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MEDICATIONS FOR PEOPLE WITH TYPE II DIABETES: BLOOD PRESSURE MEDICATIONMillions of middle-aged Westerners have high blood pressure. As a person with diabetes, you certainly are at great risk for developing this potentially dangerous condition. About half of all persons with Type II diabetes have high blood pressure problems. You also may have a couple extra strikes against you if you’re middle-aged and overweight.Although the symptoms of high blood pressure (also called hypertension) are usually silent – just like many of the symptoms of your Type II diabetes – the potential for major health problems is loud and clear. Uncontrolled hypertension can lead to stroke and death.Fortunately, there are many blood pressure medications available for your doctor to prescribe. Although all these medications, when taken every day, are effective in lowering blood pressure, some of them can also affect blood glucose levels. In addition, some can cause fatigue that interferes with exercise or activity, some can raise blood fat levels, and some can damage the kidneys or eyes.Because of the potential effects on other body systems, your doctor will select a blood pressure medication that works well with your efforts to control your diabetes. (Don’t ever take any medication that has been prescribed for a friend or relative. Although that person may have hypertension just like you, the medication he or she takes may have adverse effects on you.)All the drugs used to treat hypertension have the potential of lowering blood pressure too much, leading to dizziness, especially when you stand up quickly or get out of bed in the morning. Be aware of this and take precautions to avoid taking a spill. If the dizziness or wooziness persists, talk with your doctor about it.If your blood glucose measurements go out of kilter when you start on a new medication or a different dosage, record the results in your diary and contact your doctor. A change in drug or drug dosage may be needed. The same advice holds true if you have been taking a drug at the same dosage for a while and suddenly start having abnormal blood glucose readings.Among the most popular medications used to treat hypertension are the angiotensins converting enzyme inhibitors (or ACE inhibitors). These drugs cause few side effects, don’t damage the kidneys, and are effective in people with diabetes. A group of medications called calcium channel blockers also are both effective and relatively safe for people with diabetes.Two other kinds of blood pressure-lowering medications are called alpha blockers and beta blockers. Alpha blockers tend to be used more commonly than beta blockers in persons with diabetes because they have less effect on blood glucose. Beta blockers are sometimes prescribed for persons with heart problems, so if you’re taking this type of drug you need to be especially aware of the possibility of the drug causing a low blood glucose reaction.*29/210/5*

COPING WITH SEIZURES AND EPILEPSY: THE FIRST “BIG” SEIZURE WHAT YOU SHOULD KNOWThere are many different kinds of seizures, and each may affect you and your child in a different fashion. Some children will have only one seizure. Others may have many. You, the parent, will have to find a way of coping, and so will your child. The child’s strategy will vary with his or her age, and the strategies of both of you will vary with your personalities as well as with the type and frequency of seizures. But common themes run through all these variations.Since a single seizure usually has its greatest effect on the parent, it is parents of these children who need advice first. In the second part of this chapter, we discuss how parents and a child can cope with epilepsy itself.The First “Big” Seizure What You Should Know”Richard just had a seizure!” you shouted at your husband over the phone. “He’s on his way to the emergency room in an ambulance! They said that he had a grand mal seizure! Meet me there right away!”A generalized tonic-clonic, shaking seizure (once called grand mal) is the type most frightening to parents. This one seizure has changed your life. Can you ever look at your child the same way again? Can you really let him go out and play in the backyard without watching him? Suppose he has another seizure? Maybe he could hurt himself. What would the neighbors think if they knew? Will your best friend still let her son come over to play? Will she take the responsibility of watching him? How about the school? Do you want them to know? Do you want it on his records? Will the school allow him to be normal, to do all the things his classmates are doing?The first thing you need is information. You need to talk to your doctor about what he thinks caused the seizure, about tests and treatment, and about your child’s future. If your child’s seizure was related to infection or head trauma (a provoked seizure), it is unlikely to recur. When your child recovers and whatever caused the seizure is gone, the seizures will be gone. If the seizure was caused by a fever (a febrile seizure), your child will probably need a few tests, but no treatment, and your child will outgrow these seizures as he gets older.But in more than half of the cases of seizures in childhood, no cause can be found. If no cause is discovered, that is, if your child has had an idiopathic seizure, the chance of recurrence is about 30 percent. In this situation, where you don’t know the future, it’s understandable that your anxiety may be higher. We emphasize to worried parents that the best thing is not to be able to find a cause because seizures of unknown cause are most likely to be controlled with medication and most likely to be outgrown, even if they recur. The causes we find are usually worse than the causes that we can’t find. This seems difficult for parents to believe. But it’s the truth.Even if the doctor finds a cause for the seizure—a scar, a tangle of blood vessels, or even a tumor—usually something can be done, as discussed earlier, or at least you know the cause and can focus your anxiety.*166\208\8*

Nothing gives greater happiness to a woman than giving birth to a healthy baby. No young person can fully understand the meaning of parental bliss until parenthood is realised. But how great is the distress when a sickly child is born, or worse, a deformed child, perhaps with twisted limbs, hands or feet missing, or any other of those terrible deformities which, unfortunately, can occur. How terrible must be a mother’s feeling of guilt when she has to admit to herself that she might bear some or all of the blame for this calamity. Scientific research has shown that the first four to eight weeks, even the first three months of pregnancy, are the most crucial as far as harmful influences on the developing life in the womb are concerned. Some suggestions are given below on what a mother-to-be can do to best prevent abnormalities in the develop­ing baby.
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Vitamin D is also essential, for if it is lacking, calcium will not be fully assimilated and utilised by the body. Oranges, cod-liver oil, various emulsions containing cod-liver oil, and all natural products and nutriments containing vit­amin D are indicated for this purpose. Vitaforce is a very good and balanced formula incorporating some of these substances.

Another important factor to consider is the efficiency of the kidneys and the skin. If these excretory organs are in any way obstructed, accumulations of uric acid and other metabolic waste matter will cause metabolic disorders and may prevent the assimi­lation of calcium.

Special attention must be given to the way you eat, that is, you should eat slowly, chewing the food thoroughly so that it becomes well mixed with saliva.

Returning to calcium for a moment, it has been observed that lack of calcium causes disturbances in the glands with internal secretions; the lymph glands can also be impaired. This can lead to flatulence, internal fermentation and putrefaction in the bowels, thus poisoning the system.
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Cause

These infections of the cuticle or nailbed are due to infection with bacteria or a fungus, which enter the skin through a crack in the cuticle of the nail. This is more likely to occur if your child bites or chews his fingernails.

Clinical features

The finger is swollen and red, and sometimes pus oozes from the nailbed or cuticle. The lymph glands in the armpit may also be swollen in reaction to the infection.

Treatment

If the infection is only mild, and no pus is present, soak the finger in an antiseptic solution and then apply iodine. If there is pus in the sore, your child will probably need antibiotics. If the infection is fungal, then your doctor will prescribe an antifungal cream which should be used for 2-3 weeks.

When to see your doctor

See your doctor if your child has any of the symptoms described above or you are worried.

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All children at some time have illnesses that require medical attention. Most will be relatively minor, such as the coughs and colds that are a normal part of growing up. Sometimes an illness may be more serious, so that prompt and expert medical attention becomes a matter of life and death. Access to good medical care for your child is very important, and parents need to choose a doctor carefully.

In some communities there is only one doctor, so there may be no choice. Most parents will have a choice of health care providers for themselves and their children. Some families will have gone to the same doctor or clinic for many years, and it seems natural that the children should also attend that doctor. While there are obvious advantages in the one doctor or clinic seeing all members of the family, many parents choose a different doctor for their children, for reasons outlined below.

If your family moves into a new community, you can obtain a list of local doctors from the Australian Medical Association or sometimes from the local hospital, or else ask friends, neighbours or the local maternal and child health or community nurses. Parents should not hesitate to ‘interview’ doctors to see whether they seem appropriate to provide medical care for their child. If you don’t have a good instinctive feeling about the doctor after talking to him, it may be wise to seek somebody else.

Here is a checklist of some of the things that you may want to consider in choosing a doctor for your child. The list is not intended to be complete and is not in order of importance. You may wish to add points you think are important.

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DIMINISHED AFTERGLOW: I don’t glow after sex, I just sort of smolder. I think it’s the origin of the word “burnout.” I feel spent.

HUSBAND

Absence of afterglow was reported in 907 of the husbands. They could not understand the idea of feeling invigorated after sex, instead feeling that sex had exhausted their energy supply, at least temporarily.

I feel a sense of relief, or completion, but I sure wouldn’t say a “glow.” It’s like a job well done. It’s getting off.

WIFE

Five hundred fifty-one women reported the lack of or diminished afterglow. More often than the men, they knew about afterglow, might have felt it following some of their sexual experiences, including masturbation, but reported a connection between partner and the afterglow phenomenon. It is difficult to glow alone after being sexual with someone.

DIMINISHED CONTEMPLATION: I just tune out after it’s over. I don’t feel like moving, thinking, talking, or doing anything but sleeping. I drift away.

HUSBAND

Four hundred fifty-three men reported the absence of or no understanding of reflection or contemplation following the sexual experience. The “energy release” model of early sexual research probably conditions many men to feel that an athletic event has ended when sex is over. It was new for most of the men to ask themselves about satisfaction, to reflect on the sexual experience rather than to forget it.

I’ve learned to tune out after sex. I used to laugh sometimes, cry other times, or sometimes get real philosophical. It was like I was on a drug after sex, like it was with some good pot. Now I don’t have the time or the interest. I just turn over and go to sleep.

WIFE

One hundred twenty women reported this problem, and the majority of the wives in the sample reported that the reflective phase of the sexual system diminished with length of marriage. Our culture’s linear view of time, the start/stop orientation we bring to sex, does not help us reflect. We tend to be prospective in our sexuality; foreplay is much more popular than after- or replay. Hot-running life-styles allow little time for looking back or prolonging experiences through reflection. We barely have time to enjoy the moment once, and seldom twice or thrice.

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We have never really talked. When I ask her for more attention, more feeling, she takes it as a criticism orputdown. We just can’t talk it over, work it out. She has no idea how I really feel inside.

Husband

Do you feel clearly understood in your marriage, sometimes even well beyond what you say or do? Do you feel “well sensed ” and listened to beyond words (attention)? Or do you seem to have to expend a great deal of energy just to get your feelings stated, and even then feel misunderstood (disattention)? This atten-tion/disattention issue is another example where it seems that attention must be much “better” than disattention. The purpose of taking this test is to learn a new view of the marital system that allows for constructive disattention, some relief from the vigilant state required for constant attention. It’s the strong relationship that can tolerate misreadings and occasional low empathy because it is counterbalanced with corrective reading and sensing of one another’s feelings. If you score this test by placing each item on a circle instead of a line, you see how systems theory works. Too much attention, for example, throws the circle off balance; it turns awkwardly and may steer off course. The same is true for too much disattention.

One of the husbands managed to learn this new scoring system by equating it to breathing. You need to inhale good fresh air, but you have to make time to exhale also. This “flowing” concept is at the heart of a systems view of intimacy.

Attention in this case does not just refer to talking and listening. Psychotherapy, marital therapy, and so-called sexual therapy focuses primarily on words, on talking, thinking, listening, and physically touching and being touched. Super marital sex adds “supersensory” communication. I am not referring to “extrasensory” perception, because sensing is not an “extra.” We all have

it, but we must learn to develop it. Supersensory marital communication can be practiced, enhanced, and strengthened. We can go beyond talk-and-touch therapy, and work toward our own forms of “marital telepathy.”

Physicists know that communication takes place on levels beyond the see and touch world. Physicist Fritjof Capra writes, “Throughout history, it has been recognized that the human mind is capable of two kinds of knowledge … the rational and the intuitive.” This part of the marital sexual system test refers to the intuitive dimension of marital interaction, a dimension too long ignored by professional therapists and health-care workers. All healing depends as much or more on intuitive communication and awareness than it does on the rules of rational, verbal communication.

Our example couple scored high toward the disattention end of the axis. Not only was the husband unaware of his wife’s pain, but she, too, failed to sense his difficulties. The husband stated, “I leave the table because I just don’t know what to do. If I try to help, I think she thinks I don’t think she is doing a good job, sort of letting us all down.” The wife responded, “He just does not give a damn. He’s just lazy and self-involved. He never gives one thought to how I might feel.”

When I presented a part of this report at a recent professional meeting for therapists, one of my colleagues stood up and said, “I tell my couples that the only way anyone is ever going to know how you feel is if you tell them. You must share your feelings and listen for the feelings of your spouse. Now you come along and tell us that there is some sort of ‘supersensory communication’ in marriage. There just is no such thing. We have to talk, listen, and do. This is a ridiculous idea . . . sensing. That’s when couples get in trouble, trying to sense instead of trying to communicate.”

I responded by saying, “You are making an important point, but if you will let me continue, I think I can document my ideas with case examples.”

The therapist answered, “Never mind. I can just tell what you are going to be saying, and I don’t want to hear it.”

The audience laughed at the obvious contradiction, referring to his “sense” of what I was going to do as a means of denying that sensing goes on all the time.

Again, some “rest” from constant attention is necessary in any system. Watching and listening or being watched and listened to all of the time can be as disruptive to the marital system as no attention at all.

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