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By F. Gelford. University of Medicine and Dentistry of New Jersey.

Older mem- ories are lost last in this type of MS buy hytrin 1mg low price, whereas remembering recent events presents the most difficulty buy hytrin 5mg line. Thus safe 2 mg hytrin, counseling for this problem must be focused on understanding and adjustment. Antidepressants may help in controlling some of the emotional lability, whereas tranquilizers sometimes are necessary to control behavior. Many people with MS do not want to recognize the psy- chological component, and counseling must be subtly offered or it will be strongly refused. Coping skills must be developed on an individual basis; they cannot be learned simply from reading a 139 PART III • Your Total Health book. These skills involve learning to deal effectively with stereo- types of the disabled in the community, perceived changes in mas- culinity or femininity, changes in relationships, changes of roles within the family, changes in employment status, increased dependence on others, and changes in physical condition. Some practical coping techniques include: • Make a list of conditions required for positive self-esteem, and discipline yourself to create at least some of them • Determine a way (small or large) to contribute to society and follow through with your plans • ttend appropriate counseling sessions • earn to say no to certain requests in such a way as not to damage your self-esteem • Make a list of people who can be relied on for various kinds of support and call on them for assistance when feelings of despair appear • iscipline yourself to stay as healthy and as physically fit as possible • reate opportunities to get out of the house • T ake charge of situations rather than allowing them to dic- tate to you, and • Prioritize projects RELAXATION TECHNIQUES Although stress usually is viewed as something to be avoided, real- istically the key is to learn proper ways to manage unavoidable stress. Some stress is desirable—it energizes us, motivates us, and captivates our interest. The stress that must be managed is the "dis- tress" that may hamper our ability to cope with the events and peo- ple in our lives. Body and mind are linked, and stress affects both our physical and emotional well-being. Stress may produce physical signs such as "knot- ting" of the stomach, increased spasticity, headaches, tight or sore mus- cles in the neck, and an increased pulse rate. If left unchecked, more 140 CHAPTER 22 • Adapting to Multiple Sclerosis severe symptoms will appear, such as insomnia, fatigue, anxiety, poor concentration, and poor problem-solving abilities. Although stress usually is viewed as something to be avoided, realistically the key is to learn proper ways to manage unavoidable stress. Relaxation techniques provide a tool with which stress can be controlled, putting you in better overall control of your life and your well-being. To be successful, you must learn to keep a passive attitude and let go of thoughts that drift in and out of your mind. Tell yourself to relax your feet, calf muscles, thighs, buttocks, abdomen, chest, arms, hands, neck, and head. Group counseling may be helpful when you think that no one understands your problems or if your support system is inadequate. There is no sim- ple way to do this, but it is clear that if one surrenders, one loses! ACTH—Adrenocorticotropic hormone; a hormone produced by the pituitary gland that stimulates the adrenal glands to produce cortisone. Allergic encephalomyelitis (EAE)—A disease of animals and occa- sionally of humans in which an immune reaction (allergic) occurs involving the nervous system (brain and spinal cord); similar to MS in many ways. Amino acids—Compounds composed of carbon, nitrogen, and an acid; the building blocks of proteins. Amyotrophic lateral sclerosis (ALS)—A central nervous system dis- ease of unknown etiology, almost invariably fatal. Antibody—A protein made by the immune system of the body in response to a substance, usually of foreign origin, called an antigen. Apraxia—The inability to perform a purposeful movement even though the ability exists to perform the components of the move- ment. Autoimmune disease—A disease, such as rheumatoid arthritis or MS, that involves the immune system of the body, turning against a component of the body itself. Autonomic nervous system—The portion of the peripheral nerv- ous system that is not under voluntary control.

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There are many penile vacuum devices buy 5 mg hytrin free shipping, which consist of a tube that is placed over the penis with a rubber band around the top of the tube generic hytrin 2 mg visa. A pump removes the air from the tube order hytrin 2 mg on line, creating a vacuum that draws blood into the penis to produce an erection. When the erection is adequate, the rubber band is slid onto the base of the penis and the tube is removed. The erection produced by this method is not as firm as an erection produced by other methods, but it may be adequate for many people. Testosterone injections and the oriental drug yohimbine have been used with variable but not encouraging success. Sildenafil (Viagra®) often allows for a good erection, and has become a major advance in the management of erectile dysfunc- tion. Although great strides have been made in diagnosing sexual dif- ficulties and providing alternatives, the key remains good commu- nication between partners and between the person with MS and his or her health care team. By exploring options, requesting informa- tion, and seeking appropriate referral, a satisfying sexual life may be maintained while coping with the diagnosis of MS. It usually is vague—mild numbness, some tingling, possibly a feeling of weakness, or occasionally some urgency of urination. However, if the symp- tom persists, fear overcomes denial, often accompanied by self- directed anger. The fear is that of "going crazy," of believing that nothing really is wrong but it is "all in my head. Some physicians are vague about the problem, refraining from giving it a name, whereas others may mention MS. Stress and fear build until the tests are completed and the diagnosis is confirmed. This often is followed by a sense of relief that the problem is medical rather than psychological. However, this relief soon disappears, and anger accompanied by grief surfaces once again. These feelings often are directed some- what randomly, sometimes toward family, friends, or physicians as if they were responsible for the disease. A lack of understanding 136 CHAPTER 22 • Adapting to Multiple Sclerosis leads to more anger, fear, and resentment, and a "why me? Some parallels may be drawn between the process of adjust- ment to MS and the stages of grief, as described by Elisabeth Kubler-Ross in her book On Death and Dying. This is followed by anger, then by a bargaining stage, which in turn evolves into depression, and finally into acceptance. Family and close friends also go through this adjustment process, and children may follow suit in their own way. As grieving evolves into depression in the newly diagnosed per- son with MS, it may be accompanied by loss of sleep, change of appetite, and feelings of despondency. This sequence results from decreased self-esteem; changes in self-image, life plans, goals, and values; and frequently a fear of rejection by family and friends. Resolution of these feelings is hoped for at the end of the cycle, accompanied by the feeling of peace that comes with the under- standing that life must go on. David Welch (personal communication) has observed the following stages of development in understanding MS: 1. Implicit in this admission is that from that moment on all relationships will in some way be altered. The disease requires the subordination of some things to the requirements of others. The element of stress is constant throughout all phas- es of the adjustment process. Its effect on the actual demyelination process is unclear, but in all likelihood stress does not increase demyelination.

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A pessimistic Leninist bolstered by a ponderous scientific construct hytrin 5 mg on-line, Bourdieu stands out as the ultimate doctrinaire more concerned with self-promotion than with democratic intellectual engagements 1 mg hytrin otc. Upon the death of this visionary and despotic reformer buy hytrin 5 mg with mastercard, the great families plotted to come up with a successor who would surpass everyone else — or at least, offend none. But there were only women — Catherine I, Anna Ivanovna, Anna Leopoldovna, Elizabeth I. These autocrats imposed their violent and dissolute natures upon the empire, along with their loves, their feuds, their cruelties. Born in 1911 in Moscow, Troyat is a member of the Académie française, recipient of Prix Goncourt. JEAN-MARIE ABGRALL HEALING OR STEALING — Medical Charlatans in the New Age Jean-Marie Abgrall is Europe’s foremost expert on cults and forensic medicine. He asks, are fear of illness and death the only reasons why people trust their fates to the wizards of the pseudo- revolutionary and the practitioners of pseudo-magic? We live in a bazaar of the bizarre, where everyday denial of rationality has turned many patients into ecstatic fools. While not all systems of nontraditional medicine are linked to cults, this is one of the surest avenues of recruitment, and the crisis of the modern world may be leading to a new mystique of medicine where patients check their powers of judgment at the door. Mind and Body 132 APPENDIX: Letters from Patients 170 INDEX 185 Introduction This book is the successor to Mind Over Back Pain, which was published in 1984. It described a medical disorder known as the Tension Myositis Syndrome (TMS), which I have had reason to believe is the major cause of the common syndromes of pain involving the neck, shoulders, back, buttocks and limbs. In the years since that first publication I have further developed and clarified my concepts about how to diagnose and treat TMS, hence the necessity for this book. Over the years the increasing incidence of these pain syndromes has created a public health problem of impressive proportions. One continues to see the statistic that somewhere around 80 percent of the population have a history of one of these painful conditions. An article in Forbes magazine in August 1986 reported that $56 billion are spent annually to deal with the consequences of this ubiquitous medical disorder. It is the first cause of worker absenteeism in this country and ranks second behind respiratory infections as a reason for a doctor visit. After a few million years of evolution, has the American back suddenly become incompetent? It is this book’s purpose to answer those and many other questions about this widespread problem. The thesis will be advanced that, like all epidemics, this one is the result of medicine’s failure to recognize the nature of the disease, that is, to make an accurate diagnosis. The plague ravaged the world because no one knew anything about bacteriology or epidemiology at the time. It may be hard to believe that highly sophisticated twentieth-century medicine cannot properly identify the cause of something so simple and common as these pain disorders but physicians and medical researchers are, after all, still human and, therefore, not all-knowing and, most important, subject to the enduring weakness of bias. The pertinent bias here is that these common pain syndromes must be the result of structural abnormalities of the spine or chemically or mechanically induced deficiencies of muscle. Of equal importance is another bias held by conventional medicine that emotions do not induce physiologic change. The disorder is a benign (though painful) physiologic aberration of soft tissue (not the spine), and it is caused by an emotional process. I first appreciated the magnitude of this problem in 1965 when I joined the staff of what is now known as the Howard A. Rusk Institute of Rehabilitation Medicine at New York University Medical Center as director of outpatient services. It was my first introduction to large numbers of patients with neck, shoulder, back and buttock pain.

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