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July 28th 2011 · Read More · Comments Off

There’s so much information available nowadays on cholesterol – some of it helpful, some of it confusing, some of it actually misleading. To make things easier, just concentrate on these most important cholesterol facts:- Your total blood cholesterol and LDL cholesterol are the most telling measures of your risk for heart disease. The best way to lower both levels is to reduce the amount of saturated fat and cholesterol you eat every day and to increase your consumption of foods rich in soluble fiber.- A small minority of people are unable to achieve a safe cholesterol level without the use of drugs. Though effective, all cholesterol-lowering drugs have side effects and should be used only after giving a low-fat, low-cholesterol, high-fiber diet a fair trial. And remember, if you are taking cholesterol-lowering drugs, the better your diet, the lower the dosage – and the lower the risk of side effects.- For maximum protection from heart and blood-vessel disease, your total cholesterol should not exceed 100 plus your age, and should never be higher than 160 mg/dl (unless your HDL is so high it pushes your total up).- Just because your HDL figure is high, this doesn’t mean you’re safe if your LDL cholesterol is also high. A high HDL cholesterol level will reduce but will not neutralize the risk of heart disease associated with a simultaneously elevated LDL cholesterol level.- While your best defense is to lower your total cholesterol and LDL cholesterol, it is known that you can safely raise your HDL cholesterol somewhat by reducing body fat, giving up smoking, and doing regular aerobic exercise.- While they are lower in saturated fat, lean poultry and fish do not contain much less cholesterol than do lean meats, so it’s best to eat no more than 3 1/2  ounces of any of these foods a day. In the high-protein category, fish is recommended over poultry since studies show a reduced risk of coronary heart disease in individuals consuming a modest amount of fish per week instead of meat, compared to those consuming meat only, and no fish at all, as their high-protein food.- Include more soluble fiber in your meals – especially oats, barley, legumes, yams, sweet potatoes, fruits and vegetables – to help lower your serum cholesterol.*15/345/5*


July 18th 2011 · Read More · Comments Off

What about gender differences? In my studies, I’ve found more similarities than differences between men and women with BDD. Men and women appear similar in terms of most demographic features (e.g., age and employment status) and in terms of most clinical features, such as which body areas they dislike, BDD behaviors, severity of BDD symptoms, degree of impairment in functioning, and number of suicide attempts. Men and women are also largely similar in terms of how many have coexisting psychiatric disorders, including anorexia nervosa, panic disorder, and depression. This latter finding is interesting because, in the general population, these disorders affect more women than men. Why men with BDD appear to have as high a rate of depression as women with BDD is puzzling. Although this finding requires confirmation, there are several possible explanations. One is that depression may often be “secondary” to BDD—that is, resulting from the distress and impairment that BDD causes. My clinical impression and recent research findings suggest that this is often the case. If this theory is correct, then it isn’t surprising that men and women are equally likely to be depressed, because they experience similar degrees of distress and impairment as a result of their BDD symptoms. Another possible explanation is that the same underlying biological and psychological mechanisms that cause BDD also contribute to the depression that accompanies BDD; because in our study BDD affected as many men as women, depression would be expected to as well.*148\204\8*


July 8th 2011 · Read More · Comments Off

We probably do not need to remind you that your family also left you with certain impressions about sex itself. But you might not be aware that your interpretation of the events that occurred may have convinced you that feeling sexual desire is a dangerous thing to do.Paula, a single, thirty-eight-year-old financial planner, was raised by a passive, long-suffering mother and a hot-tempered, domineering father who not only “called all the shots” but also physically abused Paula’s mother. “My mother loved the bastard,” Paula claims. Clearly, her anger at her father has been buried alive. But unlike Dan, who put his mother on a pedestal, Paula’s attitude toward her mother is decidedly unsympathetic. “She was a fool, a slave to him. She put up with everything he did because she didn’t think she could live without him. If there was one thing I learned from my mother, it was not to let that happen to me.” And Paula learned that lesson very well.Today she is financially independent and plans to stay that way if she ever gets married. “No man’s ever going to know how much I’m worth or be able to get his hands on my money,” she says proudly. But then, it is unlikely any man will ever get a chance to try. Paula’s relationships rarely last longer than a few weeks. They start out “hot and heavy,” since Paula feels plenty of sexual desire right up until the moment when her latest lover indicates that he wants to see her more than once or twice a week. Then her sexual desire quickly begins to fade. “I don’t think it through ahead of time,” she claims, and we believe her.”It’s the weirdest thing.” She shakes her head in bewilderment. “I wake up one morning thinking, ‘What’s this guy doing here?’ Even if we had great sex the night before, I don’t want him to touch me, because he not only doesn’t turn me on any more, he actually repulses me.”Although she is aware of her determination not to get into the kind of relationship her parents had, when she came to us for treatment, she did not realize that, at some level, she saw intimacy and any relationship as threatening. For Paula, ISD was an unconscious defense that protected her from becoming “a slave,” and prevented her from developing a stable intimate relationship.If you grew up in a confusing or chaotic home, you desperately tried to understand what was happening around you. After all, that is the fundamental task of childhood, to create an inner picture of the world and how you fit into it. This background constructs a script that makes sense to you and will one day help you function independently. Unfortunately, sometimes your family may have handed you a script that made little sense in the world you lived in then or the world you live in today.As a child, using the limited insight that is available to someone so young, you attempted to organize this script somehow; you created explanations for the unexplainable and managed the unmanageable by interpreting events in a way that made sense to you at that time. The conclusions you reached were stored away in some remote, largely unconscious corner of your mind, and will continue to influence you until you consciously confront and rewrite them.*101\261\8*


June 25th 2011 · Read More · Comments Off

We are addressing this to all those patients who are subject to anxiety, being “hyper” or overstimulated (in the sense of being “on the alert”) for much of the time. There is inconclusive evidence that this type of person may be at risk for more cardiac events than others, based on the theory that the cardiovascular system is set at a pitch that is unhealthy to sustain, much in the same way that an engine idles too high; increase the pressure and you will be in the red zone. It may also relate to those who have a concomitant cardiovascular response. By this we mean that with stress, the heart rate or blood pressure rapidly increases, and flushing may occur, but this subsides with the passage of the stress. The “edginess” we describe in this section can spill over into other vulnerabilities highlighted in the other sect ions; so don’t be surprised if you identify with the other tendencies. In particular, we see a cluster of those who identify with this section (Edgy), together with Angry, Pushy, Busy and Hurry. So, don’t be surprised if they all seem to merge together; they do, because they go together.We are also addressing those who read about and identified with anxiety and related symptoms in this book. To both, we are prepared to make a broad-based recommendation about relaxation techniques: they can benefit almost anybody, and one day they may be included in general rehabilitation programs, in the same way that exercise is routinely included nowadays. Are we getting carried away? We think so, to a certain extent, but as a counterpart to the “burn-off” of exercise, there is the “calm-down” of relaxation techniques. They are starting to enter the mainstream as approaches to dealing with CAD and all other types of illness, such as cancer, and are being incorporated into wellness programs everywhere. A boost was supplied in the 1970s with the publication of The Relaxation Response by Herbert Benson. In it, he describes a simple method for evoking the physiological as well as the psychological response of relaxation. The technique involved just two basic components: focusing and defocusing.Defocusing involves shutting out of your consciousness all the thoughts and feelings—the “distracting noises”—that enter your mind as a matter of course. For those of you who are Edgy or Shaky, this will be more easily said than done, as you are the type of person whose thoughts and feelings seem irresistibly impelled into your minds. You will need to learn to push these intrusions away. There is a fine art in doing this; you will find that if you try too hard, you may create a boomerang effect. We are talking about a gentle easing away, rather than a forceful pushing aside.Ideally, we recommend that you actively seek training in the focusing techniques. Just reading about them may get you into bad habits that are not easily correcred. So, you need to find someone with expertise in relaxation training. Should you learn individually or in a group setting? If you do not have prominent symptoms and a group is recommended by professionals or by fellow CAD patients, please go ahead; otherwise, we suggest an individualized program, which includes evaluation and learning of the basic techniques, one of which is taught each week; you will be able to demonstrate your ability to master each technique. The relaxation techniques are: deep breathing, progressive muscular relaxation, autogenic relaxation, imaging and meditation. Deep breathing is controlled, slow and deep, and has an abdominal component. Progressive muscular relaxation is familiar to many who have gone through prenatal classes, including the husbands! It is most effective as an initiator of a relaxation sequence; however, in a tense or “hyper” person it can be used with effect, and unnoticeably, for relaxation of the muscles. With autogenic relaxation, your mind focuses on specific muscle groups in terms of how they feel—hot or heavy, for example. Imaging is a skill well worth having; it involves conjuring up in the mind a scene that is full of relaxing cues, such as lying on a beach in Tahiti, with the waves lapping on the shore as the sun beats down. Although the relaxation therapist in the group setting will suggest a specific scene, in the end each individual will need to conjure up his or her own relaxing scene, as what makes you relaxed can have the opposite effect on someone else. We recommend imaging (imagining a relaxing scene) rather than active visualization (where an empowering story, such as fighting heart disease, is fantasized). Meditation can be the most difficult, but, in the end, the most satisfying of the relaxation techniques. This is particularly so if you see yourself as Mr. or Ms. Busy (see below), and are uncomfortable when your mind is not occupied. Being defocused is difficult for you, but once you persist with the meditation technique, your symptoms should subside, and soon you will develop the expertise to produce the relaxation response on demand.At the end of the relaxation course, you will become familiar with what works for you. You should then start to practice these techniques with the same frequency as a maintenance exercise program, that is, at least four times a week. The sequence is devised specifically for you, and usually consists of three of the techniques (for example, starting with progressive muscular relaxation, going on to deep breathing, and ending with meditation). The techniques should become second nature to you so that you can apply them in your daily life when you become anxious, “hyper,” tense, or whatever is responsive to the techniques.*86\214\2*


June 13th 2011 · Read More · Comments Off

Buprenorphine is a semi-synthetic opioid which, under different circumstances, exhibits agonist or antagonist actions.     Buprenorphine is indicated for the treatment of moderately severe pain. The sublingual preparation is useful for patients with dysphagia. The side effects of buprenorphine are qualitatively similar to morphine. Treatment of respiratory depression caused by buprenorphine requires larger doses of naloxone (two or three injections of 4 mg) due to the affinity of buprenorphine for opioid receptors.     The interaction of buprenorphine with other opioid drugs is clinically important. If patients taking buprenorphine are given another opioid agonist, buprenorphine will prevent or delay the action of the second drug. Patients taking morphine, especially at higher doses, may develop symptoms of withdrawal if buprenorphine is started, due to competitive displacement of morphine from the opioid receptors.*54\55\2*


June 5th 2011 · Read More · Comments Off

If the doctor suspects diabetes, because the patient has been experiencing symptoms like unusual thirst, frequent urination, fatigue, and sudden, unexplained weight loss, the glucose levels of the patient’s blood must be determined. A blood sugar level of 200 mg% or more in a person with the typical symptoms of diabetes confirms the diagnosis.When the symptoms are not as obvious, the doctor may run a fasting glucose test. The blood test is done early in the morning before any food has been eaten. Fasting glucose levels under 115 mg% for an adult, or under 140 mg% for a child, are considered normal. If glucose levels are high, the patient will be tested again, often on another day. (A single high result might be due to a laboratory error.)For adult patients, when the diagnosis is still uncertain, the doctor may administer a glucose tolerance test. First the fasting glucose level is determined, then the patient drinks a measured amount of a concentrated glucose solution. (It tastes so sweet that most people have to struggle to get it all down.) The patient’s blood is then tested again at various times after drinking the liquid to see how quickly glucose levels rise, how high they rise, and how long it takes for them to come down again. These results show how well the pancreas can cope with a sugar load. Too high a rise or too slow a fall may be an indication of diabetes. (In a healthy person, the blood sugar level is usually back down to the fasting level within three hours after a meal.)Once the doctor’s suspicions are confirmed, how does he or she figure out which type of diabetes the patient has? “Together with the results of these tests, the patient’s age and weight often pretty much tell us which type of diabetes it is,” says Dr. Douglas Greene of the University of Michigan Medical Center. “If someone is young rather than old and lean rather than fat, we suspect Type I disease (IDDM) rather than Type II, whereas we suspect Type II disease (NIDDM) if the patient is heavy and getting along in years.” Blood or urine tests for ketones also help doctors make a diagnosis: patients with Type I diabetes often have evidence of ketone buildup, which is much less common in Type II diabetes.*26\268\2*


May 23rd 2011 · Read More · Comments Off

Constitutional symptoms of ARC are the vague, general symptoms that often accompany chronic illnesses. Included are weight loss, chronic weakness, diarrhea, fever, and fatigue. Any of these symptoms may also be caused by certain opportunistic infections. Because some of these opportunistic infections are treatable, when these symptoms develop.     In people with HIV infection, the distinguishing feature of all of these constitutional symptoms is that they are chronic, that is, they don’t go away. Fever, fatigue, achiness, malaise, and diarrhea are periodically experienced by everyone; when they are caused by an acute viral infection like influenza, they interfere with daily activities, but only for a few days. These symptoms can be considered the constitutional symptoms of ARC only when they have been present for at least one month.     The combination of these symptoms can be severe enough to meet the criteria for a diagnosis of AIDS. These symptoms usually occur only when the CD4 count is below 200.     Weight loss. Weight loss is a common symptom for people with ARC. Some people lose weight simply because they lose their appetites. Some people lose their appetites because an infection in the mouth (such as thrush) makes eating difficult. Other people lose their appetites because they are depressed or anxious. Occasionally, people stop eating because food just does not taste good.     In some cases, weight loss might result from the HIV infection itself. Many infections and chronic illnesses, especially if accompanied by fever and diarrhea, increase the body’s metabolic rate so much that the body requires more calories to maintain a stable weight. If the body does not get enough calories, it takes them out of the proteins in the muscles. The result is a debilitation that somehow further weakens the immune system. Weakened immune systems open the door to opportunistic infections. For these reasons a nutritious diet and an adequate exercise program may be especially important for people with HIV infection.     Diarrhea. Diarrhea is also common for people with ARC. Sometimes diarrhea is caused by an infectious microbe which laboratory tests can identify. For many people, however, diarrhea is irregular: on some days loose stools are frequent and on other days bowel habits are relatively normal. Such cases of diarrhea are not often caused by an infectious microbe. Instead, they are caused either by HIV infection itself or by some opportunistic infection produced by a microbe that cannot be detected.     Fever. Fever, like other constitutional symptoms, is common; it can be caused by an opportunistic infection, or it can simply be due to HIV. The temperature we call a “normal body temperature” is actually different for different people; furthermore, a person’s “normal” temperature usually varies during the course of a day. Usually a person’s temperature is relatively low in the morning and has increased by about one or two degrees by the evening. This daily fluctuation in temperature is exaggerated during any illness. Though no single temperature is considered normal for everyone, temperatures above 99.6 degrees F (37.5 degrees C) are at the upper limits of normal, especially if measured during the day (rather than at night). Most people with a fever are aware that they have a fever; nevertheless, the physician will want to know what the person’s temperature is when measured by a thermometer. Rapid rises in temperature are commonly preceded by chills. Chills are an indication of the body’s attempt to retain heat by constricting the blood vessels of the skin where heat is given off. Along with fever, some people also have “night sweats,” sweating^ night which can be severe enough to require changes in bed clothing. Night sweats are usually but not invariably accompanied by fever.     The combination of fever, chills, and night sweats is relatively common in the late stages of HIV disease. Often fevers, especially fevers over 101 degrees or those accompanied by shaking chills, indicate the presence of some infection other than HIV. If you have such a fever, see a physician. The person with fever who does not have a specific treatable infection can obtain relief with aspirin, acetaminophen, or a variety of drugstore remedies that contain these agents. Acetaminophen carries on the label a warning that it causes liver or kidney damage; although the probability of this is low, it might be best to limit the amount of acetaminophen you take. The maximum adult dose is 0.6-0.9 mg (usually two or three pills) taken every four to six hours.     Fatigue. Fatigue is another constitutional symptom of ARC. It is a symptom that is difficult to measure objectively. It is also hard to separate fatigue that is caused by HIV infection from fatigue caused by anxiety or depression or by an opportunistic infection.     Fatigue can be part of the apathy caused by AIDS dementia; a careful neurologic examination will reveal whether this is so. Fatigue caused by HIV infection will usually be accompanied by a low CD4 cell count or a low blood count. Fatigue caused by depression may occur with CD4 counts that are high or low; it requires psychological support.      Fatigue may be profound. In some instances, people may be unable to perform everyday activities, may need to sleep more, or may feel muscle aches or joint pains that limit activity as well. At the extreme, the person may reach the point of “bed-chair existence,” spending virtually all the time either in a bed or in a chair.


May 13th 2011 · Read More · Comments Off

Our mass media do more than spread information and promote products; they influence how we feel about ourselves. Magazines, television, and movies tell us that we must look a certain way in order to be accepted. Although more research needs to be done in this area, magazine ads appear most persuasive, perhaps due to their pervasiveness and to the fact that the models used are extremely thin. In fact, some studies suggest that the smaller the models used in a magazine, the more young women favor that magazine.Television adds to this pressure in overt and subtle ways. During the Clinton/Lewinsky scandal, for instance, late-night television jokes about Monica Lewinsky and Linda Tripp made fun of their appearance, as opposed to examining their actions. Commercials are constantly trying to sell people on a particular look, and this can make viewers feel depressed about their current self-image. In one experimental study, ads focusing on appearance were shown to produce an immediate negative effect on die self-image of undergraduate female subjects. At best, the media are giving women mixed messages, telling them to try a rich recipe, for example, and in the same magazine including an article on how to get rid of that “disgusting” cellulite. Ultimately, what women are hearing is that their self-esteem comes from the way they look, while other values that go into each person’s uniqueness take a distant second place. The feminist movement also has suggested that judging females by appearance alone is a means of controlling women in a male-dominated society. Because men feel threatened by women who want equal salaries and competitive jobs, they put women down for their appearance to make them feel less welcome in the workplace and other venues.Social worker Carol Bloom, the author of Eating Problems: A Feminist Psychoanalytic Treatment Model, notes that while women are hardest hit, men and children are being increasingly affected: “The sociological trends are that we need new markets now to exploit. As long as products are being sold that have to do with image, you are going to have people in this very bizarre relationship to their bodies. They are going to try to transform their outer selves so that they can accomplish these culturally sanctioned goals about human identity. Women are the grossest example of this—as long as self-esteem and identity are tied together, women will be trying to get control over their food and their bodies so that they can gain acceptability.”*55\233\8*


May 5th 2011 · Read More · Comments Off

Lastly, playfulness should be mentioned as one of the elements that preserve romantic love. In the play of love a grown man and woman find perhaps their greatest source of relaxation, since in the interchange of little nothings they come as near to enjoying again the care-free spirit of childhood as is ever possible for persons who carry about with them all the responsibilities of adulthood. But one of the common tendencies of married people is to forget how to play. In this they deprive themselves not only of one of the most delightful and undiminishing pleasures of sex, but also sometimes of any sort of satisfactory sex relations at all, as we shall see in our discussion of physical sexual adjustment. All authorities on the psychology of sex are agreed that courtship should not end with marriage but that the play of romance should be rehearsed throughout marriage, if one of the greatest pleasures is not to be lost.So much for romantic love. But is this enough? If the suggestions given above for the fostering of romantic feelings are carried out completely, does that mean that the love of a husband and wife is impregnable against all contrary forces? Far from it. While we are often deluded into believing that two persons may be miles apart in ordinary interests and tastes but fully en rapport in love, the facts will not bear this out, as many married couples discover after it is too late. When one is in courtship he believes his love is infinite and that it therefore will transcend all ordinary relationships and can never be impaired by mere finite differences. But, ungracious as it is to say so, love is not really infinite—it just feels that way. And since it is in the last analysis only a finite force of attraction, we may expect it to be undermined by other finite and very ordinary forces, which draw a couple apart. Hence as the second condition of happy marriage, we have listed fundamental equality or community.*97\275\8*


April 25th 2011 · Read More · Comments Off

When I bring visitors to the Amherst College campus, I usually put them up at the Lord Jeffery Inn. The three-story structure is a prominent member of a row of immodest giants that look down on the Town Commons. Its whitewashed brick exudes New England charm in a self-important Yankee way. It does have some reason to boast. It stands in the middle of a favored hollow. In 1812, Noah Webster moved in at one end of the Commons, a block to the right of where the inn now stands. He was brought there by his stubborn determination to write a dictionary that would help unify a young country through a common language. Realizing that he had to choose between this dream and the worldly but pricey environs of New Haven, Connecticut, he reluctantly moved to the backwater town of Amherst, abandoning mainstream society for, as he put it, “a humble cottage in the country.” He joined about twenty-five other families whose life was organized around the Commons, which was then a gentle slope of birch trees on which grazing privileges were shared on a rotating basis by the town’s cows.At the Webster end of the Commons, just twenty steps from where the inn is now located, stood the one-room schoolhouse that so appalled Webster that he set to raising money to build Amherst Academy almost as soon as he arrived. Within three years the academy had been built a block uphill from the schoolhouse, just beyond the corner of the Commons. Webster postponed his dictionary by several more years to raise money for a college even more earnestly than he had for the academy, partly because he felt poorly treated by Williams College, which had rejected his proposal to affiliate with Amherst Academy. The episode started a usually friendly rivalry between Williams College and Amherst College, which continues to this day. The first austere buildings of Amherst College still stand at the top of a hill two blocks to the inn’s left, at the other end of the Commons from Webster’s “humble cottage.”In the year of Webster’s death a teenage Emily Dickinson, living a few doors down the road from Webster’s farm, could look out her bedroom window toward the Commons. Webster had returned to New Haven by that time, but Dickinson still felt his legacy as she walked alongside the Commons past the Webster farm to attend, somewhat irregularly, the academy. The legacy was also felt by the young poet Robert Frost and the young physicist Niels Bohr, at the other end of the Commons, as they struck up a friendship at the college a century after Webster busily raised money for a school that would link the Arts with the Sciences.The visitors invariably enjoy their stay at the Lord Jeffery Inn, but it seems as though they should be feeling apprehensive, just as they would if they sat down to eat at a diner called the Typhoid Mary Cafe. As a visitor pulls up a blanket on a cold winter night at the inn, he might remember that Lord Jeffery Amherst was the guy who is famous for giving smallpox-laden blankets to the Indians of western Pennsylvania.*50\225\2*