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AIDS DEMENTIA COMPLEX: HIV AND THE CENTRAL NERVOUS SYSTEM-ATTITUDE CHANGE

admin — Fri, 22 Jul 2011 14:38:49 +0000

The biggest change in people’s attitudes is an increase in apathy. People with dementia gradually become less responsive, harder to talk to, emotionally flat. They lose interest in their jobs, their family and friends, their homes, even themselves. Perhaps some of the problems of memory loss and difficulty concentrating are caused by apathy. Lisa said her husband, Glen, lost his «sparkle» and became less affectionate, gave short answers to questions, and couldn’t get interested in a conversation. She described a typical conversation: «I’d say, ‘What are you thinking about?’ He’d say, ‘Nothing.’ I’d say, ‘What did you do today?’ He’d say, ‘Rested, watched TV, read the newspaper, that’s about it.’ I’d say, ‘Anything interesting on the TV or in the paper?’ He’d say, ‘I can’t say so.’ I’d say, ‘Are you hungry?’ ‘No.’ ‘Are you thirsty?’ ‘Hard to say.’» Lisa’s daughter agreed: «Dad was always happy to see me, but he’d lose interest. He was real dull, not enthusiastic about anything. He just seemed to go through the motions. When I’d call him on the phone, we’d talk a minute and he’d just hang up. We used to talk for a while. If I didn’t call him, we wouldn’t talk for a week.» Caregivers routinely report that people with dementia seem content just to sit and stare. When people are in the later stages of dementia, their apathy becomes even more distressing for the caregiver. People with dementia gradually become disconnected from the world, stop laughing or empathizing or showing affection, and finally become so disconnected that they will not speak. Even though apathetic people seem depressed and unhappy, they say they are not. They are satisfied with their quietness. They are not sad, not frightened, not lonely, only disconnected.In the early stages of AIDS dementia complex, people who are apathetic can often be drawn out. Mental health professionals say they do not know whether being drawn out decreases apathy or just makes the situation less distressing for the caregiver. In any case, they say, it can’t hurt. Lisa found that trying to draw her husband out often helped: «I’d try to talk to Glen about recent events, or someone I saw that day, or what happened around the neighbourhood. That often got him talking. When he became less affectionate with the grandchildren, I’d remind him of the good times we’d had with them, and then bring them over, one at a time, and that seemed to work. When he got less affectionate with me, I began sitting on the arm of his chair and snuggling against him, and he seemed to like that. Or I’d talk about our memories, like when we were dating or got married, and that got him talking too. But sometimes I just let him be disengaged. I think he needed some of it.» Dean says he doesn’t socialize well any more and that other people do more of the talking, though he enjoys listening to the talk. «But I can’t handle strange social situations,» he says, «no company picnics, no big parties.» Because people with dementia are both apathetic and have difficulty concentrating, they need help making decisions. They can’t pay attention for long, they become confused, and they don’t care much about the outcomes; as a result, they make decisions slowly or not at all. Lisa’s husband needed several days to make a decision. «If a friend called and asked us to eat dinner that night,» she said, «he couldn’t answer because he couldn’t make a decision that fast. In those cases, I made the decisions. When the decision was important or when we had two or three days to make it, then he could make up his mind.» When the decision is important—like deciding when to apply for disability insurance or how to provide for children—the person with dementia has difficulty both making the decision and acting on it. Caregivers need to present the options one by one, slowly, discussing each one, the way Lisa did with the decision to lend the lawnmower. They should repeat the options until the person with dementia understands, even if that takes days or weeks: «Should the child live with your mother? Your sister? Should the child be adopted?» Once the person has made the decision, caregivers need to write down the list of things to do, the steps to take, one simple step at a time. If the person seems to have trouble carrying out the decision, the caregiver should remind him: «We talked about this and I know you want it done. Shall I call the lawyer for you? Shall we do it together tomorrow? Shall I come over at ten?» Decisions may need to be repeated, gently and sympathetically, for days.*147\191\2*

HORMONE REPLACEMENT THERAPY AND HEALTHY BONES: ELISE’S STORY

admin — Sun, 17 Jul 2011 14:32:06 +0000

One of my patients started on estrogen and progestin as she neared her fiftieth birthday and her periods became few and far between. After Elise went through menopause, a bone density scan showed her Z-score (comparing her to other women her age) was actually positive, and her T-score (comparing her to peak bone density) was just —.3. In the midst of what would otherwise have been the most rapid bone loss of her life, Elise was sitting pretty thanks to HRT.In this case, I know HRT was largely responsible for Elise’s relatively dense bones because although she took calcium supplements fairly regularly, her diet and exercise habits were otherwise far from ideal. Her job, in addition to being extremely stressful in general, required constant travel. Because of her schedule, she had long ago given up on the idea of a regular workout. Elise felt she couldn’t really eat right, since so many of her meals came from vending machines or room service or while dashing through the airport; For all these reasons, Elise had room for improvement. She began taking a range of other supplements along with her calcium, and starting paying attention to what she ate. She couldn’t always get all the calcium and other nutrients she would like (which is where the supplements come in), but found it was just as easy to grab a yogurt as anything else to eat, and began carrying healthier snacks along with her in her travels. She also committed to a walking program she could do wherever she was, and began making inquiries about gym facilities at the hotels she was destined for.If she sticks to those things, I’ve no doubt that her next bone scan will show her density to be right up there with the densest of 30-year-olds.*134\228\2*

COPING WITH THE UNCERTAINTIES OF SEIZURES AND EPILEPSY: ABNORMAL MOVEMENTS

admin — Sun, 03 Jul 2011 14:16:46 +0000

When brain damage affects areas of the brain that control the coordination of movements, the child may be athetoid; movements are performed slowly and in a writhing fashion. Damage to other areas of the brain may cause more rigid movements, that is, dystonia. Since these control areas lie deep within the brain in regions less likely to cause seizures, epilepsy is uncommon among such children. They are also less likely to be retarded.Children with damage to multiple areas of the brain may have both spasticity and either athetosis or dystonia. Such children are said to have mixed cerebral palsy.»How can I help my child who has cerebral palsy?»Helping your child to cope with cerebral palsy depends on whether or not there is mental retardation. Many children with cerebral palsy are of normal intelligence, and for these children the motor dysfunction can be enormously frustrating. To be unable to dress, to go to the bathroom alone, to feed yourself can create such a sense of helplessness and dependence that depression is not uncommon. And yet children with cerebral palsy are increasingly able to find areas in which they can become competent and ultimately develop self-esteem. Appropriate use of computers allows both learning and communication. Motorized wheelchairs and special adaptations may permit mobility and independence. It is amazing what can be done to help unlock the real person who is within.For the child with cerebral palsy as for the child with mental retardation the most important ingredients in successfully coping are development of motivation and self-esteem. Motivation can be stimulated by activities and hard work such as those involved in preparing for the Special Olympics. The joy of successfully participating in such sports promotes self-esteem. Special Olympics is a model of what can be achieved in other areas of life, with patience and persistence. Such children need role models of successful handicapped adults. Their ability to become an achieving adult begins with small successes in the family and in the school.Helping your handicapped child to cope with the accompanying psychological problems is still an art, not a science. How to do this is unclear, but he, and you also, need help in articulating your frustrations, concerns, your anger, and your hopes.There has been amazing progress in recent years in enabling both the retarded and those with cerebral palsy to participate more fully in the community. The old stereotypes of institutionalization and handicap persist. But these children, while disabled, are not able.*201\208\8*

PATHOGENESIS OF PULMONARY TUBERCULOSIS

admin — Wed, 22 Jun 2011 14:30:01 +0000

Tuberculosis is spread from infected individuals through the air by tiny droplets that contain Mycobacterium tuberculosis. These droplets are aerosolized when an infected patient coughs, sneezes, or speaks. Particles larger than this size are deposited in the upper air-way and tend not to cause infection. After inhalation, droplets are deposited in the respiratory bronchioles or the alveoli, where the organisms can multiply. They can then spread via the lymphatics to the hilar lymph nodes and through the bloodstream to more distant sites. Multiplication continues until the replicating mycobacteria are of a sufficient size to elicit a host immune response. In normal individuals, the growth of M. tuberculosis is halted once cell-mediated immunity develops. This usually requires 2 to 12 weeks and corresponds temporally with the development of reaction to the tuberculin skin test. Once cell-mediated immunity develops, granulomas consisting of macrophages and activated T lymphocytes can form and arrest the growth of the organisms. A small number of viable mycobacteria may persist inside the granulomas, typically in the necrotic center. Often, this primary infection is clinically silent, but it may manifest as a mild pneumonic illness. Primary infection can occasionally overcome the host defenses, resulting in primary progressive disease. In most patients, however, the mycobacteria remain arrested inside the granulomas, with the potential for reactivate in the future. Reactivation occurs to create active disease.About 10% of infected persons will develop active tuberculosis, with the highest risk of developing active disease in the first 2 years after infection. Certain host factors are associated with an increased risk of developing active disease. Patients with the man immunodeficiency virus (HIV) have a greatly increased risk of developing active tuberculosis and may progress from latent disease to active disease at a rate of 10% per year.*59/348/5*

BDD BEHAVIOURS – WEIGHT LIFTING, AEROBICS, AND OTHER FORMS OF EXERCISE

admin — Tue, 14 Jun 2011 14:24:31 +0000

Some people with BDD exercise excessively. They may run or do aerobics to decrease cellulite or the perceived flabbiness of their thighs, or to make their arms or legs slimmer or larger. Others do sit-ups to flatten their stomach. These behaviors are carried to an extreme. As a 30-year-old woman said, «My whole day is planned around exercise.» A man I treated was so worried about not exercising during his hour-long drive to see me, thinking his muscles would «shrivel up,» that he joined 5 gyms between his house and my office, which he worked out at along the way.Exercise often doesn’t have the desired effect, and some people think it makes them look even worse. One woman did what she called «extreme exercises» to decrease supposed facial bloating. «But the exercise didn’t have the desired effect,» she said. «In fact, it made my legs look bigger and worse. I became obsessed with my legs while I was waiting for them to decrease in size.»Nick, a 32-year-old former car mechanic, carried weight lifting to an extreme, severely damaging his body. He believed his body was too small, which he related to feelings that women didn’t find him attractive or «enough of a man.» To increase his size, he ate massive quantities of food, weight-gain powders, and special vitamins. He also wore extra shirts and padded his clothes. «But the main thing I did,» he said, was lift weights. I lifted for hours a day. In retrospect, I realize I looked fine before I started to lift, and I’m sure everyone else thought I looked fine, too. I looked normal. I was 195 pounds; I wasn’t fat, but I wasn’t overdeveloped. Now I realize I probably looked even better that way. But at the time, I thought I looked too small. I was obsessed with looking bigger. I wanted to be stronger and more masculine. I wanted to be the biggest person on the planet!»I became obsessed with working out. I spent a lot pf the day lifting. I had to exercise before I left the house. I had to get the feeling and the look of bigness before I went out. I was trying to keep up with my friends who were using steroids. And I did get big—I got a lot of reinforcement for it. People would compliment me. Sometimes I even felt high while I was lifting. But I still felt I wasn’t big enough. I had to get even bigger.»Lifting became the focus of Nick’s life. «It’s embarrassing to talk about this,» he said. «I’m ashamed of how it interfered with my life—I stopped working because of it, I dropped out of life…. I couldn’t concentrate on my work because all I was thinking about was lifting. I actually stopped working because I couldn’t get out of the house without exercising. I didn’t see my friends—I just stayed in my basement lifting. I lost a lot of them because of it. Once, I got so upset thinking I wasn’t big enough that I stayed in my basement for a month, lifting and lifting. I was desperate to be bigger—I couldn’t get out of the basement! I was so depressed, thinking I’d never be big enough, that I thought I’d rather be dead. I couldn’t let anyone see my body.»Nick injured himself so severely that he had to stop playing sports, and he wasn’t able to work. He was often in pain, and even had difficulty walking. When I saw him, he was in physical therapy and had to use crutches to walk. «I totally ruined my body by lifting,» he said. «I tore my muscles apart. The irony is that now I can’t work out at all—not even a normal amount.»*110\204\8*

EPILEPSY AND ITS SPECIAL FORMS/SPECIAL PATTERNS AND CAUSES: CHRONIC INFECTIONS

admin — Wed, 08 Jun 2011 14:14:32 +0000

Acute bacterial and viral infections of the brain (meningitis and encephalitis), as we know, may cause acute seizures and may occasionally damage the brain and result in epilepsy. Other infections that occur before birth or, rarely, after birth may also damage the brain and lead to epilepsy. The most common infection of the brain world-wide is cysticercosis; in some countries this may be the most common cause of epilepsy, but in the United States it is a rare cause of seizures. A doctor will suspect this diagnosis when single or multiple areas of typicalcalcification, the result of cysts within the brain, are spotted on the CT. Surgical removal of these cysts may cure the child’s epilepsy.Another brain infection is toxoplasmosis, an infection spread by cats. If a pregnant woman acquires this infection it may be transmitted to her baby and cause scarring in the brain. Infection, often undetectable in the newborn, is first manifested, possibly, as mental retardation or as seizures. A CT scan can detect scars within the brain and aid diagnosis. Also, small scars on the retina in back of the eye may be noted by your physician and suggest a diagnosis. In addition, blood tests can confirm what the observations suggest. Suspected toxoplasmosis is often treated in an attempt to prevent further damage. The treatment of seizures in affected children is similar to those used in the treatment of other forms of epilepsy.*101\208\8*

BACH FLOWER REMEDIES: CHICORY PEOPLE’S BEHAVIOR

admin — Thu, 26 May 2011 14:09:55 +0000

Chicory people may even simulate sickness to keep friends and relatives waiting on them. They may even weep incessantly just for wanting attention all the time. Chicory characters like to have a kind of possessive pride in the feelings and lives of their dear ones. The grandma is very helpful to all the members of her family, loves them and wants to control their lives – organizes, guides, criticizes and directs and quite often forces her attention on the family. She feels hurt if her attentions are not accepted with gratitude. In her own words » I am telling you because I mean you well.» The Chicory mother feels happy in the company of her children. She feels elated if her grown up children make distant calls «How do you do»? on week days, and travel long distances on Sundays and holidays to see her personally. She is aptly described as «the needy mother». When a child feigns sickness – headache, stomach ache or nausea, when the school bus comes to pick him up and feels alright when the school bus has left him, then it can safely be presumed that there is nothing physically wrong with the child. He only wants attention all the time for which the proper remedy is CHICORY.Similarly there are many professional beggars in India who mangle some body-part to invoke sympathy or attention of the public. They need CHICORY Remedy.*86\308\8*

SKIN IN ADOLESCENCE: ACNE

admin — Wed, 18 May 2011 13:55:06 +0000

Acne is the bane of many teenagers’ existence. Although it is considered a ‘normal’ part of growing up, it seems unfair that just as interest in the opposite sex is beginning and confidence is all-important, a teenager may develop acne. Indeed, the psychological effects of acne can be devastating. Despite all this, it often goes untreated even though there are effective remedies available. It must also be said, however, that many ineffective remedies are promoted, so it is important to be discerning when it comes to choosing a treatment. Neither should acne be dismissed as ‘just a stage’ a person is going through, as many people continue to have acne into their twenties, thirties, and even forties.The exact causes of acne are not known, but much research over the last twenty years suggests that genetic and hormonal factors are major contributors. If there is a family history of moderately severe acne it is very likely that children will develop acne at puberty. The natural history of acne is that it will eventually disappear in the late twenties. About ten per cent of people, however, continue to suffer from acne in their thirties and forties and this can often be predicted by their family history.That hormonal factors are important is evidenced by the fact that acne often begins at puberty. In women, it may also vary with the menstrual cycle. Male hormones are more potent in producing acne than female hormones, so men tend to have more severe acne than women. Women with high levels of male hormones also usually have more severe acne.Acne develops from the increased production of sebum (oily secretion) by the sebaceous glands. These glands are under hormonal control and are deep below the surface of the skin. Under hormonal influence they produce and secrete sebum, and the more sebum that is secreted, the more severe the acne tends to be. Sebum secretion is markedly increased at puberty and has several effects on the skin:- Sebum is a very sticky substance, similar to mozzarella cheese in texture, which blocks the oily glands. This leads to blackheads and whiteheads.- Sebum is an irritant to the skin and therefore produces inflammation which leads to red lumps.- Sebum is a good growth environment for certain bacteria, called propionibacterium acnes, which live in the sebaceous glands. They are attracted to sebum and they release various inflammatory products which in turn lead to pus, inflammation and cysts.
*15/150/5*

THE SELF-POISONER: PATTERNS OF SELF-INDUCED TOXICITY – PERSONAL PERFORMERITIS

admin — Fri, 22 Apr 2011 12:54:16 +0000

«Record-keeping» is particularly poisonous when a person constantly compares himself with himself. Usually, he has a mental progress chart that is part of his poisonous onward-and-upward demand for continual improvement. The greater his need to prove himself in this way, the more toxic he becomes. The poisoning effect of performeritis is increased by the person’s uncertainty of how good he really is. The standards he sets for himself, measured against what he imagines to be the capabilities of others, are merely the product of his own fantasies. He is trapped on a self-improvement treadmill.A woman became upset whenever she felt she was not the most attractive female in the room. She rejected the friendship of women whom she saw as rivals. Typically, her women friends were older, overweight, or in some other way clearly less attractive than she. She subjected herself to a lifelong beauty contest at the expense of enjoying her over-all growth as a person. The process became even more deadly when combined with her morbid fear of growing older. She fantasized diminishing attention and admiration from men as an over helming catastrophe.A similar toxic pattern occurs in aging men who become anxious about their virility. Toxic performeritis often begins to affect their sexual behavior, in that they feel compelled to prove their sexual prowess at the expense of the experience itself. Any relationship is poisoned to the degree to which it is contaminated by preoccupation with performance. In T people of both sexes, anxiety about aging tends to take on an obsessive quality. To the extent that the obsession demands the time, energy, and resources of the person, the remainder of his total identity is deprived and disregarded.
While we all may be interested in developing some talent or ability, focusing on these aspirations at the expense of appreciating present functioning is toxic. Performeritis postpones gratification to some future time. Most self-nourishment comes from functioning in the now.*56\350\8*

HIV INFECTION AND ITS EFFECTS ON THE EMOTIONS: GUILT AND SELF-WORTH-CAUSES OF GUILT

admin — Tue, 19 Apr 2011 12:22:19 +0000

Guilt does not necessarily have a cause. Guilt, like fear, is a feeling that may or may not have anything to do with the facts. Some people feel honestly that they did something they should not have done. Perhaps they knew they ran a risk when they became infected. Others are accepting blame for something over which they had no control. Perhaps they knew nothing about the virus or they thought they were taking appropriate steps to avoid infection or they unknowingly received infected blood. Guilt, like all other reactions to this infection, is a natural human feeling. Sooner or later in their lives, most people feel guilty about something, sometimes justifiably, sometimes not. Alan, for instance, remembers stealing a plastic toy from a dime store when he was seven years old, and though he does not feel like a criminal, he does feel a vague sense of shame and is not able to forget the incident. Perhaps guilt comes from a sense that good behavior deserves reward and bad behavior deserves punishment. Perhaps people feel that since the virus feels like a punishment, they must have behaved badly. Perhaps social disapproval operates the same way: people feel isolated and punished, so they feel they must have done something wrong to deserve it. Both of these possibilities are built on bad logic and are just plain wrong.
*77\191\2*