At the same time that you’re working on many other changes, you may be entering a new phase of dealing with external appearances and differences. Recall the time it took for you to get used to the change in your image after you started using assistive devices, such as braces or a wheelchair. Remember how Joan refused the power wheelchair for a couple of years because it looked stodgy and bulky? As she reentered life more fully, she realized that the power chair gave her greater freedom and autonomy to do the things she wanted to do. She began to adapt or modify her image of herself in the power chair. This is what reframing your self-image is all about.

As you gain more self-direction, you’ll probably feel free to make the decisions that feel right to you, including decisions about how you present yourself to others. Have you learned the art of reframing your picture to highlight those aspects of yourself that you value most – a well-developed, muscular upper body, beautiful long hair, friendly eyes, nicely proportioned figure, big smile, or symmetrical features? Lee, for example, is conscious of the cut of his suit jackets, preferring a shorter cut, which looks better when he’s in his wheelchair. Lark wears slacks because she feels she looks more attractive in them. She always dresses up, believing that “people treat you with more respect” if you are well dressed and that a good appearance creates positive attitudes and enhances relationships with others.

Remember: there are many “right” decisions. Listen to your inner voice to find out what you want. Some people proudly include their sports wheelchair or crutches or power chair in their photographs. Others do not. How you choose to see yourself is up to you. This is a part of the fine-tuning of your adjustment to spinal cord injury.

*168/156/5*

Mindfulness is a way to listen more closely to your mind and body to increase your understanding of your inner self. It gives you more personal power over your cravings and emotions. It provides a way to observe your mind, to watch your thoughts and feelings without being caught up in them.

Mindfulness is simply a different way of looking at things, a way that will enlighten, strengthen, and empower you. I see it happen to people every day.

The three characteristics of a mindful approach to your eating are:

1. Paying Attention

You must begin to focus your attention on the thoughts, feelings, and circumstances that trigger your desire to eat and make it difficult for you to stop eating. This means paying attention. Paying attention means not allowing yourself to be distracted.

2. Increasing Awareness

Once you begin to pay attention to your eating, you must begin to develop a sense of focused concentration on all aspects of your relationship with food. You must become aware of the details of how, what, where, and why you eat.

3. Focusing on the Present Moment

Mindfulness involves focusing on a particular moment in time. When you eat, you must begin to concentrate exclusively on eating. During a meal, I don’t want you to be thinking about what happened earlier in the day or what is going to be happening tomorrow. Neither do I want you to be on automatic pilot, only half aware of what you are doing. This will be a new experience since we live most of our lives in the past and future in a semiconscious state of going through the paces of day-to-day living.

*64\358\8*

The normal vagina is potential space but during this Stage , the upper two-thirds balloons out and forms a cavity to accommodate the erect penis. The lower one-third is narrowed because of vasocongestion and grips the penis firmly. The uterus also enlarges during this stage, and a remarkable yet consistent change takes place in the clitoris. The whole clitoris retracts upwards in front of the symphysis pubic bone, while the glans withdrawn beneath the foreskin. It is not easy to locate the body and the glans of the retracted clitoris with the finger and inexperienced males—often fumble searching for it.

The clitoral body retraction is a sure sign that the female is about to reach her orgasm if stimulation is continued, otherwise the clitoral body and glans promptly return to their original overhanging position. In fair women, the inner lips (labia minora) become congested and appear bright red in colour. The colour change is not so prominent in dark-complexioned women.

The Plateau Phase may last from 30 seconds to a few minutes before culminating in an orgasm. If the orgasm does not place, pelvic congestion may persist for a few hours and may lead, to tension and frustration.

*104\262\8*

HRT has been seen as a universal panacea, a solution to all menopausal problems from osteoporosis to ageing skin. It has been pushed by the media and is supposed to give us the energy of a spring chicken and the libido of a teenager. The principle behind HRT is that it supplies us with hormones when our own production slows down. Thus we can avoid the hot flushes, the night sweats and many of the other ‘symptoms’ of the menopause with the medical equivalent of one-stop shopping. Dr Ellen Grant, who wrote The Bitter Pill, suggests that HRT, which delivers a constant level of oestrogen, is like having a car stuck in a single gear. Surely it is better to let our own pituitary gland and ovaries work together to make fine adjustments constantly for our hormone needs at each moment, like a car with automatic gears? Given optimum health, our hormones are able to balance themselves. Our bodies are able to make the judgment on whether we have too much of one hormone, or need to produce more of another: just like a central heating thermostat, which will switch on the boiler if the room temperature drops and turn it off again when the room heats up.

Oestrogen therapy has been around since the 1930s when injections of oestrogen were given for menopausal symptoms. Because of the inconvenience of this form of treatment, implant pellets of oestrogen were introduced in 1938. HRT was originally called Oestrogen Replacement Therapy because only oestrogen was given as the treatment. However, it became clear that giving oestrogen alone could increase the risk of cancer of the womb and breasts. When research studies appeared to demonstrate that this increased risk could be up to seven times higher for womb cancer, there was panic. Oestrogen therapy declined sharply in popularity. Then progestogen, the synthetic version of progesterone, was added to the therapy for ten to fourteen days each month and HRT, using both hormone drugs, was re-marketed. Since then there seems to be no end to what HRT can do for us. There is always something new. Over the last year, I have seen newspaper reports that HRT might help patients with ME, inflammatory bowel disease, post-natal depression, pre-menstrual migraine – and prevent Alzheimer’s disease. An opera singer found that it had a wonderful effect on her voice. Most of us are much more interested in just what the risks of HRT really are. The main reasons for the addition of progestogen to HRT are to protect the womb lining from over-stimulation and subsequent cancer, and to cause a regular bleed. Women who have had a hysterectomy obviously cannot get womb cancer so they are not given progestogen.

It is important to make clear the difference between progesterone (our own naturally occurring hormone) and progestogen (the synthetic hormone in the Pill and HRT). Many people, even doctors, treat them as the same thing and they are not. Progesterone is made just prior to ovulation by the corpus luteum and is the major female hormone for the second half of the menstrual cycle. It is absolutely necessary to maintain a pregnancy. As progesterone raises at ovulation our body temperature rises ready to ‘incubate’ the fertilized egg. If we are pregnant, progesterone continues to rise. If we are not pregnant, both oestrogen and progesterone levels fall and we have a period. If a woman does not produce sufficient progesterone when the egg is fertilized, she can miscarry.

Progestogens, on the other hand, are synthetic. Though they are able to fulfill many of progesterone’s functions, the human body has difficulty ‘recognizing’ and coping with progestogens because they are not natural, hence the well-known side effects such as mood swings, depression, etc. These synthetic progestogens are used for their progesterone-like action but they can have additional male or female hormone effects. So one type of progestogen may cause enlargement of the breasts, while another can increase the growth of facial hair. All somewhat alarming.

*9/101/5*

“Amino acids” are a buzz-word today. We buy amino acid shampoos and hair conditioners, amino acid skin lotions, even amino acid cosmetics. Unfortunately, most of this is pure sales hype; few people really understand how these amino acids affect our health and weight.

In the first place, they aren’t even what you think of as acids. They don’t sting or eat into your skin, and they’re not corrosive. You can swallow them without burning your throat. Their name comes from the fact that they belong to the chemical family of acids.

Amino acids are the building blocks of your body. You get them from the protein you eat, which is made up of combinations of different amino acids. Your body breaks protein down into its amino acid building blocks, then uses those blocks in various combinations to make your hair, fingernails, muscles, cells, tissues, and chemicals. In all, there are twenty-two different amino acids your body needs.

When I was explaining this to one of my patients, a sculptor and artist, her face lit up. “I get it, it’s simple. They’re just like the color chips of a mosaic. Each color is different, with its own identity and characteristics, but they all fit together to make the whole thing work!” I had to admit, after years of reading learned papers on the subject, that’s still the best explanation I’ve ever heard.

*58\242\2*

Planning the diet means more than just including certain foods in the daily menu. There are many other factors that can influence the digestion, and these must be carefully considered before we get down to the selection of food. Among other things we have to think about overeating, eating too rapidly, eating when tired and taking food into the stomach when the digestion of a previous meal is still going on. When we are analyzing our daily habits these things are worth thinking about. It is not a matter of following rules like a rule of thumb; it is better to inculcate them into the general way of life.

We should have three mealtimes a day because this gives the stomach time to finish its processes. To eat between meals is plain folly like trying to do one job before the other is finished. This is often a mental rather than a physical habit, and certainly is not the call of hunger. Eating when tired is a bad habit, and is asking for trouble. Such a thing may set up indigestion that will hang on for many months unless it is carefully handled. Over-eating is not the bad habit today that it was many years ago. Still, it does exist, and must be eradicated as a habit that undermines the health of the system.

Rushing over a meal will often lead to trouble and is a matter of temperament more than anything else. Persons who practice this habit feel deep down in their consciousness that eating is not important and they begrudge the time that is given to it. This’ is a habit that has usually developed in early life and will take a good deal of patience to eradicate. But it must be overcome. Taking food quickly into the stomach without thoroughly chewing it and tasting is an act of sheer vandalism. Nature has added her exquisite flavours and aromas to foods to tempt the taste and smell so that they should be enjoyed leisurely and deliberately.

It is just as important, therefore, that we bear these points in mind as it is to get the proper food into the diet.   If we are out of temper with the world and ourselves and rush our meals, the digestion is bound to suffer; and no matter how pure and suitable the food may be, a stomach that is upset will fail to make good use of it. Before any kind of food can be digested and assimilated the alimentary tract must be in the condition to accomplish it, so that point precedes the regulation of the diet.

*40/154/5*

At around forty, people enter a period of transition from their younger years to what has traditionally been called “middle age.” It is a time when the visions and energy of youth begin to give way to hard realities and when most people first confront their own mortality and sense that time is running out. Some feel alarmed because their physique has folded and their youth “has flown the coop,” never to be regained (despite attempts at fancy diets, jogging, hair dye, and face-lifts). For most people, life must be reappraised in terms of goals, accomplishments, and experiences. As a result, a midlife crisis sometimes begins to take shape. From a sexual perspective, the male seems to be particularly vulnerable to the midlife crisis. Since rumor has it that after age forty a man is “over the hill” sexually, many men begin to check their sexual performance for signs of wear and tear. This is well-described in the following:

He notes that it takes more time to become aroused. Where it used to be a matter of seconds and a mere glance at the orbs of flesh colliding beneath a pair of tennis shorts, he may take minutes or more to reach erection as he gets older. He also notices, correctly, that he is slower on the comeback. In the sweet agonies of teen age he may have walked about with an erection all day, seldom completely losing it even after he made love or masturbated — a virtual prisoner of his hormones and tight-fitting pants. But now each sexual act has a definite beginning and end, and it may be a matter of hours or all day before he can reach erection again. Comparisons, stinging comparisons … he is not the boy he once was.

Once a man begins to question his sexual capabilities, the odds are that he will experience difficulty getting or keeping an erection. This, of course, “proves” the correctness of the underlying concern, and a vicious cycle is set in motion.

Some men turn to younger sexual partners to heat up their passion4 and Others succeed, at least to a certain degree, in blaming the problem on their wives. But the middle-aged male is in a precarious position of sexual vulnerability. If he goes to a physician to discuss the problem, he may be told (as several of our patients have been), “At your age, you shouldn’t worry about it anymore.”

The woman’s midlife crisis is less apt to include concern about her sexual capacity. For women who have chiefly been mothers, it is a time for an emerging identity, a freeing of the inner self as children reach a relative stage of greater independence. It is a bittersweet time in which a woman who has not established a career or nonfamily interests may mourn the passing of her offspring into their own maturity and may simultaneously look at available options for redirecting her talents and energy. As children leave home, the “empty-nest syndrome” may strike, causing depression and listlessness as the woman tries to deal with too much unstructured time and few sources of rewarding or interesting activities. Since these vulnerable feelings may be followed by or coincide with the menopausal years, it may be a particularly trying period for such women. Interestingly, recent research suggests that it is not only women who may be affected by the empty-nest syndrome. Roberts and Lewis point out that men are also sometimes distressed by their children’s departure from home, “discovering that their marriages and friendships had become empty shells about the same time that loved children were leaving.” Of course, having children leave home can have positive effects on a marriage, too — for instance, it gives couples a chance to focus on their own interaction and can create opportunities for freer, more relaxed sex as well.

There are more and more variations on the midlife transition today. Career-oriented women who postponed motherhood (and time off from work) until their mid-thirties may be anxious to reconfirm their work identity, but may have trouble finding a job or getting back on the “fast track.” Other mothers who refused to restructure their lives around childrearing and continued to work outside the home — either by choice or by economic necessity — may feel considerable guilt or exhaustion. Still other women find their lives complicated by divorce and face child-rearing as a single parent; alternatively, if they remarry a man with children of his own, the family interactions may become particularly complex.

Another component of the midlife crisis for both sexes that has been generally overlooked is the phenomenon of sexual burnout, which may affect as many as 20 percent of people in this stage of the life cycle. Unlike occupational burnout, which occurs largely in reaction to a person’s intense investment of time and energy in his or her work coupled with chronic, unrelenting emotional pressure, sexual burnout stems from tedium and satiation with the same sexual-routines. More than simply boredom, which can certainly be one of its precursors, sexual burnout is typically marked by a sense of physical depletion, emotional emptiness, and a negative sexual self-concept. Caught in the throes of sexual burnout, the middle-aged adult develops a feeling of sexual helplessness and hopelessness, as though nothing can be done to rekindle erotic passion or pleasure. Sexual burnout occurs not only in married couples but also in singles who have previously been very active sexually.

Sexual burnout is not the same as the sexual lack of interest that often accompanies depression. Depression is typically marked by disturbances in sleep and appetite and by a general loss of pleasure in all or almost all usual activities or pastimes. People experiencing sexual burnout do not have these symptoms. While the prognosis for sexual burnout is generally good, since most people recover spontaneously from this syndrome over time, about 10 percent of those affected remain sexually inactive on a relatively permanent basis. Perhaps this indicates that they are happier with celibacy than with cultural stereotypes that prescribe sexual participation as obligatory for a “healthy” adulthood, or perhaps it shows their inability to overcome the negative effects of the sexual burnout syndrome.

Of course, not everyone experiences a full-blown midlife crisis, and for some, the forties and fifties are a time of happiness and sexual satisfaction. One woman told us, “I’d never want to be twenty-one again — being forty-five is more fun!”

Most men have “discovered” their sexuality in a joyous way by their twenties, but — at least in past generations — a sizable number of women did not awaken from their socially programmed sexual dormancy until their thirties or forties. Given the traditional limits set on female sexual behavior and feelings (“nice, girls don’t. . .”) and given the traditional division of marital responsibilities (domestic and childbearing duties are “female,” career orientation is “male”), this pattern should come as no surprise. As a result, many women undergo a process of sexual self-discovery in mid-adulthood, perhaps including being orgasmic for the first time. The woman in this phase of the life cycle is just as likely as her mate to seek out extramarital sexual opportunities, although this fact is not written about extensively.

The sexual problems of mid-adulthood are not restricted to heterosexuals, although little attention has been given to the middle-aged homosexual population in America. Here, too, a wide variety of patterns is seen. Gay men in their forties may find that it becomes more difficult to attract younger partners on physical grounds alone. As a result, some homosexual males turn to paid male prostitutes, others become relatively celibate, and still others form long-term relationships that provide companionship and emotional support as well as sexual opportunity Gay men who were previously in heterosexual marriages — including many who were fathers — often decide to divorce and change to an exclusively homosexual life.

It has been noted that some gay males who have put an emphasis on conquests, techniques, and the ideals of the youth culture develop much anxiety about aging. These men sometimes resort to face-lifts or hair transplants to retain the illusion of their youthfulness (as some heterosexual men do, too) and they often develop depression or become alcoholic as a reflection of the negative sense of self they experience as their aging becomes more apparent. However, most homosexual men do not encounter such difficulties; generally, they have the same types of problems as they grow older that heterosexuals have.

Lesbians are often able to make an easier transition into middle-adulthood because of the fact that more of them are in lasting, one-to-one relationships. Nevertheless, while concern over physical attractiveness may not be quite as strong an issue as it is for some gay males, there can be intense jealousy that arises in these relationships “whenever the relationship is threatened by other women who might intrude and attempt to disrupt the coupling”

*97\342\2*

Makes about 35 ounces

This stop gap formula can be used in emergencies or when the ingredients for homemade formula are unavailable.

1 cup Mead Johnson low-iron, milk-based powdered formula

29 ounces filtered water (3 5/8 cups)

1 large egg yolk from an organic egg, cooked

31/2 minutes (See recipe for egg yolk)

1 teaspoon cod liver oil

Place all ingredients in a blender or food processor and blend thoroughly. Place 6-8 ounces in a very clean glass bottle. (Store the rest in a very clean glass jar in the refrigerator for the next feeding.) Attach a clean nipple to the bottle and set in a pan of simmering water until formula is warm but not hot to the touch, shake well and feed to baby. (Never heat formula in a microwave oven!)

*27/165/1*

One of the commonest early symptoms of diabetes among women is itching and soreness between the legs. The vulva and vaginal area, and sometimes the skin around the anus, are extremely sore and red and so itchy that the sufferer has a desperate desire to scratch, which is embarrassing and makes everything more sore. There is frequently a creamy vaginal discharge and the skin may be covered with white flecks. This condition is caused by the fungus which also produces thrush in babies. It can be cured by an antifungal cream (it is important to insert the cream high into the vagina to destroy the fungus completely) or by pessaries or special tampons. It is also important to control your blood glucose level, because the fungus likes a sugary environment.

Men can get thrush too, and may develop soreness of the penis. Thrush can be passed on by sexual intercourse and so both partners should use the antifungal cream.

The thrush fungus and other organisms may also colonize skin folds of very overweight people in places such as the groin, under the breasts and sometimes the umbilicus or belly button. This is because sweat collects there and provides a moist environment for the fungus to grow. Again, antifungal creams usually cure this, but the ultimate solution is to lose weight and to control your blood glucose level.

*35/102/5*

Cyclosporine

Cyclosporine is often used to suppress the immune system following organ transplants. It also provides benefits in rheumatoid arthritis, inducing rapid improvement when taken in high doses and slower improvement at low doses. There is some suggestion that cyclosporine may actually be a disease-modifying drug that can delay the appearance of new joint erosion, although this is far from proven. Unfortunately, cyclosporine can cause numerous toxic effects, including seizures, inflammation of the brain and kidney injury.

Leflunomide

The new kid on the immunosuppressant block is leflunomide, sold under the trade name Arava. Approved by the FDA in the fall of 1998, leflunomide is said to work by different mechanisms’ than most other immunosuppressing drugs. However, the exact mechanism is not certain. It appears to prevent more cells from being made in the synovial membrane by limiting cell division. Clinical trials of the drug demonstrated that it was able to relieve pain and swelling associated with rheumatoid arthritis, and it may slow damage to joints. Side effects seen most often in these trials included stomach upset, weight loss, rashes and other allergic reactions, and reversible hair loss.

Warning: There are concerns, due to information from animal studies, that the drug may cause birth defects; it should not be used by pregnant women, or even by women not using reliable methods of birth control. Like most of the rheumatoid arthritis drugs, it may also be toxic to the liver, and should not be used by anyone with liver disease. Your doctor should check your liver enzymes periodically while you are using it.

*27/306/5*