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EFFECTS OF SPINAL CORD INJURY ON SEXUAL FUNCTION

admin — Sat, 23 Jul 2011 16:52:52 +0000

Spinal cord injury affects sexual function by disrupting the nerve impulses, or messages, between the brain and the rest of the body. When the genitals are stimulated, the brain registers excitement. When the brain is stimulated (for example, by sexual fantasies or talking to a partner about sex), the body may respond with physical excitement. If the spinal cord is damaged, these messages are disrupted, the extent of disruption depending on the level and completeness of the injury.A woman with spinal cord injury can continue to participate in sexual intercourse and other sex acts regardless of her level of motor impairment, though limited mobility may affect positioning and the extent to which she can take a physically active role. Her sexual function is affected primarily by loss of sensation. Vaginal lubrication, sexual excitation, and orgasm may be affected. Complete injuries result in greater disruption. Incomplete injuries have a greater likelihood of leaving a full range of sexual experience. Female fertility is not affected by spinal cord injury at any level.Men with spinal cord injury also have varying degrees of sensory and motor impairment that affect excitement, orgasm, positioning, and mobility during sex. Spinal cord injury also directly affects the ability to have an erection. Normally, men can get an erection in several ways.Psychogenic erections are caused by mental stimulus (sexual thoughts, seeing your partner naked, reading a story about sex): the brain sends messages through the spinal cord to the penis, causing an erection. Erections of this type do not occur after complete spinal cord injury, but can occur after incomplete lesions in some individuals.Reflexogenic erections are caused by direct stimulation of the penis, such as rubbing or stroking. These erections do not require communication between the penis and the brain. They are caused by a spinal reflex involving communication between sensory and motor nerves within the sacral spinal cord (a similar mechanism causes limbs to move involuntarily during a spasm, even though your brain cannot make them move voluntarily). Men with injuries at the cervical or thoracic levels can usually get reflexogenic erections. These can result from direct stimulation that is nonsexual, such as pulling on your catheter or friction from bed sheets or clothing.Spontaneous erections occur in response to internal physical stimuli, such as a full bladder – “morning erection” is a good example. Spontaneous erections, like reflexogenic erections, are caused by spinal reflexes. Men with complete injuries in the lumbar or sacral regions usually cannot get erections of any type.
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EPILEPSY AS A PSYCHO-SOCIAL DISEASE

admin — Tue, 19 Jul 2011 16:41:13 +0000

Epilepsy is usually considered a medical disorder. But for centuries it has been a psycho-social disease as well. This is not because of anything intrinsic to the disorder. Epilepsy is not confined to any social group, nor is it contagious. Epilepsy is a psycho-social disease because of the reactions, or perceived reactions, of society to persons with epilepsy, and because of the psychological and social problems often associated with the disorder.Epilepsy is a chronic condition, but unlike most other chronic health conditions, which have constant problems, recurrent seizures of epilepsy wax and wane over time. Dr. William Lennox, considered one of the fathers of American epilepsy treatment, characterized the disorder as “a recurrent tidal wave” compared with the constant rough seas of many other chronic health disorders. This is an apt metaphor.Most of the time, most people with epilepsy are normal, subject to the same stresses and strains as everyone else. Most of the time, seizures do not complicate their lives. Most individuals with epilepsy take their medication and go on. But then, usually without warning, some of these individuals with controlled epilepsy are suddenly swamped by the tidal wave of another seizure. After the seizure they usually right themselves and put their lives back in order, not knowing when, or if, another tidal wave will strike. Thus epilepsy is complicated by the uncertainty factor.Where will your child fit on the broad spectrum of the epilepsies? Will he or she have “benign” epilepsy of childhood or one of the other chronic epilepsies in which recurrent seizures vary in frequency and severity? Will he have one of the additional disabilities sometimes associated with epilepsy?The underpinnings of many future possible difficulties begin in childhood and are, to a large extent, the result of the psycho-social impact of epilepsy on the child and on the family. If the physician and the parent are sensitive to the possible development of these problems, many can be avoided.*210\208\8*

HELPING YOUR HEART: KEEP NORMAL WEIGHT

admin — Thu, 07 Jul 2011 16:27:11 +0000

Your heart may be strong enough to perform many functions singly, but if it is called upon to perform several simultaneously, it may not be able to do so and trouble will result.The worst possible combination would be for a cardiac patient to eat a large meal at noon, go outside immediately and dig in his garden in the hot sun, and then become enraged with his wife or neighbor over some trifle. To understand the reasons for this also helps explain the common news items in our papers about persons who developed a heart attack while shoveling snow. With these facts in mind, the post-coronary patient can save himself a great deal of trouble. To be forewarned is to be forearmed. A basic underlying rule for such patients should be to avoid unnecessary mental or physical strains.We cannot do a great deal to change the basic situation. It is impossible for us to replace the scarred tissue remnant of previous living muscle with new muscle. The changes that have occurred as a result of the aging process cannot be reversed. Although in some instances the coronary blood vessels can be operated upon and blood flow can be increased through the vessels, in many instances this cannot be done. How fortunate it is, indeed, that the patient may have a powerful weapon at his disposal to overcome his own situation and increase his life span. That weapon is moderation.The person who weighs 200 pounds demands more from his heart when he walks down the street at a leisurely pace than the person who weighs 150 pounds. Each of those 50 additional pounds requires increased blood flow. A great many coronary patients in our society are grossly overweight. If this excess weight is lost, if the person is trimmed down to bare muscle and bone, he can increase his reserve heart capacity and thereby be able to do a great deal more without symptoms of cardiac trouble. When your doctor tells you to lose 20 or 30 pounds, he means it for your good. The rewards are enormous and may possibly be measured in months and years of additional life.*14/309/5*

IMMUNE POWER DIET: IRON OUT IMMUNE IMBALANCE

admin — Wed, 29 Jun 2011 16:50:22 +0000

You’ve heard it said that somebody has “an iron constitution.” That kind of person seems able to withstand unusual stress, eat anything, drink too much, sleep too little, be on the move constantly, and yet always manage to have vitality and energy to spare. These people are more resistant to germs, and seldom catch the colds and flu that hit the rest of us. Even if they do get sick, these lucky “iron constitution” people never get very sick; they seem to bounce back with remarkable resiliency.There is actually a deep biological truth in the notion of an “iron constitution,” because iron is one of the prime minerals you need for a super-tuned immune system. Iron enhances immunity in several ways:Boosts your overall resistanceKeeps your immune tissues healthyEnergizes your T cellsIs a constituent of chemicals that your T cells need to kill invadersMakes your scavenger cells pounce even more enthusiastically on bacteriaIron has another special benefit, unlike those of the other immune nutrients which rebuild and renew only your primary immune health-keepers, the white blood cells. Iron also vitalizes your red blood cells, the back-up troops in the battle to keep you healthy and strong. The job of the red blood cells is to transport vital oxygen to all of your body’s tissues, and this is necessary to life itself.QUICK IRON CHECKHow do you know if you don’t have enough iron? Look for any of these signs:Chronic fatigueChronic malaiseFrequent sickness or infections

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LOGICAL ANALYSIS OF POSTURE: EXPERIMENT THAT MAY CONVINCE YOU THAT SOME MUSCLE FIBRES CAN EXTEND OR ELONGATE

admin — Sat, 18 Jun 2011 16:49:22 +0000

Here is an experiment that may convince you that some muscle fibres can extend or elongate. On the inner surface of the hand, across the wrist just below the palm you will find two lines. Join these lines of both hands together and bring the palms of your hands together as in prayer. You’ll see that the sizes of the fingers (when pressed together) of both hands are normally the same. Both palms of your hands and fingers are normally of the same dimension. Now raise one arm horizontally, take a deep breath in and breathe out slowly, imagining that your fingers are stretching out away from the palms. Imagine that some unknown force is pulling your fingers. Stretch them like this for a few times, reaching out for some mark on the wall. Then join the palms together starting with the lines below the palms and ending with the fingertips. You will notice that the fingers that were ‘instructed’ to stretch are longer than those on the other hand. This may surprise you as it is difficult to imagine that fingers can elongate at will. It does show, however, that muscles can stretch away from the body if the right instructions are given to them from the conscious brain.

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WOMENS PROBLEMS: INVESTIGATION AT AN INFERTILITY CLINIC

admin — Thu, 09 Jun 2011 16:48:02 +0000

Doctors do not consider a woman infertile until after at least one year during which normal frequency of intercourse has occurred. Figures show that 90 per cent of women usually become pregnant within 12 months when trying. A further four per cent become pregnant during the subsequent 12 months. Pregnancy is more likely during the early years of marriage, for this is when sexual drive and frequency of intercourse are maximum.By the time a couple arrives at the gynaecologist’s office, they have usually tried all the usual (and often the unusual) ideas they believe may play a beneficial part. Many foolishly hawk themselves round to the fringe medical men, attending quacks, buying strange medicines, strange herbal preparations, taking vitamins en masse, in the hope it may increase their powers of reproduction. Aphrodisiacs arc often taken also, but these are invariably followed by further failure.Attending a gynaecologist who has access to an endocrine or infertility clinic attached to a major, well-equipped hospital with full facilities for investigation is the soundest idea.Usually the female partner fronts up first, for mostly the women believe they are the culprits. In fact, about 23 per cent of cases are due to female causes; a further 25 per cent are due to male faults; and the remaining 50 per cent are due to factors affecting both partners.Sometimes males simply refuse to attend for checking, believing the reproduction business is entirely within the female domain. This is a foolish attitude. Marriage, and reproduction, is a two-way deal, and total co-operation of both partners is more likely to yield successful results.*44\45\4*

STAYING FIT AND SLIM: MAKE NEW CHOICES

admin — Fri, 03 Jun 2011 16:46:42 +0000

This may be the most exhilarating revelation of all: the fact that we have a choice. That when we feel the cue to eat something we know is unhealthy, we can stop for a moment, focus on what it is that’s provoking us to eat, and, as clearly as we can, figure out what our real options are. That’s what freedom of choice means. Your first disappointed response might be that you don’t feel “free” anymore to eat French fries, fatty meats, butter, and ice cream. But when you take a moment to remind yourself what these foods are going to do to you if you eat them (clog your arteries, increase your cholesterol and blood pressure, thicken your middle, and, quite frankly, dramatically increase your chances of developing life-threatening disease) – and what the healthy foods will do for you if you eat them (lower your serum cholesterol, help you lose excess body fat, improve your cardiovascular health) – you’re truly using your free will and your intellect to choose a better, healthier alternative.And the alternative doesn’t always have to be another kind of food. What about doing some stretching or aerobic exercise? Lydia В., a free-lance writer, came up with an ingenious solution that made new use of her cookie jar. It was once filled to the brim with chocolate-chip cookies, to which she turned whenever she felt the least twinge of writer’s block or anxiety about her mother, the rent, the weather, an upcoming date, or the cat getting fur on the couch. Now when she feels anxiety, she still reaches into the cookie jar – but she takes out one of several notes to herself that say things like “Go for a walk,” “Play with the cat,” “Water the plants,” “Take a bike ride,” “Call a friend.” She may also, however, have a slice of Apple-Date Cake! (Remember, eat if you are hungry – but eat the right things.)Alternatives abound. Take the time to consider your choices when you’re planning your menu, making up your shopping list or selecting food from the grocery shelves. You are always in control, no matter how strongly the wrong foods seem to plead with you to take them home. That moment when you pull back on the reins, take a breath, and really see what you’re about to do – that moment of “time out” – is crucial. And when you feel as if you just might cave in, remember that you’ve always got the power to stop, take a step back, and assess the situation more clearly. Sometimes a craving for food really does mean you’re hungry – so eat! But have frozen nonfat yogurt or fresh fruit sorbet instead of ice cream.The trick to controlling your behavior is recognizing that the small steps, the seemingly insignificant changes (like popping a grape into your mouth instead of a peanut), do add up. Take a moment to concentrate on the immediate actions you do have the power to take – not on the ultimate goals that can be attained only with time.Say you want to lose 25 pounds, but you feel exasperated because you can’t change everything right now. Our immediate-gratification “buttons” always seem to demand pushing. But when you rail at the frustration of having to lose that weight slowly, you can take “time out” and remind yourself it is coming off – that you’re doing exactly what you need to do to take (and keep) it off. The three or four months it takes to lose the weight are nothing compared to the years ahead of enjoying life at your proper weight – you’ll barely remember a few months of “waiting” during which that weight loss seemed impossible!

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THE BARE ESSENTIALS OF AT-HOME SKIN CARE: TONE AND MOISTURISETONE

admin — Fri, 27 May 2011 16:45:44 +0000

There’s just something about toners that people really love. Toners are actually relics of the days when most cleansers left heavy residue on the skin and one needed to remove it with this extra step. Today’s cleansers pretty much clean up after themselves, so a toner with strong astringent actions is unnecessary, not to mention dehydrating. A benefit is derived, however, from using a toner that is formulated with active ingredients, such as antioxidants. If you choose to use such a toner for these benefits, just keep in mind that the percentage of active ingredients in a toner isn’t as high as you’d find in a cream.MOISTURISEThere’s something comforting about a moisturiser, even if it’s just because they’re such a traditional part of the skin grooming process. Pretty much every complexion can benefit from a moisturiser, even an oily skin.Moisturisers don’t erase years off your age, but they perform another function that is almost as important: they keep your skin hydrated. As the uppermost level of the skin, the stratum corneum, confronts a daily assault from the environment, a moisturiser works by creating a barrier between your skin and the air. Without this barrier, the skin would flake and get irritated.Of course, many of today’s popular moisturisers, whether oil-based or water-based, don’t just hydrate. (And besides, where’s the sex appeal in that?) A moisturiser containing antioxidants, such as vitamin C and green tea, performs a double duty by adding an extra source of protection against free radical damage from UV radiation from the sun and other environmental influences.

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ON GUARD AGAINST THE ACUTE—BLINDSIDED BY THE CHRONIC: THE WAYS WE HAVE FOUGHT

admin — Mon, 16 May 2011 16:43:39 +0000

Why has the war metaphor so dominated our approach to infectious disease? One reason is that the metaphor has been successful in some arenas. We humans rally to the defense against a common enemy, and this support led to the control of many damaging infectious diseases during the first half of the twentieth century. Still, the only case of complete victory—eradication of the enemy—has been the smallpox campaign, and that vaccine was no high-tech wonder. William Jenner took pus from a sore on a cow and used it to inoculate those whom he hoped to protect from smallpox. The primary technological advance for vaccine development involved growing the still mysterious vaccinia virus in cows to amplify the virus, and then scraping the infected cow tissue to get the material for the vaccine. If we allow the definition of war to include organized attacks on populations of other species, the eradication of smallpox during the 1970s was literally a war, the most cost-effective antimicrobial war that has ever been fought. It was accomplished in just over a decade with a modest price tag of $300 million. The army comprised a few hundred officers (physicians and epidemiologists) and a few thousand foot soldiers (assistants working in the lab and outside community). In 1977 they rooted out the smallpox virus from its last refugia: Bangladesh and Somalia. Their efforts were heroic but their enemy was vulnerable. As microbial targets go, the smallpox virus was a clay pigeon. Its ability to change form was so limited that vaccination with a different virus of the same evolutionary group, the vaccinia virus, could trigger an immunity that would knock out the entire spectrum of smallpox viruses. To win wars, social values must be compromised. One of the first to be diminished is the value of human life, because war involves the killing of people. Freedom is another casualty. Imagine what would have happened if each soldier in the trenches of the Somme or Galipoli had been given a free choice to go back to his family without penalty or to die in a fruitless rush against the enemy trenches. How many would have stayed? The actions taken in microbial wars need not be as severe, but it is wishful thinking to expect that we can win these wars while adhering to all our peacetime values. Administrative agencies such as the World Health Organization set up guidelines to help preserve such values. Yet even in the war against smallpox—the most lopsidedly winnable of our microbe wars and the most illustrious victory of the World Health Organization—these guidelines had to be violated. One of the commanders in this war, Isao Arita, later confided, “If we hadn’t broken every single WHO rule many times over, we would never have defeated smallpox. Never.” Part of the problem is that the need to break these rules increases the closer one gets to eradication. Some people are willing to receive a vaccine, others are obstinately opposed. The early positive effects of vaccination provide an inflated sense of success because the success is enhanced by those who choose to cooperate. The completion of the campaigns often requires that the last holdouts are persuaded to cooperate or forced to submit. All eradication campaigns suffer from this Achilles’ heel. Some people want to have their houses fumigated, others resist. Some prefer to have their contagious illness treated, others refuse. If we are to win some of the more winnable wars—those against measles and polio, for example—we may need to violate more rules than have been violated to date. Vaccines were the first great strategic success in the war against infectious disease, but the return on the investment has steadily declined as increasing amounts of money have been invested in this option. The most successful vaccination campaign, the eradication of smallpox, is attributable to an eighteenth-century innovation, the vaccinia vaccine. It cost almost nothing and swept aside one of humankind’s worst infectious adversaries. The great vaccination efforts of the first half of the twentieth century were cheap and marvelously successful. Vaccines against diphtheria and tetanus were developed with less money than is now sometimes awarded in one grant from the National Institutes of Health. Vaccines against pertussis and polio were developed during the 1950s; they were successful but came with greater financial cost and more collateral damage than the smallpox program. Some of the viruses in live polio vaccines reverted to neurovirulence, causing paralysis in a small number of those vaccinated. Moreover, vaccine viruses proved infectious for those in contact with the vaccine recipients. This secondary transmission of vaccine virus increased the protection of the population and was therefore considered a bonus so long as the viruses did not revert to neurovirulence. But polioviruses are particularly prone to mutations. The live viruses in the polio vaccines were like unseasoned soldiers who could not be trusted to protect without shooting innocent civilians. The threat of reversion to neurovirulence has been recognized since it was encountered in Philadelphia in 1935 when an experimental polio vaccine was administered to several thousand children. Viruses from an attenuated live vaccine reverted to neurovirulence, killing five of the nine children who contracted polio from it. Reversions to neurovirulence have occurred sporadically since then and have made vaccine researchers apprehensive; they are hoping that the vaccine viruses left as a legacy of the live poliovirus vaccination programs will not develop similar reversions to virulence, generating new polio outbreaks where wild polio has been eradicated. A more sinister problem was recognized by Michele Carbone in the early 1990s. Some polio vaccine batches were contaminated with a monkey virus, SV40, which now appears to be causing cancers of the brain and lungs in a small percentage of those who were vaccinated in the 1950s and early 1960s. Live vaccines against measles and mumps were developed in the 1960s, and a few more vaccines were added during the last three decades of the twentieth century: vaccines against hepatitis viruses A and B, Haemophilus influenzae, and the perennial ones against influenza. The effectiveness of these vaccines has varied from the magnificent suppression of encephalitis by the Haemophilus vaccine to the erratic performance of the influenza vaccines. But the important point is that these successes came from increasing expenditures in vaccine research. The cost-effectiveness of vaccine development has eroded because of the many failures, such as the efforts to develop vaccines against malaria and AIDS. Vaccine development certainly has a place in our future, but their use as weapons to destroy infectious adversaries is becoming more costly and generally less effective. We will need to develop and use vaccines more cleverly to improve their performance.

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ASSESSING RISKS AND BENEFITS AFTER A SEIZURE: DECISIONS ABOUT EVERYDAY LIFE

admin — Tue, 03 May 2011 16:42:25 +0000

We have discussed the advantages and disadvantages of raising your child in a padded cell. Once you allow your child out you will have to assess the risks and benefits of most of his daily activities. For example:”Can my child still ride his bike?”To help you assess the answer, we would have to ask, “How old is the child?” “How frequently does he have seizures?” “Does he have a warning of the seizure?” “How reliably would he respond to that warning?” “How much does he ride his bike?” “How important is bike riding to him?”You would have to assess how great are the chances of his being injured on the bike. There are substantial risks to any child of being injured while bike riding. Are they much greater now? Thinking carefully about your answers to these questions will enable you to be protective, but not overprotective. Perhaps you can be appropriately protective by insisting that he wear his helmet that has been sitting in the closet.

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