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CHANGING THE HORMONE BALANCE BY HAVING TABLETS OR INJECTIONS OESTROGEN-TYPE FEMALE HORMONES (CONCLUSION)

Men who take oestrogens also have their own special problems. These hormones can cause loss of interest in sex, impotence (inability to get an erection), decreased growth of facial hair, and enlargement of the breasts which can be painful. This last one can be prevented by giving the breast area a small dose of radiotherapy before starting your oestrogen treatment. Once it has developed, the only ways of getting rid of it are by stopping your oestrogen treatment or having your breasts removed surgically.
If you have unpleasant symptoms as a result of oestrogen treatments ask your doctors what the alternatives are. You may prefer a different form of hormone treatment or even to stop hormone treatment altogether.
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EMERGENCY CHILDBIRTH: GUIDE ON HOW TO DELIVER A BABY

If the situation arises that you are unable to get to hospital and the birth of your new baby is imminent then it is important to have an idea what to do. I would suggest that you talk to your practitioner about this during your pregnancy.
If the pains are bearing down in nature and/or the waters have broken then the birth may be imminent and you should prepare for the birth. The following is a guide on how to deliver a baby in an emergency.
Call for an ambulance or medical aid
Then wash your hands and arms using soap, a nail brush and hot water.
You will need the following:
1.  Three clean sheets
2.  A sharp pair of sterilized scissors to cut the umbilical cord
3. Three lengths of string or cotton tape that have been boiled for a minimum of 10 minutes
4.  Clean towels
5.  Dettol or other antiseptic
6.  Some nappies to wrap baby in
7.  A light blanket to keep the mother warm after the birth
8.  A clean handkerchief or face mask
9.  Sterile cotton wool swabs
Preparing the delivery bed
The expectant mum will need a suitable place to lie. Prepare this using a clean sheet if possible, then under the mother starting from the waist, cover the sheet with plastic and extend all the way to the end of the sheet. A new, clean, opened up garbage bag will do. This should then be covered with an absorbent material. A few layers of opened up newspaper will suffice if you don’t have anything sterile. This must then be covered with another clean sheet. Wash your hands again and allow air-drying.
The mother should be placed on the prepared bed with the lower half of her body over the sheet covering the plastic area. She should be on her back with her knees drawn up. With each contraction she will want to push. The mother must be encouraged at this time to pant with her mouth open and not to hold her breath, and to bear down.
When the baby’s head first appears, apply firm but gentle pressure in a backwards and slightly upwards direction. This will help prevent the baby being born too quickly. As the head appears it should be facing down and will slowly turn to one side during the birth. The head needs to be supported and controlled through the whole delivery.
At this stage it can be seen if the umbilical cord is around the baby’s neck. If it is, then gently pull the loop of the umbilical cord over the baby’s head. If this cannot be carried out, then try to loosen the cord enough to allow the baby to pass through the loop at birth.
The next contraction should deliver the baby’s shoulders. Once the shoulders are born, then the rest of the baby will follow on the next contraction. In preparation for this, and during the next contraction, support the baby under the armpits and lift upwards towards mother’s abdomen. The baby is now born.
Baby will be covered with mucous and be very slippery.
Taking care, wrap the baby in a clean towel or nappy. With one hand hold both ankles. One ankle should be held between the index finger and the thumb. The other three fingers fold around the other ankle.
Baby should now be held upside down. Your other hand should be supporting the head and neck. This allows the fluid to drain from the airways (throat, nose and mouth). Use the cotton wool swabs to wipe away the blood and mucous from the baby’s nose, mouth and eyes. Remember that the umbilical cord is still attached to the placenta within the mother. Do not try to pull the cord out.
When the baby cries place it on the mother’s abdomen to nurse. The baby should be encouraged to suckle the breast. This will help in expelling the afterbirth: the third stage of labour.
Following the expulsion of the placenta, the umbilical cord can be cut, but only after it has stopped pulsating.
You will now need the three pieces of sterile string or tape and the scissors. Tie the first tape around the cord 10 cm (4 inches) from the baby’s navel. It is important that these tapes be tied firmly as failure to do so could result in the newborn baby bleeding from the cord. The next tie is located 15 cm (6 inches) from the navel and the third tie should be 20 cm (8 inches) from the navel. The cord may now be cut between the second and third ties; these are the ties farthest away from the baby.
The mother can now be washed and a sanitary napkin placed in position. Remember to retain the sanitary napkin and placenta for inspection by her practitioner. A cup of peppermint or chamomile tea and a rest are recommended.
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REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: EATING FOR BETTER HEALTH –SHOPPING GUIDE

Many of the decisions you make about eating healthfully are made in the grocery store. With a little advance planning, you can select ingredients and prepared foods that fit into a heart-healthy life-style. Without planning, it is easy to slip back to your old way of eating or to stock up or imapulse buys.
These tips will help you make wise choices in the grocery store and also will make preparing meals easier.
Plan a week’s worth of menus and include the ingredients you need on your grocery list. When you plan menus and make the grocery list, keep in mind the six basic guidelines. You will probably need more fruits, vegetables, breads, and cereals than you previously bought. Foods you may have thought of as side dishes (such as pasta, rice, beans) will become more prominent on your list. Keep the smaller portion sizes in mind when buying meat. In the dairy department, look for low-fat or skim milk products.
Buy only those items on your list. Do not shop on an empty stomach. If you shop when you are hungry, you may be tempted to buy foods you don’t need.
Shop when you have time to read food labels.
If possible, buy fresh foods rather than mixes or ready-to-eat foods so that you can control what ingredients are added.
Shop the perimeter of the store. Many supermarkets place some of the most healthful foods (fresh fruits and vegetables, fresh meats, bread, and dairy products) on convenient perimeter aisles.
If you cannot resist the temptation of impulse buys, arrange for someone else to do your grocery shopping.
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FEELINGS IN PEOPLE WITH SPINAL CORD INJURY: POSTTRAUMATIC STRESS

In the first few months after spinal cord injury, a high degree of stress or anxiety is common. Some of the anxiety stems from the situation that caused the disability – for example, a car accident, shooting, or war injury. In the heat of a life-threatening emergency, and even during acute hospitalization, the body is stimulated by adrenaline and energy is focused on survival. Anxiety is automatically blocked from mental awareness in an adaptive trick that allows one to cope with the crisis at hand.
Once the immediate danger is over and you are settled into a safe, albeit difficult routine, you may find yourself flooded with anxiety, replaying the trauma in your mind (in flashbacks) or having nightmares with terrifying experiences of helplessness, impending disaster, and loss of control. These symptoms of posttraumatic stress are common after any emotionally overwhelming situation.
Again, talking it out helps. Research on the treatment of people with severe posttraumatic stress reactions suggests that the sooner they talk about the experience and associated fears, and the more detail they are able to give, the less anxiety they are likely to experience in the future.
Patty became paraplegic following a bullet wound to her spine. She was at her niece’s home, their children playing together, when the niece’s estranged boyfriend barged into the house and shot both women. Her niece was killed and Patty was seriously injured.
Patty suffered extreme pain and emotional distress while waiting for emergency assistance to arrive. At the hospital, she was mourning the loss of her niece, confronting her own disability, and worrying about the emotional effects of the event on her child. However, after emergency treatment and medical stabilization, her healing progressed nicely and her spirits were remarkably good.
Once in rehabilitation, Patty surprised the staff by talking frequently and in great detail about the circumstances of her injury, her niece’s bloody death, and her pain and terror while waiting to be rescued. She told the story to anyone who would listen, to the point that some staff questioned the “normalcy” of her preoccupation. Yet Patty seemed immune from the anxiety that many expected of her. She was able to focus on information about her recovery, participate actively in her therapies, and maintain supportive relationships with friends and family. She was eager to learn how to use the wheelchair, to get well, and to get on with her life.
Patty was doing spontaneously what most therapists would encourage any victim of a trauma to do – managing and mastering the anxiety by talking about the trauma and the feelings it evoked. Talking not only “gets it out” but also elicits support and validation from others. Thus Patty, more than many patients, was able to make new friends in the rehabilitation hospital. Fellow patients and staff members saw her as courageous and determined. This reinforced Patty’s sense of self-worth and diminished her anxiety about using a wheelchair, learning bladder care, and becoming independent. She left the hospital with some realistic anxiety about returning to work and parenting with a disability and, indeed, real social and physical challenges lay ahead. But Patty was not overwhelmed or disabled by the anxiety itself.
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SURGICAL APPROACHES TO EPILEPSY: DOUGLAS’S CASE HISTORY

Douglas had his first tonic-clonic seizure at 14. The initial CT showed a small abnormality in the anterior left temporal lobe, probably caused by bleeding from abnormal blood vessels. The doctor decided to wait and see what would happen. Six months later Doug began to have complex partial seizures, and he was referred to us. We began administration of carbamazepine (Tegretol) and discussed the option of surgical removal of the malformation both for the control of seizures and because the malformation might bleed again.
The lesion was removed when Douglas was 15, one year after his first seizure. He is now completing high school. He’s on the basketball team, and he lives without seizures and without medication.
When we recently asked Doug how he felt about all that had gone on he replied, “It wasn’t any big deal. I didn’t like having my beautiful hair shaved off, but that’s all behind me now.”
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TYPE II DIABETES AND WEIGHT PROBLEMS: FOOD, FABULOUS FOOD

In the good old days, humans ate food to survive. In the good new days, most humans (particularly the fortunate ones in most First World nations) eat food to increase enjoyment of life. We equate food with love, happiness and success.
Because we like love, happiness and success so much, many of us eat as much food as we can get our hands on – and forks into.
You may have inherited a genetic tendency for being overweight (“everyone in my family is fat or chubby”), or you may have been raised in a family where overeating was the rule, rather than the exception to the rule. The end result is that you, over the years, developed food eating habits that have nurtured the fat monster.
You are today what you have been eating during the past years.
If you’re lucky, you may be able to fight your own fat monster by just cutting down on the amount of food you eat – without anyone’s help. Or you may need the professional help of a dietitian, diabetes educator or counselor to help you with your weight control programme. Whether you do it alone or with the help of someone else, there are certain things you need to do before you sit down at your next dinner table.
You need to create a list of foods you love – and really can’t cut out – and the foods you really won’t miss when they’re dropped from your diet. You also need a list of foods that fall between the loved and the not loved.
When you consider the foods that won’t be missed or are “iffy”, look for those that contain the most kilojoules. You’ll get the most bangs for your dollar when you cut out high-kilojoules, low-nutrition foods. One of the prime examples of this kind of food is alcohol (the drinking kind). When you drink alcohol, you are almost drinking the equivalent of fat in terms of the numbers of kilojoules. There is very little nutrition in an alcoholic beverage but lots of unneeded and, in your case, unwanted kilojoules.
Some people can get started on a weight loss programme just by giving up booze. Not only will they lose weight, they will gain many other health benefits. (Don’t be misled by the newspaper stories on the benefits obtained by persons who drink one glass of beer or wine every day of their lives, compared with teetotalers. There were many other variables in the lifestyles of the two groups – drinkers and non-drinkers – that probably skewed the results of these studies.)
In social situations where everyone else is drinking alcoholic beverages, you can quietly ask for a diet soda, a glass of iced tea, or an alcohol-free substitute, such as a Virgin Mary.
In addition to alcohol, you will be able to identify quite a number of high-kilojoules foods that can be eliminated from your diet. Think about the kind of snacks you consume while watching TV. You can easily switch to low-kilojoules snacks, such as no-salt, butter-free popcorn.
The act of writing down your list of foods in the love, don’t care, and iffy columns will help you take the next step-actually eliminating some of these foods from your life.
Your skills in blood glucose monitoring also can help you decide which foods should stay and which should go. You can see, by the numbers on your glucose meter, how some foods affect your blood glucose levels. Measure your glucose before you eat a portion of a specific food and then repeat the measurement one hour later. Experiment with different combinations of foods to see which ones produce the smallest peaks in your after-meal blood glucose.
Eliminate those high-peak “villains”, along with any foods that produce high blood glucose levels for hours after you’ve eaten them. Use your blood glucose monitoring along with your bathroom scales to see the weekly progress you’re making toward your weight goals.
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OVERCOMING CANCER: PARTICIPATING IN YOUR HEALTH: HOW YOU INTERPRET THE MEANING OF EVENTS

It’s not hard to see how other people create the meaning of events in their lives (although it is not quite so easy to see how we ourselves do this). For example, the loss of a job can mean a number of things:
1. A defeat or a sign of failure.
2. A challenge.
3. A chance to start out fresh.
4. A sign that life is unfair.
Which of these meanings people attach to the experience is dependent on other beliefs they have:
1. Perceived opportunities to get other jobs.
2. The degree to which the job was a symbol of personal worth.
3. Beliefs about being in charge of one’s life.
4. Their ability to create a positive new situation.
The principle that you create the meaning of events applies to all the stresses typically identified as occurring prior to the onset of cancer. As painful as some of these experiences can be—loss of a loved one or of an important role, for example— the amount of stress and particularly the degree to which these events make you feel hopeless and helpless are the result of the meaning you attach to the experience. You determine the significance of events.
By exploring the beliefs that limit your responses, by considering alternative interpretations of life’s events and alternative ways of responding, it is possible for you to create positive meanings where negative ones existed before. When the crucial beliefs that have created the blockage in a healthy, forward flow to life are discovered and dislodged, the full energy of life can flow smoothly once again. And with that flow can come the vital force that will restore the body’s natural defenses to normal potency.
Although the exact form this freeing up will take varies from person to person, it almost always involves giving oneself permission to experience life differently. Some people may participate in their health by saying no to others’ expectations, others by saying yes to experiences and parts of themselves they have denied. When the energy begins to flow again, while there will still be problems and stresses to face, they will be faced with the belief that the problems can be solved or at the least coped with—with the belief that one has the power to make decisions that will contribute to getting well again.
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ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: DIVORCED OR SEPARATED ALCOHOLICS

Vaillant, in examining the course of recovery from alcoholism, found that quite commonly those who recovered “acquired a new love object.” Basically, those who recovered found someone to love and be loved by, someone who had not been part of the active alcoholism. This cannot be used as evidence that family treatment is not warranted because there has been too much water over the dam, too much pain, and too much guilt. The sample he studied were those who were treated prior to the time in which family involvement in treatment was commonplace. So who knows what the outcome would have been had attention been directed to family members as well. Early intervention was not the rule then either. His sample consisted of long-established cases of alcoholism. However, it does serve to remind us of an important fact. Not all families will come through alcoholism treatment intact. Divorce is not uncommon in our society. Even if alcoholics had a divorce rate similar to that for nonalcoholics, it would still mean a substantial number of divorces. Therefore, for some families, the work of family counseling will be to achieve a separation, with the least pain possible and in the least destructive manner for both partners and their children.
Issues of family relationships are not important just for the alcoholic whose family is intact. For the alcoholic who enters treatment divorced and/or estranged from the family, the task during the early treatment phase will be to help him make it without family supports. Other family members may well have come to the conclusion long ago that cutting off contacts with the alcoholic was necessary for their welfare. Even if contacted when the alcoholic enters treatment, they may refuse to have anything to do with him or his treatment. However, with many months or years of sobriety, the issue of broken family ties may emerge. The recovering alcoholic may desire a restoration of family contacts and have the emotional and personal stability to attempt it, be it with parents, siblings, or the alcoholic’s own children.
If the alcoholic remains in follow-up treatment with a counselor, the counselor ought to be alert to this. If the alcoholic is successful, it will still involve stress; very likely many old wounds will be opened. If the attempt is unsuccessful, the counselor will be able to provide support and help the person find a new adjustment in the face of those unfulfilled hopes. As family treatment becomes an integral part of treatment for alcoholism, the hope is that fewer families will experience a total disruption of communications in the face of alcoholism. It is hoped that a more widespread knowledge of the symptoms of alcoholism may facilitate reconciliation of previously estranged families.
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HIV: LUNG PROBLEMS-PRODUCTIVE COUGH, SHORTNESS OF BREATH, FEVER: BACTERIAL PNEUMONIAS

Productive cough, shortness of breath, and fever are symptoms of tuberculosis and pneumonia caused by certain common types of bacteria; these symptoms may also be caused by PCP, certain viruses, Kaposi’s sarcoma in the lung, and several other unusual conditions.
Bacterial pneumonias-Bacteria have always been a major cause of serious pneumonias. Before penicillin became available in the 1940s, bacterial pneumonias were the most common cause of death in the United States.
The symptoms of bacterial pneumonias are fever, shortness of breath, and a cough that produces thick yellow or green sputum. For some people, the major symptom is chest pain, especially when they breathe. Unlike PCP and TB, bacterial pneumonias usually begin rather abruptly, and people see physicians within days, rather than weeks or months.
Bacterial pneumonias can occur relatively early in the course of HIV infection. Unlike PCP, bacterial pneumonias do not necessarily indicate a severely weakened immune system. One common bacterial pneumonia is caused by a microbe called pneumococcus; people with HIV infection seem especially prone to pneumococcal pneumonia.
The diagnosis of bacterial pneumonias is usually established with a chest x-ray and sputum tests. Treatment with antibiotics is highly effective when begun early in the infection. Furthermore, a vaccine can now help prevent pneumococcal pneumonia.
Trimethoprim-sulfamethoxazole, which prevents PCP, will prevent pneumococcal pneumonia as well. Bacteria other than pneumococcus cause pneumonias as well, but the symptoms, diagnostic tests, and treatment are all similar.
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SKIN DISORDERS IN ADULTS: FLAKY, WEAK NAILS

Flaky, weak nails are caused by over-exposing the hands to water. Although many people believe that weak nails are due to a hormone or vitamin deficiency, this is not the case. When the hands are immersed in water, the nail cells swell. When the nails dry, the cells shrink. With repeated swelling and shrinking, the nail eventually splits.
The best way to keep your nails strong is to keep your hands out of water. It is therefore important to wear cotton gloves inside rubber or vinyl gloves for all wet work.
The cuticles should not be pushed back as this disturbs nail growth and can lead to infection. It is best to buff nails in the direction of nail growth, rather than against it. Buffing in the wrong direction tends to cause backward peeling of the nails’ top layers (like teasing your hair).
Nail polish protects the nails from water and prevents flaking. Applying nail polish or a top coat every day ‘glues’ the nail cells, preventing them from flaking off. Subsequent coats can be applied over the existing coat. Nail polish removers cause dryness of the nails, making them split more easily.
Nail hardeners are not beneficial and often cause allergic reactions. Moisturizing creams are of limited benefit because they do not penetrate the nails very well.
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