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EXERCISE PLAN FOR HEALTHY BONES: PUTTING IT ALL TOGETHER

Three weekly sessions of weight-bearing aerobic exercise are enough to give you general good health, including reasonably dense bones. But the benefits to be gained from strength training and stretching should not be overlooked. The simplest approach to working out that encompasses all those is probably to do aerobic exercise three times a week, with weight training after at least two sessions. Stretch after each workout, with at least one intensive, full-body stretch each week. You could put together any number of combinations and arrangements that would also work, so experiment until you find a setup you like and will stick to.The more you get into it, the longer your workouts will last, and you should build up to at least an hour workout each time. If you are so inclined, by all means, do something every day (just remember to alternate the muscle groups you focus on if you are strength-training every day). In moving beyond aerobics three times a week, I recommend filling in with “moving meditations” like yoga, tai chi, and qi gong because they combine many aspects of fitness.Start with shorter and/or less frequent workouts, and build up gradually to your goal. Get whatever support you need to stick with it. Join a group, take a class, recruit a partner, hire a babysitter (or take turns with another parent looking to carve out some time for exercise). Dress comfortably and appropriately. Stick to a regular place and time at first, until you’ve formed a habit. If you usually exercise outdoors, have a ready-made alternate in mind if rain or cold threatens to keep you from your routine. Schedule your workouts as you would any other important appointment. Write specific windows for exercise in your calendar, and at first be very specific: “Monday: 7-8 a.m., aerobics class at the ‘Y’; Wednesday: 6:30-7:15 p.m., meet Joyce at the gym to lift weights; Saturday: 10-11 a.m. biking,” and so on. Get those dates on your calendar before you start setting up anything else. At least until you’re in the groove, work haircuts and brunch dates around your exercise plans. Otherwise, it is too easy to let one workout after another slide, and that does your bones no favors. Once you are used to regular exercise, and realize how much better you feel when you do it (and how sluggish you feel when you don’t), you’ll no longer have to force those priorities. You may not believe me now, but once you find the forms of exercise that appeal to you, you won’t want to go without. Just because you never could stick with jogging when that was all the rage doesn’t mean you aren’t cut out for exercise. You probably aren’t cut out for jogging (and as far as I’m concerned, that’s just as well), but there are many other options you can experiment with until you find the one that really moves you (pun intended).Starting slow, setting moderate and realistic goals, attending to injury prevention, and doing what you can to ensure success will keep your body physically safe as you introduce it to new ways of moving. It will also cement this most beneficial of all habits. Bite off more than you can chew and nothing tastes good, and you’ll never go back for seconds. Let your body be your guide. You should never have any pain while exercising, though sometimes discomfort is a sign you are pushing yourself, which is not necessarily a bad thing. You may get sore or stiff after a workout, but that shouldn’t last for more than a day or two—if it does, scale back, at least for a while, because you’re doing too much too soon. Making this a lifetime habit (just as you are not “dieting” so much as changing the way you eat, permanently) is very important. When you stop exercising, bone density will stop growing and begin to decline immediately (depending on your age). It will grow again when you start again, but you’ll always be further behind than if you had never let it slide in the first place. What it comes right down to is: move it or lose it!*122\228\2*

ADOLESCENT ALCOHOL PROBLEMS: DIAGNOSING ALCOHOL/SUBSTANCE ABUSE

Often the temptation is to disregard adolescent alcohol or drug problems as “just a stage,” or a normal feature of adolescence. The criteria for a diagnosis of alcohol abuse in adolescents are the same as those for adults. It involves a pattern of pathological use and impairment in social or occupational functioning due to use. Common signs of adolescent alcohol/substance abuse include the following:unexplained drop in gradesirregular school attendanceunaccounted for personal timewearing “druggie” clothing or jeweleryincreased money or poor justification of how money was spentchange in personal prioritiesnew group of friendschange in health or groomingfailure to provide specific answers to questions about activitiespossession of “drug” materialsdesire to be secretive or isolatedunexplained disappearance of possessions in the home Other symptoms-one may see in adolescents are:decreased interest in school or family social activities, sports and hobbiesattending parties where parents are not home to monitor behaviorfrequent “flu” episodes, chronic cough, chest pains, “allergy symptoms”impaired ability to fight off common infections, fatigue, and loss of vitalitystrange phone callsnot returning home after schoolnot bringing friends homecollecting beer cans, pot paraphernalia, etc.drop in school performanceinexplicable mood changes—irritability, hostilityverbal (or physical) mistreatment of younger siblingsimpaired short term memory,frequent accidentsfeelings of loneliness, paranoia, and depressionIndicators of a significant problem would include any “covering up” or lying about drug and alcohol use or about activities, losing time from school because of alcohol or drug use, being hospitalized or arrested because of drinking/drug-related behavior, or truancy plus alcohol or drug use. Alcohol or drug use at school generally indicates heavy use. One should be particularly alert to the above signs and symptoms in children of alcoholics, who may have a genetic predisposition and the added pressures such a parent brings to the already laden tasks of this period.*149\331\2*

DISEASES OF THE VEINS: DESTRUCTION OF VEIN VALVES FROM THROMBOPHLEBITIS (CHRONIC VENOUS INSUFFICIENCY) – VARICOSE VEINS

The term “varicose veins” refers to veins that are abnormally dilated. When the veins close to the surface of the legs become varicose, you can see them as soft, bluish, curving bulges under the skin.Causes of Varicose Veins.  Conditions that may lead to varicose veins include pregnancy (because the large uterus can press on veins in the abdomen and cause back pressure to build up in the leg veins), previous thrombophlebitis, or obesity. All of these problems elevate the pressure in the leg veins or damage the valves of the veins or both.Some people are born without venous valves or without an adequate number of valves. These people frequently get large varicose veins at an early age.Symptoms of Varicose Veins. Besides the unsightly appearance, varicose veins may cause aching and swelling in the legs.Who Is Affected by Varicose Veins?One in 10 Americans has varicose veins. Women are twice as likely to have them as men, because of the effect of pregnancy.*211\252\8*

MORPHINE: OTHER ROUTES OF ADMINISTRATION-PHARMACOLOGY

Morphine injected into the subarachnoid space, or diffusing into the subarachnoid space after epidural injection, will diffuse into the dorsal horn of the spinal cord and produce analgesia by interaction with opioid receptors. The theoretic advantages of intraspinal morphine include:•    the use of much smaller doses of morphine•    delivered close to the site of action (the spinal opioid receptors)•    less central side effects•    less systemic side effects•  no neurological deficits as occur with neurosurgery or anaesthetic blocks However, after epidural injection only 10-20% of the morphine diffuses into thesubarachnoid space and there is significant systemic absorption from the epidural space. Plasma levels may be equivalent to those following systemic administration, accounting for the central and systemic side effects. At the same time, the drug concentration in the CSF is much higher than after systemic administration, producing superior analgesia. There will be some rostral diffusion of morphine injected or diffusing into the subarachnoid space, predisposing to central side effects. *49\55\2*

THE STOMACH AND IBS: GOING TO THE DOCTOR WITH ‘ACID STOMACH’ PROBLEMS – SIDE-EFFECTS

You might be given a simple antacid or a drug in the cimetidine group such as Tagamet. It cannot be denied that these drugs are effective – but it is unwise to stay on them for long periods.Side-effectsI first came across large numbers of people who were given these drugs for gastro-intestinal disturbances when they were withdrawing from drugs in the benzodiazepine group such as diazepam or lorazepam. They were also given to people who were having withdrawal symptoms from antidepressant drugs such as amytiiptyline or the MAOI inhibitors. Many were left on cimetidine on repeat prescription for long periods without review. Long after the tranquillizer or antidepressantwithdrawal was over many people reported feeling ill when they tried to stop cimetidine. A rebound over-production of gastric acid could be expected, but they also reported: irritability, insomnia, panic attacks and feeling generally very low. On the positive side, many users said that the bowel symptoms such as constipation and colic (many had suffered this for years) disappeared within two weeks of the discontinuation of the cimetidine or allied drug.Fungal infections of the skin and gastro-intestinal tract have also been reported with these drugs.Cimetidine (Tagamet – a weaker version of the prescription drug) is now on free-sale in the UK. If it helps, use only in the short term (and not before you have had a firm diagnosis from your doctor). If it make you feel anxious or irritable you would be well advised to look for a natural approach to the problem of overacidity, such as changing your diet and lifestyle. If the symptoms persist, see your doctor with a view to some investigations. If your doctor is unwilling to see if you are producing too much or too little hydrochloric acid, this test can be arranged by a doctor who practises Clinical Nutrition.*30\326\8*

AVOIDING ASTHMA TRIGGERS: FOOD ADDITIVE CLASSES

•Anti-caking agents ensure that products, such as salt, flow freely; •Antioxidants prevent food containing fats and oils from becoming rancid;•Artificial sweeteners are used to sweeten low-joule foods;•Bleaching agents whiten foods, such as flour;•Colours restore losses during processing and storage, and ensure a uniform colour in the finished product;•Emulsifers ensure that oil and water mixtures do not separate into layers;•Enzymes break down food, such as milk into curds and whey;•Flavour enhancers bring out the flavour of the food without imparting a flavour of their own;•Flour treatment agents improve flour performance in bread making;•Food acids maintain a constant acid level in food despite variations in the acid level of ingredients;•Humectants prevent foods from drying out;•Mineral salts enhance the texture of foods, such as processed meats, which might lose fats or juices;•Preservatives prolong the shelf-life of food;•Propellants are used in aerosol containers;•Thickeners and vegetable gums ensure constant consistency;•Vitamins make up for losses in processing and storage, and are added to certain foods to supplement dietary intake. Food additives are numbered as follows: 100-181 Colours200 – 297 Preservatives and food acids300 – 381 Antioxidants, food acids and mineral salts400 – 492 Vegetable gums, emulsifiers, some anti-caking agents, humectants, mineral salts500 – 579 More mineral salts and anti-caking agents 600 – 637 Flavour enhancers900 – 1202 Bleaching and flour treatment agents and propellants1400- 1450 Thickeners1505 – 1520 Miscellaneous additives*37\148\2*

BACH FLOWER REMEDIES: DR. BACH’S PHILOSOPHY – THE IMPORTANCE OF MENTAL SYMPTOMS

The importance of mental symptoms has been very well recognised in the homoeopathic treatment of chronic diseases. In taking the case history every care is taken to note the mental symptoms of the patient and in the preparation of prescription utmost importance is given to the mental symptoms.Dr. M.L. Sehgal in his Revolutionised Homoeopathy takes into account only the mental symptoms of the patient to the exclusion of all physical symptoms in the preparation of homoeopathic prescription.It is common knowledge that some persons are so sensitive to pain that they would raise great hue and cry even with the prick of a thorn, while some persons would undergo the worst of physical torture without the least murmur. This shows that there is no relation between the physical disease and the mental state of a person. It is not the ailment which matters, it is the feeling of the ailment which is important, and the feeling of trouble emanates from the brain.It is therefore necessary to remove the feeling of ailment from the brain, if the patient is to be cured.  For proper treatment of a patient, the mental state of the person has to be rectified. A Japanese doctor successfully treated many cases of cancer by simply convincing the patient that he was not suffering from cancer. One of his cases was reported thus: A patient whose swelling on the throat was diagnosed as cancerous after biopsy of a tissue and was given an appointment for operation on a certain date went to see this doctor.   “What”? said this doctor,”who told you this is cancerous”?   He felt the swelling with his hand and proclaimed that it was only an eruption which would suppurate and open in a couple of days and after discharging the pus, the swelling would subside. Such was the magic of the doctor’s confident tone that the patient was convinced that he had no cancer and the previous diagnosis of the experts was wrong. True, in a couple of days the suppurated eruption opened up, and the pus discharged. The patient was cured.According to this Japanese doctor, you have to remove the feeling of sickness from the mind of the patient and the physical symptoms of his disease would automatically disappear. Very often we come across patients who have heart trouble due to mental causes. Originally the trouble started with some gastric trouble. The flatulence with an upward pressure caused some pressure in the left chest. The patient was rushed to the nearest heart specialist. The E.C.G. was clear but the specialist advised the patient to come for another E.C.G test after a week, and meanwhile to take care. This advice to take precautions against heart trouble and E.C.G tests installs in the mind of the patient a doubt and fear that he has some heart trouble. In time this apprehension takes the form of certainty and the person becomes a heart patient.*21\308\8*

THE ALEXANDER TECHNIQUE IN PREGNANCY: EXERCISES FOR TONING THE ABDOMINAL MUSCLES

It is important to develop a healthy muscle tone before (if possible) and during the pregnancy. Supple and elastic abdominal muscles can stretch more easily and support the pregnancy better, assist in an easier birth and contract back into shape more quickly after the baby is born.Healthy muscle tone, as we have seen, is dependent on overall use. In the Alexander Technique we never think of one set of muscles working in isolation from the rest, and the way your abdominal muscles work is dependent on the way the whole body is used. The way that you are taught to use yourself in Alexander lessons – to keep the neck free and allow the back to lengthen and move as a whole, and using movements such as monkey, squatting and lunging for your everyday activities – promotes good tone in these muscles.However, our normal everyday activities may not include the whole range of movements required to tone up the abdominals, particularly if we lead a sedentary lifestyle, with all its activity-saving conveniences. Therefore, we recommend that you practise some abdominal exercises during this time when extra demand is being put on them.Details of commonly taught exercises can be found in a number of general books on pregnancy and childbirth. However, there are some exercises that we strongly advise you against. These include all kinds of ‘sit-ups’ with straight legs, and straight leg raises with both legs extended, both of which can cause back strain and unnatural ligament and nerve elongation, weakening the lower back.Some exercises are safe, however, and these can usually be practised throughout pregnancy. A note of caution: if any of the exercises cause pain or discomfort you should consult your midwife or doctor. Remember that in the later stages of pregnancy, exercises done lying on your back may cause restrictions in the blood flow to both you and your baby as the weight of the uterus falls on to the main blood supply. If there are any signs of dizziness, shortness of breath or discomfort, stop and change position. These exercises can also be used for getting back into shape after the baby is born.The exercises should not be practised as a quick routine but with direction and conscious control. Breathing is a very important consideration in any kind of activity. Move slowly and gently enough to allow smooth and continuous breathing. Do only a few of each at one go, and always finish with an Alexander resting position. It is not how many times, how quickly or how strenuously you do them that counts – it is how well you do them that makes them really effective. We also advise you, if possible, to ask your Alexander teacher to take you through these exercises to help you maintain your directions while doing them and to make sure that you are not harming yourself.Two beneficial abdominal exercises that we recommend are both done in semi-supine. The first is to lie and gently rock the legs from side to side; in the second, one leg at a time is gently extended in a sliding motion and then returned to the bent-knee position. Hip-hitches or tail-wagging on all fours is another well known and safe exercise.*43\346\2*

ABSCESSES: BOILS (CARBUNCLES)

Boils or carbuncles are swellings of the skin, which often develop around the hair follicles. Sometimes there is just one, but often there are more. It is a painful condition and arising from toxins in the bloodstream, again mostly due to the wrong foods. In these cases the best course is often a revision of the diet, and frequently I also advise a period of fasting, as this allows the body to detoxify itself. I can assure you that any patient who suffers from boils or carbuncles with regularity, will be more than willing to co-operate. As always, proper elimination is necessary for good health. When the nervous system is confused by a misunderstanding of our physical ailments and our anatomy, the circulation of the blood is always interfered with and this, in turn, causes constipation. The framework of the body must be seen in its entirety and it is not only the bowels, the lymph glands, the nerves, the arteries or the veins that need help. It is possible, and even likely, that there are more than one or two factors that require attention.This is also the case with varicose veins which result from blockage of the ventricles (or veins) that return the blood to the kidneys and heart. A circulatory system with abscesses, varicose veins or haemorrhoids, is usually a sign of an inefficient bowel function and diminished elimination. Some people tell me in all sincerity that they have no bowel problems, yet, when quizzed, they tell me that they have a bowel movement every second or third day. Nevertheless they don’t consider this unusual. One of the basic rules of good health is that whatever is imported, ought to be exported within a period of twenty-four hours. Abscesses, boils, carbuncles, etc. cannot be expected to disappear unless the toxicity problem has been resolved.*31\147\2*

INFECTIOUS THREATS NOW: HYGIENIC IMPROVEMENTS AND AGAINST INFECTION IS THE USE OF ANTIMICROBIALS

The second great strategy is hygienic improvements. No other single intervention in the history of medicine has saved as many lives and reduced as much suffering as the provisioning of uncontaminated water, which is necessary to curb the great plagues of diarrheal disease. Before cities cleaned up their water supplies, about one out of every five residents would die of diarrheal diseases, particularly typhoid fever, dysentery, and cholera. Provisioning of clean water dropped this death toll virtually to zero. Hygienic improvements in hospitals during the same period transformed hospitals from institutions that served as the last stop for the living to places where people had a good chance of being cured, particularly after antibiotics were introduced.     We can think of hygienic improvements as the strafing of enemy forces as they try to cross bridges, the point being that enemy forces are stopped by disinfecting, filtering, or washing them away while they are en route to their target. Those with a less militaristic disposition can equate hygienic improvements to the Marshall Plan, which rebuilt postwar Europe. Infrastructural improvements that encourage safe drinking water, sewage disposal, hand washing, disinfection of hospitals, and use of gloves allow people to improve their lives by reducing the ravages of microbial warfare. Whatever the metaphor, the overriding argument is that hygienic improvements work and are relatively inexpensive. We relax them at our own peril.     The third great strategy against infection is the use of antimicrobials. When antibiotics were introduced, some hoped that they might put an end to bacterial diseases. The track record, as of the mid-1940s, bolstered this lofty expectation, at least for those who did not bother to consider evolution. Those who did, however, sounded an alarm almost from the beginning of the antibiotic era. The discoverer of penicillin, Alexander Fleming, warned in the late 1940s that antibiotics might soon lose their effectiveness through the evolution of antibiotic resistance. Another Nobel laureate, Joshua Lederberg, voiced a similar warning during the early 1950s. But the alarm went largely unheeded.     Although antibiotics are a marvelous solution for the individual patient, they are a poor way to control disease in a population. Their flaw stems from an ethical dilemma: what is best for the individual patient may often be at odds with what is best in the long term for the society. The individual patient usually benefits by taking antibiotics. The society pays a price over the long term because the more antibiotics are used, the stronger are the selective forces favoring the evolution of antibiotic resistance. Societies might reduce this price if they were able to restrict antibiotic usage, but they have few options. If the restrictions are voluntary, a physician who does not treat a sick patient with an available drug will likely lose the patient—if not to death, then to another physician. If the restrictions are mandatory, their enforcement would undoubtedly lead to a black market in effective antibiotics. Even if societies had the power to enact such restrictions, ethical considerations might cause them to choose not to exert it.     Should the possible long-term interests of the society as a whole restrict the access of individuals who need an antibiotic now? The antibiotic might not even be necessary in the future if other antibiotics were developed in the meantime. There is no easy way out of this dilemma. The best long-term solution is undoubtedly to reduce the need for antibiotics rather than to restrict their availability. But this solution requires clear and clever thinking about evolutionary processes, something that has been in short supply in the health sciences throughout the past two centuries.     Still, for all the negative press antibiotics have received in the context of antibiotic resistance, they remain one of the three great achievements in the fight against infectious disease. Many of the difficulties that are encountered with antibiotics result from a failure to distinguish between purposes for which they are particularly suited and those for which they are not. Antibiotics are an excellent weapon for destroying the microbes that are on a rampage in a sick patient. They are a poor weapon for controlling the spread of infectious agents through a population—when they are put to this use, problems of antibiotic resistance are sure to be exacerbated. Hygienic improvements and vaccination are the better weapons for this goal.     This rule of thumb sounds simple, but it is frequently violated. It is violated when hospital staff decide to treat wards prophylactically with antibiotics instead of maintaining the high hygienic standards that prevent infections. It is violated when antibiotics are offered to poor countries as a cheap solution to diarrheal diseases instead of making the more expensive improvements in water supply and sewage disposal. It is violated when tuberculosis control policies rely on seeking out and treating the infected individuals in a city rather than improving housing quality, airflow, and nutrition in the hotbeds of tuberculosis transmission.*27\225\2*

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