WHAT’S HOT IN DIABETES: TYPE 2 DIABETESA critical issue in type 2 diabetes is the steady increase in prevalence over the past decade, particularly in developed countries. There has been an alarming increase in numbers of obese individuals and the choice of a sedentary lifestyle. It is now clear that type 2 diabetes is caused by a combination of insulin resistance and progressive insulin deficiency, and therapy must be directed at both defects. Exciting studies have now demonstrated that intensive lifestyle changes, including a regular exercise conditioning program and modest weight reduction (5-10%), will delay the onset of type 2 diabetes in those with impaired glucose tolerance. Specific methods to accomplish this, as was done in the research trials, are now widely promoted. Translation to the real world will be difficult.One of the most exciting developments in diabetes is the general acceptance by the medical community that a metabolic syndrome (previously called Syndrome X or the Insulin Resistance Syndrome) usually precedes and accompanies clinical diabetes. This syndrome has the essential components of impaired glucose tolerance (or frank diabetes), centripetal obesity, hypertension, elevated plasma triglyceride, and low plasma HDL cholesterol levels in variable combinations. Other vascular risk factors may be present, such as microalbuminuria and decreased fibrinolytic activity. A focus on prevention of future cardiovascular events in these people who often have “mild” diabetes has dramatically changed our therapeutic strategies, very early in the course of diabetes mellitus.*4\357\8*
CONTROLLING RISKS FOR CARDIOVASCULAR DISEASES: MONITOR YOUR CHOLESTEROL LEVELS If a blood test reveals that you have a high level of total cholesterol (more than 240 mg/dl), the first thing you should do is to have the test retaken to make sure that the reading is accurate. (Remember that prior to having your blood drawn, you must not eat or drink anything for 12 hours.) If your total cholesterol level still high, you should request that a lipoprotein analysis be done to determine the level of LDLs and HDLs in your blood. Lipoprotein analysis, which also requires that you fast for 12 hours, measures the level of three substances: total cholesterol, HDL, and triglycerides. The level of LDL is derived using a standard formula: LDL = Total cholesterol – HDL – (Triglycerides:5). For example, if the level of total cholesterol is 200, the level of HDL 45, and the level of triglycerides 150, the LDL level would be 125 (200 – 45 – 30).In general, LDL is more closely associated with cardiovascular risks than is total cholesterol. However, most authorities agree that by looking only at LDL, we ignore the positive effects of HDL. Perhaps the best method of evaluating risk is to examine the ratio of HDL to total cholesterol or the percentage of HDL in total cholesterol. If the percentage of HDL is less than 35, the risk increases dramatically.The ratio of HDL to total cholesterol can be controlled either by lowering LDL levels or by raising HDL levels. The best way to lower LDL levels is to reduce dietary intake of the major sources of saturated fat. However, in extreme cases medications can also be used.*12/277/5*
TUMOR RECURRENCE AND TAMOXIFEN RESISTANCE: IS TAMOXIFEN RESISTANCE THE SAME PROBLEM?Typically, most patients with breast tumors that are estrogen and progesterone receptor positive will respond to tamoxifen. When they develop resistance to tamoxifen after six months to a year of therapy, the tumor will begin to recur. Fortunately, for many patients who no longer respond to tamoxifen therapy another effective hormonal agent can be found. These alternative agents usually work for a period of time not exceeding a year, after which the patient again develops resistance. Tamoxifen tends to be given as a “first-line” therapy because it has significantly fewer side effects than other hormonal agents, so the development of resistance to this drug is a significant clinical problem.At one time it was thought that a patient who no longer responded to tamoxifen probably was not taking the drug as directed (thus not enough drug was getting into the breast tumor cells) or perhaps was eating a diet high in “phytoestrogens.” These are estrogenic compounds found in many plant products that were believed to stimulate the growth of breast cancer cells just as estrogen does. The phytoestrogens are known to be capable of diminishing the effects of the antiestrogen tamoxifen. Weight gain over a prolonged period was also suspected to contribute to the loss of tamoxifen effectiveness. Because tamoxifen is a drug that is taken up by the fat cells and often retained in fatty tissue, an increase in weight without an increase in tamoxifen dose was believed to decrease the amount of drug available to the breast tumor. Even though all these explanations are plausible, their overall contribution to tamoxifen resistance is now considered minimal. Tamoxifen resistance apparently is associated with resistant mechanisms at the level of the breast cancer cell itself.*42\320\2*
It is not unusual to hear complaints about chills and colds when seasonal changes occur. Most people accept them as unavoidable, not realising that it >s really up to us to do something about them. Women seem to be more prone to catching colds, since they are usually more reluctant to exchange their elegant thin stockings for warm or, better still, thick knitted woollen ones. It would indeed be most appropriate to limit the use of elegant apparel in favour of warmer clothing, or even to put it away altogether for the duration of the winter.
The change of season is the most difficult time for the body, for it is still accustomed to the warm summer and unprepared for the sudden onset of cold weather. That is why we must protect the body with whatever clothing is appropriate for the weather. Most important of all, keep the feet warm and, as I have pointed out already, woollen stockings and a pair of good, warm shoes are indispensable if you wish to discourage colds. It is an accepted fact that warm feet and a cool head are necessary for good health. As long as the feet are warm we will hardly ever catch a cold, because the feet are the indicators of the general warmth of the body.
*143/28/1*
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As leucorrhoea often affects the kidneys, although these will benefit from the sitz baths, they will need further stimulating. This can be achieved by taking a mild kidney tea together with Nephrosolid. It is understandable that leucorrhoea can have a weakening effect on the nerves. Hence we will want to build them up by regularly taking Avenaforce in alternation with Ginsavena. Neuroforce tablets are also excellent for this purpose.
On the other hand, I would advise against the use of strong antibiotic medicines. Why? Because these drugs destroy not only the harmful but also the useful and necessary bacteria, making the restoration of bacterial flora more difficult. If we want to cooperate with nature we must not first destroy its workings. Rather, we should take care and refrain from drastic medicines that destroy the beneficial organisms we want to build up, for experience shows that harmful bacteria recuperate faster than the useful ones.
The treatment of leucorrhoea, usually a very stubborn condition, requires patience, perseverance and absolute regularity in taking medication. There is no other way to achieve a permanent cure. At the same time, it is very important to avoid any detrimental habits and influences even after the cure has been achieved.
*142/28/1*
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There are many different ways of choosing a babysitter. Some parents form a babysitting club with others where they take turns to look after each others’ children. Most commonly, parents will find someone by word of mouth, from friends or neighbours. Often there will be teenage children in the neighbourhood who will be looking for extra pocket money. There are babysitting agencies who charge a commission (usually this is paid by the babysitter), and who carefully screen applicants before they will employ them. Although agencies usually are a little more expensive, they have the advantage of ready availability of a sitter, as well as a careful selection process.
If you are considering using someone you do not know, ask for references and make sure you interview her beforehand about her experience and to get a sense of her personality and how she relates to children. You may want your children to meet the babysitter as well, to see how they relate to each other.
have her visit in advance, preferably during the day, or at least to come an hour or so before you leave. This time is important as it allows her to meet the children and become familiar with the house.
Show her around the house, including the doors, locks, location of telephones, alarms, torches, first aid kit, light switches, and so on. Make sure she knows what to do in an emergency, how to handle the children if they wake from sleep, and any special needs they may have. It is important to leave the telephone number for where you will be, and an emergency phone number of relatives or friends in case you cannot be contacted for some reason.
Remember that having a babysitter should be a positive experience for your children and so preparation is important. Your usual sitter may sometimes be unavailable, so it is a good idea to go through the process described above with a couple of sitters.
*106\90\8*
OUR MARITAL HEALTH/SEX AND PROBLEMS OF DAILY LIVING: WORKING IN SEXUALITY
1 think the only people who can have a career and have a lot of sex must be prostitutes. They do it for their living. I have to make a living and then try to make time for sex, and there isn’t much of that at all.
WIFE
Working and the workplace are two of the major sources of stress in our society. They take a physical and emotional toll everyday of our lives, sometimes leaving us with little time or interest in other areas of daily living. My interviews indicated that, unless we are able to enjoy our work, little else will bring us happiness.
Although there were exceptions, men interviewed tended to view their work as closely related to their self-esteem. They often felt sexually invigorated by some “conquest” or “victory” at work. “I can tell when he’s made a big sale,” said one wife. “He comes home horny. He wants victory sex.” “That’s true,” responded her husband. “When I’m on my game, I want to get on her.” Even though both partners laughed during this exchange, the male success-object orientation is often seen in the work/sex connection.
Women are equally involved in their careers, but they continue to be expected to “add” career or working outside the home “to” their lives. The men interviewed tended to be more supported in their work, and more adjustments were made for their working than was true for women. Women were expected to find more hours in their day, to add to an already heavy home workload. Sometimes token, sporadic chore-sharing on the part of husbands was the only accommodation made for the working wife. The increased frequency of wives working outside the home is more an addition to rather than change in the role of the married woman.
I recently asked an all-male audience how many of their wives worked. Several hands were raised. I then asked how many of their wives worked outside the home. Many of the men were perplexed, even embarrassed at their own sexism, which resulted in their failure to see work done at home as “real work.” This same sexism causes many wives to attempt to carry an unhealthy burden of career development, income production, and almost solo home maintenance.
Recent data indicate that over one third of women with master’s degrees in business administration “opt out” of the business world. More likely they are “pushed out” when they hit the ceiling of resistance to women in high positions, and confront the inevitable sexist assumption that they, more than men, have “other things” that are more important. An increasing health risk exists for women unless the “Wonder Woman” syndrome of doing it all is addressed. Doing it all can seldom allow for fulfilling sexuality.
“I feel like I’m drained,” said the wife. “At work, I get calls about the kids’ school and even think about dinners, entertaining, house issues. At home, I hardly have time to think. I certainly don’t have much energy left. Sex takes energy, so it gets on the agenda, reported in the minutes only when we can both find some time.”
*216\97\8*
Sex roles are very complicated in most societies. This third point is less a sociological or anthropological question than it is a clinical question about expectations of maleness in your own relationship. Warren Farrell, in his book Why Men Are How They Are, and Carol
GilHgan’s book In a Different Voice provide interesting insights about this issue. How do you see men?
Dr. Farrell reports that male fantasies emphasize variety of sexual partner and the challenge of the hunt, of finding new and better sexual objects. He writes that women value sameness of partner, commitment to and from one man. Dr. Gilligan suggests that all interactions with the primary caretaker, in almost all cases the mother, determine the gender-role behaviors of men and women. Both researchers know that the brain-experience connection is a mutually influential one.
“I know this will date me, but I see men as providers, caretakers, and sexually active. They are aggressive and less emotional than women. I know that sounds stupid, but it is how I see them.” This report from one of the wives was not atypical. Stereotypes die hard and continue to influence the sexual interaction within the marriage, regardless of intellectual protests of “nonsexist” views.
“Men just have to do it all, and I think they want to do it all. It is in the nature of things and in their nature to be the doers, the responsible ones,” reported one husband. You can see the love maps of both these spouses. Can you imagine how each of these people came to feel and behave as they do?
A word of warning. It is not always the case that the spouse’s actual behavior matches his or her report. How we feel is the real love map. How we behave is only a rough approximation of that map and is filtered and changed by social constraints that may mask the real map itself.
*76\97\8*
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