After you have been diagnosed with RA you will wonder what course or natural history your arthritis will follow. Will it continue in the same way it started, or will additional, or different, joints become involved in time? The answers to these questions are as different as the persons asking them. In some cases, indeed, the way arthritis starts allows physicians to predict the course it will follow, but this is not true in every ease.
The following four general courses that RA can follow were described before current treatments (or therapeutic strategies) had been developed, and therefore they reflect the untreated natural histories of RA. Keep in mind that what follows are four potential courses of untreated RA. The actual course of any given individual’s RA may vary from any of these four courses.
1. Spontaneous remission. The person who develops signs and symptoms of RA and then, with little or no medication (generally only non-steroidal anti-inflammatory medications, called NSAIDs), becomes symptom-free, is said to have gone into spontaneous remission. Remission may be described as a period of time during which there is no evidence of active disease or illness, in this case, RA.
During remission from RA, blood tests, such as the erythrocyte sedimentation rate, often produce normal results. Generally it is estimated that 20 percent of all RA patients will have a spontaneous remission, but more than 50 percent of these will have a recurrence of RA in the future. Thus, in reality, probably only 5 to 10 percent of untreated patients have a permanent remission. The majority of people with RA require continued treatment.
Patients and physicians often wonder how long they should wait for this potential spontaneous remission before starting stronger medications designed to bring on a medically induced remission (these medications are called DMARDs, or disease-modifying anti-rheumatic drugs). The optimal period to start DMARDs varies from case to case, but most rheumatologists would begin if there was any evidence of impending joint damage and certainly if joint damage was visible on x-ray films. This is particularly important since it is now generally believed that these drugs are most effective if taken early in the course of arthritis.
2. Remitting. Some people with RA have a series of flare-ups of arthritis followed by a return to normal health between attacks. A person who has remitting arthritis may not need remission-inducing medications if there is no ongoing joint damage and if joint function returns to normal between flare-ups. The attacks themselves, when the arthritis is active, are commonly treated with NSAIDs. Attacks that occur very frequently or that are very lengthy may begin to affect the person’s life-style, and then the person with RA and the physician may decide that DMARDs should be taken.
3. Remitting progressive. The third possible course of RA is one in which the person experiences a pattern of flare-ups without a return to normal health between attacks. Joint damage over time is a distinct possibility in this course of RA because some inflammation remains in the joints between attacks. In this case, DMARD therapy ought to be a serious consideration.
4. Progressive. In this course, the person experiences a gradual increase in pain, swelling, and joint damage over time. Usually this progression occurs very slowly, but some people experience a rapid loss of function. Early treatment with DMARD therapy in an effort to halt progression of arthritis is recommended.
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Drugs, however, not only create other diseases, but seem to be erratic in dealing with relapses associated with highly emotional environments and difficult life situations. In Introduction to Psychopharmacology (Lader, 1980, p. 58) we read that assessment studies on maintenance therapies (antipsychotic medication which suppresses chronic symptoms such as hallucinations) show that ‘drugs made a demonstrable difference to patients in low EE homes.’ An EE home is one where the closest relative at the time of the schizophrenic’s admission was low on the number of critical, hostile or emotionally overcharged comments. ‘Life events also seem important and tend to cluster in three weeks immediately before, relapse.’ Drug maintenance therapies seem relatively ineffective in preventing such event-related relapses, especially when life events are major.
There are other problems connected with medications besides their inefficiency. Many patients go off ‘meds’ not only because they found something of value in even the most nightmarish mental conditions, but also because they cannot tolerate either the drug’s effects or the social implications of being drugged. These patients are disturbed about the overall effects drugs have or do not have on their, lives.
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Adolescence is a time to explore your limits, test your boundaries. Wherever a parent defines a boundary, it is the function of adolescence to stretch it. This is a necessary part of the process of learning about who you are, where you fit into the world, and what it is that makes you unique. Taking risks is part of that exploration, but when you get a combination of risk-taking and sexual curiosity, you have a dangerous cocktail. Volatile if you add ignorance to the mixture.
One adolescent health counsellor tells of a fourteen-year-old mother still mystified as to how she could possibly have become pregnant. ‘My mother told me not to sleep with a boy or I would get pregnant. I had never slept with him. We had only had sex in the back of the car.’
Studies around the world have looked at young people’s altitudes to safer sex. A condom manufacturer told me that their market research showed ninety percent of people aged sixteen to twenty-one knew that it was sensible to use condoms, yet in only thirty percent of sexual encounters did they actually use one. This begs the question, ‘Why?’ What factors come into play at the time of sexual activity that stand in the way or common sense? The answer is a complicated equation. The most often cited reason is this feeling of immortality, the ‘Nothing can happen to me!’ mentality. It
lakes a while to develop an understanding of consequences. ‘If I do this … then THIS will happen.’ This is compounded in times of economic uncertainty with high levels of unemployment. If a young person feels their prospects are hopeless, they will have no vision of themselves in the future. That being so, then their actions today don’t matter. They won’t care if they look after themselves or not.
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Conflict arises when a young person’s actions go against parents’ beliefs, and this is particularly so in the context of sexuality. Parents may have to ask themselves, ‘Is it really worth declaring war?’ One area where parents’ attitudes may clash with their children is on a sexual activity with a traditional image problem. Although attitudes to masturbation have progressed a lot in the past twenty years or so, there are still some people who see it as a sin with dire consequences. However, it is now widely recognized as a natural form of sexual expression.
Around puberty both boys and girls become aware that masturbation is a sexual activity and it is an opportunity to explore your sexual responses in privacy. This is probably the first time we become aware of the ability to orgasm. One friend recalls the first time he ejaculated. T remember I was masturbating in the shower one day when I was about thirteen. I saw this white stuff coming out of the end of my penis and my erection disappeared faster than it had ever done before. I had no idea what k was. I thought I had burst something, so I spent the next hour or so checking all my bits and pieces, and nothing seemed to have dropped off. After it happened a few more times I figured it must be okay, so I stopped worrying. Then I heard a few of the boys at school joking about it, and I realized I wasn’t the only one!’
It is a frequent cause of battles within families. A friend, now in her thirties, has bitter memories of the time her mother found out she was taking the Pill. ‘I was about nineteen and I had been going out with Rick for over two years. He was a bit younger than me, but we knew we were both ready for a sexual relationship. My mother always had this expectation that I would be a virgin when I got married. That was about all she ever said about sex at all. Although I never challenged her about it, it had never been my plan. I think I’d been sexually active for about four months. I came back from a weekend away at a girlfriend’s house and Mum found my packet of contraceptive pills when she was looking through my bag for washing. Well, I couldn’t have imagined a worse reaction if she’d found out I had a terminal disease! She cried, she yelled, she called Rick all sorts of terrible names and said I was ruined and all that. I felt guilty, like I’d really let her down. For ages afterwards I had trouble having sex, like every time Rick and I got close I felt like I was hurting Mum or something. It took me years to forgive her for it, and we still never talk about anything really personal.’
The issue here is clearly one of permission to make your own choices. One of the biggest difficulties about being a parent is the ability to accept that we cannot dictate every thought, belief or action of another person, even if it is our own child. The achievement is in equipping our children to make responsible decisions for themselves.
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Hepatitis A (infectious hepatitis) is transmitted through personal contact, or through contaminated food or water. The incubation time for the disease is 4-6 weeks. The illness tends to be more severe in adults.
Hepatitis B (serum hepatitis) is transmitted in children mainly via needle injuries. Children in institutions are also at slightly greater risk of being infected. In adults the risk is greatest amongst drug users who share needles.
All forms of hepatitis present a similar clinical picture, although hepatitis A tends to be more sudden in onset than hepatitis B. With hepatitis A, the child usually experiences initial symptoms of tiredness, fever, nausea, loss of appetite, vomiting and diarrhoea. The skin may feel very itchy, and the abdomen may be a little swollen and sore, especially over the upper right side overlying the liver. After several days the urine may appear to be darker and the skin take on a yellow tinge (jaundice). Convalescence may take several weeks. If your child has hepatitis B, he may at first complain of aching joints and may have a skin rash. Hepatitis B tends to be more severe than hepatitis A, and the clinical features tend to develop more slowly.
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When sex education and love education fail, there are clear signs of such failure. They are all very, very important signs of problems for the developing young person.
Drugs: There is no high like the high of intimacy with another person. When that high is not available, it may be sought elsewhere, and that elsewhere might be drugs. Moodiness, changes in eating habits, anger without explanation, pallor, darkened circles beneath the eyes, withdrawal, defensiveness, and marked personality change are some of the signs of drug use. There are others, but I believe that our society’s failure to help our young people become sexual people plays a major role in their turning to artificial and deadly ways to get high. The war on drugs must be accompanied by an emphasis on teaching loving and intimacy. We are leaving our children with nothing to do with their developing sexuality. If we don’t teach them safe means of sexual self-expression, they may find other, dangerous ways to express themselves.
“Just say no” has been the new major campaign against dru{ use. It will never work. The issue is, What can our developing young people say yes to? How can they safely say it? Both answers relate as much to sexuality as any other aspect. A society thai campaigns against sex, drugs, and violence, but fails to teach sexuality, love, and tenderness, is running a dishonest and ineffective campaign.
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SCORING: 3—ALWAYS 2—USUALLY 1-SELDOM 0—NEVER
1. I feel I must respond sexually to my spouse’s advances.
2. I try to match my response to my husband’s, faking if I have to.
3. When I start to feel very good sexually, start to really get involved in the sexual experience, I get distracted by my spouse’s response.
4. I find that if I am too active in my sexual motions, it tends to cause my spouse to lose control of his sexual response, sometimes making him come too soon.
5. My orgasms are characterized by a throbbing in the vaginal area.
6. When I have not had sex in a long time, I tend to be more easily aroused.
Why Wives Have Too Many Orgasms
7. I experience some physical discomfort when I have sexual intercourse, g. I try to “match” my response to my spouse’s, and if he is tired or wants to suspend sexual interaction, I go along.
9. I have trouble letting go and getting lost in my orgasms, usually trying to “come” like my husband “comes.”
10. If I don’t feel contractions in my vagina, I don’t feel as if I have had a really complete sexual experience.
11. My orgasms are essentially the same no matter what type of sex I am having (coitus, oral sex, masturbation). Whatever the source of stimulation, I essentially climax the same way.
12. As I get older, I notice that my orgasms are less intense than they used to be. The throbbing is less intense and there are fewer throbs.
13. I notice that my lubrication is less and less reliable than it used to be.
14. I feel a “turn-taking” in our sex, so I must have orgasm first and then he takes his turn.
15. Before orgasm, I feel warm and close in our lovemaking, but after orgasm, there seems to be a distance between us.
16. I have trouble “getting over the edge.” I seem to get right to the point where I could come and then it is difficult for me to go the rest of the way.
17. I hold back during sex. I might want to talk, groan, or say loving things, but I have trouble expressing myself during sex.
18. If I have masturbated, I feel some guilt, and this can even extend to my sex with my husband.
19. I feel that sex is focused on my breasts and in my genitals. I feel reacted to in parts, not “me.”
20. I feel “worked on” during sex, rubbed and stimulated to get ready or to
get “there.”
Thirty-five or more points on this test, and it is likely that you are not experiencing psychasms but orgasms, working toward physiological reflex in response to genital or breast stimulation.
Remember that the object of this test is to promote discussion with your partner, not replace one set of expectations with another. Super marital sex depends on being open to the gift of complete erotic response with someone else, not on living up to the new goal of psychasms instead of orgasms. Orgasms are reflexes. Psychasms are emotional and conscious experiences related to a freedom from “organ reflex.”
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TRUE HEALING – PRACTICAL ADVICE/ACCELERATING THE DETOXIFICATION PROCESS – REMOVAL OF DENTAL AMALGAMS
Dental amalgams, whether gold or silver, contain mercury, one of the most toxic metals to our body. Having amalgam fillings, is like having a constant supply of toxic mercury, released slowly but constantly.
Removal and replacement of amalgam fillings instantly removes the source of mercury supply, however the mechanical removal process itself (drilling) can temporarily increase the concentration of mercury in your body.
Note, that it may take a considerable amount of time for your body to neutralise and excrete the mercury that has accumulated in your body over many years.
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