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AFTER SPINAL CORD INJURY: LIFE CONTINUES

Some people’s idea of really “doing” a jigsaw puzzle is to cover up the picture of the completed puzzle on the front of the box. This adds to the challenge of figuring out which notch fits into which groove, by matching colors, patterns, and shapes. The trial and error needed to arrange the pieces without knowing what the completed picture looks like can be frustrating, but the final feeling is one of triumph.
Much the same process has been going on as you “reemerge” after spinal cord injury. So many pieces to reconnect – and the final picture an unknown. First there was the pre-disability you, then the trauma and its aftermath – hospitalization and (in most cases) rehabilitation – then your return home, perhaps to school or to work, or a new home somewhere else. You resumed the daily rhythm of your life. You began to go out with friends again. Life, with its disability blip, continued.
You are beginning to feel like yourself again. It may have taken one, two, or even five years to arrive at this point. But at last you can say, “I’m back. I’m my old self.” Or, “I’m my new self” – a surprising arrangement of your jigsaw puzzle.
As you begin to feel in control of yourself and your life again, you may be ready to chart where you are and what you’d like to do to make life more complete. Remembering the variety of experiences you have endured, survived, and mastered will give you the sense that “you can do it.” Indeed, as your ability to deal with life and its adversities deepens, you may find a wellspring of strength and confidence for the years ahead. In short, you’ve discovered that life is a journey of “uncovery” and “discovery” – of the world and its possibilities, and of yourself, your talents, and your deepest resources.
*162/156/5*

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WEIGHT CONTROL: CALORIES COUNT

To enable you to obtain a better understanding of the number of calories in many foods and the appropriate portion size, I want you to begin to do the following:
Read Labels
Before purchasing a food or beverage item, it’s very important to read the container label. Start with the number of calories per serving and the total number of servings per container. Multiply these numbers. That represents the total number of calories in the entire container.
Calories per serving x Servings per container = total calories for the entire container
You then need to determine your average portion size. It probably is much, much more than you realize and greater than the serving size described on the label. That “small” bowl of fat-free frozen yogurt you’ve been downing may be more like 450 calories than the 150 calories you thought you were having. To better gauge portion/serving size, purchase a measuring cup, a food scale, and other items that establish portion size. If you go to my web site, www.jimkaras.com, you will find a complete listing of the items I am recommending and can purchase them directly. Here are a few visuals that should help you to begin to gauge portion size:
3 ounces of protein = the size and thickness of the palm of an average hand or the size of a deck of cards
1 ounce of cheese = the size of four dice
1 average-size piece of fruit = the size of a baseball or the size of an average fist
You will also find a complete listing of calorie counts for popular foods on the site as well. Like the food diary, you don’t need to use these for the rest of your life, just long enough to create or improve caloric awareness. Pretty soon determining portion size will become second nature. You’ll quickly get a feel for what four ounces looks like.
As you begin this process, be aware that many of the foods Americans frequently consume are extremely caloric:
Food item Calories
1 ounce of granola 130
1/2 cup of premium ice cream 150-300
1 ounce of mixed nuts 160-180
1 medium-size fig 50
1 medium-size avocado 300
1 cup of guacamole 400
1 ounce of mozzarella cheese 90
1 ounce of Brie cheese 100
1 ounce of American cheese 110
2 tablespoons of peanut butter 190-210
1 tablespoon of mayonnaise 100
1 tablespoon of real salad dressing 45-85
1/2 ounce of croutons (about the size of two dice) 65
Diet Busters
I also want to mention what I refer to as “diet busters”: traditional favorite foods that we may think of as being “healthy,” when in reality they are loaded with calories and fat and can quickly sidetrack a weight-loss program. The list includes:
Food item Calories
Typical restaurant Caesar salad 660
Taco Salad from Taco Bell 850
Deli tuna fish sandwich 750
1 cup of hummus 440
1 ounce of pesto sauce (only 1 ounce) 150
Three-egg omelet with 2 ounces of cheese 600-700
*65/280/5*

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HEADACHES: CRANIAL NERVES

There are twelve cranial nerves, the nerves that arise from the brain itself, but all the pain impulses in the head are carried by only two of these, the fifth and ninth cranial nerves, which also serve most of the other sensations felt in the head and face. Pain can also be produced by stimulating the tenth and eleventh cranial nerves, as well as nerves coming from the spinal cord in the upper part of the neck; this pain is felt at the back and top of the head.
The fifth or trigeminal nerve arises from an area in the upper part of the hind-brain and its control centre (nucleus) lies deep in the spinal cord in the neck. In this part of the nucleus the areas of the face are represented in a concentric way, so that damage to the upper part can cause tingling or loss of sensation round the lips. The main trunk of the nerve splits into three branches in an area of the skull near to the front of the upper part of the jaw bone. The upper branch goes to the area of face above the eye and forehead, the middle branch to the cheek, whilst the lower one goes to the lower jaw. There is, of course, an identical nerve on the other side of the face. When a dentist anaesthetizes half the jaw, it is a branch of this nerve that he is blocking.
Much of the knowledge regarding these pain pathways was ascertained by experiments on volunteers undergoing operations, since such a detailed analysis could not be obtained by work on animals; this speaks volumes for the co-operation and interest of the volunteers. Many of those who suffer from headaches are keenly interested in co-operating in research. The methods employed in these experiments varied, e.g. mild electric shocks and traction, but they were not the sort of stimuli that cause headaches in everyday life.
The sites within the head which give rise to pain are related to blood vessels, and the relationship between these and the structures they supply are of paramount importance.
Blood vessels, especially arteries, have a muscular coat which enables them to change their diameter. These changes both alter the amount of, as well as the resistance to, blood flow. The smallest blood vessels (capillaries) form a network to supply organs with oxygen and nutrients, without which body tissues die. Blood flow to the tissues can also be regulated by opening or closing parts of the capillary system.
Pain due to stretching of blood vessels is the explanation of all vascular headaches, including migraine. The pulsation felt over the temple during an attack is due to dilatation of blood vessels and pressure on an artery, because it prevents or limits pulsations, lessens the pain. This is the way that an ice pack, by producing constriction of blood vessels, relieves an attack.
Before the headache phase of migraine, which is due to widening of blood vessels (vasodilatation) outside the skull, there is a narrowing of blood vessels (vasoconstriction) inside the head. Why this first phase occurs is not known but, during a migrainous attack, there may be a very low cerebral blood flow (similar to that following a stroke caused by blockage of a blood vessel).
The decrease in blood flow to the brain accounts for the visual symptoms and other odd sensations before an attack. During or soon after the decrease of flow in the brain, there is a dilatation of the branches from the extra-cranial carotid artery and this marks the start of the headache. The throbbing pain is made worse by the release of chemical substances (kinins and histamine). Nausea supervenes and this also occurs when the vessels are dilated passively. This simplistic explanation of the sequence of events in a severe attack of migraine gives a picture of the complex changes involved.
*22/152/5*

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WOMEN’S HEALTH: OTHER BITS AND PIECES

As well as the reproductive organs, the pelvis also contains various other structures. Important amongst these are the ligaments and other vital bands that hold everything in position. In front of the uterus is the bladder which holds the urine. Behind is the bowel. On top, the large and small intestines are lot a led. All strut-lures are covered with thin slippery membranes which allow one organ to move against another.
Although most women have normal structures, occasionally there may be a developmental anomaly that can produce odd-ball anatomical effects. For example, the hymen may be devoid of a hole; when menstruation commences, blood simply builds up until it is discovered, usually by a doctor checking the girl for the non-appearance of her periods. Vagina and uterus may be choc full of accumulated blood.
Sometimes abnormalities in the shape and structure of the uterus may take place, or there may be a double uterus.
In other cases, the sex of a baby at birth may not be obvious. Male and female have com pot tents that arc physiologically similar —for example, the head of the penis equates with the head of the clitoris, and testes equate with ovaries. Each comes from a similar part in the developing embryo. At birth the penis may be excessively small; there may be unusual external openings. This is called ‘intersex’ and. it is believed, affects 2-3 per 1000 births. Cases may be detected at birth, when a decision is made which sex the child should be called; other cases may not be detected until puberty (when menstruation fails to occur) or by chance in later life. It is a difficult subject, and a little bizarre. It is one, understandably, that those involved prefer not to discuss with others.
*10\45\4*

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SOME EATING RULES TO LOSE WEIGHT

Never skip meals
Eating breakfast is essential to your success at weight loss. Skipping any meal only leads to a diminished metabolism. Please, never, ever skip meals.
Eating breakfast may be the key to not just losing weight but keeping it off. Researchers from the Center for Human Nutrition at the University of Colorado Health Sciences Center in Denver looked at eating habits and weight loss in more than three thousand people. Of a group that lost over seventy pounds and kept it off (yes, that’s seventy pounds, not seventeen) the study indicated that 78 percent reported eating breakfast each day while only 4 percent of the successful losers did not. The researchers believe that those who eat breakfast are better able to control their hunger and overall caloric intake throughout each day.
Drink plenty of water
I am going to make this as simple as possible: Before each meal or snack, you should drink eight ounces of water. It’s so simple. Start each day with a big glass before breakfast, have another before each of your snacks and subsequent meals, and right there you have consumed between forty ounces (three meals and two snacks) and forty-eight ounces (three meals and three snacks) of water. It isn’t difficult to add more water and stay properly hydrated.
The majority of people I work with who lose weight and keep it off continue to drink lots of water well after they reach their goals. They become water drinkers for life!
Doctor it up if you have to. Add lemon or lime. Drink bubbly water, such as Perrier or Le Croix, or flavored sodium-free seltzer, which I love. No, carbonation does not give you arthritis, as some people have incorrectly stated. And don’t forget, tap water is just fine and free.
Here is another idea: Drink iced tea at lunch, then when you are halfway through, dump lots of additional ice into the glass. Do the same when you are drinking diet soda. Add lots of ice and watch your water consumption rise. Once again, just be careful: if these beverages contain caffeine, then they are also diuretics.
*58/280/5*

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DAILY PLAN FOR HEALTHY SKIN: PREPARING FOR BED

It takes about three hours for such a meal to digest, so it will be wise to spend most of this time without undertaking anything very strenuous.    This will mean that the time will be reached when it will be necessary to prepare for bed. The skin sufferer should spend the last half-hour of the day stimulating the skin and toning up the muscular system. If it is indicated a bath will be taken – perhaps the Epsom salts bath –  and this will use up at least thirty minutes of the time. If the bath is taken in the strenuous way which we have described in an earlier chapter then no further exercises will be necessary. On the other hand it may be the evening for an air-bath and some exercises to stimulate the circulation.
The room should be warm but well aired and the whole of the body should be exposed. The skin needs airing in this way after being covered with clothes all day and nothing is more refreshing to the system. At the same time a few exercises may be undertaken to prevent chilling and to tone up the muscles. There is no need to practice any set system. If one is used to a few exercises that one likes, all well and good; if not, then keeping in mind the idea of a circle is a very good way of inventing them. Try to circle the head, then the upper part of the body, then lift one arm and circle it, then the other; lift one leg and do the same; then the other, and so on. If you have been stooping most of the day, then try to stretch the opposing muscles; if you have been standing most of the day, do some exercises sitting on a chair and using the upper part of the body; if you have been sitting during working time, then try circling the feet and the legs so as to equalize the circulation. If you have a mirror, take a look at your figure and then try to adopt a better standing position. Watch yourself when you move around, and try to correct some of the mistakes you make in carrying yourself. In this way ten minutes’ exercise can be done without any boredom at all and with great benefit to yourself. And if the body is unclothed the skin will be stimulated so that the sweat and the sebaceous glands will function properly.
Children who have a tendency to skin troubles should be trained from quite early days to take an air-bath in this way, and by the time they are grown up they will be able to expose their skin in quite cold air with no danger of “catching” cold. As a matter of fact taking air-baths in this way is one of the best ways of preventing colds, because a healthy skin is one of the best safeguards against all kinds of coughs and colds. The person who catches colds and suffers from chills is most likely to be one who wraps up too warmly and coddles himself too much. By exposing the skin to the air he will be able to “harden” himself and prevent the recurrent colds.
*44/154/5*

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NATURAL MEN’S HEALTH: HOW TO EAT – COOKING AT HOME

Many of my male patients confess that they have no idea how to throw a healthy meal together. For that reason, they tend to favour takeaway food as it is easy and requires no cooking apart from reheating in the microwave. Unfortunately takeaway food is often loaded with fat and, when reheated, many of the enzymes so essential for vitality are destroyed.
Over the years I have given the following hints to men, especially those who are bachelors or divorced, to help them prepare and cook a simple meal.
Try and keep some healthy food in your cupboard so you don’t get caught snacking on unhealthy options at midnight when you’re hungry and tired.
Go to the supermarket and buy the following pantry items that can be kept for long periods in your cupboard. These foods mean you won’t need to shop every day, but only every two to four weeks:
• tins of salmon and tuna
• rice (preferably brown)
• cous cous
• pasta
• beans and pulses such as soy beans, baked or tinned beans and lentils.
• cereal
• tomato paste
• fresh snap-frozen peas or some snap-frozen mixed vegetables of your choice
• sea salt, black pepper.
*99\258\8*

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CANCER TREATMENTS: CHEMOTHERAPY

Chemotherapy is a widely used term for very strong ‘anticancer’ drugs, which are designed to kill off and reduce the cancer cells invading further into the body. Some are given by injection, others by intravenous drip, and some in tablet form. The term, ‘chemotherapy’ implies that all drugs given for cancer are the same for each patient with the same side effects. This is not true.
There are hundreds of different types and combinations of ‘anti-cancer’ drugs. Your cancer specialist will recommend the best combination of drugs to treat YOUR cancer. This may differ from experiences of others that you know, so it is not helpful to think that your reactions will be the same as theirs. The cancer specialist will spend time discussing the length of treatment, possible side effects and ways these side effects can be minimized.
I felt that my best chance of survival was to agree to chemotherapy rather than opting for a purely natural approach. Because I am so much into natural therapies, I never really saw the chemo in a positive way -1 thought chemo was putting toxic stuff in my body and I wanted it out as soon as possible. I just felt totally vulnerable, but deep down knew I really had no choice if I wanted to survive.
Seline
Some drugs are stronger than others and may cause hair loss of the head, pubis, eyebrows, armpits and legs. In almost all cases, the hair does grow back within eight weeks of completing the chemotherapy course. However, despite this, many women find it difficult to cope with the loss of hair as for many it is the first breakthrough of ‘denial’ into the realization that ‘Yes, my cancer is a reality’.
One of the oldest myths is that chemotherapy causes severe vomiting and nausea. Yes – last century it certainly did, but improvements in medication now mean that there is very little vomiting and nausea in most cases.
Nausea and vomiting from chemotherapy drugs are now significantly reduced thanks to extra ‘anti nausea drugs being given at the same time as the chemotherapy to reduce this side effect.
Some drugs may cause temporary mouth ulcers and loss of appetite, extremely dry skin, and brittle nails, reduced sense of smell, constipation or diarrhea.
Most patients having chemotherapy experience tiredness in the first two to three days after each treatment. This is due to a build up of the drugs in the body to fight the cancer cells. It is also nature’s way of enforcing the patient to rest to enable this ‘fight’ to happen in the most effective way. The tiredness may lead to a loss of interest in sexual intercourse and libido.
Some patients experience slight forgetfulness, including the ability to spell, but mental function usually returns to normal after the treatment is finished.
The chemo builds up in your body and by the second, third, fourth I lost my sense of humour. We would go out and meet our mates for lunch and laugh.
They made us feel good and it was most important to stay in touch with friends.
Fran
Most of these side effects are extremely normal despite some patients thinking they ‘were going mad’ as a result of the treatment. Many patients find it beneficial to ‘celebrate’ the half way mark of their treatments, knowing they are nearly finished.
*28/144/5*

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DIABETIC EMERGENCIES

Hypoglycemia, or insulin reaction: Taking too much insulin, exercising too much without eating, skipping or delaying a meal (or even not eating as much as planned) will mean that there is not enough sugar in the blood to use up the injected insulin. Then the blood sugar level will fall—sometimes to a hypoglycemic level, far below normal. The person may turn pale and feel shaky or dizzy. Arms and hands may feel numb, and there may be a tingling sensation around the mouth. As sensitive brain cells become affected by the lack of sugar, the person may become tired and irritable, feel disoriented, say irrational things, and even act peculiarly. Without prompt treatment, an insulin reaction may lead to convulsions and collapse.
Ketoacidosis (sometimes called diabetic coma): This develops gradually after a number of days of poorly controlled diabetes. Without enough insulin, the body is unable to utilize sugar for energy, so it begins to use stored fats instead. The ketones released when fats are broken down build up in the blood and pass into the urine and breath. These acid ketone bodies act as poisons, and the person may ultimately fall unconscious.
What to do in diabetic emergencies: Both insulin reaction and ketoacidosis are very serious medical emergencies. Their causes are opposite, and they require opposite treatments.
For insulin reaction, immediately provide sugar in the form of two sugar cubes, one-half cup of fruit juice or regular soda (not diet soda!), or the amount of candy equal to six or seven Lifesavers. Within ten minutes the person should feel better. After the insulin reaction is over, additional food such as milk, bread, and crackers should be eaten, and then normal activities can be resumed.
Never try to force any food or drink down the throat of an unconscious person—it might go into the windpipe and cause suffocation. An emergency injection of glucagon can help to bring a person out of a severe insulin reaction. A doctor might also give an intravenous injection of glucose. In any case, speed is important.
Ketoacidosis requires emergency treatment in a hospital. But what if a person with diabetes suddenly collapses, and you are not sure whether the cause is ketoacidosis or insulin shock? What should you do?
When uncertain, treat for an insulin reaction. Hypoglycemia develops so rapidly that quick action may be needed to save the person’s life or prevent brain damage. If it turns out that the person was really suffering from ketoacidosis, a little more sugar is not going to make much difference, and there will be time to correct for the mistake with injections of insulin. Call a doctor if the person does not respond to a dose of sugar within ten to fifteen minutes, or falls unconscious.
*35\268\2*

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BONE DENSITY AND RISKS THAT YOU CANNOT AVOID: GENDER AND AGE GENDER

Women have generally been considered to be at higher risk for bone loss and osteoporosis than men. And it is true that the average woman’s peak bone mass isn’t quite as high as the average man’s, and that bone loss generally starts earlier in women than men because of menopause. But as we get better at understanding and diagnosing low bone density, I think we’ll start finding that many more men would benefit from building or maintaining bone mass. After all, the risks listed in this chapter, in the main, don’t discriminate based on sex. Right now, we don’t generally look for osteoporosis in men; as we do start looking, I believe we will (unfortunately) find it. The good news is that once we find osteoporosis—or increased risk of it—we now know what to do about it in order to preserve not just life, but also lifestyle.
AGE
The older you are, the more likely you are to have already lost bone. But drastic bone loss is by no means a foregone conclusion if your diet and exercise habits have been sound over the course of your life, and, if you are a woman, you began taking HRT as you entered menopause. The biggest age-related jump in risk for women is menopause, during which bone loss accelerates for several years before settling down to a slower pace. For men, the rate of change doesn’t pick up until around age 65. For both men and women, after ages 30 to 40, bone for the most part isn’t being built up, it is slipping away.
*28\228\2*

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