The physical examination can include a general examination of all the body’s systems, e.g. the pulse is taken, the heart listened to, blood pressure measured, and the abdomen felt. In a full neurological examination, the cranial nerves are tested one by one. The ability to smell may need to be tested. It is important to test vision, especially visual acuity and visual fields. The ophthalmoscope is an instrument designed so that the doctor can look at the optic nerve and the blood vessels at the back of the retina; its use is particularly important in certain cases. Movements of the eye, facial muscles, soft palate, and shoulder movements are tested as are sensation on the face and hearing.

The power of the muscles and sensation in the rest of the body is then tested as are fine movements and co-ordination. The reflexes are tapped to see if they are equally brisk on each side and the sole of the foot scratched: a down-going toe in response to this is normal. At some stage the doctor will listen over the neck, head, and eyes for any murmurs, noises caused by turbulence in blood flow produced by narrowing or malformations in blood vessels.

In most cases of headache, the examination is negative, suggesting that all is well but, occasionally, a small change may alert the doctor to the possibility of a more serious problem and it is then that the patient may be referred to the specialist for investigations.

*35/152/5*

If you had sexual contact with an adult during your childhood, chances are that you find sex confusing at best. As in Sylvia’s case, the sexual abuse that frightened you and that you instinctively knew was “bad” involved physical stimulation that sometimes felt “good.” Sex became hopelessly tangled up with fear, confusion, shame, powerlessness, guilt, and betrayal. You certainly are not alone if you concluded that it was bad to feel good. What’s more, childhood sexual abuse probably convinced you that sexual desire is dangerous. Desire was a weapon used against you. After all, your abuser’s lust was the out-of-control force that compelled this trusted adult to hurt you.

The end result of learning that sexual pleasure is “bad” and sexual desire is dangerous varies depending on the nature of the abuse; how old you were when it occurred; how many years it continued; the violence, threats of violence, or manipulation involved; whether anyone else knew about it; what happened if it was discovered or you exposed it; and the specific methods you used to cope with it. The survivors of incest and child molestation whom we have treated report a wide range of long-lasting reactions that affected them even while they were blocking all memories of the abuse from their minds. Having sex, or facing the possibility of having sex, can reactivate the feelings associated with traumatic sexual experiences even.when you do not remember the experiences themselves. As a result, you may:

• “space out” during sex

• feel numb or panicky during sex and in sexual situations, sometimes to the point of having anxiety attacks

• avoid sex, using various tactics to keep yourself out of sexual situations and occasionally becoming extremely anxious when you anticipate sexual overtures

• use sex to meet all your needs, sometimes leading to promiscuous sexual behavior

• feel disgust with sex, certain aspects of sex, specific body parts, or being touched in any way

• try to control all aspects of a sexual situation in order to feel safe

• feel terrified by the mere possibility of engaging in sexual activity

• have sex even though you do not want to

*106\261\8*

Both teaching and community hospitals present the patient with a bewildering array of people with different titles offering different services. Hospitals also follow certain practices that may likewise be confusing. The following glossary of the people and practices a person in a hospital can expect to see might help eliminate some of this confusion.

Physician-of-Record-Your physician-of-record is the physician medically and legally responsible for your care—that is, for all medical recommendations, including decisions about diagnostic tests and about your treatment. Your physician-of-record is most often your primary care physician, but sometimes it is the physician assigned from the hospital staff. Even though you might see nurses and residents more often, the physician-of-record has ultimate responsibility for your medical care. Every person in a hospital has a physician-of-record.

*161\191\2*

Dr. Bach described WALNUT remedy as a specific for those who have decided to start a new chapter in life, breaking all old conventions and socialties, age-long relationships, hereditary diseases, and such vices as have, become a part of life itself.

Left to oneself, the task would be very difficult and painful and the person feels shaky. Walnut provides the necessary steadying support to the person at that crucial moment when he falters to take the last step which would make his break from the past complete. In the negative Walnut state the person is prone to ailments from heredity, from change of climate, change of food habit, change of environment, change of life i.e. teething, puberty, menopause etc.

For persons who are unable to break loose from the influence of a stronger and more dominant personality, CENTAURY is prescribed for weak-willed persons who cannot even think of going against the wishes of the stronger personality and dare not break and old convention. WALNUT is meant for persons who have determination and strength of purpose and a will to break loose from old conventions and to snap old ties, but at times may be dissuaded to do so under the influence of a stronger will.

*197\308\8*

After-effects of mental or physical shock. Star of Bethelhem relates to the soul potential of re-awakening and re-orientation. When a person experiences a severe shock, his whole constitution—his body, his mind, his brain and his whole nervous system-is shaken and a sort of numbness of his mental faculties sets in. It is to get out of this inertness and to reactivate his mind that Star of Betehlhem is called for. It makes no difference whether the after-effects are due to physical or mental or spiritual traumatic experiences.

In the positive Star of Betehlhem state, the person possesses the necessary inner strength and poise to absorb the shock and maintain his balance in emergencies.

In the negative state, however, the person feels completely overwhelmed by the sudden, unforeseen happening as in a serious road accident; a hold up by gun-wielding gangster on-the highway; people trapped in a building on fire; ship wrecked on the high seas; car going downhill with its brakes suddenly failed; sudden war declared between two neighbouring countries; when you are in the enemy territory; sudden death of a young promising and only son of a window.

Such emergency cases are quite common in the present day life and the people who can face the situation with equanimity are very few.

Fortunately such emergencies are few and far between. But the effects and after-effects of such traumatic experiences may be disastrous and long lasting.

The physical effects of an accident, may appear as swelling, a wound, a fracture or pain, and all these effects are liable to disappear after proper treatment for sometime.

But the after effects of shock whether physical or mental is long lasting and sometimes very disasterous. When a patient says that ah his present diverse ailments date back from a particular accident which occurred several years ago, the veracity of the above statement is proved.

What happens in a violent accident is that, besides the local injuries which appear on body tissues and bones, some latent injuries may be caused to the internal parts which derail the vital force in the body and the whole balance between the soul, mind and body is disturbed, resulting in sometimes unpredictable results.

A woman was knocked down by a buffalow in a street which damaged her digestive system, and she became diabetic. While recording her case history in the dispensary, we found no trace of ‘sugar’ in her heredity and proceeded to treat the case as an after-effect of trauma.

A child fell from the roof. After a few minutes, he got up by himself and went upstairs apparently unaffected by the fall. Four years after, he started having epileptic fits. The doctor diagnosed the trouble as due to the remote effect of the fall from the roof. The after-effects of mental shock are, however, very insidious and deep-acting.

*179\308\8*

Methods of fertility control that rely upon the alteration of sexual behavior are called fertility awareness methods (FAM). These methods include observing female “fertile periods” by examining cervical mucus and/or keeping track of internal temperature and then abstaining from sexual intercourse (penis-vagina contact) during these fertile times.

Two decades ago, the “rhythm method” was the object of much ridicule because of its low effectiveness rates. However, it was the only method of birth control available to women belonging to religious denominations that forbid the use of oral contraceptives, barrier methods, and sterilization. Our present reproductive knowledge enables women and their partners to use natural methods of birth control with fewer risks of pregnancy, although these methods remain far less effective than others.

Fertility awareness methods of birth control rely upon basic physiology. A released ovum can survive for up to 48 hours after ovulation. Sperm can live for as long as five days in the vagina. Natural methods of birth control teach women to recognize their fertile times. Changes in cervical mucus prior to and during ovulation and a rise in basal body temperature are two indicators frequently used in natural contraceptive techniques. Another method involves charting a woman’s menstrual cycle and ovulation times on a calendar. Any combination of these methods may be used to determine fertile times more accurately.

Cervical Mucus Method

The cervical mucus method requires women to examine the consistency and color of their normal vaginal secretions. Prior to ovulation, vaginal mucus becomes gelatinous and stringy in consistency, and normal vaginal secretions may increase. Sexual activity involving penis-vagina contact must be avoided while this “fertile mucus” is present and for several days following the mucus changes.

Body Temperature Method

The body temperature method relies on the fact that the female’s basal body temperature rises between 0.4 and 0.8 degrees after ovulation has occurred. For this method to be effective, the woman must chart her temperature for several months to learn to recognize her body’s temperature fluctuations. Abstinence from penis-vagina contact must be observed preceding the temperature rise until several days after the temperature rise was first noted.

Calendar Method

The calendar method requires the woman to record the exact number of days in her menstrual cycle. Since few women menstruate with complete regularity, a record of the menstrual cycle must be kept for 12 months, during which time some other method of birth control must be used. The first day of a woman’s period is counted as day 1. To determine the first fertile unsafe day of the cycle, she subtracts 18 from the number of days in the shortest cycle. To determine the last unsafe day of the cycle, she subtracts 11 from the number of days in the longest cycle. This method assumes that ovulation occurs during the midpoint of the cycle. The couple must abstain from penis-vagina contact during the fertile time.

Women interested in fertility awareness methods of birth control are advised to take supervised classes in their use. The risks of an unwanted pregnancy are great for the untrained woman.

*14/277/5*

As you grow older, your body will change and you’ll experience changes that can affect your sexuality.

You’ll undergo menopause. You’ll experience hormonal changes that affect your skin, hair and nails. You’ll develop wrinkles, and your bones will become more brittle.

These are the normal results of the aging process. You can’t stop aging, but you certainly can slow it down and fight it off.

These changes occur in all women. Some, however, come along faster and stronger in women with diabetes – particularly in diabetic women who have long periods of high blood glucose.

Here are some of the changes that may result from long periods of high blood glucose.

The function of the pituitary gland (the ”master” gland) may interfere with the production of sex hormones – oestrogen in women and testosterone in men – which may be reduced.

The nerves that stimulate the tissues in the vagina may be damaged, and this damage slows secretion of lubricant. Without lubricant, sexual intercourse may be painful. Nerve damage also may interfere with the woman’s ability to experience a sexual climax.

Tissues may show signs of premature aging. Among these signs are wrinkles, sagging breasts, growth of facial hair, loss of underarm and pubic hair, graying and loss of hair on the head and increased brittleness of nails.

*44/210/5*

Commencement of menstruation is a complex but intensely interesting phenomenon. Two or three years before puberty, stirrings start to occur in a tiny organ called the pituitary gland. This small piece of tissue is located at the base of the brain, and is connected by a short stalk to an adjoining portion called the hypothalamus. The hypothalamus is the whip cracker; and for reasons that are not entirely understood, it manages to make the pituitary gland produce chemicals called hormones. Two important ones that will subsequently influence menstruation are called the follicle-stimulating hormone (or the F.S.H., in medical short-hand) and the luteinizing hormone (or L.H.).

These valuable hormones are pumped directly into the bloodstream and circulate all around the body. But they ultimately reach the ovaries in the pelvis, and here they have a remarkable affect. In short, they are responsible for initiating the onset of menstruation.

Once menstruation has commenced, the intricate relationship between the hypothalamus, pituitary and ovaries continues unabated throughout the woman’s reproductive life.

*13\45\4*

Diarrhea is a relatively common complication of HIV infection. It can be acute, meaning that it begins suddenly and lasts for a short time, or it can be chronic, meaning that it persists for several weeks or months. Diarrhea has a number of causes. Many people have diarrhea simply as a result of anxiety. Some people have recurrent bouts of stomach pain and diarrhea, called irritable bowel syndrome, that go on for years without any identifiable cause. Some people have diarrhea because of HIV itself. Some people have diarrhea because they do not have the enzyme called lactase that is necessary to digest a milk sugar called lactose. Some people with HIV infection who were once able to tolerate lactose become unable to tolerate it. In lactose intolerance, the diarrhea occurs after people eat food containing lactose, including milk, ice cream, cheese, instant coffee, chocolate, cream, cocoa, and cream fillings. Yogurt, however, is tolerated by some people who are otherwise lactose intolerant, and is worth trying because it is a good source of protein and calcium. Other symptoms of lactose intolerance are cramping and gas.

Another cause of diarrhea is the drugs commonly used by people with HIV infection. In fact, probably almost any drug used to treat an infectious disease can cause diarrhea. Some antibiotics only cause what is called nuisance diarrhea: a few loose stools most days. Other drugs can cause severe diarrhea accompanied by fever and cramps. The antibiotics that most commonly cause severe diarrhea are clindamycin, ampicillin, amoxicillin, and a group of drugs called cephalosporins. Drugs that less commonly cause diarrhea are trimethoprim-sulfamethoxazole, erythromycin, penicillin, and ciprofloxacin. Any person who has severe diarrhea while taking such drugs should discontinue the drug immediately and notify the physician. Less serious forms of diarrhea are often dose-related, that is, diarrhea can be reduced simply by reducing the amount of the antibiotic. Or the person can be prescribed another drug.

Diarrhea in people with HIV infection is also caused by infections of the digestive system, primarily infections of the small bowel and the colon. Infections are especially likely if the diarrhea is accompanied by a fever. Acute diarrhea can be caused by a number of microbes that are either easily treated with antibiotics, or that go away without treatment, or that progress to chronic diarrhea. Acute diarrhea is often due to food poisoning, viral infection, or anxiety, which are occasional problems for everyone, with or without HIV infection. Perhaps the most common cause of chronic diarrhea in people with AIDS is Cryptosporidium, a parasite that is easily detected by stool exam. Diarrhea caused by Cryptosporidium is usually prolonged and intermittent. At times, it can be severe, causing watery diarrhea ten to twenty times a day; other times it is better. Other common infectious causes of chronic diarrhea are a tiny parasite called   Microsporidium, cytomegalovirus, and Mycobacterium avium. These latter microbes cause a diarrhea that persists for months, and that, unlike most of the opportunistic infections in HIV infection, cannot be successfully treated with antibiotics. A substantial portion of the people with HIV infection have a chronic diarrhea for which their physicians can establish no clear cause.

Call your physician if the diarrhea is severe, or if it is accompanied by severe pains in the abdomen or by fever, or if it persists. Chronic diarrhea is less common, often occurs late in the course of the infection when the CD4 cell count is low, and is often accompanied by severe weight loss and malnutrition.

The first test to diagnose severe or chronic diarrhea in a person with HIV infection is an analysis of the stool for infectious microbes. If no microbes are found, and if the symptoms are severe, it is often recommended that the digestive system be examined directly with an

instrument called an endoscope. An endoscope is a long tube that can be passed through the mouth to look at the small intestine, or passed through the rectum to look at the colon. The physician who performs the test is a gastroenterologist, a specialist in digestive diseases. Endoscopy permits not only a direct view of the wall of the intestine, but also removal of a small piece of tissue (a biopsy) of any area that appears abnormal. The tissue can then be examined under the microscope to identify the nature of the problem. A number of x-ray procedures also allow a look at the intestine. The person should be forewarned that these types of specialized tests tend to be unpleasant and expensive. Endoscopy of either the colon or the small intestine, plus the professional fee of the gastroenterologist, plus the pathologist’s interpretation of the results will cost between $1,000 and $2,000.

The treatment of diarrhea depends largely on the severity and cause. When drugs are responsible, a physician will reduce or discontinue the drug. Regardless of the cause, it is important, first, to drink enough fluids and, second, to eat enough food. The usual recommendation is to eat small, frequent meals and to drink fluids between meals. Avoid insoluble fiber: seeds, brans, nuts, whole wheat bread, the skins of fruits and vegetables. Avoid anything that causes gas: carbonated drinks, beans, cabbage, spicy foods, gum. Avoid fats, milk, cheese, ice cream. Since caffeine is a bowel stimulant, avoid coffee, tea, colas and some sodas, hot chocolate, and chocolate.

Soluble fiber, like pectin, counters diarrhea: oatmeal, jello, apples, bananas, mangoes, melons, fruit nectars, and cooked and skinned fruits and vegetables are sources of soluble fiber. Try white bread, white rice, noodles, and pastas. Drink plenty of liquids: water, clear fruit juices, clear soups, broth, ginger ale and caffeine-free colas (stir out the bubbles). Dietitians call such a diet a BR ATT diet: bananas, rice, applesauce, tea (caffeine-free), and toast. The BRATT diet, though helpful in controlling acute diarrhea, lacks many nutrients and should not be continued for more than a week. In addition, avoid drinking fluids during meals; fluids should be taken between meals. As with nausea and vomiting, it is important to replace lost electrolytes: try saltines, pretzels, clear fruit juices, Gatorade, ginger ale or caffeine-free colas, potatoes, bananas, clear soups.

When diarrhea is unrelated to food, there may be an advantage to adding foods containing soluble fiber—as listed above—in an effort to add bulk to the diet.

With severe diarrhea, when malnutrition becomes a worry, supplement the diet with special high-nutrient fluids such as Ensure, Sustacal with fiber, Enrich, or Magnacal. High-nutrient fluids, which can be obtained in grocery stores and pharmacies, provide a rich source of calories and protein. (Note: some people cannot digest high-nutrient fluids, and their symptoms worsen until they stop drinking the fluids.) For people who have a severe disease of the small intestine that interferes with their ability to absorb food, such as severe cryptosporidiosis, their physicians may prescribe an (expensive) food supplement of predigested nutrients such as Vivonex T.E.N. All of these dietary decisions are best made with the advice of a physician and a dietitian.

Drugs may also be used to reduce diarrhea. Some drugs that reduce diarrhea are available without prescription: Donnagel, Kaopectate, Lactinex, Pepto-Bismol, and the like. None of these seems to work well most of the time, but they may be worth trying. If the diarrhea is caused by a microbe, your physician will prescribe drugs to eradicate the microbe, if it can be treated; the specific treatment will depend on the microbe found. As noted, however, many microbes do not respond to antibiotics, and sometimes no microbe is found at all. In these cases, diarrhea is treated with prescription drugs—including loperamide (Imodium), diphenoxylate (Lomotil), tincture of opium, and paregoric—that quiet the motion of the muscles of the intestines. Other drugs used to treat diarrhea—like ibuprofen, indomethacin, or

somatostatin—seem to work, but no one knows why.

When a person with HIV infection has diarrhea, the caregiver should use common sense to avoid unnecessary exposure to stool. The stool of a person with HIV infection seems to contain no virus, and stool is not thought to be a source of transmission of HIV. The only infectious diseases that might be transmitted to others through stool are Cryptosporidium and salmonella; both are uncommon, and when they do infect people with intact immune systems, the diarrhea is only temporary.

*128\191\2*

Foundations

Foundations are used mainly to give an even skin tone and to cover blemishes. They range from very light to very heavy preparations with the coverage being determined by the titanium dioxide content. The heavier the foundation the more effective it is as a sunscreen. Even the sheerest foundations provide a sun protection factor of at least two. Heavy foundations give unlimited sunscreen protection, guarding the skin from ultraviolet A and В light and even visible light, while moderate coverage foundations provide a sun protection factor of about five.

Your choice of foundation depends on how much coverage you like, the shades available and your skin type. If you have oily skin or acne, it is best to use oil-free foundations such as Revlon’s New Complexion Oil Free, Max Factor Pan-Cake, Shiseido Pureness, Lancome’s Maquicontrole, Estee Lauder’s Demi-matte and the Almay oil-free foundation. It is best to avoid creamy or paraffin-based ones such as Dermablend, Dermacolor or moisturizing foundations. Foundations are best applied with a wet sponge. This gives the most even and natural look.

Foundations can also successfully hide or cover certain blemishes:

- Red blemishes. Red blemishes such as broken capillaries or high cheek colour can be covered with either a green or yellow foundation, with yellow often looking more natural than green. Yellow and green neutralize the red blemish. Regular foundation is then applied over the top.

- Birthmarks. Birthmarks may require a heavier, stage-type foundation such as Dermablend or Dermacolor. These foundations are also waterproof and so can be used when swimming or during strenuous sporting activities.

- Sallow complexion. Skin which is sun damaged becomes sallow, almost yellowish in appearance. By using a pinkish foundation, the skin will take on a ‘healthier’ glow.

- Brown spots Brown spots can be partially covered with a white, pearlised make-up which reflects light and may make brown spots and wrinkles appear less pronounced. Christian Dior, Clinique and Orlane all make these products. It is also helpful to apply a slightly darker foundation over the whiter undercover.

- Acne scars Acne scars can be concealed using a new wax made by Dermacolor, which fills the depressions. Make-up is then applied over the wax.

Powder

Powder is used over foundation to provide a matt, smooth finish to the skin. It is available as powder compacts or as loose, dusting powder before applying the second coat. It contains oil-absorbing agents and helps to set foundation. It is best to use a translucent powder so that the powder colour does not clash with the foundation pigment. Powder can also be used as a base for lipstick and eye shadow, allowing them to set and stay on the skin longer. Powders rarely cause skin problems, and can be used by people with any skin type.

*80/150/5*