Most of the recent developments in sexuality and fertility after spinal cord injury focus on male sexual function. Several medical and surgical techniques have been developed for treating erectile dysfunction resulting from spinal cord injury.

On the medical front, medications to treat impotence – especially Viagra, which has received a great deal of attention in the press – may be very effective for some men with spinal cord injury, making genital intercourse possible. Another recent development is the use of a suction pump that can be applied to the penis to help create an erection. Surgical techniques include two types of penile implant, one that keeps the penis in a semi-erect condition and another that uses a miniature internal pump to create a full artificial erection. Unfortunately, the pumps have not been very successful, because they are susceptible to mechanical failure.

Treatment of infertility in men with spinal cord injury has improved greatly. There are various methods of inducing ejaculation in men with spinal cord injury, to obtain sperm for artificial insemination or in vitro fertilization. A testicular biopsy, in which a small piece of testicular tissue is removed, can also be used to collect sperm cells directly from the testes.

Perhaps the most disturbing aspect of sexual dysfunction after spinal cord injury, for both men and women, is the loss of genital sensation. This sensory loss is a direct result of damage to nerve fibers carrying sensory information between the genitals and the brain through the spinal cord. Unfortunately, no way is yet available to repair these nerve fibers. However, research is underway in many laboratories.

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Controlling diabetes is essentially a matter of fine-tuning diet, medication (if any) and exercise. Any disruption in the harmonious balance of these three control mechanisms can bring on problems, some of them potentially life-threatening.

Among them:

Hypoglycemia. This is a condition marked by an abnormally low level of blood sugar. In a diabetic, it can be brought on by:

Accidentally taken too much insulin or an oral anti-diabetic drug.

Undereating, eg. going on a rigorous religious fast.

Exercising too much

The symptoms of hypoglycemia include:

Sweating

Headache

Nausea

Palpitation

Mental fuzziness and disorientation

If untreated, rapid loss of consciousness and, sometimes, convulsive seizures.

Prolonged, repeated bouts of hypoglycemia may have serious consequences, including permanent brain damage.

What to do

If the person is conscious and able to swallow, sugar should be immediately given by mouth. If this is done during the brief period of warning symptoms, it can prevent the loss of consciousness.

If the person is unconscious, he needs to be given an injection of glucagon, a hormone that counteracts’ the effect of insulin. But hypoglycemic coma often signifies a serious emergency requiring immediate admission to a hospital.

Ketoacidosis. If Type I diabetics do not get the required amount of insulin, high levels of glucose remain trapped in the blood. With the cells being starved of their primary energy source (i.e. glucose), the body begins to burn large amounts of fats instead of sugar. This causes certain products of fat breakdown (known as ketones”) to accumulate in the blood and spill over into the urine. The blood becomes excessively acidic, a condition which can cause dehydration, bringing on diabetic coma (ketoacidosis). Insulin-dependent diabetics are asked to carry out frequent urine testing as a means of checking for acetone (an early sign of ketosis). Type II diabetics rarely get out of control with this complication.

Ketoacidosis may occur as a result of:

Inadequate insulin therapy

Stress Infection

The symptoms include:

Increased urination, leading to excessive thirst and possibly dehydration.

Fast, panting breathing

A characteristic sweet odor (caused by the excretion of acetone, one of the ketones, by the lungs). What to do:

Ketoacidosis is a serious complication which usually requires hospitalization. Get to urgent medical help if you have any reason to suspect it. The injection of insulin is essential to tackle this diabetic emergency.

Hyperglycemia. In neglected diabetes, or even in a diabetic who has omitted to take his insulin, glucose levels in the blood can shoot up too high, a condition known as hyperglycemia. Certain drugs taken in large quantities — such as epinephrine (used to treat respiratory illnesses), phenylephrine (in nasal sprays and cold medications), and caffeine (in headache and cold drugs, and in OTC appetite suppressants) — can also raise blood sugar levels. This can lead to a very dangerous condition marked by coma.

Blood sugar can accumulate to very high levels before the sugar spills over into the urine. Therefore, it is blood testing (not urine testing) that can tell you when you have hyperglycaemia without symptoms.

*65\332\2*

Headaches can accompany some brain tumors, and people suffering from recurring or severe headaches are often quite concerned that they have a tumor. But it is rare for headaches that recur for several years to be due to a tumor, no matter how severe the head pain is. Headaches usually do not occur until late in the course of most brain tumors, after many other symptoms have developed. Some patients with brain tumors do not experience headache at all.

The headache of a brain tumor does not have any particular characteristic to identify it. The pain may be over the entire head or localized in a special area. It is frequently a dull pain and may be very mild, and it may last for only moments at a time or be continuous.

The headache due to a brain tumor rarely awakens people during sleep, as migraine or cluster headaches do. Movement of the head and changes in posture may increase the discomfort, but this characteristic is shared by many other headaches, like migraine and the headache associated with fever. The brain tumor headache may be eased temporarily by simple analgesics, such as aspirin. For this reason alone, the prolonged use of analgesics for undiagnosed headache is clearly unwise.

*63\88\2*

Mrs. Chandihok called at 8 p.m and complained of very severe pain in a tooth. “Uncle, I am feeling such an excruciating pain in my tooth that I want to pull it and throw it out”. Throwing out an undesirable thing called for 3 doses of Crab Apple. When she met me after 3 days, she wanted to know the name of the wonderful remedy, the very first dose of which rid her of the terrible toothache, before she had even crossed the street outside my house.

Mrs. Ramneet had some white spots on her lips for which she could not get any relief from different modes of treatment.

When we took her case history to find her constitutional medicine, we were surprised that she was suffering from several serious ailments. But she was more interested to do away with a few painless spots on the hps than get herself treated for more serious ailments which required urgent attention. It was a clear case of a person attaching more importance to trivial details than the main picture. CRAB APPLE T.D.S for 3 months removed the white patches and also relieved her of all other troubles.

*100\308\8*

Many people go through a period of emotional shock following a paralyzing spinal cord injury. This may include a period of disbelief (“This can’t be real, this can’t be happening to me”) and distrust in the doctors’ diagnosis or prognosis (“They must be mistaken. This is only temporary. I just need time to heal.”). Professionals often speak of this reaction as denial, and indeed some patients literally deny that they are impaired. In our experience, however, this type of total denial is quite rare. More typically, patients deny the permanence of their injuries and deny the impact the injuries will undoubtedly have on every aspect of their lives. The positive, flip side of this phenomenon is hope. Hope for recovery is normal and emotionally adaptive, even while recognizing the likelihood that some of your limitations will be permanent. And in fact, medical advances may one day lead to partial or total cures for the paralysis of spinal cord injury.

Lark developed incomplete C5-6 quadriplegia after a diving accident. Soon after her hospitalization, some of the staff asked her if she’d like to meet with a former patient who could act as a role model for her. She declined. “You don’t know that I won’t recover,” she said. “Why should 1 make myself miserable now when I don’t know what recovery there will be? I can wait two years and be miserable then!” She rejected a “disabled role model,” feeling that her denial at that point, combined with hope, helped her cope emotionally and motivated her efforts at rehabilitation.

*31/156/5*

Smoking

Smoking is a definite cause of atherosclerosis. There is no argument about this in medical and scientific circles. Smoking is bad for everyone, but especially for people with diabetes. If you are a smoker, stop now. Smoking is so dangerous that you should stop even at the expense of a temporary gain in weight, although obviously it is better not to gain weight if possible. If you are a non-smoker, do not start smoking.

Blood fats

Although elevation of the blood glucose is the most obvious abnormality in your body chemistry, fat metabolism is also affected. This may have the effect of raising your blood fat levels and making the development of arteriosclerosis more likely. It is therefore particularly important that anyone with diabetes does not eat excessive amounts of fat. Most researchers also think that the fat that diabetics eat should be low in saturated fats and high in polyunsaturates, but a few feel that this point is still debatable. As well as reducing fat, keeping to a high fibre diet is helpful in preventing the development of atherosclerosis.

Hypertension

High blood pressure of hypertension is more common among diabetics than non-diabetics. Various effects of diabetes, including atherosclerosis, contribute to this. The important message is that you should have your blood pressure checked at least once a year. If it is high it should be treated, because high blood pressure can put a strain on the heart and also lead to kidney damage and strokes. It may also add to the effects of diabetic angiopathy.

If your doctor starts giving you treatment for hypertension, you must continue to take the pills for ever, or until the doctor tells you to stop. There are many different pills for the treatment of hypertension. If those you are taking do not agree with you, do not just stop taking them, but tell your doctor so that he or she can choose another drug that may suit you better.

Beta-blocking drugs (for example, propranolol, atenolol, metoprolol and other -olols) may reduce or suppress the warning signs of hypoglycemia. This effect is more frequent with so-called non-selective or more widely active beta-blockers. Thiazide drugs (for example, bendrofluazide) may increase the blood glucose level and sometimes make mild, previously undetected, diabetes obvious. Thiazides cause diuresis or urinary water loss. Other diuretic drugs may be used to treat hypertension and can also increase the blood glucose level (for example, frusemide or bumetanide). Diuretic drugs cause sodium and potassium loss in the urine. Chlorpropamide can also produce a low blood sodium level and this may occasionally cause symptoms.

Many doctors advise people with hypertension to avoid added salt in their diet. There is still some controversy over this but it seems sensible to avoid excess salt. The food we eat contains what we need before flavouring is added.

Obesity

Being fat makes high blood pressure worse and also places a strain on your heart. It makes your cells resistant to the action of insulin. The solution is obvious.

Exercise

Regular exercise is also good for the circulation and the heart and helps keep your body sensitive to the effects of insulin. If you have poor circulation in the legs, regular exercise of the leg muscles, such as walking, helps alternative circulation to develop and improves the blood supply.

Always bear these points in mind:

1. Hardening of the arteries or atherosclerosis is more common in diabetics than in non-diabetics.

2.   Atherosclerosis can cause poor circulation in the legs, coronary artery disease (angina, heart attacks), high blood pressure and strokes.

3.   Much can be done to prevent atherosclerosis.

4. If you smoke stop. If you do not smoke – do not start.

5.   Reduce your intake of fats. It is probably better to eat polyunsaturated rather than saturated fats.

6.   Eat a high fibre diet.

7.   Avoid added salt.

8.   Watch your blood pressure.

9.   Do not get fat.

10. Exercise regularly.

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Why are two different numbers used to measure blood pressure?

The first or top number measures the systolic pressure or the pressure that the heart is exerting when it is actually pumping. The bottom number is called the diastolic, and it measures the heart’s pressure between beats or when it is at rest. This means that the top or systolic pressure is the maximum pressure, while the diastolic or bottom number represents the minimum. This will explain why the bottom number is invariably smaller.

Is it true that the bottom number is the most important one?

A. There used to be some feeling that the diastolic reading was more critical than the systolic. However, today most doctors regard both as equally important. In any case both generally move together in the same direction. That is, an increase in one will generally be followed by an increase in the other and vice-versa.

What about the popular saying that a person’s blood pressure should equal 100 plus his age?

In most western countries peoples’ blood pressure does tend to rise until the age of 55 or so. However, there are groups in the South Pacific, South America and Africa whose blood pressure remains the same throughout life. Even in this country, some five per cent of the population retains the same level of blood pressure in old age as they had in youth. The fact that blood pressure usually does go up with age does not mean it must or should go up. Dr. Josef R Hrachovec, a research physician at the Gerontology Centre at the University of Southern California says in his book, Keeping Young and Living Longer, that “low blood pressure throughout life is truly and perfectly normal.” It’s also most desirable and, in many cases, perfectly attainable.

*10/151/5*

The question the reader will ask at this point is ‘Given all this epidemiological study, do we know the causes of cancer?’ Broadly the answer is ‘yes’ in many circumstances and for many cancers, and the opportunities for prevention that this understanding generates are there to be taken. We do not always know how the factors that have been identified by the epidemiological studies discussed in this chapter link up to what is being learned in the laboratories of the molecular biologists. This connection is being made rapidly and will be increasingly clear by the end of the century. Epidemiology has been very successful in discovering or confirming which features of our lives in the Western world can be now identified as causes of cancer.

A few hormones can certainly cause cancer. When large quantities of the female hormone oestrogen were given for medical reasons during pregnancy, rare kinds of cancer were liter found in the daughters of these women. Large quantities of oestrogens which were formerly given to women for menopausal symptoms undoubtedly caused cancer in the uterus although newer preparations do not. Oral contraceptives represent a complicated case, perhaps involving a real increased risk of breast cancer, particularly in young people. On the other hand, the Pill is capable of reducing the risk of ovarian cancer and cancer of the body of the uterus. Both risks and benefits can therefore be claimed for the Pill and controversy about its use is likely to continue.

At a more subtle level, it is possible that some of the effects of child-bearing may include a reduction in some cancer risks, probably generated by changing hormone levels. This is particularly apparent in cancer of the ovary, where having been pregnant appears to be protective.

*30\194\4*

People with BDD may drop out of elementary school, high school or college because they can’t concentrate, don’t want to be seen, or are depressed because attended classes for the past three years. Instead, he’d been living with his parents. “First I started missing classes and school activities because my hair bothered me so much I couldn’t go. I was too embarrassed over it. It always looks strange. It never looks neat or natural. It sticks up and looks bizarre. If I spray it, it looks greased down. Barbers ruin it, so I cut it myself and it looks ridiculous. I spend hours in front of the mirror combing it and trying to fix it. Once I had a perm, and it looked better for a while, but when it grew out I looked like a terrorist.

“First I started missing some classes, and my grades started dropping because I couldn’t concentrate. But I was determined to blast through everything, and I pushed myself, but that didn’t work. I started missing so many classes that I took a year off. I didn’t tell the school officials why because I was too embarrassed. I tried to go back, but I couldn’t concentrate so I dropped out again.”

Rebecca had also missed many classes. “I wouldn’t go to school. I couldn’t concentrate because I’d be worrying about my skin or going to the mirror all the time to pick it. And when people saw me, I thought they were judging how it looked. I finally left college because of it. I was very active in high school, and I had lots of friends. But I couldn’t leave my room in college. After I left school I stayed in bed for two weeks…. I let myself down by leaving. I want to go back in January, but I won’t be able to succeed unless I’m feeling better. This problem is an obstacle to getting on with my life.”

*126\204\8*

A recurrent UTI occurs within 4 weeks after previous infection. Symptoms that occur sooner than this are likely to be relapses due to the original pathogen. In such cases, it is important to perform urine cultures and re-treat for at least 2 weeks.

Recurrent UTI is usually caused by factors that allow increased bacterial adherence to urinary epithelium. Investigation for anatomical or functional urinary tract abnormalities are generally of low yield. In less than 1% of cases, a surgically correctable lesion is found.

Patients with recurrent UTI can be instructed on patient-initiated therapy. At the onset of typical UTI symptoms, patients simply begin a 3-day course of antibiotics. Patients with more than two episodes of cystitis per Year can be offered antibiotic prophylaxis. If the infections are temporally related to intercourse, a single dose of antibiotics should be taken within 2 hours after intercourse. If the infections are unrelated to intercourse, patients can be given continuous daily prophylaxis. Prophylaxis is 95% effective in reducing recurrences without causing an increase in bacterial resistance. Unfortunately, recurrences tend to happen when prophylaxis is stopped.

*143/348/5*