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HIV: PROBLEMS AFFECTING THE WHOLE BODY-FEVER

July 22nd, 2011

Symptoms that affect the whole body, or constitution, are called constitutional symptoms. Constitutional symptoms include fever, night sweats, weight loss, fatigue, lethargy, and malaise. All these symptoms are relatively common both in the general population and in people with HIV infection. People with HIV infection tend to have constitutional symptoms when the CD4 count is low, unless the people are also depressed or have some unrelated medical problem like influenza. Some of these symptoms—fatigue, lethargy, malaise—are subjective and difficult to measure. Others—fever, severe weight loss (wasting)—are more objective.     Fever-Physicians always want to know when a person with HIV infection has a fever: fever is an objective indication of a problem that is not just a day-to-day variation in health status. Fever, especially prolonged fever in people with low CD4 counts, is usually the result of infections. In people with HIV infection, the infections that are most likely are tuberculosis, sinusitis,    Mycobacterium avium-intracellulare infection, cytomegalovirus infection, fungal infection, Pneumocystis pneumonia, and lymphoma.     Most people with fever are aware of it. They cannot tolerate the usual range of heat and cold that most people consider normal room temperature; they have chills and sweats. In people with HIV infection, fevers often begin gradually, occurring off and on for extended periods of weeks or months. The fever is often accompanied by sweating at night, called night sweats, that may be severe enough to require changes in pajamas and sheets.     It is important to measure the fever. The body temperature that is normal differs for different people and at different times of the day. The average temperature is 97 degrees F at 3:00 A.M. and 99.3 degrees F at 5:00 P.M. In general, temperatures are about two degrees higher (on the  Fahrenheit scale) in the late afternoon than they are in the morning. A fever usually exaggerates this daily variation, and the highest temperatures usually come after 6:00 P.M. For this reason, people with HIV infection who think they have a fever should take their temperatures several times during the day, when they feel feverish, and in the late afternoon. Although there is no general agreement on the precise definition of fever, most physicians consider 99.6 degrees F or 100 degrees F to be a fever. (Temperature is measured on two scales: the Fahrenheit, or F scale, commonly used in the United States, and the centigrade, or C scale, used in the rest of the world and in some hospitals in the United States. A temperature of 98.6 degrees F corresponds to 37 degrees C.)     Fever is basically treated by treating whatever is causing it. Treating fever itself is a little controversial. Fever actually has advantages: the immune system works better at higher temperatures, and fever is an important indicator of the course of the disease and of the effectiveness of treatment. But fever is also unpleasant for the person who has it and increases the metabolic rate, burning more calories and making good nutrition more difficult. Otherwise, there is little evidence that fever is harmful.     When the decision is made to reduce fever, the usual drugs are aspirin or acetaminophen. The fever decreases or disappears when people take one of these drugs, but returns when the effect of the drug wears off. For people with persistent fever, these fluctuations in temperature can be more unpleasant than a steady, if high, temperature. For this reason, people with persistent fevers are often advised to take these drugs regularly, every four to six hours, without waiting for the fever to recur.*136\191\2*

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LIVING WITH SPINAL CORD INJURY: FERTILITY

July 12th, 2011

Female fertility is not affected by spinal cord injury: for a woman of childbearing age, the ability to become pregnant persists unless she has some unrelated fertility problem. Menstruation may stop immediately after the injury, but usually resumes within six months. Keep in mind, however, that even during this early time, ovulation continues and you can become pregnant. The length and duration of your menstrual cycle may change after injury, and bleeding may be lighter or heavier.If you don’t want to become pregnant, some form of birth control is just as necessary after spinal cord injury as before. If you do become pregnant, there are special considerations for ensuring the health of you and your child, as discussed shortly.Male fertility after spinal cord injury is a more complex matter. For most men with spinal cord injury, fertility problems result from inability to ejaculate, from retrograde ejaculation (ejection of semen into the bladder rather than out of the penis), or from lowered sperm counts or decreased motility of sperm.Several techniques are available for obtaining sperm from men with spinal cord injury, for use in artificial insemination of a partner or for in vitro fertilization (fertilization, in the laboratory, of an egg that has been removed from the woman’s body and will be re-implanted as an embryo).In vibratory stimulation, a vibrator is applied to the penis to produce reflex ejaculation. This technique must be used with medical supervision owing to the risk of autonomic dysreflexia. The technique usually works only for men with lesions above T12, because thoracic and sacral pathways are necessary for the reflex.Another technique for obtaining sperm is electro-ejaculation, electrical stimulation of the prostate gland and seminal vesicles that produces muscle contraction and ejaculation. A specially trained clinician places the device in the man’s rectum and stimulates the genitals electrically through the intervening tissue, producing ejaculation. The procedure can be scheduled when the man’s partner is ovulating, and artificial insemination can be done immediately after. Or the sperm sample can be used for in vitro fertilization.A new technique for in vitro fertilization is intracytoplasmic sperm injection. This technique improves the chances of fertilization by selecting only the healthiest sperm cells in a given sample and then directly injecting the sperm into the egg cell using microscopic equipment.Depending on your individual situation, you may be able to father a child without medical intervention or with one of the techniques described above. An urologist who specializes in fertility can provide a thorough assessment of your individual situation and help you explore your options. The American Society of Reproductive Medicine can supply you with a list of medical centers that provide infertility treatments of all types.
*127/156/5*

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COPING WITH SUBSTANTIAL HANDICAP: MENTAL RETARDATION, CEREBRAL PALSY, INTRACTABLE SEIZURES

July 1st, 2011

For 80 percent of children with epilepsy, seizures can be controlled. For those children and their families, epilepsy is not and should not be a substantial handicap. For zo percent, the uncontrolled seizures themselves may constitute a significant impairment; and for some children with mental retardation or cerebral palsy, epilepsy may be a substantial secondary disability. These children and their parents carry a significant burden, a greater degree of guilt, anger, frustration, sorrow, and just plain hard work. These parents need to understand these disabilities so they may help their children as much as circumstances allow.Damage to the brain causes these problems. Damage in the motor areas of the brain causes cerebral palsy. When damage or dysfunction occurs throughout a considerable area of the brain it may lead to mental retardation. Epilepsy also exists because the brain is not functioning properly. Mental retardation and cerebral palsy, while sometimes accompanied by epilepsy, never cause epilepsy. Epilepsy never causes cerebral palsy and seldom causes mental retardation.Parents with a severely disabled child must also gradually come to a realistic acceptance of their child’s disability. Mechanisms for coping are the same as for the parent of the less disabled child, but the goal is often far more difficult to achieve. In addition to working through your own adjustment, you must also help your child get the service he will need. You must be an advocate. Both you and your child will have special needs. Finding the help is sometimes difficult; for some people, accepting the help is even more difficult.*193\208\8*

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PREVENTION OF INFECTIVE ENDOCARDITIS: MISCELLANEOUS RISK FACTORS

June 24th, 2011

Although structural heart diseases are the most studied risk factors for IE, a few other risk factors are worth noting. It is unclear how to quantify the risks from these risk factors, or how their presence may or may not affect the decision to offer antibiotic prophylaxis.Previous endocarditis, with or without current structural abnormalities on echocardiography, should be considered a high-risk condition.Diabetes has been identified as a risk factor for IE in several series. It is not clear whether this increased risk is due to microscopic endocardial damage or the relative immunodeficiency associated with diabetes.Chronic renal disease is common in patients with advanced diabetes but was shown to be an independent risk factor in a large study.Nosocomial endocarditis accounts for 10% to 20% of all endocarditis cases in most published series. Furthermore, patients who acquire endocarditis on the inpatient wards are more likely to contract IE with Staphylococcus aureus or Enterococcus, and thus have a significantly higher overall mortality rate than outpatients who contract IE. Careful attention must be paid to inpatients who are going to undergo invasive procedures or who have longstanding indwelling central venous catheters.Systemic lupus erythematosus and the antiphospholipid antibody syndrome are both likely elevate a patient’s risk of contracting IE. This is most likely due to the 25% to 75% chance of clinically significant valvular disease in patients with these diseases. Especially in the presence of a heart murmur or any history of symptoms potentially related to valve disease, a cardiac work-up should be undertaken in these patients prior to making a determination regarding antibiotic prophylaxis for IE.The true effect of immunodeficiency on the development of IE is unknown. Other immunodeficiencies (human immunodeficiency virus infection, organ transplants) have not been specifically identified as risks for IE, as patients with these conditions have not been included to any significant degree in the older studies that form the basis for current recommendations.*47/348/5*

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BDD BEHAVIOURS: “DO I LOOK OKAY?”

June 19th, 2011

Peter, a 40-year-old unemployed carpenter who hated his ears, jaw, and eyes, discussed his appearance and questioned his wife so often that she left him. “All I did was complain about how I looked and talk about how I wanted plastic surgery,” he said. “I didn’t accept her reassurances. She considered it mental abuse. She ended up hating me because of my obsession and because I talked about my looks all the time. Once I drove her so crazy talking to her about it that she pulled a knife on me. She threatened me, lIf you think you need surgery, now you’ll really need it!’ “One parent told me something that’s been echoed by many other family members: “The most frustrating part of it is that no matter what I say, it doesn’t really help.” Indeed, responding to requests for reassurance is a no-win situation. Saying the person looks fine doesn’t help, but neither does telling them that something is wrong. If you say they look fine, they usually don’t believe you. They think you’re just trying to be nice or that you didn’t get a good enough look at the problem. Or maybe you need new glasses. A handsome young man told me that he could “just tell” that his parents think he’s ugly, even though they tell him he’s handsome, because it’s “their moral obligation.” Another told me that “reassurance doesn’t really help, because why did everyone laugh at me at camp and in the locker room?” And a very attractive woman  said, “When people say I look fine and I get complimented, they overdo it, so I must be really ugly.”*103\204\8*

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EPILEPSY AND ITS SPECIAL FORMS/EPILEPSY SYNDROMES: WHAT MAY INFANTILE SPASMS OCCUR?

June 8th, 2011

Infantile spasms may occur in the young child who has developmental problems of the brain or with brain damage caused by birth injury, meningitis, or head trauma. Abnormalities of metabolism such as low blood sugar or amino acid problems may also be responsible. All of these are designated as “symptomatic” infantile spasms, since they are caused by the underlying process. A second and smaller group of infantile spasms are called “cryptogenic” since their cause is unknown. Children with cryptogenic infantile spasms appear perfectly normal in development before the seizures begin.Infantile spasms are virtually always accompanied by an abnormality of the EEG known as “hypsarrhythmia,” a wildly chaotic pattern with multiple spikes and slow waves. While it may or may not be true, it is useful to think of this EEG pattern as imposing severe “static” on the brain waves so that the brain functions poorly and the child’s functioning deteriorates.A physician evaluating a child with infantile spasms should search for treatable metabolic causes of the spasms and infectious processes. An EEG and a CT or MRI scan should also be requested. Unless a specific treatable condition is found, and one rarely is, treatment for the spasms should begin promptly.We initially treat all such children with ACTH (adrenocorticotropic hormone), a form of steroid given twice a day by intramuscular injection. However, some physicians use oral steroids, benzodiazepines such as diazepam (Valium) or clonazepam (Klonopin), or valproic acid (Depakote, Depakene). The relative effectiveness of these various forms of treatment has not been tested, nor has the duration of treatment been established. Each treatment has substantial risks or side effects, but, as indicated above, there are also substantial risks in not treating this form of epilepsy. Clearly we do not understand the reason for the related retardation or its optimal treatment. Further research is needed.*94\208\8*

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BACH FLOWER REMEDIES: CENTAURY REMEDY & THE TYPE OF PERSONS NEEDING CENTAURY REMEDYCENTAUR

May 28th, 2011

Y gives strength to the mind and to the body. It provides necessary strength to the physical body to remove the after-effects of illness.It provides the necessary mental strength to the person to shake off his servile attitude – the ready submission to obey the just or unjust orders of others.It reverses his mental outlook from negative centaury type to positive centaury type.The positive centaury type chooses his own way of life, without interference from any body; he serves others of his own free will and is capable of refusing to do others’ bidding if he wants to, he is a free member of the society with his own individuality and his own opinions. He follows the dictates of his own conscience in adhering to his mission of life without interference from others.It is not difficult to spot the type of persons needing centaury remedy. Here are a few examples.1. A normal girl who did not marry so that she could serve her old and invalid mother.2. A young and promising boy with an Engineering Degree sat on his father’s cloth shop because he could not go against the wishes of his father.3. A young handsome boy who could not marry his beautiful classmate because he could not refuse the orders of his mother who had selected an ugly daughter of a rich man to be her daughter-in-law.4. An educated and accomplished newly wed girl, who meekly submitted to the most unbecoming demands of her spoilt spouce, without protest.5. A person, who cannot refuse to do other’s work, in spite of his being extremely tired and physically weak.6. He unconsciously copies gestures, phrases and opinions of a stronger personality.*64\308\8*

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BATHING AND HEALTHY SKIN

May 19th, 2011

The skin is self-cleansing and does not depend for its essential cleanliness on soap and water. If people exposed their bodies to the air and sun there would be no question about skin odours or other such things. But as the body has to be constantly clothed, then the ordinary water bath is of vital necessity.Other things being equal, the body should be washed all over once a day with soap and water. The full bath-tub makes this practice easy and luxurious but it is by no means entirely necessary. So far as cleanliness is concerned, there is no doubt that a large vessel of water may take the place of the bath, and, without immersing the body in the water, the wash-down can be made just as effective.The best time for the bath for ordinary people is just before retiring, so that all the secretions of the skin that have collected under the clothes can be removed before going to bed. If the full bath is taken it should not be too hot, because this will tend to increase the temperature of the body and stimulate the heart, and this makes sleep very difficult for some people. The ideal way to take the bath is to have the water pleasantly hot when getting into the bath and just cooling off when one leaves it. It is not necessary to use too much soap. If one lathers the feet, under the arms and other parts wherever the skin is in folds, then the rest of the body need only be lightly soaped.In addition to the ordinary cleansing bath one may, with advantage, use the Epsom salts bath occasionally even when the skin is healthy, as it seems to have a slightly stimulating effect upon it and is useful in relaxing all the muscles under the skin. About two pounds of crude Epsom salts may be added to the bath of fairly hot water, and from fifteen to twenty minutes may be spent in it comfortably relaxing.For those who have a really healthy skin and a system that can stand a good reaction the cold bath may be advised. The bath is filled, and the bather gets quickly in and out and rubs down vigorously. Such a procedure is not advised to those who are not sure of their general condition, and in any case one should go into a training period before making the plunge. On the other hand, the cold rub down is very stimulating to the skin and helps to keep it in good condition. Use a bowl of cold water and sponge the body over with it, and then rub down with a good rough towel. Those who find this too strenuous are advised to wring out a towel in cold or warm water, depending on their reaction, and rub down thoroughly with it. In this way the advantages of both the air-bath and the friction bath may be enjoyed.
*16/154/5*

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AFTER THE MASTECTOMY

May 4th, 2011

A great deal of effort is now made by surgeons to preserve as much of the female figure as possible. And there have been many changes in recent years in the extent of surgical operations.If major surgery is required, some large centres back this up with reconstruction surgery. This offers the patient a relatively satisfactory final appearance. In fact, some large British hospitals routinely follow breast surgery with cosmetic surgery. They have found an enormous increase in the number of women now attending for breast checks. If surgery is required, much of the fear vanishes, for the patient knows that the final outcome will be relatively good and aesthetically pleasing.Even if a radical mastectomy is performed—in which the breast and the muscle tissue underneath, plus the lymph glands in the armpits are removed—many suitable prostheses are readily available. When these are expertly fitted, it is difficult for an observer to detect that surgery has occurred, from the outward appearance when dressed.Closer attention to the final outcome, cosmetically, is fortunately having a beneficial effect on many women. By removing the fear factor, it is permitting earlier diagnosis and treatment, the essential prerequisites to better long-term results.Check your breasts regularly yourself. Become an expert. If there is any question of a lump, or if you notice any abnormality whatsoever, visit your doctor immediately.*133\45\4*

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HIV INFECTION AND ITS EFFECTS ON INTERPERSONAL RELATIONS: FEELINGS ABOUT SEX-SOLVING THE PROBLEMS

April 16th, 2011

Some people react to these feelings, as Alan did for a while, by becoming celibate, not having sex at all. Celibacy is one solution. If you are uncomfortable having sex, or if you feel no desire to, don’t bother with it. Many find sexual release in masturbation.     After a while, many people adjust to safer sex. “The way I’ve adjusted to safer sex,” says Alan, “is by psyching myself into thinking I prefer it. It wasn’t easy, but I did it, and now I can’t not practice safer sex, even if my partner wants to do it differently. I can’t ejaculate inside someone any more.”     Lisa and her husband also worked out a mutually satisfying solution: “The virus was pretty hard on our sexual relationship. Oral sex had been an important part of our lives. I tried oral sex with him while he was wearing a condom, but it tasted too bad. We ended up having sex with him wearing a condom, and with mutual masturbation. It was satisfying enough.”     Some people set limits on sex. Dean and his partner had sex less often. That made Dean feel guilty, but his partner said, “I can handle that better than he can. I look at him and he looks so tired.” Some couples have sex quickly, and say that is better than nothing. Some couples in which only one person is infected give control to the uninfected person to determine how often they make love and what happens during love-making.     One good solution is to accept the necessary changes in sexual practices, and where those changes are less than satisfying find other ways to accomplish the same intimacy, reassurance, comfort, and bonding. “Sex always created a bonding between me and my husband,” Lisa said. “Safer sex could do that too. But I also tried to re-create that bond by doing more things together and having more communication.” Dean said the same thing: “We gave up having sex and make love now.” All kinds of physical intimacies that are not sexual can also create bonding: holding hands, touching, giving baths, giving massages, combing hair, napping together, taking showers together, playing card games, lying in bed together, sitting together to read the morning paper or to watch TV or to listen to music, sitting together and reading aloud to each other. Lisa found that her husband responded as she had hoped: “My husband had always had a fear of intimacy. I saw that dissolve. He told me things he never had before. It took time and love to overcome the fear and guilt.”
*90\191\2*

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