“When are you going to start Frank on medication? What are its side effects?”
“Now that Sarah has had a seizure, how long before I can allow her to ride her bike again?”
“Billy was going to go on a trip out west this summer. Should I put down the deposit? Will he be able to go?”
Life is full of risks and benefits. We take risks for ourselves and for our children every day. Although no one would ever do it, the safest place to raise a child is in a padded cell. In that cell the child cannot be injured when he falls down, tumbles from a tree, or crosses in front of a car. Your child will be safe! But you will be sorry. Clearly, a child raised without risk would be a very abnormal child. Living, therefore, is best seen as a series of assessments of the relative importance of risks and benefits. Making decisions about which risks (costs) to take for which benefits is what we all do subconsciously all the time.
Risk-benefit analysis involves weighing the good against the bad. On the good side of the scale, we calculate the chance of a benefit and worth of the benefit. A small chance of winning a large amount of money in the lottery may be “worth it” and outweigh the risk involved in losing a small amount of money. Worth has different meanings in different situations and to different people. Achieving “worth” or “winning” always involves some risks and consequences that must be weighed against the potential benefits.
Medicine is a series of risk-benefit analyses. In the past, physicians tended to do all of the analysis for you and recommended what you should do—whether your child should take medication and what medications he should take. This is much easier for the parent, and perhaps for the doctor as well since it doesn’t involve as much time and discussion. With the advent of a more medically sophisticated public, however, the patient and the family are, and should be, more closely involved in the decision-making process. The physician will still weigh the risks and the benefits and make recommendations on the basis of his assessment, but you as parent should weigh them as well. The risks of what he recommends are your risks (or your child’s), not his, and the benefits that accrue, accrue to you or your child. You may evaluate the worth of the benefits or the consequences of the risks differently from your physician.
*41\208\8*
DECISION-MAKING: ASSESSING RISKS AND BENEFITS AFTER A SEIZURE
TYPE I DIABETES AND EFFECTS ON THE KIDNEYS
All the blood in the body is continually filtered through the kidneys. These two large, bean-shaped organs get rid of many of the body’s waste products and poisons by producing urine. Blood cells and large molecules such as proteins are held back by the kidneys. There is a continual trading of chemicals back and forth. If there is too much of something in the blood—a salt, for example—the excess passes into the urine. If there is only just enough of a substance, or a shortage of it, the kidneys will return it to the blood.
In a healthy person, there is just the right amount of glucose in the blood, so the kidneys hold it all back. Normally there is no sugar in the urine. But when the blood sugar level rises beyond about 180 mg%, the renal threshold, the excess sugar begins to “spill” over into the urine, like extra water over a dam. The presence of glucose in the urine is called glucosuria.
There must always be enough water in the urine to keep irritating and poisonous wastes well diluted. As the amount of glucose spilling into the urine increases, the urine becomes more concentrated. So the kidneys must pass out more water to keep the urine diluted enough. Then the body becomes dehydrated, and the person becomes thirsty. With all the extra water flowing out through the kidneys, minerals are washed out too, along with proteins and fats, which are not normally excreted by the kidneys. So a person with uncontrolled diabetes begins to lose weight.
Meanwhile, despite all that sugar floating around in the blood, the person is unable to use sugar effectively as a fuel for normal body activities. Chemical distress signals are sent out by the hungry cells, and a metabolic switch-over begins. The body begins to raid its fat stores for energy fuel, and it may even begin to pull protein from the muscles. (That’s like a family who have run out of fuel oil chopping up their furniture and burning it in the fireplace to keep warm—it may solve the problem temporarily, but it creates even worse problems later on.)
When fats are broken down for energy, chemicals called ketone bodies are formed as by-products. These build up in the blood and spill over into the urine; they may give the breath a distinctive “fruity,” acetone odor. Ketone bodies are somewhat acid, and they upset the acid balance of the blood. This is a delicate balance, and it is normally maintained within very narrow limits. Too much acid can poison or even kill body cells. If too much fat must be used to provide energy because there is not enough insulin to allow the use of glucose for fuel, a state called ketoacidosis develops. The person may lose consciousness, may go into a coma, and—if not rescued by prompt medical treatment may die.
*15\268\2*
ALTERNATIVE THERAPIES FOR BONE DENSITY: HOMEOPATHY
Homeopathy is often confused with herbal medicine, but its guiding principle is quite distinct. Homeopathy views any symptom as the result of some injury to or imbalance in the body, and holds that substances that elicit the same symptoms, when taken at microscopically small dilutions, will paradoxically help relieve them by restoring balance (the hair of the dog that bit you). Many homeopathic preparations are marketed for relief of menopausal symptoms, including hot flashes and night sweats, moodiness, and nausea. Since the same hormonal imbalance that produces those signs forces decreases in bone density, relieving the overt symptoms might also mean improving your bones. Classical homeopathy doesn’t offer treatments specifically for low bone density, though it offers some remedies to address symptoms of osteoporosis. But new homeopathic remedies from outside the orthodoxy, like blends including Silica, Chamomilla, and/or Mercurius, are aimed directly at promoting healthy, dense bones.
One of my patients, a woman with a thyroid disorder, already had dangerously low bone density in her 50s. She didn’t want to take HRT and opted for diet, exercise, and supplements, including isoflavones instead. She also then began a homeopathic regimen because she felt her density was low enough to merit direct intervention. She had a low NTX level, indicating a low fracture risk, so she had time to experiment with this kind of treatment before considering less gentle and more aggressive options. When she comes back for another bone density screening, I expect to see improvement. If I don’t, we’ll consider changing tactics.
Two common homeopathic prescriptions for imbalances along the lines of menopausal symptoms (one of which would be bone loss) are calcarea carbonica and calcarea phosphorica. Once again, you’d do well to consult a professional, as homeopathy is always carefully geared to the individual and her particular symptoms. There is not a lot of science backing up homeopathy for low bone density, but at the very least it will cause no harm. If homeopathy appeals to you, I think it is well worth investigating.
*167\228\2*
LIVING WITH EPILEPSY: RISKS OF PREGNANCY OTHER GENETIC ISSUES
Some people ask us about the risks for their child if other family members have epilepsy. Some parents who do not have epilepsy themselves ask about risks for subsequent children when one of their children has had seizures. The answers to these questions require more detailed explanation.
Epilepsy may be a manifestation of some other disease. Some metabolic diseases, such as the aminoacidurias like phenylketonuria (PKU), and degenerative diseases, like Tay-Sachs and metachromatic leukodystrophy, may cause seizures. If one of your children has such a metabolic disease, the risk of a subsequent child’s having it is one in four. That other child is also likely to have seizures. If your brother or sister had the condition and you did not, you might carry the gene. If you do, and if you were unlucky enough to marry someone else who also had the same abnormal gene, then the chance of your child’s being affected could be as high as one in four. If you do not carry the abnormal gene, your chances of having an affected child are zero.
In a few diseases such as tuberous sclerosis or neurofibromatosis, the recurrence rate may be as high as one in two. If you, as the parent, had tuberous sclerosis, for example, half of your children could also have the disease and may have seizures.
If one of your children has idiopathic seizures, seizures for which the cause cannot be identified, the chances of other children also having seizures is twice as high as in the general population. Thus, they would have a 3 to 4 percent chance of having epilepsy. If one of your children has a febrile seizure, or a seizure after head trauma, the chances of brothers and sisters having similar seizures are also twice as high as the general population.
In summary, there is a genetic tendency to inheriting epilepsy, but the risk is small both for the child of a person who has epilepsy and for her brothers and sisters.
*271\208\8*
MEDICAL TREATMENT OF SEIZURES: BLOOD LEVELS OF ANTICONVULSANTS AND THE THERAPEUTIC RANGE
One of the principal advances in our ability to control seizures came when we learned how to measure the amount (level) of an anticonvulsant in the blood. From knowledge of this level, we were able to assess the amount of the drug actually reaching the brain. And yet this advance is less than two decades old.
Even now many physicians do not fully understand the use of blood levels and the concept of the “therapeutic range” of a given drug. Parents (and physicians) often believe that these levels ensure control of the seizures or guarantee the absence of side effects, misbeliefs that often lead to misuse of the blood levels.
Blood levels are measured in the serum (liquid portion) of the blood, which may be taken by needle stick from a vein or by pricking the finger. The level is measured in many laboratories, most, but not all of which belong to a quality assurance program. (There are several different methods of measuring the drug level, but those techniques are not important here.) The test must be requested and interpreted by your physician.
The level of the drug in the blood will vary, to some extent, depending on how long after the previous dose the blood is drawn. Remember, we have talked about a drug’s half-life. The level of the drug in the blood will be highest one to two hours after a dose, when most of the drug has been absorbed. The level will be lowest just before the next dose. How much variation there will be between those two will depend on the half-life of the drug and the time between the doses. While some physicians prefer to measure the level at the “trough,” the low point, this measure is only important if the child is having seizures at that time. It may be just as important to measure the blood level at a time when the child is having seizures to see if the level is low, or to measure it when the child is sleepy, dizzy, or having other unexplained symptoms in order to ensure that the level is not too high.
*110\208\8*
THE CARBOHYDRATE ADDICT’S PROFILE
CHANGING THE HORMONE BALANCE BY REMOVING OR DESTROYING GLANDS – REMOVAL OF THE ADRENAL GLANDS (GENERAL INFORMATION)
The problem is that this operation also permanently removes our only source of corticosteroid homones. As we have seen, these hormones are essential for life. If your adrenal glands are removed, you must take as much corticosteroids as they would normally have produced, for the rest of your life. This means taking about forty milligrams (mg) of cortisone or ten milligrams of prednisone or one to one-and-a-half milligrams of dexamethasone every day and much more whenever you are under stress. The symptoms of corticosteroid deficiency and what to do to prevent these from happening.
If your adrenals are removed, you should at all times carry a card or wear a bracelet stating this. It is essential that, in any emergency, your doctors know that you must be given large amounts of corticosteroids.
What are the alternatives to removal of your adrenal glands? With breast cancer, the chance of this operation producing a remission is similar to the many other ways of favourably changing the hormone balance. Remember that there is even another way of stopping your adrenals from producing hormones. Aminoglutethimide can do this by chemical means and has the major advantage of producing only a temporary effect. Whenever the treatment is not controlling your cancer, it can be stopped and your adrenal glands will start working normally again within a few weeks. If they’ve been removed, you’re stuck with taking replacement hormones, not just for the time (if any) during which the treatment is working against your cancer, but for the rest of your life.
*453/40/1*
OVERCOMING CANCER: OUR PATIENTS’ EXPERIENCES WITH THE RESENTMENT IMAGERY PROCESS
We have frequently observed over the last several years that after our patients have forgiven others, the final person to forgive is themselves—for their own participation in the event and their contributions to the discomfort and stress that followed it. This can be an especially important process for people with malignancy, because they often find themselves victims of a guilt-resentment cycle for having the disease and having given their families pain and stress. Three examples may clarify how this process has actually worked.
Edith
Edith, fifty-three, had breast cancer that had spread to her bones and intestines. An only child, she had been extremely fond of her father, a charming, successful man, but she felt that her mother consumed so much of her father’s attention that there was none left for her. She felt angry toward her mother and competed with her for her father’s love.
While Edith was in her forties, her father died of cancer. She suffered a great sense of loss from his death and now found herself responsible for caring for her mother, who was quite elderly and living in a nursing home. Her mother complained bitterly if Edith did not visit her every day, and even when she did visit regularly, her mother invariably evoked feelings of guilt and inadequacy. Edith not only had the present inconvenience and emotional turmoil of caring for her mother, but she also felt forced to cope with earlier unresolved feelings of resentment. Shortly after her father’s death, Edith developed breast cancer.
After she became aware of her resentment, we suggested that she visualize good things happening to her mother. While practicing this exercise for several weeks, Edith gained new insights into her mother’s loneliness, particularly since her widowhood, and began to see that her mother’s demands and complaints were not aimed at her personally but came out of her fears and frustration. She also became aware of her own feelings of insecurity and inadequacy generated by her father’s death.
As a result of these recognitions, Edith was able to make decisions about whether or not to visit her mother without feeling guilty when she did not visit her. She also discovered that when she reacted less defensively to her mother’s comments, her mother’s behavior became gentler. An unexpected payoff from resolving her feelings about her mother was that Edith found she was able to communicate more satisfactorily with her own children.
Edith had a dramatic remission of her widespread metastases and has been able to remain very active for the past three years.
Betty
Betty, thirty-five, was experiencing much anger and hostility. She was quick to challenge almost everything—the temperature of the room, the quality of the food, anyone who asked her why she smoked, and so on. After a very upsetting conflict with a member of our staff, Betty tried the resentment imagery process and discovered she had a seemingly endless list of things about which she could feel resentful. Indeed, she even found that she would seek out other people’s difficulties and start resenting for them. For instance, at our residential treatment center, she discovered that the staff cook and the cook’s husband were unhappy with the center’s manager and planned to quit, and she brought their resentment up at our group meetings.
As she became aware of the role these feelings played in her approach to life, she also recognized that she had learned this approach from her mother, whose attitude had been that “the world was picking on her.” (Betty’s mother, incidentally, had died of breast cancer.)
We worked with Betty again after she had been using the resentment imagery process for six months, and it was quickly apparent that she had changed significantly. Gradually, she had learned to catch herself when she started to collect resentments and recognize that, even if injustices did exist, she was damaging her own health by going out of her way to look for them. Her facial expression had softened, she was much more direct in expressing her feelings, and she felt less depressed and anxious. Psychological tests that we gave her also indicated that she spent less time repressing and denying her feelings, showed increased resiliency and, in general, felt better about herself.
Ellen
At thirty-two, Ellen had breast cancer with bone metastases. During her initial work with us, she began to realize that she had spent much of her life blaming her parents, particularly her mother, for having damaged her psychologically in her early childhood. She blamed much of the pain in her life on that perceived hurt.
When we asked her to use the resentment imagery process and report on it, she said that at first she had great difficulty creating a picture of her mother. Then, after forcing herself to picture her mother and see good things happening to her, Ellen discovered that she was really angry with herself for having messed up her own life. She realized that she had used the resentment toward her mother as an excuse to avoid facing her anger at herself, and she saw that the person she really needed to forgive was herself.
Ellen began visualizing hugging herself, patting herself on the back, seeing good things come about in her life. She changed noticeably. Whereas she had formerly shown very little emotion and often felt extremely depressed, now she began to show signs of vitality and energy.
Importantly, Ellen learned to use her feelings toward her mother as feedback. Whenever she found herself raking over old resentments toward her mother, she knew she was covering up anger at herself. At such times, she would visualize herself with greater self-acceptance and more responsibility for solving her own problems. One year later, psychological tests indicate that considerable psychological improvement has taken place. Her physical health has also improved greatly. She is very active and has no evidence of disease at this time.
*57\347\2*
BREAST X-RAY: MAMMOGRAM
This is a specialized breast X-ray where the breast is sandwiched between two X-ray plates. I joked once, when having a mammogram myself, that if men had to have them, they would never have been designed the way they are. The radiographer told me that unfortunately men with testicular cancer do have to go through exactly the same routine, only it isn’t their breasts – keep that in mind as you go through the minor indignity of a mammography check. It is a slightly uncomfortable (not painful) procedure, less so for post-menopausal women whose breast tissue is less active than in younger women. Usually four X-rays are taken, two of each breast – one compressing the breasts horizontally and one vertically.
Mammograms are more useful for women beyond the menopause when the breasts lose volume and ducts shrink and eventually atrophy. There is less to confuse the eye when interpreting the results and so it is more successful at picking up small cancers. Mammograms will only show the breast itself (i.e. not the axilla tail or underarm area).
If you are unhappy with a mammogram result, have the situation reviewed by a breast surgeon, as about 10-15 per cent of the time a malignant lump will not show up on a mammogram. A persistent lump, which does not go away or which changes in nature, should always be investigated further.
To improve the chances of the mammography being accurate, make sure that you point out to the radiographer the location of any lump, and if you are uncertain that the positioning on the film plate prior to taking the X-ray is appropriate, say so. Do not be embarrassed about discussing these questions with the technician.
Mammography is also used for routine screening of post-menopausal women, as well as for investigating suspicion of breast cancer. Calcification of tissue can be seen in very early development of breast cancer and is one of the signs that are looked for with mammography. However, calcium flecks, known as calcifications, can also result from stagnant milk secretions within breast cysts and are totally harmless. Micro-calcifications are more suspicious if they are clustered in one section of the breast than if they are scattered throughout the tissue, and around 20 per cent of micro-calcifications turn out to be cancerous.
*48\240\2*
COMING OFF DRUGS: A HEALTHY BODY-SEX IN RECOVERY
Most addicts feel considerable anxiety about sex now that they are clean and sober. Many of them have literally never had sex without having also had some mood-altering drug or drink. Completely sober sex is thus a new experience which frightens many. Many male addicts will have been impotent at times during their drug-using and drinking life. Because of drug or drink use, many women will have had few, if any, orgasms.
If you are single, it is not a good idea to rush into a sexual relationship. Newly recovering addicts find the emotional side of a love affair just too difficult to handle. They find themselves heading for disaster. In some way, addicts and alcoholics only a few months off drugs or drink are like teenagers. They become passionately infatuated very easily. When the love affair breaks up – as such infatuations usually do – the pain of it is almost unbearable.
Newly recovering alcoholics and addicts should avoid relationships in their first year of recovery. This is nothing to do with puritanism. It is simply that the drama and pain of a love affair are too much for them. Rushing into love affairs too soon may result in turning back to drinking or drug-using.
It is also a good idea not to get involved with other recovering addicts or alcoholics of the opposite sex in the first year of recovery. Really well-balanced addicts who have been clean for several years don’t pick up or get emotionally involved with newcomers. Those who do tend to be the less healthy members and should be avoided for that very reason. You don’t want a sick relationship on your hands!
Apart from anything else, keeping away from relationships for the first year helps you concentrate on recovery. And in the first year this is, above everything else, where all your energies should be centered.
*108\116\2*