Early in the recovery process, many alcoholics have a tendency to become quite upset over very small matters. They look well, feel well, and sound well—but they really aren’t quite there yet. This can be very trying for both counselor and client and the family, too. Remembering and reminding them of how sick they have recently been makes this less threatening. The steps after any major illness seem slow and tedious. There are occasional setbacks; yet eventually all is well. It works that way with alcoholism, too. It is simply harder to accept because there are no bandages to remove, scars to point to, or clear signs of healing to check on. It cannot be emphasized enough that it takes time.
During this early phase of treatment, one point often overlooked is the alcoholic’s inability to function on a simple daily basis. It is almost inconceivable to therapists (or anyone else for that matter) that a person who seems reasonably intelligent, looks fairly healthy after detoxification, and is over 21 can have problems with when to get up in the morning or what to do when he is up! Along with family, work, and social deterioration caused by the alcoholic life-style, the simple things have gotten messed up, too. Alcoholics may have gargled, brushed their teeth, and chewed mints continually while drinking in an effort to cover up. They may, on the other hand, have skipped most mealtimes and eaten only sporadically with no thought to their nutritional needs. They may have thrown up with some regularity. Also, as we have seen in Chapter 5, their sleep is not likely to be normal. Getting dressed without trying to choke down some booze to quell the shakes may be a novel experience. It may have been years since the person has performed the standard daily tasks in a totally drug-free state.
Alcoholics are rather like Rip Van Winkles during the early weeks of their recovery. Everything they do is likely to feel strange. The face looking back at them from the mirror may even seem like a stranger’s. They became used to the blurred perceptions they had experienced while drinking. It is terribly disconcerting to find virtually every task one faces a whole new thing. Whereas it used to take 2 very careful days to prepare Thanksgiving dinner, it now requires only a few hours. The accompanying wine for the cook, trips back to the store for forgotten items (and by the way, a little more booze), the self-pity over having to do it, the naps necessary to combat the fatigue of the ordeal, the incredible energy devoted to controlling the drinking enough to get everything done—all these steps are eliminated.
The newly sober alcoholic is continually being faced with the novelty of time—either time left over, or the experience of not enough time, or near panic over what to do next. Many clients will need help in setting up schedules. After years of getting by on the bottle, they have to regain a sense of the “real” time it takes to accomplish some tasks. He may plan to paint the entire house in 2 days or, conversely, decide that he can’t possibly fit a dentist appointment, a luncheon engagement, and a sales call into one. She may believe that it is all she can manage to stop by the bank on the way to work, and pick up a loaf of bread and the dry cleaning on the way home. Tomorrow she intends to make new living room drapes in time for that evening’s dinner party! The perception of time is as distorted as other areas of perception. Reassurance that this is a common state of affairs, along with assistance in setting realistic daily goals, is greatly needed. This is one reason newcomers to AA find the slogans “Keep it simple” and “First things first” so helpful.
The alcoholic may not mention the dilemmas over time and schedules to you. There may be a sense of shame over such helplessness in the face of simple things. However, a gentle question from you may open the floodgates. This provides the opportunity to help bring order out of chaos. You can offer the alcoholic some much-needed guidance in remastering the details of daily living. All too often the wail is heard, “I don’t know! The house was a mess…. The kids were a mess…. I was a mess…. I just couldn’t handle it, so I drank!”
Another area in which the counselor has to reorient the alcoholic to reality involves the misperception of events. The faulty memories caused by the drugged state will have to be reexamined. One cannot always wait for some sudden insight to clear things up. For example, he is talking to you about difficulties he has had with his wife. He remembers her as a nagging bitch on his back about a “few little drinks.” You might remind him that on the occasion in question, he was picked up for driving while intoxicated with a blood alcohol content of 0.20— clearly not a few. Then go on to point out that because he has misperceived the amount he was drinking to such an extent, he may have misperceived his wife’s behavior. The opportunity is there, if indicated, to educate the client briefly on the distortions produced by the drug, alcohol, and to suggest that sober observations of his wife’s behavior are more valid. You might instead suggest a couple’s meeting, but keep clearly in front the issue of the alcohol use.
*102\331\2*
Steroids
Cortisone is a natural hormone produced by the adrenal gland. Cortisone derivatives are called steroids or corticosteroids. Steroids regulate the metabolism of sugars and minerals in the body; thus, they have an important controlling mechanism of all bodily functions. Cortisone-like drugs — steroids — have very powerful anti-asthmatic actions, but their mode of action is not known. They also improve the effectiveness of the bronchodilator medicines during acute and severe attacks and can be life-saving during critical acute attacks. They are also capable of reversing or preventing attacks of asthma in people who are not responding to other medication.
While oral steroids have the ability to relieve symptoms in most asthmatics, they are only prescribed when all other medications have failed to make an impact on asthma symptoms. Taken over a long period of time, steroids can have quite significant side effects.
Often doctors prescribe steroids for a short period — about ten to 20 days — to manage a severe bout of asthma. A short course of steroids usually brings rapid relief in acute asthma cases and is often the only alternative left to control severe and persistent symptoms. Courses lasting less than three weeks can be stopped suddenly without risk.
There are asthmatics who continue to present severe symptoms even when they are on a high dose of medication. In such cases, a doctor may have to put the patient on a prolonged course of steroids to reduce symptoms and improve overall health. A prolonged course of steroids is sometimes the only means of maintaining stable lung function, preventing further deterioration and allowing the patient to live comfortably.
SIDE EFFECTS OF STEROIDS
The potential side effects from prolonged use of steroids are many. They include lowering resistance to infection, thinning of the skin and bones, indigestion, peptic ulcers, aggravation of pre-existing conditions such as high blood pressure and diabetes, weight gain and facial puffiness. A round, moonlike face is often associated with the use of steroids. Prolonged steroid treatment can also cause the retardation of growth in children, but it is important to remember that severe chronic asthma also stunts childhood growth, possibly more so than life-saving steroid treatment.
Not everyone on prolonged courses of steroids experiences all of the possible side effects, and the severity of reactions to the drug varies from one person to another. For severe asthmatics, the side effects are less damaging than the long-term effects of chronic asthmatic symptoms. Doctors only prescribe steroids when they believe they are totally necessary for the maintenance of lung function.
It is very important to finish the course prescribed by your doctor if you are on steroids for over four weeks. Because there is a time gap between ending the treatment and the body’s ability to resume its own steroid production, you should never suddenly stop your treatment, even if you are feeling better. Suddenly stopping a course of steroids can upset your body’s hormonal balance and cause you to become very ill. Coming off a course of steroids should be gradual, conforming strictly to the doses planned by your doctor.
Doctors advise people on prolonged doses of steroids to carry an identification card including the details of the illness and medications to be administered in the event of an emergency.
Atropines
Atropines act as antispasmodics and have been used in the treatment of asthma for many years. This type of drug has a modest bronchodilator effect and is available as either a metered aerosol or a solution for a nebulizer. The brand most commonly prescribed is Atrovent. This drug works differently to beta-agonists and theophyllines and may be combined with them as additional treatment. However, never mix any of the various medications without consulting your doctor. Keep your medication program as simple as possible.
SIDE EFFECTS OF ATROPINES
The side effects from Atrovent are very mild, the most common being a dry throat and mouth.
*18\148\2*
The most valuable information you can provide to your doctor on an initial visit is your clinical history. Usually the doctor will ask you to describe your symptoms and then will ask you specific questions about your symptoms, such as:
- Which joints are painful or stiff?
- When is the pain or stiffness worse?
- What makes the symptoms better or worse?
- How long does the morning stiffness last?
- Do you feel tired much of the time?
Providing your physician with complete and accurate answers to these questions is one of the most important roles you can play in your own medical care. This is because the physician depends on an analysis of the clinical history to help identify the cause of your joint problems.
It’s a good idea to prepare a written record of your symptoms as they occur. You can draw up a list of symptoms, including where you feel pain or stiffness or swelling and the time of day when it occurs or when it is the most bothersome; take this list with you to the doctor’s office. This list will help you answer your doctor’s questions accurately because you will have a written record of what you have been experiencing before your visit. Not everyone can remember exactly when pain or stiffness or swelling was first experienced or pinpoint the onset of changes in ability to I perform a given task. Once you become aware of these changes, however, it is a good idea to keep a record of them.
*15/209/5*
an obsession is a gate crasher, an intruder in the night. The person afflicted with an obsession struggles mightily to resist it. This resistance can take up prodigious amounts of time and energy. Melissa said: “I try to stop thinking these thoughts but I can’t. . . . It’s like I’m involved in a battle with Satan, like he’s forcing them into my mind.” Jeff, sharing the OCD sufferer’s most typical refrain, said: “I fight them with all my might, but I can’t stop them.”
Recently I saw a young mother who was having thoughts about harming her baby. Could there be any obsessions that are more unwanted? Hospitalized for exhaustion, thinking she had “gone crazy” and might actually harm her child, she told me:
I was doing great until I got home from the hospital with my baby. All of a sudden, while I was feeding her, the thought came into my mind that I could choke her to death. I saw myself killing my baby. God bless her. I haven’t been free of that thought since. I don’t want my husband to leave me alone because I’m afraid of what I might do. I don’t let myself go to sleep because I might let my guard down. I try to stop these thoughts every second of the day with all my strength, but they don’t let up.
The terrible irony is that, indeed, the more strongly you resist an obsession, the more strongly it comes back. The mind does not work like a computer screen, where an unwanted thought is simply deleted. Rather, as a student patient of mine once observed, an obsession is like Freddie, the character in the Nightmare on Elm Street movies. Every time people thought they were finally rid of Freddie, he came baaaaack even stronger.
The strong resistance engendered by obsessions is probably their most defining characteristic. When I was in training at the University of Iowa, my chief of psychiatry, the noted researcher Dr. George Winokur, emphasized this point: “Look for how much the patient resists the thought—how much he or she fights it,” Winokur used to say. “That will tell you whether you’re dealing with an obsession or something else.”
Again, to distinguish: An obsession is not a depressive preoccupation. A sixty-two-year-old man with intrusive, recurrent, and severely troubling thoughts was referred to me for “treatment-resistant OCD.” The usual anti-OCD medications and behavior therapy had been tried. Nothing worked. He presented as a worn-out, agitated gentleman who spoke of nothing else but his fears of going into bankruptcy and losing his farm—concerns that were, in reality, totally groundless. He did not, however, resist these thoughts or consider them unwanted. On the contrary, to him these were realistic worries that needed to be dealt with immediately. What tormented him were recurrent, depressive thoughts, not obsessions. The patient responded to a standard antidepressant medication, imipramine (Tofranil).
An obsession is not an addiction. Degree of resistance also serves to differentiate obsessions from addictions. Obsessions are always unwanted—and not just 80 or 90 percent unwanted, but 100 percent. No part of a person wants an obsession. With an addiction, the unwanted urge carries a certain thrill. The gambling addict, for instance, gets a kick out of the action. A part of him looks forward to gambling, even while another part of him knows that he shouldn’t do it. With an obsession, there is no enjoyment at all.
*9/338/2*
One of the most highly publicized viral diseases is hepatitis, generally defined as a virally caused inflammation of the liver. It is characterized by symptoms that include fever, headache, nausea, loss of appetite, skin rashes, pain in the upper right abdomen, dark yellow (with brownish tinge) urine, and the possibility of jaundice (the yellowing of the whites of the eyes and the skin). In some regions of the United States and among certain segments of the population, hepatitis has reached epidemic proportions. Internationally, viral hepatitis is one of the most frequently reported diseases and a major contributor to acute and chronic liver disease, accounting for high morbidity and mortality. Currently, there are seven known forms of hepatitis, with the following three indicating the highest rate of incidence:
- Hepatitis A (HAV). HAV is contracted from eating food or drinking water contaminated with human excrement.
- Each year, over 150,000 people in the United State infected, typically through something in the house sexual contact, day care attendance, or recent international travel. Infected food handlers, people who use seafood from contaminated water, and those who contaminated needles are also at risk. Fortunately, individuals infected with hepatitis A do not become chronic carriers.
- Hepatitis В (HBV). This disease, spread primarily through bodily fluids, particularly during unprotected sex, puts the infected person at risk of chronic liver disease form of liver cancer. One of the fastest growing sexually transmitted infections in the United States, with over 300,000 new cases per year, HBV infection is currently more prevalent than HIV, with over 1.2 million chronic carriers. Most people recover within 6 months, although some can become chronic carriers.
- Hepatitis С (HCV). Long referred to as non-A-non B hepatitis, hepatitis С infections are on an epidemic rise in many regions of the world, as resistant forms are emerging. Currently, it is estimated that there are 150,000 new cases of hepatitis С in the United States each year, with over 4 million people infected. The vast majority of those infected (over 85 percent) develops chronic infections, and if left untreated, they may develop cirrhosis of the liver, liver cancer, or liver failure. Liver failure due to chronic hepatitis С is the leading cause of liver transplants in the United States. Some doctors report cases in which the point of transmission is traced back to blood transfusions or organ transplants from the early 1990s.
In the United States, hepatitis continues to be a major threat in spite of a safe blood supply and massive efforts at education about hand washing (hepatitis A) and safer sex (primarily hepatitis B). Treatment of all the forms of viral hepatitis is somewhat limited. A proper diet, bed rest, and antibiotics that combat bacterial invaders, which may cause additional problems, are recommended. Vaccines for hepatitis A and В are available, although costs are somewhat high for the series of injections. Treatment for hepatitis С has been less successful, with only about 25 to 30 percent of those infected responding. Ongoing research, however, is hopeful.
*14/277/5*
Let us look at what each person takes into a marriage. A man takes into a marriage all his expectations about his wife, how she will behave towards him, the things that might disappoint her, the things he will have to do or not do, to express his love for her. He has derived this expectation of his wife’s behaviour and from the behaviour of his mother towards him. Likewise, a woman carries with her, expectations of how a man should act, what she might rightfully anticipate of how men behave in love relationships; she has derived most of these expectations from the experience of being loved by her father.
Both of them will have learned how to behave towards each other in a relationship by observing the way their respective parents related to each other.
We know that the unconscious mind does not differentiate between images of the father, the husband, and the eldest son. They all seem to be filed away in a big box, in the unconscious mind, labeled ‘significant male’. Likewise the husband’s unconscious mind lumps together his mother, his wife, and perhaps his eldest daughter, in one box labeled ‘significant female’.
For this reason, many couples find themselves accusing each other of things that each of them in fact doesn’t do. ‘You’re always complaining!’ accuses the husband (whose mother was always complaining). ‘When have I complained?’ answers his wife. ‘I can’t remember just now, but I know you’re always doing it!’ he answers. Really, it was his mother who was always complaining, and his unconscious mind has identified his wife with his mother.
Distortions such as these are commonplace, the cause of a great deal of mystifying confusion during discussions between spouses about their problems in relating to each other. Sometimes they become aware that they have been accusing each other of behaviour which is in reality the behaviour of a parent, and which this son or daughter didn’t like. Now the husband or wife behaves in a way that perhaps resembles slightly the unacceptable behaviour of that parent, and the result is that this person is accused of the behaviour which is in fact the behaviour of the parent, long ago.
*56/129/5*
Peter had been an asthmatic all his life but his condition bothered him very little. He took a few puffs of his bronchodilator when he felt he needed it, which was only a couple of times each week. Peter took great care of his lawn and loved gardening, which he did almost every weekend. When he turned fifty-six he decided to semi-retire.
Unfortunately Peter also had some digestive problems: stomach aches, some loose bowel movements and a gnawing feeling just above his navel which persisted in spite of antacids he took from time to time. Eventually his doctor diagnosed an ulcer, prescribed cimetidine (in the form of a drug called Tagamet) and told him to relax. This was in 1990 and in those days doctors believed ulcers were caused by stress and acidity.
Now Peter enjoyed a few drinks every day. By no means a heavy drinker, he could nevertheless hold his liquor quite well on the odd occasions when he drank more than usual. Then, about a month after starting his anti-ulcer medication, something strange happened. He went to the local club to celebrate a friend’s birthday and drank a little more than usual; and he got thoroughly drunk after about six beers. Then for no apparent reason, he found he had to use his puffer more frequently, every day in fact. Within another month he found that even a few glasses of beer made him feel unwell and his use of puffers increased to several times each day. Luckily for him his daughter was studying naturopathy and she discouraged him from taking stronger medication before consulting an alternative doctor.
Peter came to see me. After hearing his story I asked him to stop gardening for a week while I ran some tests. I explained to him that the pesticides he was using with gay abandon may aggravate matters for him. I knew something Peter didn’t, and his doctor had obviously not even thought of: that the great majority of ulcers are caused by an infectious organism and that the drug he was taking for the ulcers placed a great strain on the detoxification machinery of his liver, the so-called ‘cytochrome P-450′ group of enzymes. The liver also has to clear alcohol from the system and is in charge of the detox mechanism that takes care of organochlorine pesticides.
By the time I saw Peter again I had the results of his liver detox and intestinal infection tests. They showed that his liver’s capacity to clear chemicals was grossly overloaded and that he was indeed afflicted with a massive infection by helicobacter pylori which, as we now know, is often responsible for ulcers. Peter told me that a few days after stopping all alcohol and gardening he felt much better and he only needed to use his puffer once a day, if that.
His stomach was bothering him constantly though. I first recommended that he stop gardening, or at least using pesticides, altogether and told him to continue avoiding alcohol for the time being. I placed him on a special detoxification regimen of a diet and antioxidants while I arranged for further tests to assess the damage to his stomach. These confirmed the helicobacter problem and he was then successfully treated for that infection. His ulcer no longer needed medications. What surprised him most was the fact that his asthma ceased to bother him and he no longer needed to use his puffer regularly. He was wondering about the connection.
I explained to him that, because his liver detox system was overworking, it produced a cascade of particles called ‘free radicals’. These are highly toxic and can affect almost every part of a living organism. The antioxidants I prescribed counter-acted their effect to some extent and, when his liver no longer had to cope with the drug, the alcohol and the pesticides, his whole system was once again balanced. As a result of that his asthma improved.
*17\145\2*
For the first time, scientists are talking seriously about a cure for diabetes, the “sugar disease” that afflicts 13 million Americans and each year kills 300,000. Five million of those who have diabetes don’t know it. You could easily be one of them.
Diabetes starts insidiously with excessive thirst, frequent urination, and fatigue. As the years roll by, the disease damages blood vessels, nerves, the heart, kidneys, and eyes. Diabetics are twice as likely as unaffected people to suffer from coronary heart disease and strokes. They may die of kidney failure, are often blinded, and have an amputation rate 40 times higher than that of non-diabetics. With its complications, diabetes kills more Americans than all other diseases except heart disease and cancer.
Noreen Harmer’s victory over diabetes is one example of how the bold new researchers are making inroads toward a cure. Ms. Harmer is one of about 500 recipients of a transplanted human pancreas. The organ puts out the vital hormone, insulin. It enables Ms. Harmer to turn the foods she eats into energy. After 25 years of daily injections of insulin -sometimes as many as four a day – she had no sign of diabetes after her transplant.
“I didn’t know what the outcome of the transplant surgery would be,” says the 35-year-old part-time waitress from Howell, Michigan. “But I did know what the long-term outcome of diabetes would be. I’m one of the lucky ones.”
Pancreas transplants are still largely experimental. Other advances on the road to a cure for diabetes are as follows:
• New hope of transplanting insulin-producing cells into diabetics where they will grow, produce insulin, and wipe out the disease
• New insights into the viruses that may cause diabetes by triggering the body’s immune system to destroy the insulin-producing cells in the pancreas
• A new use for cyclosporin, the drug that revolutionized organ transplant surgery. Cyclosporin clamps down on the immune system. In diabetes, it is believed that the body’s own strong immune system may destroy the insulin-making cells. It may lead to remission in new cases of one type of diabetes.
• New technology that enables the patient to monitor her condition closely at home by performing blood tests that were once confined to the laboratory
• New diets full of starches (the foods once forbidden to diabetics) and fiber, which help regulate blood sugar levels
What is diabetes, anyway? Simply, diabetes is a chronic, metabolic disorder in which the body is unable to turn digested food into energy. The hormone insulin is the key. Normally, the body metabolizes, or breaks down, the carbohydrates we eat into the most basic glucose. Without insulin, the glucose cannot be used by the cells as a source of energy. This unused glucose piles up in the blood to very high levels. The glucose attaches itself to blood and other proteins. The sugar coating makes the big proteins stick together in clumps. Because these proteins are, in a sense, sugar poisoned, they cannot carry out vital cell chemistry, which leads to complications.
There are two types of diabetes. Type I, of which there are estimated to be more than 500,000 victims in the United States, was formerly called juvenile diabetes because it usually strikes children and young adults. Their pancreases stop making insulin, so patients need daily injections to survive.
Type II, once called adult-onset diabetes, usually affects people 40 or older who are overweight. Because the pancreas functions abnormally, it makes an insufficient amount of insulin or the body is unable to use properly the insulin that the pancreas makes. Type II diabetics usually are treated with oral drugs and diet.
*1/266/5*
The nutritional care of the patient who has sustained a myocardial infarction must be tailored to the individual’s needs. It must include planning for the acute illness, the period of convalescence, and following recovery. Several factors must be considered in planning for the patient’s diet, namely shortness of breath, fatigue, abdominal distention, the presence or absence of edema, loss of appetite, and fear of eating.
An essential characteristic of therapy in acute myocardial infarction is rest. A regimen of nutritional care has been described by Christakis and Winston, and is summarized as follows.
Acute illness
For the first 24 to 48 hours the physician may direct that no food be given by mouth. Then a low-fat liquid diet supplying 500 to 800 kcal (1000 to 1500 ml fluid) is used for two or three days – longer if arrhythmia persists. This diet can include clear soups, weak tea, decaffeinated coffee, ginger ale, fruit juices, and skim milk. Very hot and very cold liquids should be avoided. Only small amounts of liquid are given at one time. The possibility that milk may produce distention because of lactose intolerance should be kept in mind.
Generally it has been considered advisable to feed the acutely ill patient. A recent study, however, has shown that it made little difference whether the patient was fed, or fed himself. Men, especially, preferred to feed themselves.
Within a few days the patient usually progresses to a soft diet with these characteristics:
1. 1000 to 1200 kcal so that there is minimum circulation required for the digestive-absorptive processes, and to initiate weight loss if obese.
2. Five to six small, easily digested meals, especially if the patient is dyspneic or has angina.
3. Cholesterol restricted to 300 mg.
4. Low in saturated fat with an increased proportion of polyunsaturated fatty acids.
5. Restricted in sodium if there is congestive heart failure.
6. Avoidance of distending foods.
When diuretics are given to the patient with congestive heart failure, the potassium loss may be increased. The physician may request the inclusion of more potassium-rich foods such as plums, prunes, orange juice, potatoes, and other vegetables. The use of a potassium salt as medication is a more reliable way to assure compensation for the losses.
Maintenance diet
As the patient adjusts once again to a normal pattern of living, his diet is based upon his weight status and the blood lipid levels. Gradual weight loss is indicated if the patient is obese; however, some patients do not respond well, physically or psychologically, to weight-losing regimens. A maintenance diet that is restricted to 300 mg cholesterol and that is reduced in its saturated fatty acid content may be useful in reducing the likelihood of a recurrence of the coronary. The selection of the diet to be used on a long-term basis is best determined by the levels of the blood cholesterol and triglycerides about 6 months to a year following the heart attack.
*3/234/5*
Loss of Appetite and Weight
Lack of appetite and consequent loss of weight are other common symptoms of cancer, especially in older people. These may be due to poor appetite, resulting in less intake of food. Moreover, cancer tissues burn excessive energy of the body. Vomiting and diarrhea, wherever present, also accounts for less absorption of food. Sometimes, the loss of weight occurs so slowly that it is hardly noticed.
Natural Remedies: The use of orange and lime are extremely valuable in controlling loss of appetite. They stimulate the flow of digestive juices, thereby improving digestion and increasing appetite. The use of garlic is also beneficial as it stimulates the digestive tone and improves appetite.
Nausea and Vomiting
Nausea and Vomiting are common symptoms after chemotherapy or radiation. Sometimes, they are so severe that they become unbearable.
Natural Remedies: Ginger juice can help in the treatment of this condition. A quarter teaspoon or 15 drops of fresh ginger juice, mixed with half a teaspoon each of fresh lime and mint juices and a teaspoon of honey, constitutes an effective medicine for this purpose. The juice of red beet is another effective remedy for vomiting. About half a cup of the juice, with equal quantity of water, may be taken twice daily. Adding half a teaspoon of lime juice to this juice will increase its medicinal value.
*9/355/5*