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ETHICAL ISSUES IN OBESITY TREATMENT: ETHICAL DESICION MAKING

Friday, May 8, 2009 | 7:44 am

The client. Your clients, like you, are hurhan beings with complex motives and needs. Some of these will be well-understood by the clients and some will be more apparent to others than to themselves. It is not usually ethically acceptable to take clients at face value, especially when you are dealing with potentially very complex issues.

What is this client asking for? Why does he or she want that? With personal issues such as health, fitness and appearance the client’s expression of his or her needs can easily be distorted by anxiety.

The woman in the above example who wishes to get a satisfying relationship by losing fat is unlikely to give this initially as her reason for seeking help. If she is partially aware of and embarrassed about her insecurities, she may deny this even if you ask directly about it. You need to take some care in considering what the initial request for help really represents.

What are his or her strengths and weaknesses? Consider what the client is and is not capable of achieving. Sometimes you can teach the skills and knowledge required. Sometimes the client already has these, so they can be left out of the program. Sometimes you can refer them to someone else who can offer better help or modify your approach accordingly.

What are the probable consequences of this client successfully losing fat? Of staying the same? You should consider whether the gains that can be reasonably expected would be a worthwhile return on the effort and cost involved. You should specifically take into account potential unwanted effects, particularly if the fat loss efforts are unsuccessful. This should include some thought about how the client and other important people in her life are likely to respond to the client losing fat and how they would respond if she regained it. The responses will not always be entirely positive.

What is this client’s history of obesity management? How have these past efforts affected them? Most clients have already made many efforts to lose fat. This history of efforts to lose fat makes up a powerful set of learning experiences that shape what clients expect of you and of themselves. Unless there is good reason to expect a different outcome, it may be unethical to repeat things that have been unhelpful in the past. It is almost certainly unethical to re-expose the client to something that has already been found to be harmful.

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(posted in Weight Loss)

THE G.I. FACTOR: THE CARBOHYDRATE/G.I. FACTOR LINK

Friday, May 8, 2009 | 6:44 am

Newer studies are revealing that the physiological responses to food (how food acts in the body) are far more complex than was previously appreciated. What is true is that different carbohydrate-containing foods do have different effects on blood sugar levels.

Only in recent years have scientists begun to study the actual blood sugar responses to hundreds of different foods in real people, healthy people and people with diabetes. They gave them real foods—not solutions of sugars and starches in water. They measured the blood sugar levels at frequent intervals, for as long as two to three hours after the meal. To compare foods according to their true physiological effect on blood sugar levels, they came up with the term ‘glycaemic index’.

The glycaemic index (or G.I. factor as we have called it) is a ranking of foods from 0 to 100 that tells us whether a food will raise blood sugar levels dramatically, moderately, or just a little.

This research has turned some widely held beliefs upside down.

The first surprise was that many starchy foods (bread, potatoes and many types of rice) are digested and absorbed very quickly, not slowly as had always been assumed.

Secondly, they found that moderate amounts of most sugary foods (confectionery, ice cream etc.) did not produce dramatic rises in blood sugar as had always been thought. The truth was that foods containing sugar actually showed quite low-to-moderate blood sugar responses, lower than foods like bread.

So, it is time to forget the old distinctions that were made between starchy foods and sugary foods or simple versus complex carbohydrate. These distinctions are based on chemical analysis of the food, which does not reflect the effects of these foods in the body. The G.I. factor takes us nearer to a full understanding of how the body responds to carbohydrate foods.

The G.I. factor is a ranking of foods based on their overall effects on blood sugar levels. Blood sugar or blood glucose? Blood sugar and blood glucose mean the same thing, although the latter is technically more correct However, we use the term blood sugar in this book because It is more widely understood. ‘Glycaemic’ refers to ‘blood sugar’.

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(posted in Diabetes)

THE SELF-MANAGEMENT OF DIFFERENT KINDS OF PAIN:

Wednesday, April 29, 2009 | 4:35 am

THE SELF-MANAGEMENT OF SUDDEN UNEXPECTED PAIN

This is a different clinical problem again. The difficulty with sudden unexpected pain is that the pain is likely to get out of hand and overwhelm us. It is then easy to be overcome with distress before we can compose ourselves. It happens in the case of an unexpected blow, a broken bone, a burn, or even a severe sprain.

Our studies in the self-management of pain help in two ways. If we have learned something of the approach and have had some experience in the mental exercises, we do not react so drastically to sudden pain. This has been my own experience, and a number of patients have volunteered a similar observation. In the second place, if we should find that we are suddenly threatened with loss of control in this way, we now have the means to bring ourselves quickly under control and restore our composure.

As in each of the other aspects of pain and anxiety, we work to bring our principles of

self-management more and more into our everyday life. So when we experience some sudden and unexpected pain, even if it is only of minor degree, we immediately restore our composure by momentary mental relaxation instead of giving vent to our feelings as we have done in the past. Be warned that there is a good deal of false teaching by psychiatrists and those who should know better that it is good to give vent to our emotions and feelings. If we give vent to our feeling of pain, we too easily become distressed, and the intensity of the pain is increased.

Four years ago a dentist came to me. He has a degenerative condition of his backbone so that the nerves are pinched as they come from the spinal cord between the bones. He suffered sudden unexpected twinges of acute pain as well as quite severe chronic pain. His work as a dentist with the long hours on his feet and the necessity of leaning forward over the patient made him very vulnerable to this condition.

He has learned to control the pain. He is still working full-time. Between patients he occasionally lies down in a side room for a few minutes to re-establish his mental and physical relaxation.

A seventy-two-year-old single woman was referred to me in the hope that I might be able to help her with the pain in her tic douloureux. This is a shockingly painful condition characterized by sudden jabs of acute pain in the side of the face. The first attack had come on eleven years previously, but this had settled down. She was now subject to continual jabs of pain when she was talking or eating. On occasions the pain was excruciating. Three years previously she had developed trigger points on the face and tongue, and if these were touched, it would precipitate excruciating pain. At night if she moved in her sleep and the bedclothes brushed her face, pain would be precipitated in this way.

She was a very courageous, stoic woman, and I have no doubt that at times she experienced really terrible pain. However, she wanted to avoid the orthodox treatment by injection or the operation of cutting the nerve, both of which leave that part of the face without feeling and so open to injury.

She was a particularly good patient, as are many people who are in extreme pain. I only saw her on four occasions. She then claimed that she could reduce the pain to quite bearable proportions; and she did in fact allow me to touch the trigger spots, which previously had been so exquisitely tender.

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(posted in Anti Depressants-Sleeping Aid)

PIGMENT DEPOSITS IN THE IRIS: LIPOFUSCIN: THE ‘WEAR AND TEAR’ PIGMENT

Wednesday, April 29, 2009 | 3:35 am

This Fe-free pigment can appear in the iris in a range of colours varying from light yellow to black-brown. It is formed within the ganglion cells of the Nucleus niger and Locus ceruleus, and appears mostly as ‘wear and tear’ pigment in old age. However, it can also originate from protein metabolism without such regressive changes.

Lipofuscin (never melanin) is a constituent of the extra-pyramidal system. In the Zona reticularis of the suprarenal body, lipofuscin can be recognised microscopically as a dark brown colouring in conditions of old age. Although lipofuscin is described as a product of old age, it can also exist as a degeneration product in young people and as a sign of exhaustion of particular organs, hence the terms: liver-, renal- and pancreas-pigment.

At this point, I would like to include the group of rheumatic-gouty deposits. In my view, the duration of the condition can be assessed from the colour of the signs. The longer the disease has been present, the darker is the colour of the pigment.

Even though the above-mentioned pigments are topolabile, the presence of the flecks in the different zones of the iris can still be assigned to definite organ systems. If the light reddish pigment, as described in detail in the literature under the term—Nux vomica pigment, appears in the stomach and intestinal zone (first major zone), then it shows that a condition of fermentation affects these organs. If the discolouration extends outwards beyond the iris-wreath, then other organ systems can be affected.

The yellow to brown deposits which extend from the iris -wreath to the outer margin of the iris (Berberis pigment) indicate general disease of the body (Maubach: Reibekuchen-iris). In this case, the condition arises from a gouty disposition of hereditary origin. Indications of the acute phases of gout appear white, and generally lie next to dark signs in the bone area (fifth minor zone).

The pigments described as liver-, renal- and pancreas-pigment are likewise found in the ciliary zone.

Pigment deposits may appear in the iris if an organ is affected. However, since the differences of colour and localisation of pigment-flecks are insufficient for diagnosis, one must look for other signs in the organ areas of the iris in order to reach a definite opinion. Iridologists have been concerned with iris pigment-signs from the first beginnings of irisdiagnosis, commencing with Liljequist and continuing with Attila von Peczely, Schnabel and Angerer. In spite of their extensive works, there still remains a wide field for further research.

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(posted in General health)

TREATMENT FOR THE ACHING MISERIES: PROGESTOGEN

Wednesday, April 29, 2009 | 2:25 am

However, there are synthetic forms of progesterone, called progestogens, which can be in pill form. The trouble is that you can’t depend on getting the same results with a substitute as you can with the real thing. If you take progestogen, your body will cut back rather than increase the amount of progesterone it will produce. And remember the object of the exercise is to provide you with more progesterone. However, doctors at St Thomas’ Hospital who treat their patients with progestogen, under the trade name ‘Duphaston’ are pleased with their results. They claim that this drug can relieve many of the symptoms for a majority of their patients. Unfortunately, the picture isn’t entirely rosy. I feel it’s only right to warn you that Duphaston can and does have some unpleasant side effects for some of the women who take it. On the other hand, doctors at St Thomas’ Hospital are encouraged by the success of their trials of this drug, which they say helped seventy per cent of their patients.

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(posted in Pain Relief-Muscle Relaxers)

THE ACHING MISERIES (CONGESTIVE DYSMENORRHOEA): FATIGUE-EATING FOR ENERGY

Tuesday, April 28, 2009 | 5:55 am

As soon as you start to feel fatigue, particularly if it makes you snappy or irritable or, worse, if you suddenly have a migraine or you feel terribly tired and dizzy or in a panic, then you really should check to see that you have been eating enough. You may have been skimping meals or missing them altogether, so what you are suffering from is lack of nourishment or a drop in your blood sugar level. We all need sugar in our blood to keep us going, and when stocks run low our bodies send out very clear signals to us. We feel hungry and start looking at the clock, wondering how near it is to elevenses or tea time. We say we would give anything for a bar of chocolate. We think about food.

Perhaps you have been ignoring the signals? Check and see what you have actually eaten during the day—and, just as important, how long it was between one meal and the next. You may have missed breakfast because you woke up feeling so tired that you decided to lie in. If you are a mother at home, you may have cooked something for the children and gone without

yourself. You may have skipped your tea break and even your lunch hour because you were working so slowly you thought you would never catch up if you stopped for something to eat. In fact, you may have felt quite noble sacrificing your food for the sake of greater efficiency. Actually, you were sacrificing your efficiency too. We work slower and slower when we’re hungry and the more hungry we get, the slower we become. Fortunately we get faster and more accurate immediately we’ve eaten sufficient food.

If you are on a controlled diet you will probably find you can work perfectly well and diet in the weeks after your period, but it might be a good idea to ease up before your period is due. That’s when you really need adequate food—an English breakfast if you can face one, elevenses, a proper meal at mid-day, tea at four o’clock and then a good evening meal. This is another occasion when husbands or relations can be such a help. They notice when you are missing meals, even if you don’t. After all, they’re the ones who get snapped at when you are low. Accept their help. You’ll be all the better for it—even if you can’t get into that skin-tight dress.

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(posted in Pain Relief-Muscle Relaxers)

CHILDREN’S VISION PROBLEMS: SIGNS, CARE AND TREATMENT

Tuesday, April 28, 2009 | 4:00 am

Signs and symptoms

There are clear symptoms that may indicate poor vision. If your child habitually tilts his or her head or looks out of the corners of his or her eyes, if the eyes cross or move away from normal, or if the child squints or is excessively sensitive to bright lights, there could be an eyesight problem. Holding objects close to examine them, failure to recognize familiar people at a distance, headaches following use of the eyes, problems in school, and a dislike of reading may also signify poor vision.

At birth, a baby who has normal eyes can focus on an object and visually follow movement. If an infant’s eyes seem to make random, searching movements, he or she may have defective vision.

Vision can be tested at different ages in a variety of ways. During the first week of life an infant should be able to fix his or her eyes on a bright light. By two months of age, the child’s eyes should follow that light as it moves through a 180-degree arc. By seven or eight months the child should be able to recognize and respond to facial expressions. After age three, a child’s eyes can be tested by having him or her focus on charts that use pictures or the letter E pointed in different directions. Finally, around age five or six, the child’s eyes can be tested using a standard Snellen eye chart.

Home care

Be alert to the symptoms that can indicate impaired vision, and have the child’s eyes examined periodically.

Precautions

• A child who cannot see the television screen from a distance or who holds books close to the eyes may be nearsighted.

• A child’s vision should be checked annually, beginning no later than age four.

Medical treatment

At each annual eye checkup, your doctor will examine your child’s eyes inside and out with an ophthalmoscope, and test the child’s vision using a chart of letters in rows of diminishing sizes. If an abnormality is suspected, your doctor will refer your child to an eye specialist for more detailed examination and correction of the problem.

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(posted in General health)

LIVING WITH DIABETES: ISLET CELLS COULD BE USED

Thursday, April 23, 2009 | 2:43 am

It is possible to separate the islet cells (which make insulin) from the gland tissue (which makes digestive juice) in the laboratory. This can be done from adult pancreases but is a difficult procedure and only a very small proportion of the adult pancreas consists of islet cells.

Islet cells can be obtained from the pancreas of fetuses obtained in abortion, or new-born babies who die soon after birth. It has been hoped that these islet cells, which can be cultured in the laboratory, can be placed in the body of persons with diabetes and grow there to produce enough insulin to control the diabetes.

So far work in this field has been somewhat discouraging, though there is some encouragement in that the system works well in experimental animals. It is not known yet whether in the human the islet cells could grow in number and function normally after transplantation.

Tissue rejection remains a problem with islet cells as with transplantation of the whole or part of the pancreas. It is likely that this problem of tissue rejection will be solved eventually. Tissue rejection refers to the process in which the body fights against strange and foreign tissues placed in the body, and thus rejects the transplant which can no longer survive.

The major problems may prove to be in the supply of islet cells and whether they can function properly when they are transplanted. There are problems in obtaining pancreas tissue from aborted fetuses – problems that are moral, ethical and practical – and these problems have not been resolved. It is not known whether islet cells will grow and function adequately when placed in a person with diabetes or whether they themselves may be damaged in the same way as the person’s own pancreas cells were damaged when he developed diabetes.

These questions are the subject of a great deal of active research in several world centers including in Australia. It may be many years before they are answered but the possibilities are very hopeful.

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(posted in Diabetes)

MANAGING OUR STRESS: MEDITATION IN OUR LIFE

Thursday, April 23, 2009 | 2:37 am

In classical meditation it is regarded as important that the meditator should meditate sitting cross-legged in the position known as the lotus posture. In the ashrams of India and the zen-dos of Japan this posture is regarded as essential, and the beginner is told to get his legs as nearly as he can into this position, and to maintain it, no matter how much it hurts, for the duration of the meditation. There is none of this in the meditation that I would advise you to pursue. If we are striving against discomfort and pain, the essential stillness of mind is impossible.

For the type of meditation that I advocate, we must start our meditation in some position of slight discomfort. Then we let our mind run quietly, with as little thought as possible, and we are soon no longer aware of any discomfort. This transcendence of slight discomfort is an essential feature of successful meditation.

It does not matter how we induce the slight discomfort. This will depend on age, and on the physical and mental condition of the meditator. At the start, just sitting straight on an upright chair may be enough to produce slight discomfort. As the beginner becomes more experienced, he will soon learn that he quite easily transcends greater degrees of discomfort. He can then lie flat on his back on the floor, or sit cross-legged on a cushion or pillow, or better still on the telephone book. The meditator may prefer to kneel, either kneeling up, as in a posture of prayer, or kneeling back with the buttocks resting on the heels. If this produces too much discomfort, it can be reduced by placing a pillow over the heels.

The important factor is that the discomfort must never be so great that it is not transcended in the first few minutes of meditation. Furthermore, the discomfort needs to be progressively more severe as the meditator becomes more experienced.

Any idea of meditating while lying comfortably in bed is quite useless. In this case the individual may become relaxed. And of course physical relaxation is a good precursor to meditation, but when lying in bed the relaxation comes from nervous impulses to the brain reporting relaxation of the muscles. This is not what we want. We are seeking a form of relaxation which arises in the brain itself.

In classical meditation the meditator is taught to be constantly aware of his breathing. The breath goes in and out, in and out. The awareness of it means that there is continuing activity of the mind, which means that this process produces a type of meditation quite different from that which I advocate. There is another point. The awareness of our breathing gives our mind something to do, and so reduces the intrusion of thoughts. This makes meditation easier. So those learning to meditate easily fall into the habit of stilling their thoughts in this way. But if we are meditating with awareness of our breathing, our brain never achieves the quiet stillness which is so effective in restoring harmonious function and so relieving stress.

These same principles apply to the technique of visualization. In the last few years there has been a great vogue of visualizing in meditation. The idea is not new to me as I described it in a textbook, A System of Medical Hypnosis.

In this procedure the meditator sees in his mind’s eye the desired result being fulfilled. The person who is under stress visualizes himself calm and at ease in the face of various problems. The technique has become quite widely used with patients suffering from cancer. Of course, while the patient visualizes, his brain remains active, and the therapeutic effect of stillness of mind is never attained.

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(posted in Anti Depressants-Sleeping Aid)

INFERIOR PSYCHOLOGICAL REACTIONS TO ESCAPE STRESS: DEPENDENCE

Thursday, April 23, 2009 | 2:34 am

The way in which we manage our dependence reactions is an important part of successful living, and may become intimately bound up with our reaction to stress. In infancy and childhood we are completely dependent on our parents. In adult life we provide dependence for our own children. In old age our children provide dependence for us, and we learn to accept it.

The dependence that we give our children is not constant. It is variable. We instinctively vary it according to the child’s needs. If something has gone wrong for him, or he is having a tough time, we move closer. When things are going well, and his need of dependence on us is less, we move away so that he comes to learn the self-dependence of adult life.

In our adult life, when things go wrong, we tend to fall back on childhood reactions and patterns of behaviour. Some people, when they come under stress, try to cope with the situation by craving for an intense dependent relationship. The businessman, under stress from problems at work, may become intensely dependent on his wife. The intensity of the dependence may progress to real childishness at home although it is never shown at work.

The relationship reactivates feelings of childhood. He feels more secure, and the symptoms of stress are reduced. And because he feels better, he tends to prolong the over-dependent reaction long after the problem causing the stress has been resolved. The result is that the wife comes to find herself burdened with the emotional needs of another child.

We must be clear about this. It is only the intensity of the dependence reaction following stress that makes it pathological. The giving and acceptance of emotional dependence, when the other needs it, is what man and woman is all about.

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(posted in Anti Depressants-Sleeping Aid)

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