CARE OF THE SPINE TO PREVENT DISORDERS: CARE OF THE NEWBORN – THE FIRST MASSAGETraditionally, the baby gets its first massage when it is five days old. That is when it is first bathed in water with a little salt and aqueous solution of the Neem leaves (for their antiseptic properties). Mustard oil or ghee (clarified butter) is used for massage. Even though mustard has a pungent smell it has many therapeutic properties and amongst them is its ability to warm up the muscles by drawing in more blood.The baby is gently massaged all over with emphasis on the neck and shoulder area. It is placed on a mat, but surrounded by the legs of the Dai, with the head closer to her ankles, and massaged. These gentle but healing strokes soothe the most irritable of all babies and, even though they may struggle in the beginning, they later become very calm, often falling asleep. After the massage, the baby is put out to lie and soak in the morning sun, first on the back and then on the stomach for a few minutes. After this it is bathed and wrapped up warm. The wrapping of the baby in a clean cotton cloth is in itself an art. The spine, right up to the neck, is maintained in a straight alignment with the help of the cloth. This ritualistic therapy of the mother and child goes on for 40 days and it gives the baby’s musculo-skeletal system the best chance to rectify the trauma of birth and help it to develop.Unfortunately, this tradition is fast dying in India, like so many other useful and sensible things. The urge to be modern is so strong that one by one that country is shedding all its traditional values and practices.*92\30\8*

ISD AND RELATIONSHIPS: TROUBLE SPOTS – POTENTIAL SOURCES OF CONFLICT FOR ALL COUPLES – THE PREVENTING PROBLEMS FROM GETTING SOLVED IN A SATISFACTORY MANNERIn addition to preventing problems from getting solved in a satisfactory manner, communication breakdowns leave a trail of hurt feelings, resentments, misunderstandings, and fuel for future conflicts. And certain types of communication—which we did learn while growing up—can actually create conflict and increase your chances of experiencing sexual problems, including ISD.For instance, many of us seem to believe that being in an intimate relationship endows us with mental telepathy and we expect to be mind readers. But no matter how close you feel to your partner, you can still guess wrong—and often do. Likewise, if you expect your partner to know how you feel and to act on that knowledge, doing precisely what you wish, you will be disappointed, no ifs, ands, or buts about it.Accusatory statements, which Frank and Liz specialized in, are outright attacks on your partner that escalate conflicts.Kitchen sinking—bringing up past events, old injuries, and everything but the kitchen sink during arguments— ensures that conflicts will escalate, but never actually get resolved. Kitchen sinking is a habit many people with sexual problems display, either using other issues to keep the focus off the hot topic or using the sexual problem to hurt or humiliate the partner who has gained an advantage in the nonsexual conflict.Linked to your own unrealistic expectations, unreasonable demands—like insisting that an emotionally depleted partner make time to make love, or repeatedly attempting to seduce a partner who has ISD—leave you feeling frustrated and your partner feeling inadequate, anxious, and angry.Using sex as your only means of expressing affection is another mistake. Far too many of us, men especially, do not know how to convey tender or loving feelings in words or with nonsexual touches. Some of us can’t even hug our partners—or be hugged by them—without turning the token of affection into a sexual overture or interpreting it as one. This contributes to ISD by:• creating resentment and hostility in partners who come to believe they have to “put out” sexually in order to receive any affection at all• limiting the amount of intimacy in your relationship by avoiding all physical contact, fearing that it will lead to sex when sex is not what you want• leading you to assume that your relationship’s low or absent sexual desire can mean only one thing—that your partner does not love you anymoreFinally, as we have pointed out in earlier chapters of this book and will explore as a part of the self-help strategies in Chapters Six, Seven, and Eight, miscommunication or no communication about sex itself decreases sexual satisfaction, increases performance anxiety (as you guess about whether you are doing it right or pleasing your partner), and can make sex an activity you dread rather than look forward to.*123\261\8*

BACH FLOWER REMEDIES: DR. BACH’S PHILOSOPHY – THE PATIENT’S MENTAL STATEIt is asserted that Bach Flower Remedy never fails to give relief provided it is prescribed on the true mental state of the patient. To get the correct mental state of the patient, it is necessary to carefully note the words as they emnate from his mouth and not to intervene when the patient is talking. Do not ask any questions while the patient is talking, and do not try to translate his mental state in your words and seek his confirmation of your translation. Similarly if a representative of the patient calls for some medicine, he should state the case in the same words as uttered by the patient, and not give the translation of the patient’s words according to his understanding.Suppose the patient says, “Doctor give me some tonic”, and you by way of clarification ask him if he is feeling weak, the patient will probably nod his head in assent, and you will probably prescribe “Olive” for weakness which is wrong. The correct remedy is “Horn Beam” for the patient was asking for a tonic and did not complain of weakness or easy fatigue.Similarly, if a patient comes to you weeping and complains of severe headache, he expresses an unbearable state of mind and the correct medicine is ‘Cherry Plum’, but if he says that he has such severe pain in the leg that he would like to cut off the leg and throw it away, then his primary desire of throwing away some undesirable thing, (in this case the painful leg) is to be taken into account and ‘CRAB APPLE’ prescribed.*23\308\8*

THE BONES – BODY MECHANICS: THE BACKBONE – THE SHOULDER BAG TILT & THE PELVIC TILTThe Shoulder Bag TiltIt is not usually anything dramatic which causes these displacements; using the body asymmetrically is the most common cause. Habitually using muscles on one side of the spine can pull the vertebrae sideways; for example always carrying the shopping or a child on one side, or reaching up to high shelves with the same hand, or taking your body weight mainly on one leg and one hip.The Pelvic TiltThe lower body takes the same punishment, and often the pelvis gets pushed up. This happens by bearing weight mainly on one side as you stand, or by continually letting the same leg take the impact of stepping down. The result of this habit can be back pain.Because the pelvis is pushed up on one side it can appear that one leg is shorter than the other. You can check this by lying back in the bath, raising your feet and holding your ankles together. Look at your big toes, if they start and end at the same place then your pelvis is straight. If one toe looks shorter, then you could be pulling up on that side. This is very common and nothing to worry about unless you have back pain, in which case you could see an osteopath or chiropractor. To balance the pelvis and avoid future trouble, try standing on a box and swinging the short leg; or tying a belt or pair of tights around your ankle and instep, putting on a laced shoe or trainer, tying the other end to the leg of the bed, and then lying on the floor and shuffling back until you can feel some traction on that leg. Remember to weight-bear evenly if you have to stand and to step off the curb and down the first stair with the long leg.*121\326\8*

BABY CARE AND EPILEPSYBreastfeeding is best for your baby, and if you want to breastfeed, there is no reason why you should not do so. Even if you are taking anticonvulsant medication you can breastfeed quite safely. Although your drugs will pass into the breast milk, they will be in such small quantities that they do not affect the baby. The exceptions are phenobarbitone and diazepam, which may make the baby drowsy.However, if lack of sleep is an important trigger factor for your seizures, it may be more practical for you to bottle feed, so that you can share the disturbed nights with your partner.Safety precautionsYour epilepsy does not present any risk to your baby, except for the small one that he might be dropped if you have a fit while holding him. A few common-sense precautions are a good idea:Sit on floor cushions while feeding your baby;Wash and change the baby on a waterproof mat on the floor, rather than on a bed or high surface;Do not bath your baby if you are alone.ImmunizationSome parents who have epilepsy are reluctant to have their babies immunized, because they believe that some vaccines, particularly the whooping cough vaccine (included in the triple vaccine given to babies at two, three and four months and again as a booster at four to five years) may cause seizures.If you think that your child is slightly more at risk of developing epilepsy than other children, because they may have inherited the tendency from you, it is understandable that you should want to do everything you can to avoid increasing that risk further. At the moment the weight of the medical evidence is that vaccination is safe for children, and that the real risks come from not vaccinating your children so that they are vulnerable to the disease. The current Department of Health guidelines are that even those children who have a close family relative with epilepsy should be immunized. However, this question is something that you should discuss with your doctor at the appropriate time, to make sure that you have the best and most up-to-date advice available.*85\193\2*

LIVING WITH YOUR DIABETES
Doctors and other health care professionals talk about you as ‘a diabetic’ or ‘a person with diabetes’ and you may also talk about being a diabetic or having diabetes. But this is a very poor description of you. You are a unique individual with your own lifestyle, work, hobbies, family background, home, friends, ideas and dreams. No one else in the world is capable of offering your special gifts to society. The fact that you have, at some stage in your life, been diagnosed as having diabetes is a very small part of your whole person.Your diabetes is also unique to you – no one else responds in precisely your way to changes in food, exercise, treatment and the passage of time. This is why it is very important that you learn all you can about your own diabetes. Armed with this knowledge and with the experience built up by health care professionals, scientists and others (including those with diabetes) you can take command of your diabetes and ensure that it remains well controlled and does not get in your way. Your diabetes is an inescapable part of you, but there is no need for it to intrude on your enjoyment of life.This all sounds great in theory, but when you wake up in the middle of the night and start worrying and wish that it wasn’t you, that it was all a terrible mistake and you are going to wake up in the morning non-diabetic, then it is not so simple. Being diabetic is not easy all the time. The first, and maybe the hardest, step is to accept that you have diabetes and that for the foreseeable future you will remain so. This acceptance does not come overnight and some people with diabetes never fully accept it.Jo has been diabetic for ten of her eighteen years. Nowadays she is in and out of hospital with ketoacidosis and mistakes in her insulin dose. I asked her how she felt about being diabetic and the answer was simple: ‘I don’t want to know.’Being an ostrich is all very well, but if you try to bury your diabetes in the sand you find that the rest of you gets covered in grit too!There is a tendency to see diabetes in terms of blood glucose levels and the mechanics of insulin injection or pill dose. When you go to your clinic you will be asked all about this and about symptoms of tissue damage. Sadly, in many clinics, there is too little time and too clinical an atmosphere to discuss how you feel emotionally. Many people with diabetes feel that the doctor’. . . doesn’t want to know about my private worries. He is much too busy thinking about my sugar levels.’ If you are worried, then we do want to know. It will help us to help you, and you may feel better sharing your anxieties. If something is worrying you, even if it seems to be nothing to do with your diabetes, the anxiety may upset your glucose balance.Nellie is seventy-five years old and has been diabetic for twenty years. When she came to the clinic recently she looked tired and had lost weight. I asked her how she was sleeping.’I can hardly sleep at all. I’m so worried,’ she said and she started crying quietly.She told me that because her husband had worked past the official retirement age his pension had been reduced. They were finding it very hard to pay the bills and she could not afford her proper diet.’But I’m keeping you from your work, doctor,’ she said. I pointed out that she was my work at the moment. Later, I arranged for her to discuss things with our welfare expert, who found that she was entitled to an additional allowance.Feel free to discuss how you view your diabetes with your diabetes advisers, your family doctor, your relatives and with your close friends. It will help them to understand. You will be helping your doctor too. I am not diabetic and I do not know what it feels like to have diabetes. I need my patients to tell me how they feel. I learn more from my patients than I ever have from textbooks, and that helps me to look after future patients.
*116/102/5*

PERICARDIAL DISEASE: PERICARDIAL EFFUSIONPericardial effusion means that there is a collection of fluid around the heart within the pericardial sac. The type of fluid in the pericardial sac depends on the underlying cause. Infection may produce a collection of pus. Tumor that has extended into the pericardium or rupture of the heart after a heart attack with leakage of blood can produce bloody pericardial effusions.Pericardial effusions may or may not press on the heart enough to limit its movement within the sac. If the fluid accumulates slowly so that the pericardial sac can distend, it may not compress the heart. However, if the fluid accumulates fast enough or reaches a large enough amount, it can compress the heart and reduce its efficiency.In this case the heart cannot expand enough during diastole to fill sufficiently, so there is less blood to be pumped out on the next beat. When the heart is affected in this way, the condition is called cardiac tamponade.*217\252\8*

RHEUMATOID ARTHRITIS: EXERCISES FOR PEOPLE WITH MODERATELY INFLAMED JOINTSModerately inflamed joints are also known as subacute joints. Although the inflammation is moderate, these joints still cause some discomfort, and pain increases after the joint has been stressed. For example, you may not notice moderate inflammation in your shoulder until you attempt to retrieve an object from a high shelf. And moving moderately inflamed finger joints might not cause you any discomfort until you try to unscrew the lid of a jar. Subacute joints may have morning stiffness, but it does not last as long as it does in highly active joints.General exercise program guidelines for people with moderately inflamed joints include the following:1.  Move joints through three, four, or five repetitions of each range-of-motion exercise. Do two or three stretches until you feel that you are at your maximum range of motion, then add one or two more stretches to be sure. Do this once or twice per day.Goals: Maintain and slowly increase motion and flexibility. Increase muscle tone.Precautions: Cut back the number of repetitions if increased swelling or pain occurs.2.  Incorporate isometric strengthening exercises into your regimen. Hold each contracted muscle against a fixed resistance for six seconds without moving your joints. Elastic bands or other forms of fixed resistance can be used. Use about three quarters of your maximum strength (or less, if pain occurs). Do this one, two, or three times with each muscle group, taking a ten-second break between each contraction. Isometric strengthening exercises are usually performed only once daily. Goal: Increase muscle strength.Precautions: Your joints should be kept immobile during this form of therapy. Keep the tension in your muscles, not in your joints.3. Gradual addition of endurance exercises may be appropriate at this stage. Adding a swimming program is often recommended because the buoyancy of the water relieves stress on joints. Other forms of aerobic exercise may be recommended if your hips, knees, and feet are not inflamed. Before adding exercises such as walking and bicycling to your program, talk it over with your physician.Goal: Increase endurance and fitness.Precautions: Check with your doctor to see if you are ready for aerobic exercises.*75/209/5*

ARTHRITIS: SELF-CARE HELPS MANAGE SYMPTOMSArthritis means joint inflammation and refers to several diseases that cause joint pain, swelling and stiffness. There are over 100 different types of arthritis, but the majority of cases fall in one of the four listed on page 269. Most arthritic conditions cannot be cured, but their detrimental effects can be limited with consistent self-care and medical support.
Prevention While you can’t prevent arthritis, it is possible to delay the onset and slow the degenerative process.Avoid trauma, overuse and repetitive or jarring activities. Vary your exercise and activity schedule to allow changes in the pressure and stress on joints.Exercise regularly. Aerobic exercise increases blood flow to nourish joint tissues. Exercising with weights strengthens muscles that support and protect joints. Stretching and range-of-motion exercise helps maintain joint flexibility.Control your weight. Excess pounds place stress on weight-bearing joints such as knees.
What you can do After arthritis has developed in a joint, self-care can help you maintain joint function and decrease pain, swelling and inflammation. Take aspirin or ibuprofen to relieve pain and inflammation (follow directions and warnings on package). NEVER give aspirin to children/teenagers. It can cause Reye’s syndrome, a rare but often fatal condition.Rest sore joints. If you must continue to put weight or stress on the joint, take breaks and rest.For inflamed, swollen joints, apply ice pack for 10 to 15 minutes every hour for two hours, then leave ice off for two hours. Repeat this cycle for 48 hours or until swelling is gone. For protection, place a washcloth between bare skin and ice. Do not use heat as long as there is swelling.If joint is not swollen, apply warm, moist heat for 20 to 30 minutes, three or four times a day. Follow heat with gentle full-range-of-motion exercises and gentle massage.When joint pain and inflammation subside, continue the prevention measures listed above.Become informed about your type of arthritis. Ask your doctor for self-care treatments specifically for you. Learn about resources in your community such as support groups, physical therapy, occupational therapy and stores that carry medical supplies.When to  seek helpAlthough arthritis is a slowly progressive disease that can be managed well with self-care, there are three problems that require medical help quickly:Infection in a jointBroken bone near arthritic jointNerve damageCall your doctor if you have:Sudden swelling, heat or redness in joint(s)Joint pain that is severe or interfering with usual activitiesJoint pain that requires you to take aspirin, ibuprofen or any other pain reliever daily or frequently to ease the pain. NEVER give aspirin to children/teenagers. It can cause Reye’s syndrome, a rare but often fatal condition.Pain upon motion of the joint, or limited movementFrequent joint pain and a history of ulcer or a bleeding disorderJoint symptoms and a rash or feverInability to move or use jointSudden pain in joint with numbness or tingling in limb below, back pain with numbness in legs, or loss of control in bowels or bladderPossible fractureArthritis worsens or does not improve after six weeks of self-care*92\303\2*