal cord injury.
Before embarking on any treatment for spinal cord injury (especially one that promises a cure), get another opinion from an accredited, hospital-based or university-based rehabilitation program or a board-certified physiatrist.

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We have already discussed the role of calcium in the prevention of colon cancer. This has been a very significant finding given the fact that over half the population is marginally deficient in calcium due to insufficient daily intake. Patients with low selenium intake are also at risk for developing colon cancer and breast cancer, as well as lung cancer.
Polyps are growths that can occur in the rectum and colon. These can be easily removed, but they often recur. About 20 percent of all polyps transform into cancer, so it is important to try to prevent their recurrence once they have been resected. The recurrence of polyps was examined in one study sponsored by the Ludwig Institute for Cancer Research in Toronto, Canada. After surgical resection of polyps in 200 people who were then deemed free of all other polyps, one group of 100 patients was given a daily supplement of 400 milligrams of vitamin С and 400 IU of vitamin E. The other group received a placebo. After two years of treatment, a slight reduction of polyp recurrences was noted in the patient group receiving the vitamin supplementation.
Another similar study at six different research centers in the United States involved 865 people. They too had resected polyps and were deemed free of polyps at the time they were enrolled in the program. One group received supplements of vitamins С and E; the second group received beta-carotene; the third group got vitamins С and E as well as beta-carotene; and the fourth group got a placebo. This trial is still ongoing, but the results thus far are encouraging and show some promise, since the people who received vitamins С and E plus beta-carotene had a decreased recurrence rate.
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If you have just had coffee or a cigarette or if your bladder is full, don’t take a reading, because these factors increase your blood pressure. Sit quietly for 5 minutes before you take a reading. Then follow these steps:
Position your arm at heart level on a table or arm of your chair. Right-handed people usually find it easier to measure the pressure in their left arm, and left-handed people in their right arm. Apply the cuff to your bare upper arm. It should fit snugly, with its lower edge about 1 inch above the bend in your arm. Ask your doctor what size cuff you should use.
This woman is using a blood pressure cuff with a built-in stethoscope. The mercury-column measuring unit is on the table.
The placement of the stethoscope depends on the type of blood pressure unit you are using. If your unit has a built-in stethoscope, place the flat disk over the pulse two inches above the bend of your elbow. If you are using a stethoscope that is not attached to the blood pressure cuff, place the flat disk over the pulse at the bend of your elbow.
Squeeze the hand bulb repeatedly. When the pressure gauge reading is 30 mm Hg above your anticipated systolic blood pressure, stop pumping. You should not hear any pulse sound when you listen through the stethoscope.
Deflate the cuff slowly (about 2 to 3 mm Hg per second). As the pressure falls, listen for the pulse sound. Note the reading on the gauge when the beating first becomes audible. This is your systolic blood pressure.
Continue deflating the cuff. Note the reading when the heartbeat ceases to be audible. This is your diastolic pressure.
Your blood pressure is written as systolic/diastolic (for example, 140/90).
Repeat the procedure at least once to confirm the accuracy of your reading.
For hearing-impaired persons, an electronic monitoring device may be best. Have your measuring device recalibrated every 6 months or so at your doctor’s office, fire department, or public health service. Also check your measurement against that taken by your nurse or doctor occasionally to assess the accuracy of your results.
Your doctor will tell you how-often and at what times of the day you should measure your blood pressure. Remember that blood pressure varies, so don’t get too worried if a reading is unusual. Repeat the measurement in an hour.
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Although information about your disability may be overwhelming at first, you need to learn as much as possible about your body’s new demands and functions. Ask your doctor or nurse for information about your injury and about aspects of your function that trouble you the most – whether sexuality, bowel and bladder control, or use of a wheelchair. Concentrate on developing new skills. Take an active role in setting daily, weekly, or long-term goals. By discussing your goals with the therapists, you can more fully participate in your rehabilitation and more quickly master the skills necessary to alleviate your anxieties.
Working closely with your nurses and therapists in developing a predictable routine is important. It may be helpful to involve a spouse or family member in this process. Ask the staff to give you realistic expectations about the availability of care. Waiting for things to happen is easier when you know you’ll have to wait and don’t experience constant anticipation and frustration.
Through communication about your needs, you and your caregivers (or family members) may be able to reach workable compromises: using the telephone at a prearranged time, changing your therapy schedule to accommodate care needs or family visits, and so forth. Expressing your wishes about seemingly small, personal preferences can also be important in reestablishing a sense of control. Don’t hesitate to ask for your favorite soap, cosmetics, clothes, plants, or pictures to be brought to the hospital or rehabilitation facility. Make sure you have a reliable method for controlling the television, lights, and call-bell in your room, or arranging for regular assistance to do so.
Finally, try to pace your day so that you get some respite from the demands of your disability. Some people do this by becoming a couch potato at the end of the day – watching television, reading, or doing crosswords. Some build in a short period each day when someone else attends to their needs so that they can rest from the effort of doing everything for themselves. Another idea is to arrange for a psychological break from the hospital atmosphere, such as getting a special meal brought in, having a party in your room, or getting some quiet time with a spouse. These activities can break the single-minded focus on recovery, provide relaxation and rest, and remind you of the rewards of life beyond the hospital – thus giving meaning and purpose to your daily struggles with rehabilitation.
*39/156/5*
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Sometimes the seizure activity, while lateralized to one side of the brain, is not sufficiently localized for removal of only a small focal area. More extensive surgery may be both necessary and helpful. Sometimes we have to take out extensive amounts of the brain or even one half of the brain, hemispherectomy.
Yes, it is possible to remove one half of the brain and still have a child of normal intelligence whose only disabilities are difficulty using the arm on the opposite side and a hemianopsia, meaning that he can’t see off to that side of his body. Such children are able to go to regular schools. When older, they can hold full-time jobs and live virtually normal, independent lives. Hemispherectomy is rarely performed, only perhaps ten to twenty times a year in this country. It is mentioned here so that you will know that it does exist and that in very carefully selected situations—when the child has severe damage to only one side of the brain, and already has damage to motor function on the other side of the body, and experiences uncontrollable seizures—a heroic operation such as this can be done. It can be life-saving and allow an otherwise profoundly handicapped child to lead a far more normal life, one free of seizures.
Rarely, or so it seems, a child is born with major abnormalities on only one side of the brain or sustains damage or inflammation (Rasmussen’s syndrome  to just one hemisphere of the brain. If your child’s seizures are consistently coming from one side of the brain and do not respond to medication, it may be worth discussing the possibility of hemispherectomy with your physician.
Hemispherectomy is not a procedure for everyone, not even for everyone with damage to one side of the brain. It is major surgery that should only be done in a small number of epilepsy centers with experience with the procedure. The outcome for the child depends primarily on the normality of the remaining hemisphere. Indeed, it seems from these children that no brain tissue on one side is preferable to the constant electrical interference coming from abnormal brain tissue. It appears that this constant electrical interference impairs the function of the good side. Beth is a good example.
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Bret Michaels, the lead singer of the heavy-metal group Poison, manages to combine the routine of blood tests and insulin shots with a demanding job and an unusual life-style. Michaels was first diagnosed at the age of six, learned to give himself injections at ten, and has been part of a rock band since high school. It’s sometimes difficult to mesh eight blood tests and three insulin injections a day with a life of concerts and partying, with constant travel and irregular hours.
Michaels admits that he hasn’t always kept to a strict life-style, and there have been some problems along the way. He passed out from an insulin reaction in the middle of a concert one night, in front of 20,000 people at Madison Square Garden. The group had been celebrating the success of its first album, and Michaels was suffering from a hangover and unable to eat after taking his insulin shot. Drinking (which he knows he shouldn’t do) makes it harder to control his blood sugar level, and overindulgence has put him in the hospital twice.
On the road in Maine, the rock star discovered a different kind of hazard. A hotel maid pricked her finger on one of his discarded needles. She called the police, who arrested Michaels as a suspected heroin addict. His tour manager brought Michaels’ insulin supplies and blood-testing kit over to the station, and he was released just in time to make his concert appearance. Michaels does work out regularly, lifting weights and mountain-biking, and he is careful about his diet. But “I don’t let diabetes run my life,” he says, and adds, “Most diabetics could never live my erratic life-style.”
Some occupations’, such as piloting an airplane or driving a bus, may not be open to people with diabetes, especially those who are taking insulin. These restrictions are imposed for safety reasons. Passing out from an insulin reaction at a rock concert may be embarrassing, but in some jobs it would be a disaster. Many people’s lives might be endangered if an airplane pilot or bus driver suddenly became unconscious on the job. But with relatively few exceptions people with diabetes are free to take up any occupation they wish.
Insurance companies used to refuse to write life insurance policies on people with diabetes. That made sense when people with the disease generally died within a few years after being diagnosed. But modern treatments have permitted most people with diabetes to live a nearly normal life, and insurance companies have changed with the times. Now life insurance policies are available for people with diabetes, although they may be charged somewhat higher premiums.
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Heightened public awareness and an improved prognosis for cancer victims have made the cancer experience less threatening and isolating than it once was. While you may hear of some stories of recovering cancer patients experiencing job discrimination and being unable to obtain health or life insurance, these cases are decreasing in number. Several states have even enacted legislation to prevent insurance companies from canceling policies or from instituting other forms of discrimination. Health insurance can be obtained through large employers. Because large employers spread the insurance risk among many employees, insurance companies accept all new employees without underwriting.
On the personal side, assistance for the cancer patient is more readily available than ever before. Cancer support groups, cancer information workshops, and low-cost medical consultation are just a few of the forms of assistance now offered in many communities. Breast cancer activists learned a great deal from the success of the AIDS activists who pressured Congress to provide funds for AIDS research. The National Breast Cancer Coalition and other grass-roots groups have lobbied to increase cancer research dollars. Their efforts have been paying off. Government funding has increased substantially over the past decade. The battle for funds continues.
Increasing efforts in cancer research, improvements in diagnostic equipment, and advances in treatment provide hope for the future.
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“BDD is the absolute core of what led to my alcohol and drug use. “I slept too much and did alcohol and drugs as an escape, to try to forget my scars,” he said. “Sometimes drinking decreased my concern temporarily. But sometimes the alcohol could make my symptoms worse, and it became a problem in its own right. After his BDD improved with the medication fluvoxamine (Luvox), he stopped using alcohol and heroin. In fact, he’d been selling heroin to support his habit, and had been in jail several times. This, too, stopped when he was treated with Luvox.
Emily described her experience as follows. “The only thing that brought relief was drinking…. My symptoms were totally debilitating, so intensely painful, and they were making me more and more depressed. Even though I was suffering so much, and drinking too much, no one knew I was suffering from BDD because I managed to look as though I was doing okay. I pulled it together, but the agony inside was totally overwhelming. I couldn’t talk about it with other people.
“I finally went to my doctor and told him about the situation because I was worried about my drinking. He told me when I stopped drinking I wouldn’t be depressed. But that wasn’t true for me. I drank because of body dysmorphic disorder…. I drank and slept to deal with it. What causes me the most pain now is the effects of my drinking on my son. I wasn’t there for him. That’s the part that hurts me the most.”
Some men with muscle dysmorphia use anabolic steroids to bulk up. This is a family of drugs that includes the male hormone testosterone as well as numerous synthetic derivatives of testosterone. Unless prescribed for specific medical treatment, anabolic steroids are illegal in the United States and many other countries. They may increase the risk for heart disease, stroke, and possibly prostate cancer. They can also cause irritability, aggression, depression, and physical dependence. And to shed pounds or body fat, some people use ephedra-related products (such as ephedra, ephedrine, or ma huang), dietary supplements which are chemical relatives of speed. In high doses, ephedra may have very serious health risks. It can cause heart attacks, strokes, seizures, and even death.
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White patches in the mouth, sometimes painful, often painless, are most commonly symptoms of thrush, and less commonly symptoms of oral hairy leukoplakia.
Thrush-Thrush is a common infection of the mouth caused by the fungus Candida albicans. Candida albicans is found in the mouths of most people; thrush occurs only when the fungus begins growing out of control. Symptoms include white or grayish-white patches that look a little like cottage cheese along the gums, along the inside of the cheeks, or on the tongue. Thrush can be unnoticeable, or it can cause pain severe enough to interfere with chewing or swallowing. Thrush does not cause fever, malaise, fatigue, tooth loss, or headache. Since most people have the fungus in their mouths, thrush is not considered contagious.
What appear to be patches of thrush can also simply be food particles in the mouth. The distinction is easily made by rinsing the mouth to remove food particles. Thrush cannot be removed without direct scraping, and scraping will leave an inflamed spot where the white patch was. A physician can usually verify the diagnosis by simply inspecting the mouth. Microscopic examination of the patch to identify the fungus can be done but is usually not necessary.
Thrush can result from taking antibiotics, which inhibit the bacteria in the mouth that seem to control the growth of Candida albicans. People with HIV infection are therefore more prone to thrush when taking trimethoprim-sulfamethoxazole, tetracycline, ampicillin, amoxicillin, erythromycin, ciprofloxacin, or other antibiotics.
Thrush is commonly viewed more as a nuisance than as a serious problem. Symptoms are often trivial, and even when severe, they are easily corrected with medication. Thrush becomes more serious when it extends to the back of the throat to the esophagus: the pain from
swallowing might cause people to stop eating, and the treatment given may be somewhat different than for thrush that is restricted to the mouth. The diagnosis of thrush in the esophagus can be made only with an endoscope, which is a tube put through the mouth by a medical specialist (gastroenterologist), or with an x-ray called a barium swallow. In many cases, these diagnostic procedures are unnecessary: the existence of thrush in the mouth, accompanied by painful swallowing, is enough to make the diagnosis.
About 80 to 90 percent of people with HIV infection eventually develop thrush; it is often the first condition indicating that the immune system is weakening. The CD4 count is usually around 100 to 400. Thrush is not an AIDS-defining diagnosis, but it does imply that AIDS is likely to occur within two or three years, unless treatment slows the progression of HIV infection. Thrush occurring in the esophagus, however, is an AIDS-defining diagnosis.
Common treatments for thrush include gargling with and then swallowing nystatin solution; sucking clotrimazole troches; or taking such pills as ketoconazole (Nizoral) or fluconazole (Diflucan). All of these are prescription drugs. If any of the drugs fails, another will usually work. Thrush is generally controlled after one or two weeks of treatment.
Occasionally people do not do well with any of these treatments, either because the diagnosis was wrong to begin with or because the infection has extended to the esophagus. In the latter cases, treatment with such drugs as amphotericin B, given intravenously, may be required for a few days.
In people with HIV infection, thrush tends to recur once treatment is discontinued. As a result, it is common practice to give these drugs for a long time, initially to control the infection and then to prevent its recurrence. Or people keep on hand the drugs prescribed for their original infection and use them intermittently whenever symptoms recur.
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Although sun damage is the major cause of ageing and wrinkles, there are a number of other influences.
Movement and expression lines
Many wrinkles and furrows are caused by exaggerated expression lines. As you watch people speak it is easy to see how they develop expression lines.
Both horizontal and vertical lines on the forehead are due to frowning, and it is interesting that people even frown when they are speaking on the phone, when no-one can see them. Wrinkles around the mouth are very common in smokers. This is partly related to the movement of smoking and partly related to the effects of nicotine. This is obviously completely preventable.
In order to minimize movement and expression lines, you can learn to control the way you speak. It is often helpful to watch your own facial expressions in a mirror while you are talking on the phone. This way you can privately observe your expressions and learn to modify them.
Squinting
Wrinkles around the eyes readily develop through squinting and smiling. Because the skin around the eyes is so fine, wrinkling occurs very easily. Squinting can be avoided by wearing ultraviolet A blocking sunglasses such as Rayban and Polaroid Glarefoil during all outdoor activities and while driving. These sunglasses will also protect the skin around the eyes from the ageing effects of ultraviolet A light, and will minimize the risk of developing cataracts on the eyes themselves. Regular sunglasses do not block out ultraviolet A rays unless they are labeled as providing 100 per cent ultraviolet protection.
Sleeping lines
Sleeping on one side of the body can create vertical lines which are most pronounced on the forehead. Unless the skin is sun damaged these sleep lines do not contribute significantly to ‘ageing’
Weight loss
Overweight people often have more youthful and less wrinkled skin. Sudden or rapid weight loss often leads to the loss of fatty tissues in the cheeks, allowing the skin to be pulled down further by gravity. It is best to lose weight slowly and not to overdo it.
Smoking
Smokers tend to have noticeable lines around their lips, but elsewhere their skin also ages prematurely. Nicotine contributes to skin damage, although the reasons why remain unclear.
Menopause
Loss of oestrogens during menopause seems to contribute to premature ageing of the skin, although the reason for this is not well understood. There is currently a trend to prescribe oestrogens for menopausal women to prevent osteoporosis and heart disease, and this may also help prevent ageing of the skin. At this stage, however, there is insufficient data to validate the association with premature ageing.
Gravity
Gravity pulls the skin downwards, creating jowls around the jaw-line, hooding and bags around the eyelids. The effects of gravity are more pronounced in sun-damaged skin.
True biological ageing
Even areas of the body which have never seen the sun alter over time. The skin becomes thinner, more transparent and the effects of movement and gravity cause sagging and creases.
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