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The skull X-ray gives only limited information, e.g. it will show fractures, sinusitis, or inflammation of the bone. A tumour within the skull may show itself by thinning or thickening of the bone overlying it. Shadows of calcium can be seen in various areas within the skull cavity, e.g. a common place is the pineal gland; this is normal but, since this gland is central, a displacement signifies a growth pushing it to the other side. Calcium can also be seen when deposited in a slow-growing tumour, abscess, or blood vessel malformation. These alarming features are virtually never found in a patient with migraine. In fact, the skull X-ray of 100 people without headaches would show abnormalities about as often as those of 100 migraine sufferers. The X-ray is justified on the grounds that something may be discovered, albeit rarely.An X-ray of the chest is occasionally done as a screening measure in eliminating certain causes of headache, e.g. in tumour of the lung, which may spread to the head.Since headache may be due to neck trouble, an X-ray of the cervical spine is sometimes indicated. Although migraine is not usually caused by problems in the neck, wear and tear of the neck vertebrae can cause pain with consequent spasm of the neck muscles, which pull on the scalp to give tension (muscle contraction) headache; treatment of arthritic pain can often relieve these headaches. Pressure on the roots of the cervical nerves also causes pain, particularly over the back of the head.


In addition, if you are just beginning to remember or deal with traumatic sexual experiences, you may have flashbacks to the assault. During sex or in sexual situations, thoughts, feelings, and even visual images of the traumatic incident may appear in your mind, sometimes so forcefully that you actually confuse what is happening now with what happened then, or you look at your partner and see your abuser instead. This is a truly terrifying experience.Indeed, Rebecca, a twenty-three-year-old sales clerk who could “go only so far” with her fiance before feeling her sexual urges turn into panic and disgust, was disturbed by that type of flashback. She called our office one morning and insisted on seeing us as soon as possible. “It was awful,” she declared. Her skin was pale, her eyes red-rimmed with dark circles around them. She did not have to tell us she had not slept since watching her fiance turn into her stepbrother right before her eyes. “We were doing what we usually do,” she continued, “making it as romantic as we could. We’d lit some candles and Joey turned around to switch off the lamp, only when he turned back he wasn’t Joey anymore. He was Ronnie, my stepbrother. He looked like Ronnie, looked like he was wearing Ronnie’s striped pajamas. When he took my hand I was sure he was going to put it on his penis and say, ‘Make it feel good, Becky. Rub it like I taught you to. If you do it good, maybe I’ll teach you something new.’ That’s what Ronnie used to say. I think I even heard Joey say it. I don’t know. I’m so scared. Am I losing my mind?”If you have a flashback, you too may think you are losing your mind. You are not. Many sexual assault victims have them and learn to overcome them by using specific techniques like those we have included in Chapter Six, or others you can find out about by reading any of the excellent resources listed in the Bibliography.Of course, incest and child molestation are not the only types of traumatic sexual experiences linked to ISD. Rape or any other form of sexual assault—no matter how old you are when you experience it—leaves you terrified, emotionally devastated, sometimes physically injured, and almost always plagued by a pervasive sense of powerlessness and by fears about losing control. For months, years, or decades, you may find that you cannot become sexually aroused without feeling afraid and experiencing many of the same reactions to sex that incest victims do. A 1983 study of female survivors of sexual assault showed that more than half of them had long-standing sexual desire difficulties, including ISD.*107\261\8*


Because hospitalization accounts for 80 percent of the health care bill and because hospitalization costs are so high, the medical profession has developed a series of alternatives to hospital care. The alternatives include expanded outpatient clinics, chronic care facilities, home care programs, and hospice programs. Although the motivation for these changes has been economic, the result has been humane: most people prefer almost any health care setting to a hospital.     Expanded Outpatient Facilities-Outpatient facilities—physicians’ offices, clinics, or specialized facilities—now offer many of the procedures and treatments that previously required hospitalization. Examples of these procedures and treatments include blood transfusions, some intravenous treatments, specialized diagnostic examinations like CAT scans or MRI scans, endoscopy, induced sputum tests to diagnose Pneumocystis pneumonia, and most minor surgical procedures.     The biggest reason that outpatient facilities have expanded their services is cost: treatments done on an outpatient basis are substantially less expensive than those done in a hospital. Another reason that outpatient facilities have expanded is that insurers will not reimburse people who are only admitted to the hospital to get some types of treatments and procedures. And to make things more confusing, some insurers now reimburse only those treatments done in a hospital. The contradiction in reimbursement rules is difficult to understand but important to know about. Talk to your insurance company, your social worker, and your physician. It may be that the test you need will cost more to do in the hospital, but the final bill to you will still be less.*171\191\2*


First described by Jean Marie Charcot in 1877, acute (ascending) cholangitis occurs in an infected and usually obstructed biliary system, typically at the level of the common bile duct. This illness is characterized by fever, abdominal pain, and jaundice and is an important cause of the “acute abdomen.” If the biliary obstruction is not relieved, persistently elevated intraductal pressures can cause reflux of biliary contents and bacteremia, ultimately leading to sepsis.Bile is normally sterile because of the constant flow into the duodenum, flushing the biliary system, and the antibacterial properties of immunoglobulin A and bile salts in the bile itself. The sphincter of Oddi also helps to prevent intestinal contents from refluxing onto the common bile duct. Obstruction of the common bile duct causes a rise in pressure that leads to edema and necrosis of the walls of the biliary tree. Obstructions are primarily due to gallstones in the majority of cases, and these may arise from the gallbladder or spontaneously form in the common bile duct after cholecystectomy. Other reasons for biliary obstruction include malignancy, benign strictures, congenital abnormalities, cysts, parasites (Ascaris, Clonorchis, or Echinococcus species), pancreatitis, or extrinsic compression. In the presence of any of these causes of obstruction, bacteria may reach the biliary tree by either reflux from the duodenum or translocation from the portal circulation. *106/348/5*


The time to think about shaping up for pregnancy is before you become pregnant! So, if you’re contemplating parenthood, now is when you should go all-out for fitness.
DietIf you are overweight, lose those pounds before conception. Obesity can cause numerous and often dangerous problems in the course of pregnancy – especially during labour and delivery – and trying to lose weight while you are pregnant is generally not advisable. Your chances for a healthier baby and a happier pregnancy are substantially greater if you are at your proper weight level when you conceive. Your pre-conception diet should include a plentiful variety of nutritious foods, particularly those rich in iron.
Best Iron-Rich Bets                                                 RewardsLiver (3oz.) 7-12 mg.Dried apricots (3 cup)                                                4.1 mg.Wheat germ (4 cup)                                                   2.5 mg.Tofu (lcake)                                                                2.2 mg.Prune juice (1 cup)                                                     10.5 mg.Asparagus spears (8 average, 3.0 mg.canned, drained),                                        Oysters (4 oz., raw) 6.2 mgBeet greens (1 cup, cooked) 2.8 mg.Peas (1 cup, cooked) 2.9 mg.
Vitamins С and E aid in the assimilation of iron, so be sure you’re eating enough foods with these vitamins or taking supplements.Keep your diet varied. Too much phosphorus can interfere with iron absorption unless your body is being supplied with sufficient calcium. (I’d advise taking a high-potency multiple vitamins and chelated multiple-mineral supplement with breakfast and dinner, just to keep your nutritional bases covered.) Also, keep away from coffee and tea. They, too, can interfere with iron absorption.
ExerciseThe more physically fit you are before becoming pregnant, the better you’ll be able to deal with the stresses of pregnancy. (Think of it as an athletic event, and prepare for it the same way.) Certain exercises are not recommended during pregnancy, but if your body has become used to working out, you’ll be able to get a lot more from the exercises that have been designed for pregnant women.
Drugs And Medications•   If you’ve been taking oral contraceptives, it’s advisable to wait at least three months after discontinuing use to become pregnant.•   If you are on any medication at all, ask your doctor about the risks involved before attempting to conceive.•   Have a complete gynecological examination. (This is particularly important if you or your partner has – or has had – a venereal disease.) Be sure to tell the doctor that you’re thinking of becoming pregnant as you might need immunization against rubella (German measles), in which case, you’ll probably be advised to postpone attempting conception for at least three months to avoid endangering your baby.*1/137/5*


Opoet, playwright, biographer, and scholar, the greatest literary figure of his age, Samuel Johnson (1709—1784) once wrote, “Disorders of the intellect happen much more often than superficial observers will easily believe. Perhaps if we speak with rigorous exactness, no human mind is in its right state.” His interest in the subject was due to concern for his own sanity. In Young Sam Johnson, James Clifford writes that Johnson “would become oppressed, again and again, by the morbid obsession that he was losing his mind.” Johnson was a great admirer of John Bunyan. Historian W. HaleWhite notes that Johnson was “haunted by Bunyan’s specters.” That is not surprising, as Johnson, like Bunyan, clearly had obsessive-compulsive disorder.James Boswell, Johnson’s famous biographer, notes that his subject had “queer habits which amazed all beholders,” habits we now recognize as touching and repeating compulsions. Johnson “sometimes seemed to be obeying some hidden impulse, which commanded him to touch every post in a street or tread on the center of every paving-stone. He would return if his task had not been accurately performed.”Johnson also performed compulsive rituals before entering houses: “I have upon innumerable occasions,” writes Boswell, “observed him suddenly stop, and then seem to count his steps with a deep earnestness; and when he had neglected or gone wrong in this sort of magical movement, I have seen him go back again, put himself in a proper position to begin the ceremony, and, having gone through it, break from his abstraction, walk briskly on, and join his companion.” Similar compulsions are described by another Johnson biographer, Miss Frances Reynolds, who writes that upon entering a house Johnson “whirled and twisted about to perform his gesticulations; and as soon as he had finished, he would give a sudden spring and make such an extensive stride over the threshold, as if he were trying for a wager how far he could stride.”Johnson frequently suffered a nervous tic disorder, not uncommon with OCD sufferers. Sometimes, his compulsions and tics were the object of ridicule. Boswell writes: “Once Johnson collected a laughing mob by his antics; his hands imitating the motions of a jockey riding at full speed and his feet twisting in and out to make the heels and toes touch alternately.”*16/338/2*


Shigella species require an inoculum of only 10 to 100 organisms and thus is highly communicable. Outbreaks have been traced to food and water, but most infections are transmitted person-to-person. Shigella is, therefore, a major pathogen in day care centers and nursing homes. Variable in its morbidity, Shigella produces Shiga toxin, which causes fever, malaise, cramping, tenesemus, and voluminous diarrhea that is initially watery and often becomes bloody. Because most cases are self-limited and resistance is increasing, antimicrobial therapy may not be indicated, especially if the patient is improving at presentation. But, in cases of moderate to severe illness, patients at the extremes of age, and patients with comorbid illness, antibiotic therapy should not be withheld because may decrease symptoms and shorten fecal excretion. Trimethoprim-sulfamethoxazole, ampicilline, tetracyclines, and fluoroquinolones are acceptable agents, but resistance is becoming more common.*68/348/5*


Does mother often do this?’ Sue Usiskin’s young son was asked by an indignant customer, as Sue lay on the floor after a seizure in a butcher’s shop.Children are going to be exposed to other people’s ignorance or intolerance early on and so it is doubly important that the message you give them about epilepsy is a positive one.Having a parent with epilepsy can have a huge emotional and social impact on a child. How they respond and how well they cope with it will depend more than anything else on how they see their parents behave. Children are great imitators. If their parents’ response to a seizure is calm and matter-of-fact, and their attitude is that it is no big deal, then this is the attitude the child is most likely to adopt too.Parents who have epilepsy need to talk to their children about it, to give them some kind of explanation about what is happening when they have a seizure and to reassure them that it is not dangerous. But many parents do not do this. One survey showed that less than a quarter of parents with epilepsy told their children about it. Sometimes the first a child knows about a parent’s epilepsy is when they see that parent having a seizure, a situation which can be very frightening.Sometimes the problem is that the parents themselves have only a vague understanding of what epilepsy is, and so obviously they find it hard to explain what is wrong to their child. Or they may simply be too embarrassed to talk about it, feeling that their condition is something to be ashamed of and hidden from their children – an attitude which the children themselves will inevitably pick up and reflect.In some families parents even try to avoid the word epilepsy. They may describe the seizure as a blackout, or a funny turn. Yet these euphemisms may confuse the child even more. Worse still is if the parents decide to tell the child nothing.The more reluctant parents are to answer questions or give reassurance, the more the child is likely to assume that something is very badly wrong. Inevitably the child will try to piece together an answer for him or herself, and inevitably they will come up with one that is largely based on their own fears. What they imagine to be the truth is almost always infinitely worse than the reality.Your child’s worst fear may be that their parent will die. At the very least, seeing their mother or father taking pills every day, the child is quite likely to assume that they are ill. They may need reassurance that you take medicine not because you are ill, but so that you can stay well. And if your child has seen you having a generalized tonic clonic seizure it is a good thing to tell them quite clearly, even if they do not ask, that seizures are not painful.If a parent is taken into hospital a young child may worry that they have been abandoned, and that the parent will never return. Children who are told what is happening, and allowed if possible to see or at least speak to the parent while they have to be in hospital, are much less likely to be clingy and insecure when the parent does finally come home.Older children are often afraid that they too will develop seizures. They need to know that while they may have a higher than average risk, having a parent with seizures does not necessarily mean that they will develop seizures themselves.HELPING CHILDREN COPEWhen a parent has epilepsy there may be times when the natural order of things is reversed, and the parent becomes helpless and dependent while the child finds him or herself temporarily in the role of responsible carer in a situation over which he or she has no control. How can you best prepare your child to meet this situation?One way is to make sure that your child knows what they can do to help if you have a seizure when they are there. Sue Usiskin, who has epilepsy and is an epilepsy counsellor, recommends giving children a simple, practical task to carry out. When her own children were small and she had a seizure, her son would run to get a cloth to place under her face to protect it, while her daughter would sit stroking her face, comforting her. Even very young children can be given some small part to play, and this will make them feel less helpless and less afraid.Occasionally, in families where the parent finds it difficult to cope with their own seizures, or has severe, disabling epilepsy, the parent may not be able to give the children the emotional support they need. Sometimes this situation leads to a child trying to take on too much responsibility for the parent, so that there is a swopping of roles which may not be healthy for either of them. Children are still children and they need their childhood; they should not have to take on responsibility for a parent. They need to feel protected and to be looked after themselves. If the parent can not provide this support, it is important that another adult should do so.*61\193\2*


“I’m just not interested in sex any more”. In painful contrast, of course, to thousands of others who seem to be making out like bandits all the time. You’ve tried X-rated videos, reading the Kama Sutra cover to cover and sideways, too — but nothing seems to get your gonads excited anymore. Libido is what makes us want to have sex in the first place, and if you don’t care one way or the other — though you wish you cared — there’s a long list of possible reasons why your sex drive may have shifted into low gear.The sex hormone that’s responsible for desire or arousal in both, men and women, is testosterone. It is produced in both sexes, beginning from infancy, but increases dramatically around the age of eight or nine; then, during the teenage years, levels stabilise in girls, but continue to increase in boys (in Whom it is also responsible for sex characteristics such as facial hair and a deepening of the voice). Adult men produce about 10 times the amount as adult women. However, as long as some testosterone is present, the vigour of your sex drive does not depend so greatly on how much testosterone your body is producing.What does make a bigger difference is whether you’re with the right partner, in the right mood and the right setting, and whether your libido is not depresssed by causes that can range from the menstrual cycle to recent illness.Most people with low sexual desire are “wired together” correctly, that is, they are physiologically capable of sexual function — it’s just that they are “not interested”. Sometimes they may feel an actual aversion for sex. Among the snags that can trip up desire:Previous sexual trauma such as a clumsy, brutal claiming of “marital rights” by a husband on the wedding night. Many men do not only regard the wedding night as an occasion solely geared to their sexual gratification, but even imagine that as long as they are satisfied their wives will be satisfied too. When his virtual rape does not ignite any fires for his wife, it’s put down by such a man to frigidity. But a woman who has been sexually traumatised on her first night can have her ardour dampened for all the years of her marriage.Anxiety and fears. Severe irrational fears, often arisingfrom faulty conditioning, can cause an aversion to sex. Both,men and women, can be affected by fears. The fear of appearing entirely in the nude before an opposite-sex person, the fear of seeing an opposite-sex person in the nude, the fear of whether you will “do it right”, or please him/her, the fear of AIDS, the fear of an unwanted pregnancy. The list of potential anxieties, phobias and terrors is endless. And they are all anathema to arousal. Some people fear that their sex drive will decline with the passing of the years. But this is not necessarily true; rather, it is the mistaken conviction that your libido will decrease that often sets up the anxiety which can translate into reality if you obsess on it too long.Depression is one of the most common causes of low libido, especially in women.A particular kind of depression known as post-partum depression often sets in after a woman has given birth to a baby. It is quite common for sexual desire to be dampened during this period. (Sometimes, though, it is not post-partum depression, but the stress of coping with the new demands that causes libido problems during this time.)Unresolved anger or conflicts. Sex does not take place in a vacuum. If you are seething with hidden anger, resentment or hostility toward your partner because of deep-rooted marital problems, you cannot possibly feel turned on by him or her.Poor sexual technique. Even love and loyalty are, in the end, not enough to keep you sexually interested in a partner who’s too clumsy and fumbling under the covers, too ignorant of sexual technique to excite you.Loss of attraction. Over the years, both, men and women can find that their partner is no longer attractive to them. Often, they are reluctant to face up to this fact, and instead try to plumb the depths for other plausible-sounding reasons for their declining interest.Poor body image or self-esteem. Real or imagined physical imperfections can make many women especially feel undesirable. As a woman ages and begins to lose her youthful looks and beauty, she may become increasingly anxious about her appearance — from facial wrinkles to thinning hair. This can translate into a lack of sexual self-confidence which itself can depress arousal.Similarly, although mastectomy (the surgical removal of all or part of a woman’s breast as a cancer treatment) does not affect her capability for sexual response, she herself may feel a loss of sexual desire … and of being desired.Hormonal imbalances. Anything that alters the balance of your sex hormones can lower libido. In women, this includes the contraceptive pill, pregnancy, breast-feeding, menopause, a hysterectomy (surgical removal of the uterus), oophorectomy (surgical removal of the ovaries).Pituitary tumours can produce excessive amounts of prolactin which suppresses the production of testosterone and can affect not only libido but also potency in a man.Medications. There’s a whole range of drugs out there that can lower libido in both, men and women. They include certain blood pressure medications, cholesterol-lowering drugs, some tranquillizers and anti-depressants, anti-ulcer drugs.Alcohol and street drugs can also affect libido over time.*142\332\2*


Varicose veins are very common and are hereditary. They often appear between the ages of twenty and thirty and usually get worse with age. They can also worsen following pregnancy and with prolonged standing. Compression stockings provide graduated compression (that is, more compression at the ankle level) and may help prevent the progression of varicose veins, whereas support pantyhose provide only haphazard, irregular compression (usually where it is not needed) and are of no benefit in varicose vein prevention. Compression stockings are essential for those with varicose veins and should be worn on a daily basis by people who have a tendency towards varicose veins or who are standing for long periods of time each day. They are also useful during pregnancy and for long airplane journeys. Mild compression stockings are very sheer and are available in many fashionable colours. These are good for everyday wear. During treatment for varicose veins and during pregnancy moderate compression stockings are recommended.People traditionally associate treatment of varicose veins with extensive surgery, causing unsightly scars and prolonged convalescence. Nowadays, the trend in treatment is to perform limited surgery in addition to sclerotherapy (injection of the veins). While surgery is essential for veins which originate in the groin, others can be successfully treated with sclerotherapy as an outpatient procedure, causing minimal interference with a person’s normal lifestyle.There are now also methods of identifying abnormal veins, by Doppler Ultrasound and Duplex scanning, which mean that surgery can be more accurately planned and only ‘faulty’ veins removed. As a result, surgery is less traumatic, there is less scarring and recovery is quicker.Sclerotherapy is an excellent alternative to surgery for minor varicose veins, requiring no hospitalization and a good, long-term cosmetic result. Minor veins can also be removed by a ‘microsurgical’ technique, whereby the veins are removed through a micropuncture and extracted with a hook which resembles a crochet needle (called a Muller hook). This latter technique leaves only imperceptible scars.

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