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Stress is one of the most misused words in the English language, and its precise meaning is often forgotten. It is defined in the Shorter Oxford Dictionary as a ‘demand upon energy’. This is a difficult concept to apply to the human body and not a factor that can easily be measured. Although breaking a leg is caused by undue stress, it is not this mechanical use of the word that is usually intended; more often, the implication is a strain on the mind (psyche) with a consequent decreased ability to cope. There are some people to whom stress is a challenge to be overcome who are unhappy without tension in their lives; there are others who cannot tolerate any form of stress. Most people fell between the two extremes, their responses depending on the situation. Many studies have been undertaken on stress, particularly in its part in relation to heart disease; based on these studies people have been classified into two groups: ‘A’ type and ‘B’ type. The ‘A’ type takes stress badly, almost as a personal affront, getting tense, edgy, ‘rushing about’, and exhibiting a high degree of tension; the ‘B’ type is much more relaxed and, when under stress, tends to utilize the situation in a constructive manner. It is found that type ‘A’ is almost twice as likely to develop heart attacks as type ‘B’. Comparable studies have not yet been done in migraine but personality does seem to play a large part in determining who gets migraine, and it may well be that different responses to stress are important in determining the frequency of attacks.
It is not known whether stress provokes migraine by increasing the production of adrenaline or noradrenalin or whether its effect is unrelated to biochemical changes.
Exercise can provoke attacks of migraine but it has also been recommended as a prevention of attacks. The truth is that exercise is a particular form of stress, so that the same chemical changes take place, e.g. an outpouring of adrenal hormones which makes the heart beat faster to supply more blood to the exercising muscles.
A rice dish with a protein and three coloured vegetables. Salad on the side.
A legume dish with a variety of beans such as chickpeas, soy beans and kidney beans, mixed with sauteed vegetables and a spice such as ginger, chilli, garlic or all three.
Choose a protein from the following list: fish, eggs, chicken, beef, legumes, tofu. Grill, casserole or bake. Choose three coloured vegetables to accompany it, preferably 50 per cent cooked and 50 per cent as a raw salad.
A pasta with a protein; for example, bolognaise or seafood sauce (use cream sauces very moderately). Thai or curry spices with meat or fish could be used as a sauce with egg noodles.
Try to avoid eating a heavy meal late in the evening. You should aim to eat your evening meal approximately four hours before you go to bed.
If you are trying to lose weight, a thick soup and a small serve of a protein plus salad is appropriate.
People with HIV infection report that among their biggest worries are the problems of financing medical care. Unfortunately, many of their worries are justified. Although the average medical bill for the care of HIV infection is no greater than the average bill for most other serious medical conditions, people with HIV infection should be prepared for expensive medical care.
The average cost of medical care for HIV infection over a lifetime, in 1990 dollars, varies in different reports from $62,000 to $94,000. Most of the costs are incurred after the first
AIDS-defining diagnosis. The greatest part of this cost is for hospitalization—from $55,000 to $70,000—though expanded use of alternatives to hospital care has lowered that cost. Outpatient services average about $12,000 altogether. The cost of drugs is hard to estimate: drugs are much more expensive when first released than they are later, and new drugs are being released rapidly.
The mechanisms for financing medical care in the United States are phenomenally complicated and full of jargon. People finance their medical care either by themselves (called self-pay), or through private insurance, or through publicly funded state and federal programs. Private insurance and public programs are together called third-party payers. Most people finance their care through a combination of self-pay and third-party payers.
Private third-party payers include commercial insurance companies, Health Maintenance Organizations (HMOs), and the nonprofit conglomerate that is Blue Cross/Blue Shield. The main public third-party payers include Medicare, Medicaid, and the Veterans Administration. Medicare accounts for 17 percent of the financing for all health care in the United States; Medicaid for 10 percent; other government agencies for 14 percent; private insurance for 31 percent; self-pay for 25 percent; and private sponsors for 3 percent. An estimated 35 million Americans are uninsured.
Several aspects of financing medical care are unique to HIV infection:
1. People with HIV infection make up a disproportionately large number of those who receive Medicaid. By 1990, many large cities had reported that 40 percent of all persons with AIDS were receiving Medicaid; this percentage is increasing.
2. Most third-party payers will not reimburse the full range of services commonly required for people with HIV infection; services that are reimbursed insufficiently or not reimbursed at all include home care, long-term care facilities, and prescription drugs.
3. Private third-party payers have many ways—some of them devious—of avoiding reimbursement of the costs of medical care for HIV infection. They do this despite the fact that the average lifetime cost of the care of a person with HIV infection is no different than the cost of care of people with most other serious conditions.
4. Many physicians are reluctant to care for people with HIV infection because the medical care is unusually complex and because reimbursement for professional services is unusually poor due to the disproportionate number who are uninsured or recipients of Medicaid.
5. Public funds, both from the states and from the federal government, are increasingly available to people with HIV infection. However, eligibility for many of the special programs often requires a diagnosis of AIDS.
The following sections go into what may strike you as tiresome detail about financing medical care. But the more you know about what is standard or required or forbidden, the better you will be able to control your options for financing care.
Wild Rose relates to the soul quality inner motivation-an inner impulse which incites action. A person in the positive Wild Rose state goes along with life happily doing his job which he finds interesting. He lives in a feeling of complete inner freedom and flexibility and enjoys taking interest in all the happenings of his life and that of others. He is devoted to task within the greater whole—a part allotted to him for execution during his earthly life by the Supreme Being – guided and goaded by his Higher Self.
However, in the negative Wild Rose state, the personality has lost its contact with its Higher Self, and does not find support anywhere. His work does not interest him. The surroundings do not interest him. No body appears to be interested in his plight. He has also lost his self-confidence and he has lost any hope of seeing better days.
Whether it is illness, uncongenial work or monotonous life, pecuniary difficulties or social handicaps and the sorrowful state may be due to any cause, the person becomes resigned to his state. There is complete apathy and loss of interest in anything and everything, and in life itself. Yet he plods on in his uninteresting and monotonous life – he does not think of suicide even, to terminate his agony, an existence without purpose, without interest and without hope. In the inner heart he is convinced that the cause of his sorrowful state is his fate, and the fate cannot be changed, therefore he does not make any effort to improve his lot.
He is content to lead the existence of an animal (in human frame) who eats when hungry and defends himself when attacked. He does not complain of his troubles to anybody. He feels tired and weak always.
Mr. Sethi was an employee of a motor garage in connaught Place. Once he was given the duty of delivering a new Cheverolet car to a prince in a small state in U.P. He was driving the car in a care-free manner on a highway at 60 m.p.h on an empty road, when suddenly 2 young boys sitting on the side of road dared cross the road before the speeding car. Both were knocked down and what happened to them is anybody’s guess, because Mr. Sethi did not look back. He speeded up the car lest he be lynched by the angry villagers left behind.
He resigned his post from the motor-garage on his return to Delhi, as he dared not sit behind the driving wheel. Whenever he tried to do so, the scene of the two boys being knocked down by him came before his eyes and he became nervous.
Any sudden accident whether physical or mental entails a mental shock whose adverse after-effects can be counter-manded by taking ‘Star of Bethelhem’ remedy.
If the origin of a disease can be traced back to some mental shock received earlier, Star of Bethelhem would be necessary to root out the origin of mental shock and its resultant consequences.
Oestrogen also plays an important part in the development of the system’s secondary sexual characteristics. At puberty, as oestrogen production makes its first tentative faltering appearance, the typical features of the developing female gradually appear.
Oestrogen influences the development of the uterus and vagina, and external sexual characteristics. The vulval organs increase in size. The vagina becomes larger and develops its typical characteristics. Pubic, and later underarm hair develop. The breasts commence their development. Fat deposits of the body change and start to take on their typical feminine location—chest enlargement, more pronounced hips and bullocks, narrow waist.
The influence on the uterus is dramatic. Not only does this occur at puberty, when it is transformed from a juvenile organ into a fully developed adult one, but each month additional changes occur. Following ovulation, when there is a supercharge of oestrogen, the uterine internal lining, called the endometrium, becomes thick and prominent. Its blood supply increases dramatically. In short, it suddenly prepares to receive a fertilized egg. Would you believe it, but month in and month out, with unfailing regularity, in the average woman the uterus under hormonal stimulation prepares itself and waits for pregnancy. It never seems to tire, even though a pregnancy occurs in a very small number of cases. It offers an object lesson in patience and persistence.
Progesterone is the other female hormone. This also comes from the corpus luteum, which is fully productive about five days after ovulation has taken place.
Its main effect is on the uterus, but ii may also affect other organs to a lesser degree. It acts most forcibly on tissue (hat has been sensitized already by the influence of oestrogen. It aids and abets the oestrogen reaction, causing the endometrial lining of the uterus to become even thicker and more vascular (that is, the blood supply is greatly augmented). Once more, all this is in preparation for an expected pregnancy.
Incidentally, progesterone can have a few other effects, and these are often regarded with distaste by those concerned. Its presence in circulating blood can cause rapid overproduction of the sebaceous (fat-producing) glands in the skin. These are most plentiful in the face, scalp, chest and back regions. That is why many young women notice unattractive pimples, whiteheads and later blackheads appearing in the week preceding a normal menstrual period. The skin also tends to become more oily, particularly in those already burdened with greasy skin, his worth bearing this in mind, for it may be possible to schedule social engagements and other important functions at times when the progesterone levels are at their lowest ebb—and the risk of facial pimples likely to be less.
Another effect of progesterone is to raise the general body temperature by as much as 0.2 to 0.5° C. Although this is not really important in itself, it is often used when efforts are being made to pinpoint the date of ovulation. Carefully kept temperature graphs can indicate with considerable accuracy when ovulation has taken place, by the sudden increase in body basal temperature. Some women use the date system in trying to avoid pregnancy. Others use it if they are having difficulty in conceiving. For both reasons, it may be of practical importance, in any case, the system is available, for use in whichever way your doctor decides to use it in your own interest.
Progesterone also causes fluid retention, and in some women this can produce a series of symptoms that make life anything but enjoyable for many days each menstrual month. But we shall discuss this in more detail a little later.
Foot ulcers and amputations are a major cause of morbidity and increased costs for people with diabetes. Studies have shown that identification of people at risk for ulcers and/or amputation is critical and that preventive therapy, particularly for those at risk, is often effective. Risk for ulcer or amputation is increased in people who have had diabetes >=10 years, are male, have poor glucose control, or have cardiovascular, renal, or retinal complications. Amputation incidence is rising in many medical centers. Risk factors that can be identified on examination include peripheral neuropathy with decreased sensation, altered] foot biomechanics with neuropathy (callus or bony deformity), and decreased posterior tibial or pedal pulses.
Care guidelines, therefore, include an annual foot examination for all patients with diabetes and at every visit for those with peripheral neuropathy.
A study in the New England Journal of Medicine in 1975 showed that women using oestrogen could have a seven times greater risk of developing endometrial (womb) cancer. This has been confirmed by a number of other studies and oestrogen therapy has also been linked with endometrial hyperplasia – overgrowth of the lining of the womb. Oestrogen’s role in the body is to increase cell growth, so it is logical that it would directly effect the parts of a women which are most receptive to oestrogen, like the womb and breasts.
Oestrogen and progestogen together (opposed hormone replacement therapy) are now given to women who still have a womb. But the risk of endometrial cancer is still three times the rate of that for women who don’t take HRT at all.
In The Physician’s Desk Reference in America, which lists the side effects of rugs, the makers of one type of oestrogen state, ‘Oestrogens have been reported to increase the risk of endometrial carcinoma.’ In other words, they are in no doubt that the oestrogen in HRT is linked to womb cancer.
Unfortunately, researchers from King’s College Menopause Clinic in London have found that this increased cell growth in the womb (hyperplasia) does not stop directly when the HRT is abandoned. A report in the British Medical Journal in 1990 concluded that progestogens needed to be taken for an additional two years after stopping HRT to keep the womb lining under control.
Families can provide a unique kind of support, some of the closest relationships people ever have. For some people, this closeness seems to make them feel as though they and their families are arms and legs of the same body. The exact kind of support families provide is not always concrete, and sometimes it is a little mysterious. Helen’s face shines when she talks about her family: “Sometimes when I feel pretty much alone and discouraged, my family overpowers me. They just overpower me.”
One of the most important things that members of the family do is bring with them a sense of a shared past. Families reminisce, talk about good times, retell old stories. Steven’s family reminds him of the time he fell out of the tree onto the picnic table and got his mother’s potato salad all over him. With such stories about the past comes a sense of being part of both the past and the future, a sense of who you are and what your roots are, a sense of continuity. Feeling a part of something larger is a deep comfort to people affected by HIV infection. Perhaps that is what Helen means when she says her family just “overpowers” her.
Families also make people feel cared about. When Steven was sick, his mother flew in from another city to cook for him. “Nothing is like home cooking,” he said. “I call her up and say, ‘Hop on a plane, Ma, and come cook for me.’ ” Dean’s mother brought in meals, sat on his bed, and played cards with him. “All my out-of-town relatives have come to visit,” he said. “It makes me feel good, what my family does to me.” June said her relatives drive a long way to see her son: “Those that can’t come write letters saying the right things. My son knows he is accepted and loved in his family.” Feeling cared about is not only a comfort; it can also be a reason to stay alive. Dean said that without his family, he wouldn’t be here: “I would have nothing to fight for. They care about me, and because of that, it’s important that I care too.”
People affected by HIV infection seem to feel most free with their brothers and sisters. They often find it easier to tell their brothers and sisters about the diagnosis in the first place. They feel their brothers and sisters understand them and accept them as they are. “I’ve been able to talk and let loose my feelings with my sister,” Dean said. June noticed that her son seemed most comfortable talking to his brother. “My son can talk to his brother especially,” she said, “and his brother brings over his children.” Helen’s stepmother did the same thing: “My stepmother brought her little kids to visit me when I was in the hospital. I told her not to, there are germs here. But she just said, ‘You’re sick. We’re coming.’ “
In fact, many relatives, especially brothers and sisters, make a point of bringing their children to visit. Offering your children seems to be a way of offering part of yourself. And children can be so cheerful and straightforward, they are an immediate comfort. Alan said that his nephew gives him something to fight for: “I want to be here for his graduation,” he says. “And seeing him with his baby sister, it’s been worth every minute of the fight.”
Not everyone people consider family is a blood relative. People who are distant from their families make substitute families out of their friends. They celebrate holidays and birthdays together, give each other presents, stay in touch, travel together, help each other out. Steven has an old teacher who took him into her family, introduced him to her friends, and takes him on trips and out to dinner: “She’s extended family to me,” he said. A friend of Alan’s has a mother who, Alan said, “is like another mother to me.” Family also needn’t be exclusively human; many people find comfort in their pets. “My cat meets me at the door every night,” said Alan. “One night, he didn’t, and I missed him. I realized how much I appreciated that he usually did.”
In some families, the same closeness makes them expect more of each other than they would of other people: they feel that members of their family should not be gay or use drugs, should not be depressed or even be sick. Such expectations are difficult and often impossible to meet, and both sides feel disappointed and frustrated. For some people, then, the family is unable to provide much help. “My husband’s family couldn’t deal with his being sick,” Lisa said. “For a long time, they wouldn’t call, wouldn’t send money, wouldn’t come to visit. When they finally did come, they talked only about routine things.” Notice, however, that Lisa’s in-laws did come to visit, and did provide what small comfort they could by talking about routine things. Though Lisa wished they could have done more, both for her and for her husband, she recognized they had been a help. “All the same,” she said, “it helped him just to hear from them.”
Probably, even if your family cannot provide as much support and comfort as you would like, they nevertheless wish they could. They probably feel they should be able to make all your problems go away, and they feel guilty and helpless when they cannot. Perhaps the best thing to do is what Lisa finally did: accept what they are able to offer, and find the comfort in it.
Families are also prime sources of well-meant and unasked-for advice. Such advice can be hard to listen to, especially because the adviser rarely has experience with the kinds of problems HIV infection presents. As a result, the advice can sound annoying or distrustful or
condescending or just wrong. The same principle that applies to disappointed expectations also applies to unwanted advice: ignore it, or explain you’ll have to agree to disagree, and find comfort in the adviser’s good intentions and concern. Dean said his rule with his family is, “No criticisms, no advice.”
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Eye cosmetics are the most strictly regulated cosmetics on the market due to past problems such as blindness which can be caused by coal tar dyes. Most reputable cosmetic companies test their eye products in conjunction with ophthalmologists to ensure their safety and that they do not irritate the eyes.
Eye creams are basically heavy moisturizers. These creams do not prevent ageing or wrinkles, but they often plump out wrinkle lines. It is not essential to use a specific eye cream – a regular moisturizing cream will do the job just as well.
Eye shadows are used to highlight the eyes, often making them appear larger. Eye shadows are available as powders, creams, liquids, sticks and powdered metals which contain mica or fish scales to give shine.
Eye shadows tend to be chosen according to fashion and to eye shape. However, certain eye shadows can cause problems, especially irritant and allergic reactions which lead to dermatitis of the eyelids. To avoid this, it is best to use unfrosted, powder shadows. Liquids and creams contain more preservatives and so have more potential to cause adverse reactions. Likewise, earth colours are preferable to blues, greens, mauves and dark colours because they cause less allergic reactions.
If eyelid dermatitis does develop, no eye shadow should be used for at least a week after the eyelids have healed. Then, matt powder eye shadows in earth tones are recommended.
If you have very crepy eyelids, it is preferable to use a powder rather than a liquid or cream eye shadow because both liquids and creams can migrate and accentuate the creases. Shiny or frosted shadows should also be avoided as they draw attention to crepy skin.
Before applying eye shadow, it is useful to apply foundation and then powder to the eyelids so that the eye shadow will set better on the skin and not migrate into creases. If you wear contact lenses, it is best to put the lenses in before you apply your eye shadow. Choose a cream, stick or powder shadow but avoid frosted or shiny powders as particles can get under the lenses and irritate the eyes.