Let others, especially family and friends, know how they can help and support you both in words and in action. Especially in the early weeks and months after quitting, stay away from situations in which other people smoke. If you are accustomed to smoking while having an alcoholic beverage, you may have to stop drinking for a while. Alcohol lowers your inhibitions and resolve and frequently promotes a relapse.

If you truly want to quit smoking you have to develop a very negative image of cigarettes. You may look at cigarettes as a friend that will help you through any situation and will always “be there” for you. It is true that the cigarettes will always be there, but they will be there at a terrible cost. Think of cigarettes as the insidious killers that they are. It may also help to examine all of the positive aspects of quitting, instead of all that you are giving up. Make quitting a positive choice rather than a negative one. For some people, setting an example for their children is a strong motivator.

To quit smoking, you must develop a mental image that smoking interferes with your other lifetime goals. For many years, smokers have been in the minority. Now only 28 percent of Americans smoke, and the very act of smoking makes them less welcome in many environments and social circles.

*278\252\8*

Progesterone has a long history. It was originally obtained from sows’ ovaries and in the late 1930s it could be synthesized from placentas in large amounts. So placentas were quick-frozen after delivery for later extraction of progesterone. After a number of years a way was found of converting diosgenin from the wild yam (Dioscorea villosa) into progesterone. This diosgenin became the starting point in the chemical manufacturing process of progesterone which was converted to the synthetic progestogen first used in birth control pills and later in Hormone Replacement Therapy. Because progesterone is a fat-soluble compound it was usually ineffective when taken by mouth because it was metabolized by the liver and never got into the bloodstream in sufficient amounts. This led to progesterone being given intramuscularly by injection and also as a suppository inserted into the vagina or back passage. It has been used for many years in this way as a treatment for pre-menstrual syndrome. It is now available in the form of cream to rub on the surface of the skin and is sold in the USA over the counter as a cosmetic. In the UK it is sold on prescription only, which upsets many of its advocates. They claim that because the progesterone is ‘natural’ it is safe to use and should be available over the counter here too.

This ‘natural’ progesterone is often thought of as an extract from wild yam. In fact, progesterone itself is not found in wild yams. It is synthesized from the plant by a number of chemical steps which means that it is not ‘natural’ at all. The assumption was that if we ate wild yam our bodies could convert it into the biologically active human hormone progesterone. This is simply not true. While progesterone can be synthesized from diosgenin, it can only be done by a chemist in a laboratory. Our bodies are just not capable of synthesizing progesterone from a substance such as wild yam. We do not have the necessary enzymatic pathways to produce this conversion. And the fact is that these progesterone creams do not contain any wild yam at all, a fact confirmed by Dr John Lee, the Californian physician who introduced ‘natural’ progesterone to the UK and has written most widely about it. As the demand for progesterone grew, the wild yam became overharvested and other sources had to be found. Now the main manufacturers use soya beans instead. The creams are fortified with the addition of USP-grade progesterone, a white powder that used to be derived from wild yam and is now more often derived from soya beans. Progesterone is called ‘natural progesterone’ to identify it as being chemically identical to the progesterone produced by humans and to differentiate it from the synthetic progestogen used in HRT.

Why, anyway, should a progesterone supplement or replacement be necessary? Cholesterol is the starting block (the precursor) of progesterone and all the other sex hormones in our bodies. As most of us know the worry has usually been that we have too much cholesterol in our diet. So the difficulty is not that we have some undesirable shortage of this progesterone starting block but that our hormonal pathways necessary for this conversion start to shut down.

*20/101/5*

There are substantial differences in the size, color, shape, and texture of the genitals, and these features of the individual woman change, too, at different phases of the life cycle, from youth to old age. The basic anatomy is the same, but the appearance of these separate structures, and their relative distance from one another, is quite varied. The configuration of each woman’s genitals is as unique as her face. We all have eyes, a nose, and a mouth, and it is to the enrichment of our aesthetic senses that there exists such incredible variety in their relative size and shape. The same holds true for the genitals. Just as the size or shape of our facial organs is not correlated with their sensory functioning, so, too, the size or placement of the genital structures does not affect sexual functioning. Some women have thin outer lips; others, large and puffy. In some women, the inner labia show between the outer lips; in other women they do not. Clitorises vary in size, and the relative position of the urethral opening between the clitoris and the vagina varies, too. Some women’s genitals have a thick covering of pubic hair; others, a thinner covering. Also, the color of pubic hair can differ from the color of the hair on one’s head.

All too often, women measure how they look against a culturally standardized norm of how a woman should look and find themselves lacking. No matter that the model changes rather rapidly, for example, from Marilyn Monroe to Twiggy to Cheryl Tiegs, the vast majority of women do not resemble the current model. Rather than placing value on the diversity of the human form for its own sake, we tend to want to look like whoever is “in,” with support amply provided by the fashion and cosmetic industries. As a result, many women have a negative body self-image and invest a great deal of time and energy into concerns such as excess weight loss. The negative attitudes toward one’s genitals, which stem from a number of sources, both contribute to and are reinforced by a general negative self-image.

Perhaps the increasing emphasis on health issues (for example, physical fitness and nutrition), and the growing influence of the women’s movement with its message of self-acceptance, will help us to appreciate our bodies for their healthiness and their unique individuality. Knowledge about our sexual appearance and functioning can help to further establish our comfort about ourselves and our self-confidence.

*107\265\8*

To consider the main characteristics of the ‘OAK’ REMEDY.

(1) Never admits defeat even in the most adverse conditions and continues the fight in the belief of ultimate victory.

(2) He does his duty faithfully and conscientiously, even when he is dead tired, and never complains of it.

(3) After working ceaselessly without respite he may get tired and even feel sad but still plods on.

(4) He works with utmost patience and endurance as if endurance is the sole aim of his life.

(5) After hard work, body wants some rest, but the OAK person even denies this natural urge of the body, and endangers his health.

(6) When his body is unable to render help to others because of illness, he becomes despondent.

(7) His persistence to pursue an impossible feat borders on foolhardiness as he continues to waste his energy and money on a job which is beyond the realm of success by any human being.

(8) He is an inveterate gambler who would like to have “One last go” even on borrowed money after having lost all his assets earlier.

*150\308\8*

The ketogenic diet, named for the ketones excreted in the urine, is one of the oldest forms of therapy for epilepsy. It has fallen into disuse because of the availability of new and effective anticonvulsants. It is far easier to take several anticonvulsant pills each day than to adhere to this rigid and cumbersome diet. However, in situations where modern anticonvulsants are ineffective, or where their side effects are overwhelming, the ketogenic diet often can control seizures completely with few if any side effects on behavior and learning.

The beneficial effects of starvation and dehydration on seizures have been known for centuries. However, starvation and dehydration cannot be maintained over long periods of time. The ketogenic diet was developed to provide the minimal amount of protein necessary for growth, virtually no carbohydrates, and most of the required calories as fat. Numerous studies done in the 1930s found that the diet completely controlled seizures in almost 50 percent of children placed on the regimen and markedly improved seizure control in another 25 percent. However, in the late 1930s, with the introduction of phenytoin (Dilantin) and later other effective anticonvulsants, the ketogenic diet began to be used less frequently. Physicians then became less familiar with its use, and few dieticians were trained to utilize it properly. It is now used only in a few large centers.

At Johns Hopkins, where much of the early work on the diet was performed and where dieticians have continued to be familiar with its use, we have continued to use the diet fifteen or so times each year. A recent review of our results with children placed on the diet only as a last resort—severely handicapped children with frequent seizures refractory to all of the new anticonvulsants—shows that the diet completely controlled seizures in more than half of the cases. Thus, the diet continues to be a very useful form of therapy for properly selected individuals.

*143\208\8*

Autonomic neuropathy

This is a form of nerve damage that affects the nerves controlling such functions as blood pressure, erection of the penis, bowel action and bladder emptying. Autonomic neuropathy is not usually noticed by the person with diabetes; it causes no problems and is detected only by sophisticated testing. Just occasionally it does cause sufficient disturbance of these functions to be noticed:

•     Postural hypotension: poor blood pressure control may cause postural hypotension, which is a fall in blood pressure on standing. This may make you feel dizzy when you get up from a chair or bed. Wearing supportive stockings to prevent pooling of blood in the legs may help. Drugs such as fludrocortisones may reduce the pressure drop.

•     Diabetic bowel and bladder: autonomic neuropathy which involves the bowel may cause diarrhea, and this may be especially troublesome at night. It can settle by itself. If not, the diarrhea may improve with tetracycline (antibiotic) treatment.

Incomplete emptying of the bladder is another effect, and occasionally leads to urinary tract infection in the urine that is not lost. Playing special attention to bladder emptying may improve this problem.

•   Impotence caused by autonomic failure of erection.

Loss of hypoglycemic warnings

One practical problem for insulin-treated diabetics thought to be due to autonomic neuropathy is the reduction or loss of the warning symptoms of hypoglycemia. This does not necessarily apply to everyone with autonomic neuropathy; on the other hand, over the years the warning of hypoglycemia may be harder to recognize in people with no other signs of autonomic neuropathy. Bear these points always in mind:

1. Transient tingling of the hands or feet is common before diabetes is diagnosed and usually settles with treatment.

2. Tingling or numbness in the feet may develop over the years.

3. If you have numb feet, examine them every night for minor injuries. Do not walk barefoot. Choose your shoes carefully.

4. Have regular check-ups for neuropathy.

5. Good glucose control may prevent the development of neuropathy, and improve it if symptoms have become apparent.

6.     Symptomatic autonomic neuropathy is uncommon and many of its features are treatable.

*33/102/5*

When arteriosclerosis occurs in the vessels of the brain, the roughened spots on the vessel linings may cause the blood flowing over them to clot. Or the vessels may become partially or completely occluded; fatty deposits may weaken the vessel walls and rupture and bleeding result. In either case, part of the brain is injured and the person has an “apoplectic stroke”.

Cholesterol is a complex, wax-like substance. An excess, along with other fatty substances, can become deposited in the walls of the blood vessels. This leads to atherosclerosis. The cells of the blood vessels react to cholesterol as to a foreign substance. Scar tissue is laid down around it to wall it off. It is this walling off that distorts and obstructs the normally smooth, round contour of the blood vessels and produces arteriosclerosis.

When excessive cholesterol obstructs the arteries, there is a great risk of high blood pressure. Furthermore, people with high blood pressure often not only have atherosclerosis but an ailment of the middle part of the artery wall called the “media”. It is known that the atheroma (fatty substance), the scar formations of the lining of the arteries, as well as the degeneration of the middle part of the artery wall concur with high blood pressure. There is a direct relationship between these factors and the duration and height of the blood pressure.

*5/151/5*

Aluminium

Aluminium is a powerful astringent with definite irritant qualities. Dr. H.W Keens of London, England, in his recent publication titled Death in the (aluminium) Pot published by the C.W Daniel Co., London, has come to the conclusion that aluminium cooking utensils play an important role in causing cancer. He says “After oxygen and silicon, aluminium is the most plentiful element and is indigenous to all soils…

It becomes toxic to organic tissues only when rendered soluble through its interactions with certain elements and compounds…. Soda, sulphur and ammonia appear to have the property of bringing aluminium out of its normal compounds and rendering it free and soluble to interact with other causative agents of some diseases of organic matter in the respect that it favours abnormal physiological functions”.

Severe Emotional Stress

Personality traits play an important part in cancer development. Dr. Helen Flanders Dunbar claims that only certain types of people succumb to cancer. Popular health pioneer, J.I. Rodale, is of the opinion that happy people do not get cancer. Recent studies by such researchers as Dr. L.Leshan of the Institute of Applied Biology at New York University, Dr. Arthur Schmale, Jr. and Dr. Howard Iker of the University of Roschester Medical Center, and Dr. William Greene, Jr. of the University of Rochester Medical Center, all came up with findings that people with a lowered ability to deal with severe emotional conflicts and stresses, people with uncontrolled anxieties and worries, those with traumatic emotional experiences or losses are more pre-disposed to succumb to cancer.

*24/355/5*

One of the most feared complications of animal-bite wounds is infection with rabies. Although the dog is the major animal reservoir for rabies worldwide, the principal wildlife vectors in the United States are raccoons, skunks, foxes, and bats. An exposure to rabies is defined as an animal bite or contamination of an open wound or mucous membrane with saliva or infected tissue. Local health departments should be contacted regarding rabies prevalence among wild animals.

Rabies is caused by a highly neurotropic RNA virus. A bite from a rabid animal may inoculate the surrounding soft tissue with rabies virus. The incubation period varies from approximately 5 days to 1 year, although the usual period varies from 20 to 60 days. Usually, the virus is first amplified in adjacent skeletal muscle cells near the site of inoculation. Once the concentration of virus is sufficient, it can directly enter peripheral nerves (unmyelinated sensory and motor terminals) and spread by retrograde axoplasmic flow until it reaches the spinal cord, causing pain at the wound site. After the virus has reached the spinal cord, it disseminates to the central nervous system and causes rapidly progressive encephalitis. It then spreads throughout the body along peripheral nerves, including those of the salivary glands, where it is shed. Death occurs by respiratory collapse, and infection is thought to be 100% fatal.

When exposure to rabies is confirmed or a high risk identified (particularly in unprovoked animal attacks), rabies prophylaxis must be initiated promptly. Prophylactic therapy after exposure includes local wound care, passive immunization with human rabies immunoglobulin (HRIG), and vaccination. HRIG should be administered at the started of antirabies prophylaxis (day 0) as a single 20 IU/kg dose, half infiltrated around the site of exposure and the other half given intramuscularly. Three vaccines are available in the United States: human diploid cell vaccine (HDCV), rabies vaccine adsorbed (RVA), and purified chick embryo cell vaccine (PCEC). All three types of rabies vaccine are considered equally safe and efficacious. HDCV, RVA, and PCEC should be administered intramuscularly in a series of five 1.0 mL injections given on days 0, 3, 7, 21, and 28. The deltoid muscle of adults or the anterolateral thigh of small children is recommended. The gluteal region has been associated with treatment failures and is not advised. Vaccine induces an active immune response within 7 to 10 days, and immunity persists for approximately 2 years. Previously vaccinated patients do not need HRIC but should receive two doses of rabies vaccination on days 0 and 3.

Depending on the type of bite, animals should either be observed for erratic behavior for a 5- to 10-day period or euthanized at once to determine whether rabies virus is present. Examination of the animal’s brain tissue is the only reliable method of diagnosis. Healthy-appearing cats and dogs can be quarantined for 10 days and euthanized if signs of illness appear.

*128/348/5*

In counseling, problem identification and problem solving constitute a recurring process. No matter what the problem, two kinds of forces are always in action: some factors help maintain the problem; other factors are pushing toward change. These can be sketched out in a diagram, as shown below. Suppose the problem being presented is: “I don’t like my job.” The line going across represents the current situation. The arrows pointing upward stand for the factors that ease or lighten the problem. The arrows pointing downward represent the factors aggravating the problem.

If the goal of the client is to be more content at work, this might happen in several ways. The positive forces can be strengthened or others added; or attempts can be made to diminish the negative ones. A similar sketch might be made for alcoholic drinking. This kind of chart can help the counselor decide what factors might be tackled to disturb the present equilibrium.

Left to his own devices, the alcoholic would piddle along for years. The fact that he is sitting in front of you indicates that something has happened to jiggle the equilibrium. This can be a force for change. Take advantage of it. Jiggle the equilibrium further. In the example just given, to take away the family denial or coworker cover-up would blow his whole act. It is becoming widely acknowledged that for the counselor to precipitate such a crisis is the most helpful thing to do.

*122\331\2*