While awareness is growing about the many toxic chemicals that exist outside the home, an equally dangerous menace exists within the home. Many products that we invite into our homes and use on a daily basis have hidden ingredients that pose another dangerous threat to our children’s health as well as our own. The very commercial products that we spray, splash, wash with, rub on, and get pretty with harbor a more sinister side. Men in white lab coats whip up chemical concoctions that are designed to be used either in the home or on our body. While we naively accept advertising enticements, most people are unaware that personal care products are part of an unregulated industry, which incorporates known carcinogenic and hormone-disrupting chemicals.

Journalist Joel Beliefs of the Chicago Tribune wrote the following expose called “Take a Powder” providing an inside peek in the hidden world of personal care products.

Do you use toothpaste, shampoo, sunscreen, body lotion, body talc, makeup, or hair dye? These are among the personal care products the American consumer has been led to believe are safe but that are often contaminated with carcinogenic byproducts, or that contain substances that regularly react to form potent carcinogens during storage and use.

*41/165/1*

WHEN William James wrote his classic Principles of Psychology in 1890, he devoted only two pages to “love.” While noting the connection- between love and “sexual impulses,” James observed, “These details are a little unpleasant to discuss.” D. H. Lawrence, the English novelist, was much less timid in dealing with this topic. In Lady Chatterley’s Lover (1926), he suggested that love depends on being uninhibited in all respects, as illustrated in this bit of dialogue between Lady Chatterley and Mellors, her lover:

“But what do you believe in,” she insisted. “I don’t know.”

“Nothing, like all the men I’ve ever known,” she said.

They were both silent. Then he roused himself and said: “Yes, I do believe in something. I believe in being warm-hearted. I believe especially in being warm-hearted in love, in fucking with a warm heart. I believe if men could fuck with warm hearts, and the women take it warmheartedly everything would come out all right. It’s all this cold-hearted fucking that is death and idiocy.”

Until very recently, the topic of love was more in the province of writers, poets, and philosophers than in the minds of psychologists and scientists. Even though it has been said that “love makes the world go round,” few sexologists (including ourselves) have addressed this subject in any detail. Nevertheless, we have all felt love in one way or another. Many of us have dreamed of it, struggled with it, or basked in its radiant pleasures. It is also safe to say that most of us have been confused by it too.

*108\342\2*

What is a normal blood glucose level?

Normal blood glucose levels after an overnight fast in a person over the age of 1 year are 70 to 100 mg/dl (milligrams per deciliter). A deciliter is one-tenth of a liter, or about one-half cup

Levels higher than 140 mg/dl measured on two separate occasions are considered indicative of diabetes

Signs and symptoms of diabetes mellitus

The American Diabetes Association estimates that 5 to 7 million Americans have diabetes but do not know it. Mild

diabetes may produce no symptoms for years. People who are older than 40, are overweight or obese, and have a family history of diabetes have the greatest chance for development of type II diabetes.

Signs and symptoms of type I diabetes usually appear relatively suddenly:

Increased thirst

Increased volume and frequency of urination

Weight loss despite increased appetite

Fatigue

Signs and symptoms of type II diabetes usually develop more gradually and may be subtle. They include any of the above signs and symptoms (except weight loss) and the following:

Frequent or slow-to-heal infections, particularly vaginitis, skin or gum infections, or bladder infections

Blurred vision

Tingling or numbness in the hands or feet

*268\252\8*

However, in the negative Honey Suckle State the person lacks inner mobility. His mind is so much entrenched in the past that he is always dwelling in the memories of the days gone by—the missed opportunities, regret for missed chances and unfulfilled hopes; the sagely advice of a doting parent ignored during youth; the lavish spending of father’s hard earned money, resulting in the present financial difficulties; the loss of a sincere friend or a loving relative—depressing thoughts for events gone by which have no relation to the present conditions of the person. On the other side, at the time when one is sad or unhappy and feels bored, his mind may go back to the period of happiness with memories of a large happy family, company of good sincere friends, a crucial Badminton match in which he came from 2-12 to 14-12 to win the match for his school and the tremendous applause he received from the packed galleries.

In either case whether the mind is engrossed in happy or sad memories of the past, it loses contact with the present, and cannot order the body to act according to the present circumstances. He loses interest in the present and makes no effort to overcome the present difficulties—a state of stagnation when the person is no good for himself and no good to the society.

Home-sickness is a result of negative Honeysuckle state. What tragedy falls to such people can be gauged from a recent historical event.

In 1947 after partition of India, there was mass exodus of the whole communities from Pakistan to India and vice versa. People were cruelly torn asunder from their old moorings. They had to shift lock, stock and barrel from their ancestral homes to new unseen places in an unknown country with different climate, different surroundings and very often with different food-habits. Those who could adopt themselves to the changed circumstances and thought of the then present, not only survived but made very successful citizens of their new country. But the negative Honey suckle people could only lead a miserable existence on to an object death. In a normal person, occasion arises when he cannot forget a certain event in the past or in a reverie after a certain event his mind starts recollecting past events and forgets the present.

*121\308\8*

One factor that contributes to depression is loss of control. When you feel that your disability is an externally imposed event, something you cannot affect through your own behavior, you are more likely to feel depressed. The hospital staff may unwittingly contribute to this feeling by providing you with equipment or developing treatment goals without asking for your input, feelings, and preferences. Remind yourself that you do have choices, that you can take some control of your situation. Some things that depress you can be changed. When you initiate even minor changes, you are likely to feel less depressed and more accepting of your limitations.

Joan hated her heavy leather splints and worked with her occupational therapist to try various alternatives. They eventually developed a model for clear plastic splints and had them custom made by an orthopedic supply house. The splints proved just as effective and more esthetically pleasing. Bonnie, who has paraplegia, was disgusted with the way the outline of her long leg braces showed through her sweat pants, and she didn’t want to wear sweats other than in therapy. She decided to alter her jeans to fit loosely over the braces, creating a bell-bottom effect. This made her feel presentable for visitors and more in charge of her appearance.

Making decisions about your goals, equipment, and appearance can help you avoid helplessness and depression. Understanding that even normal feelings of sadness can affect your physical progress may encourage you to get support from friends and family and to recognize your accomplishments. Making choices, asking for change when possible, and getting support help you focus more clearly and objectively on your practical and physical needs.

*35/156/5*

Not everyone who comes to the Carbohydrate Addict’s Center has a constructive attitude, but Bobbi did. Unlike many of the people who have come to us unhappy with themselves and their lives, Bobbi would have to be classified as a positive person.

She was forty-six when we first met. She was married (“pretty happily,” she said), had two daughters in high school, and a job as an administrative assistant in a large insurance office.

Her dieting history was about what we have come to expect. Several times she had dieted, lost some weight, then regained what she lost. But her losses and gains had been limited to the ten- to fifteen-pound range. She took our test and was identified as being almost dead center in the moderate addiction range.

She wanted to lose “at least fifteen pounds, although twenty would make me ecstatic.” She also expressed a concern that at times her eating seemed to get out of control. When she was home alone, she said, she would sometimes find herself eating without being able to stop. She had noticed that when marketing she would buy things in anticipation of being alone, although she often told herself the food was for others. On more than one occasion she had waited for everyone else to leave the house, taken out her store of goodies, then sat in front of the television and “pigged out.” What bothered her most was that she found this to be probably the most pleasurable experience that she had had for a very long time and that she was finding that she wanted to do it more and more often.

We told her about the Carbohydrate Addict’s Diet, explaining the normal mechanism of insulin release and how its dysfunction probably caused some of her behavior. Then we explained the diet’s guidelines. Bobbi left our session bound and determined to lose weight.

When she returned two weeks later for her scheduled appointment, she was bitterly disappointed. She hadn’t lost any weight, she said.

We asked to see her weight chart. To our surprise, she admitted she didn’t have one. She explained that she had weighed herself on the first day, a week later, and then again that day. Wasn’t that enough? she asked. Other diet programs she had used required that she weigh herself once a week or that she not weigh herself at all.

Daily weighing is critical, we explained. We gave her a scenario.

Say she weighed 156 on the day she started the diet. Most people’s weights vary a pound or two from day to day, so let’s assume that although Bobbi’s typical weight was actually 158, she happened to be at a low-weight point on that first day. Assume she stayed dutifully on the diet for a week, then, at week’s end, weighed herself. Even if she had really lost two pounds she might well appear to have made no progress—having weighed herself at a day or time when the scale read 156.

People can use their weights as an excuse to eat. When they lose weight they tell themselves, Great, I can eat now. If they gain weight they say, What’s the use? I tried so hard and I gained weight, so I might as well eat. If their weight stays the same, they say, “No matter what I do, I’m not going to lose, so I might as well eat.”

That’s why we recommend daily weighings, which are then averaged for the week. This routine helps avoid such counterproductive reactions. It gives the dieter a chance to see how he or she did over the entire week; it’s the way scientists measure changes, taking as many readings as possible to average and compare them over time. It also helps you to understand the changes in your weight that take place naturally.

Several weeks later Bobbi was very much an advocate of daily weighing. “I can’t tell you how important it is. Before, I would get on the scale after a week of torture and find that I had gained a half a pound. Or I would eat like a pig for a week and my weight would stay the same.

“Now I see that it was those stupid weekly weighings. Now I can see the ups and downs during the week but I can also see the trend of the weight loss beyond the false highs and lows.

“That’s really important in keeping my motivation going.”

Bobbi lost twenty-two pounds in four months. After two years, she has maintained her goal weight. And continues to weigh herself every day and to average her weight each week. “It’s become second nature to me. It keeps me sane and it keeps me slim.”

Averaging your weight. In order to measure the rate of your weight loss, your daily weights should be averaged. This averaging helps smooth out the highs and lows, and gives you a more realistic picture of what is really happening with your weight loss.

As Bobbi found, high-weight or low-weight days can make it appear as if you are gaining when you are losing (or vice versa). This accounts for people who have been cheating on a diet but find that when they report for a weekly weigh-in at another diet program, they are told that they have lost weight or stayed the same. But the cheating will usually catch up with them in a week or two.

By averaging your weights, you compensate for high- and low-weight days and get a more accurate reading of what is really happening with your weight level. Taking regular and frequent measurements compensates for the highs and lows of any natural phenomenon. The human body is the same—it isn’t a machine, but it changes and adjusts constantly to countless factors.

*39\236\2*

Some surgeons were working on the complementary problem of getting rid of dangerous obstructions. There are two ways of doing this. Either you can break through or widen the blockage, or you can attempt to bypass the obstruction by providing an alternative route for the blood to follow. It is the difference between picking your way through a traffic jam or turning off into a side road to rejoin the main highway later on. During the late 1930s and early 1940s, Professor Alfred Blalock of Johns Hopkins University in the USA investigated this second strategy, developing a technique for linking together (anastomizing) main blood vessels. In 1944 this painstaking research and imaginative clinical application reached its high spot when the bypassing method was used to alleviate one of the severe congenital defects which cause what is popularly known as a ‘blue baby’. Why ‘blue’? Well, normally bright-red oxygenated blood is pumped from the heart to the rest of the body, but sometimes a child is born with one or a group of defects that allow unoxygenated blood to get into the system instead. Thus the body, instead of receiving freshly invigorated blood, is supplied with blood lacking in oxygen and characteristically very dark purplish-red in colour. This gives the skin a blue tinge. The less oxygen, the bluer the baby.

First attempts at a ‘blue baby’ operation

The ‘blue baby’ Blalock operated on in 1944 had a constriction of the pulmonary valve and an opening between the ventricles. He decided that the blueness would be reduced if he could link up a main artery in the aorta straight to the pulmonary artery; in other words, create a ‘shunt’. It would be only a partial correction of the defect but, if it were successful, the child should be able to live a normal, healthy life.

That, at least, was the theory, but Blalock knew very well that the technical problems were formidable and the uncertainties many. Not only was the actual surgery itself very intricate, but the patient was very young. Could a child survive this major assault on its heart? What would be the effect on the aorta, from which he was going permanently to ‘borrow’ a blood vessel? Then there was the perennial problem that faced all heart surgery – time. The projected ‘blue baby’ operation was likely to take at least 30 minutes, during which time the blood-supply to the lungs would be stemmed. What would this do to the lungs themselves? A lot of questions and a life, not to mention the fortunes of heart surgery in general, hung on this operation.

The relief and excitement when it succeeded were immense. Immediately a great many children would reap the benefit but, perhaps just as important, the cardiac surgeon became a specialist in his own right, and taken his rightful place within the surgical mainstream.

Getting to the heart of the matter

Up until the 1940s, surgeons were really working around the heart, rather than within it. Throughout the rest of the 1940s a variety of new avenues were explored to correct defects inside the heart, building on the long-awaited successes of Blalock and others. As an alternative to the bypassing of a narrowed pulmonary valve, Thomas (now Sir Thomas) Holmes Sellors managed, in 1947, to alleviate the obstruction by operating on the valve itself, and approached the problem of narrowed mitral valves by breaking the obstruction with dilators introduced into the heart.

This was the period of closed-heart surgery: all of these heroic efforts to improve the heart and circulatory system were hampered because the surgeons were having to work ‘blind’. It was still impossible to undertake profoundly intensive procedures within the heart for the simple reason that it could not be isolated from the rest of the body for long enough to allow the surgeon to do his job. Without some artificial pause in the heart’s natural activities, there was little chance of being able to carry out sophisticated surgery.

The long-term answer was, of course, to develop machines that would take over the heart’s work for long periods in the operating theatre. Before that, however, we used what now seems a rather crude method of buying time, ‘borrowed’, so to speak, from the winter habits of certain animals. It was the clinical equivalent of hibernation.

*11/353/5*

• How many cases of my type of gynecological cancer have you treated or managed before?

•     You have suggested I have some tests. What are they likely to show?

•     Have my pathology tests been reviewed? What was the expertise of the person reviewing them?

•     What treatment options are available?

•     What is the success rate of each treatment?

•     What are the physical, psychological and sexual side effects of each treatment? How severe are they? How long will they last?

•     When do I have to decide what treatment I will have?

•     Where can I get a second opinion?

•     Who will supervise my treatment?

•       How long will my treatment take?

•     What information will be given back to my GP (or referring doctor)?

•       How much time should I take off work?

•     What follow-up treatment will be required? For how long?

•     What symptoms or other physical or emotional changes should I look for during my treatment?

•     I am using complementary therapies. How will these effect my treatment?

•       How long will I be in hospital during my treatment?

•       I am concerned about the impact on my fertility and sexuality. Can you give me specific details about this? What counselors are available to talk to?

•       I am concerned about the impact on my sex life. What information is available? Who can I talk to?

• I am concerned that I may need psychological support – what signs will indicate this? What counselors are available to help?

• Who should I call if I feel I can’t cope and am overwhelmed?

• I will need the help of a social worker to help communicate my illness to my children – are there any resources I can read beforehand?

• I need help to organize my home/financial situation. Who can I talk to?

• I am concerned about the impact of the treatment on my body image (hair and weight loss). Who can I talk to?

• I am concerned about the impact of my treatment on my children. Who can I talk to?

• I am on a very controlled diet (diabetic, coelieac, gluten free, vegetarian, macrobiotic . . .) how will this affect my treatment?

• Where can I get reliable information about my condition?

• When should I contact you if I have odd symptoms or other issues of concern?

• What is the best way to contact you?

• I am a lesbian. What is your attitude toward this? Will it be of concern to any of your staff? Will my partner have open visiting rights?

• My language is very limited – who can interpret our discussions for me?

• Is there any support group I and/or my carer can join to discuss my condition and coping skills?

• I live in the country that is a long drive from the hospital – what subsidized accommodation is available, or other types of help such as financial assistance or traveling allowance?

•     How do I find out about country support groups?

•     My children are not able to travel to visit me in hospital very often and are getting very anxious about not seeing me? How do I manage this?

*33/144/5*

You may recall some of the particular family problems that relate to pregnancy and the presence of young children in the family. A few specific words should be said about these potential problematic areas. The first is contraceptive counseling. Pregnancy is not a cure for alcoholism in either partner. In a couple in which one or both partners are actively drinking, they would be advised to make provision for the prevention of pregnancy until the drinking is well controlled. It is important to remember that adequate birth control methods for an ordinary couple may be inadequate when alcoholism is present. Methods that require planning or delay of gratification are likely to fail. Rhythm, foam, diaphragms, or prophylactics are not wise choices if one partner is actively drinking. A woman who is actively drinking is not advised to use the pill. So the alternatives are few: the pill for the partner of an active male alcoholic, a condom for the partner of a sexually active female alcoholic. In the event of an unwanted pregnancy, the possibilities of placement or therapeutic abortion should be considered. If the woman is alcoholic, a therapeutic abortion certainly should be considered. At the moment, no amniotic fluid assay test exists that can establish the presence of fetal alcohol syndrome, but the possibility is there when the mother is actively drinking.

Should pregnancy occur and a decision be made to have the baby, intensive intervention is required. If the expectant mother is the alcoholic, every effort should be made to get her to stop drinking. Regular prenatal care is also important. Counseling and support of both parents if alcohol is present is essential to handle the stresses that accompany any pregnancy. If the prospective father is the alcoholic, it is important to provide additional supports for the mother.

The above touches on the problems of pregnancy with active alcoholism. Contraceptive counseling should also be considered for alcoholics in early recovery. At that point the family unit is busy coping with sobriety, and the alcoholic is engaged in establishing a solid recovery. Pregnancy is always a stress for any couple or family system.

*132\331\2*

Hormone Replacement Therapy can now be taken in a variety of different ways. There is a large range of HRT products available including implants, tablets, skin patches, creams, vaginal pessaries and gels. They are usually prescribed by your doctor.

Implants

Subcutaneous HRT is a pellet containing six month’s supply of oestrogen which is inserted beneath the skin of the lower abdomen. Implants have a number of advantages. Unlike oral HRT, they bypass the liver and go directly into the bloodstream which means that the dose of hormones can be lower but still just as effective. Many women find implants convenient. Once inserted they can be forgotten about. But unless you have had a hysterectomy you should still be taking progestogen tablets for some of the time to induce a bleed. And there are also disadvantages. Once inserted wrong doses cannot be easily changed. It can be difficult to remove an implant if you decide to stop HRT. More worryingly some women using implants can develop a form of dependency on the hormone, requiring ever larger amounts for the HRT to work effectively. The symptoms associated with the menopause seem to reoccur at shorter and shorter intervals so that the implant has to be replaced much more frequently. When their hormone levels are tested, these women often have much higher than normal levels of oestrogen and yet they are still suffering from menopausal symptoms. It may be that they are not absorbing the oestrogen properly or that the body becomes ‘used’ to a particular dose and therefore needs ever increasing amounts to elicit relief of the symptoms. A form of oestrogen ‘addiction’ has also been suggested.

Tablets

The most common way of taking oestrogen and progestogen is by mouth. Women who have had a hysterectomy are given only oestrogen. The oestrogen and progestogen tablets can be prescribed in a number of ways. The most common pattern is where oestrogen is taken continuously every day and progestogen is taken from day fourteen to day twenty-five of the cycle. Once the progestogen is stopped a withdrawal bleed is induced which mimics a period. This is called continuous therapy because oestrogen is taken all the time.

Cyclical therapy is where oestrogen is taken for the first twenty-one days of the cycle, and progestogen is taken from day nine to day twenty-one, so from day twenty-one there are seven days with no medication and a withdrawal bleed takes place.

For many women one of the advantages of the menopause is the freedom from periods, so the idea of resuming their periods and perhaps having them into their eighties if they stay on HRT is not appealing. Another approach is to use the hormones in such a way that a bleed occurs only every three months. Oestrogen is taken continuously for three months and progestogen added only at the end of the third month to induce a bleed.

The other choice is a no-bleed HRT called Livial (Tibolone). This is a synthetic compound given continuously and there is no withdrawal bleed. The prescribing recommendations for this drug specify that it should be given only to those women who have had one complete year free of periods.

Skin patches

Oestrogen is contained under the patch, which is worn on the trunk, below the waistline, and the hormone enters the body through the skin. Patches are usually changed every three to four days. Progestogen is either taken in pill form from days fourteen to twenty-five or a combination skin patch can be used which delivers the progestogen as well as the oestrogen. Some women find the patch irritates their skin.

Creams

Oestrogen-containing cream is inserted directly into the vagina with an applicator. The creams are usually used for treating vaginal dryness, itchiness and discomfort. The dose is too low to help with hot flushes.

Vaginal pessaries

The pessaries contain oestrogen which helps with vaginal dryness and pain on passing urine. Again the dose is too low to help with hot flushes.

Gels

Oestrogen is available in a gel form which is rubbed onto the lower abdomen and absorbed through the skin as with a patch. Many women have found that they react to the adhesive in a patch, so the use of a gel may overcome this.

*11/101/5*