To begin the day

Always drink a large glass of water on rising in the morning. This flushes the system and the bladder thereby helping the circulation and preventing build-ups that would cause unwanted gallstones, and helping the prostate gland.

Breakfast

A proper breakfast should always be eaten to start the day and give you the energy and calories that you need to concentrate. This is especially important if you are doing physical work or working long days.

Make yourself a fresh fruit juice using orange, pineapple or a fruit blend of your choice. Mango and pear or mango and peach are great combinations. In winter, apple or orange are good options.

Healthy cereal and low-fat milk with some protein powder sprinkled on top is a good start. Follow this with either an egg or two (have two eggs every second day if you do not have a cholesterol problem) on wholemeal toast (no bacon except perhaps on weekends if your weight is okay); or an omelette with tomato or vegetables (leave out cheese if you are watching your weight). Omelettes can be made with the whites only if you have high cholesterol.

A simple on-the-go breakfast option is baked beans on toast, or sardines or some mackerel on toast. These contain omega 3, which is excellent for keeping cholesterol under control.

A smoothie is a great choice if you’re short on time or you’ve missed out on breakfast for some reason. It can be made from skim milk and a fruit of your choice. Just throw them in the blender with a tablespoon of a tasty protein powder and a tablespoon of psyllium husks (a fibre which assists bowel movement and cholesterol reduction). These shakes can be made at the office if you have not had the time at home.

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Diabetes is a disease in which too much sugar (called glucose) accumulates in  the bloodstream rather than being transferred into the cells throughout the body. The full name for diabetes is diabetes mellitus (mellitus means “honey sweet”) term diabetes is often used synonymously with diabetes mellitus, but by itself it really refers to only one of the main symptoms of the disease—frequent urination. It is derived from the Greek word for “siphon.”

Diabetes is not caused by eating too much sugar. The body normally converts some of the food eaten into a type of sugar (glucose) that provides an energy source for the cells. Glucose is distributed throughout the body by the bloodstream. A hormone called insulin allows the glucose to enter the cells. In diabetes, either the pancreas stops making insulin or the body does not respond-properly to the insulin that is produced. In type I, or insulin-dependent diabetes mellitus (IDDM), decreased insulin production is the main problem. In type II, or non insulin-dependent diabetes mellitus (NIDDM), the main difficulty is a reduction in the body’s response to insulin. Both types of diabetes are associated with a higher risk of cardiovascular disease.

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Suggested Supplements

• Vitamin В6, 50-300 mg., daily (work up rom 50 mg. gradually)

• Magnesium, 500 mg. and calcium 250 mg., daily (Yes, with PMS the ratio should be twice as much magnesium as calcium because a magnesium deficiency causes many of the PMS symptoms.)

•   Vitamin E (dry form) 200-100 IU, daily

• Pantothenic acid (vitamin B5), 1,000 mg. (lg.), daily (When taken with vitamin C, pantothenic acid helps to control allergic responses that can be more intense during the premenstrual time.)

•   Evening primrose oil, 500 mg., 1-3 times daily (Helps alleviate pain as well as mood disorders brought on by PMS.)

•   Dong quai, 2 caps, 3 times daily, Vi hour before or after meals (begin a week before menstruation) This herb is known as the female ginseng and can improve circulation, regulate liver function, and help remove excess water from the system.

Recommended Exercise

Sustained exercise (aerobic) is best, brisk walking for thirty minutes twice daily (or swimming) is extremely effective in providing improved abdominal circulation and in minimizing PMS symptoms.

Other Benefits Of Aerobic Exercise For PMS Sufferers:

•   Helps prevent the retention of fluids

•   Increases the level of beta endorphins in the brain (thus elevating mood)

•   Aids of proper metabolization of needed nutrients

•   Minimizes constipation and encourages regularity

•   Helps reduce stress

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Self-distrust. Imitates other’s ways, manners, styles. In the negative state of ‘Cerato’, a person is seen seeking advice of others, not because of other’s superior intelligence or better experience, but because he has no-confidence in his own decisions. He is quite intelligent and capable of taking sound decisions himself, but because of lack of trust in his own decision he is always seen seeking advice from others. This foolishness sometimes costs him dearly, when due to the wrong advice received from elsewhere he does something which brings harm to his interest, then he regrets, especially so, when he recollects that his own decision (which he did not trust) was right. In seeking advice from different persons, he often gets conflicting views which cause much confusion in his mind, thus disturbing his mental peace and making him unhappy.

It is in his very nature to ask questions, seeking advice from others in his personal problems. His persistent questioning bores other people and they shun his society.

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Allergic side effects

As with other anticonvulsants, a drug rash occurring within the first two to three weeks after starting carbamazepine is a potentially serious sign. A child with a rash beginning at this time should always be seen promptly by your physician, who can then decide whether to discontinue the drug. Rare effects on the liver, bone marrow, and blood clotting cells (platelets) have also been reported.

Dose-related side effects

The signs of dose-related toxicity from carbamazepine are important because they are briefly experienced by almost everyone who uses it. The first sign of mild toxicity is double vision, sometimes accompanied by blurred vision or dizziness, most likely to occur one to two hours after a dose, when the amount of the drug in the blood is at its highest. Such symptoms last one to two hours, until the blood level decreases, not a serious side effect. If persistent and bothersome, your physician may want either to lower the dose or to spread out the medicine in more frequent, smaller doses.

More significant toxicity is displayed in unsteadiness, ataxia, sleepiness, or foggy thinking. These symptoms should be brought to the attention of your physician, who will want to check the blood level of the drug and perhaps change your child’s dose. All of these symptoms disappear when the dosage is decreased or the drug is discontinued.

Because of carbamazepine’s short half-life, physicians often recommend that it be taken three or even four times each day. We, and most patients, find that taking a drug this often is cumbersome, and that patients often forget to take some doses. We prescribe the drug to be taken only twice a day. We tell the patient (or the parent) to observe carefully if seizures occur before the next dose. If they do, then we assume that the blood level dropped too low or that the time between doses is too long and change the schedule to three or, infrequently, four times a day.

The other reason why we may decide to give the drug more often than twice a day is a patient’s experience of signs or symptoms of toxicity shortly after taking a dose. This indicates that we have given too much at one time, and again we will instruct the patient to take a smaller dose of the drug three times a day. Using this approach, we have found that the seizures of most children can be controlled if they take carbamazepine only twice a day.

In children taking carbamazepine who are given erythromycin (an antibiotic often used in place of penicillin) for infection, high levels of carbamazepine and toxicity often develop. If your physician prescribes erythromycin, he may need to lower the dose of carbamazepine temporarily.

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As a person with diabetes, you should remember that you should not exercise:

1.   When you have a minor illness, such as a cold or flu. A few days off will not send you back into a state of vegetativeness. When you feel fit you will be able to get back into your exercise routine and you can make up for lost time.

2.   When you have a minor injury. Don’t further irritate a blister on your foot by staying with your routine. The insult to the injury could result in infection, a foot ulcer, or worse. Switch to a second exercise that uses the other parts of your body until the injury heals.

Remember – and this is for everyone who exercises, whether they have diabetes or not – you should begin an exercise session with five to ten minutes of stretching and warming up and end the session with five to ten minutes of stretching and cooling down. The warm-up will give you the flexibility you need during exercise and the cool-down will allow stressed muscles and joints to relax properly.

The real part of your exercise program is the twenty to thirty minutes of activity in the middle.

Wow strenuous this exercise should be is up to you, your physical status and your fitness status. You may need to measure your heart rate in order to determine how much effort you require to achieve exercise benefits. Discuss how to measure heart rate with your doctor or with an exercise expert at a health club or at your local hospital.

Of course, if you have been totally inactive for the past twenty years, getting into exercise will be and should be a slow, step-by-step process. Don’t rush out and attempt to run five kilometers at full speed. That’s foolish and is sure to result in some dramatic problems.

Do start slowly and build up your exercise intensity over a period of weeks. Try to schedule exercise on an every-other-day basis, setting aside about an hour on each of these days. You’ll need ten minutes to warm up, twenty to thirty minutes of exercise, and another ten minutes to cool down. Add minutes to put on your exercise clothing and more minutes to change back to regular clothes.

For most adults, the right kind of exercise, the right length of time, done three times a week will produce the desired benefits. If you exercise less than this you will not get the full benefits. On the other hand, if you exercise more, such as every day or for two hours each exercise day, you won’t necessarily gain benefits, although you might feel better and your endurance might improve faster. In any case, moderation is always a good idea.

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Many things contribute: heredity, overweight, high emotional stress, no exercise, and too much alcohol. For some patients too much salt in the diet makes the pressure rise.

Salt is composed of two chemicals: chlorine and sodium. However, each element can play a role when attached to other chemicals or other elements. Sodium in any situation triggers increased blood pressure in those patients sensitive to it. Some experts say sodium results in hypertension in only 20 percent of the population; so if your pressure isn’t going up, you need not change your salt-eating habits. But if it is rising, cut back to 2 grams a day by shunning the salt shaker and avoiding processed foods high in salt or sodium.

Contrary to what you may have heard your blood pressure need not increase with age. Dr. Lot Page of the National Institute on Aging in Bethesda, Maryland, studied the natives of the Solomon Islands in the South Pacific. He found no increase in either their body weight or their blood pressure as they grew older. Scientists have made similar findings in studies of other primitive peoples. The lifesaving lesson for survival: exercise – and don’t gain weight.

In the last 20 years, scientists have learned that blood pressure is controlled by many different systems in the body. For example, your kidneys release chemicals that either increase or decrease blood pressure. So do your adrenal glands, found atop each kidney. Doctors have also discovered a hormone produced by the heart called atrial natriuretic factor (ANF). As blood pressure rises in the heart, ANF is released, causing a reduction in pressure.

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Flora

Gastrointestinal perforation typically leads to a polymicrobial infection. The types of organism involved depend on the level of perforation. Intestinal flora may also be altered by previous antimicrobial therapy or severe underlying disease. The normal flora of the stomach, duodenum, and proximal small bowel are sparse and similar to oropharyngeal flora. Low numbers of a-hemolytic streptococci, lactobacilli, Candida species, and anaerobes predominate. The distal small bowel contains larger numbers of organisms, including Enterobacteriaceae, Enterococcus species, and anaerobes.

Colonic perforation leads to hundreds of different species being introduced into the peritoneal cavity. However, once infection is established, the number is narrowed down to an average of five pathogens. The colon contains enormous numbers of bacteria, with more than 99.9% being obligate anaerobes, mostly of the Bacteroides fragilis group. B. fragilis and E. coli are the most frequently isolated organisms. Facultative organisms include E. coli, Proteus, Klebsiella, and Enterococcus species. E. coli has been shown to be responsible for sepsis and mortality in early peritonitis, while B. fragilis, in conjunction with E. coli and other flora, causes late abscess formation.

Clinical Presentation

Abdominal pain, nausea, vomiting, altered bowel habits, fever, and tachycardia are often present in patients with secondary peritonitis. Patients typically avoid movement and may keep their hips and knees flexed. Abdominal examination often reveals tenderness, involuntary guarding, and rebound tenderness. Hypotension due to sepsis and hypovolemic shock may occur with diffuse peritonitis, whereas patients with a localized abscess usually have minimal vital sign abnormalities.

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Each day we process vast amounts of information without much thought. Our behavior is almost automatic. Without benefit of a clock, we can make a reasonable estimate of the time. When shopping, we can without too much trouble distinguish the clerk from fellow customers. Sometimes, though, we cannot find a person who seems to be a clerk. Take a couple of minutes to think about the clues you do use in separating the clerk from the customers. One of the clues might be dress. Clerks may wear a special outfit, such as smock, apron, or shirt with the store’s logo. In colder weather, customers off the street will be wearing or carrying their coats. Another clue is behavior. The clerks stand behind counters and cash registers, the customers in front. Customers stroll about casually looking at merchandise, whereas clerks systematically arrange displays. Another clue might be the person’s companions. Clerks are usually alone, not hauling children or browsing with a friend. Although we have all had some experience of guessing incorrectly, it happens rarely. In essence, this is the good guys wear white hats principle. A person’s appearance provides us with useful, reliable information about that person. Before a word of conversation is spoken, our observations provide us with some basic data to guide our interactions.

We hope that you are convinced everyone indeed has keen observational powers. Usually people simply do not reflect on these skills. The only difference between a counselor and others is that a counselor will cultivate these observational capacities, will listen carefully, and will attend to how something is said and not merely the content. The counselor will ask: “What is the client’s mood?” “Is the mood appropriate to what is being said?” “What kinds of shifts take place during the interview?” “What nonverbal clues, or signs, does the client give to portray how she feels?”

So, in a counseling session, from time to time, momentarily tune out the words and take a good look. What do you see? Reverse that. Turn off the picture and focus on the sound. One important thing : the questions you ask yourself (or the client) are not why questions. They are what and how questions that attempt to determine what is going on. Strangely enough, in alcohol counseling, successful treatment can occur without ever tackling a why question. Ignoring what or how issues, however, may mean you’ll never even get into the right ball park.

So what is the importance of observation? It provides data for making hypotheses. A question continually before the counselor is: “What’s going on with this person?” What you see provides clues. You do not pretend to be a mind reader. Despite occasional lapses, you do not equate observations, or hunches, with ultimate truth. Your observations, coupled with your knowledge of alcohol, suggest where you might focus attention. An example: a client whose coloring is awful, who has a distended abdomen and a number of bruises, will alert the counselor to the strong possibility of serious medical problems. The client may try to explain this all away by “just having tripped over the phone cord,” but the counselor will urge the client to see a physician.

You do your work by observing, by listening, and by asking the client (and yourself) questions to gain a picture of the client’s situation. The image of a picture being sketched and painted is quite apt to capture the counseling process. The space below is the canvas. The total area includes everything that is going on in the client’s life.

As the client speaks with the counselor, this space is filled in. Now the counselor is getting a picture of the client’s situation. Not only do you have the “facts” as the client sees them; you can also see the client, his mood and feelings, and get a sense of what the world and picture feel like as well.

You have a notion of the various areas that make up the person’s life: family, physical health, work, economic situation, community life, how the person feels about himself, and so on.

You are also aware of how alcohol may affect these areas. As you find it necessary, you will guide the conversation to insure that you have a total picture of the client’s life. You are also aware that if the client is experiencing difficulty, having a problem, it means that the pieces are not fitting together in a way that feels comfortable. Maybe some parts have very rough edges. Maybe one part is exerting undue influence on the others. So you also attempt to see the relationship and interaction between the parts.

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