The problem is that our bodies are not machines. A car owner can calculate the number of miles his car goes per gallon and knows how much the fuel tank holds – so he knows how much fuel he needs and how often. But there are so many variables in the working of the human body that a simplistic view of food as a fuel may lead to a false sense of security.
For example, if John needs 50 grams of carbohydrate to work all afternoon, he could eat his 50 g of carbohydrate in various ways – 20 g as new potatoes, 20 g as bread and 10 g as an apple. But if he eats the potato as crisps and the apple as apple juice, the same 50 g of carbohydrate will produce a different rise in his blood glucose after the meal because these foods will be digested differently. It is possible to calculate the amount each carbohydrate containing food will elevate the blood glucose concentration as compared with an equivalent amount of carbohydrate as glucose itself. This produces the glycaemic index. For example, the glycaemic index of new potatoes is 70 but the glycaemic index of potato crisps is 51.
What are the practical implications? If there is such a variable blood glucose response to carbohydrate foods there seems little point in weighing out precise carbohydrate portions for every meal. However, for people taking insulin, it is helpful to have some idea of how much carbohydrate a meal contains as this is one factor which determines how much insulin you inject. It is also helpful for all of us to know approximately what is on our plates in terms of total energy (calories), carbohydrate, fat and protein. Start looking at the back of food packets and the labels on tins – most now provide this information. One piece of useful information is that 1 g of fat provides twice the number of calories (9 cals/g) as 1 g of carbohydrate (3.8 cals/g) or 1 g of protein (4.0 cals/g). Most foods contain water which adds to the weight but not the energy content.
John has a plateful of food containing about 500 calories. Of this 55 per cent (275 cals) should be starchy carbohydrate, 30 per cent (150 cals) should be fat and 15 per cent (75 cals) should be protein. John could eat this as 75 g carbohydrate, 17 g fat and 16 g protein. This is approximately equivalent to 290 g boiled potato (it contains a lot of water) with 100 g lean ham (it contains some water). Lettuce, tomatoes and onion rings, all of which can be regarded as calorie-free could be added, with 20 g salad cream and two apples for dessert.
There is absolutely no need to do such complex dietary calculations yourself – as discussed above this is not appropriate – but this example shows you how tiny your helpings of fatty foods should be in comparison with carbohydrate foods. Essentially your plate should contain four helpings (by weight) of dry carbohydrate food, one helping of fat and one helping of protein.
If your foods have water in them (like vegetables or meat) you can eat more of them than of drier foods. Because protein foods often contain fat you will find there is very little of your fat allowance left over for dressings or spreading on your bread. Some carbohydrate foods also contain fat (potato crisps). This can make them very high in calories (potato crisps contain 559 cals per 100 g, boiled old potatoes 80 cals per 100 g) but may also use up most of your fat allowance (100 g crisps contain 37 g fat).
Special diabetic foods have no place in your diet. They contain fructose or sorbitol and neither has been shown to be of definite benefit in the management of diabetes. You are better eating small amounts of natural foods as part of your diet.
*12/102/5*
Abnormal vaginal bleeding is the main symptom that causes a woman to present with a cancer of the cervix. This can occur in the middle of a period, it can occur following the menopause, or after intercourse because of scraping of the cancer in the cervix by the penis.
Vaginal discharge, which can often have a foul smell, can also occur. In late stages, pelvic pain due to infiltration by cancer of the nerves and the ligaments supporting the cervix may happen.
The doctor when doing a vaginal examination can usually see cancers of the cervix. A tiny biopsy, sometimes called a ‘punch biopsy’, is taken in the doctor’s office to confirm the diagnosis. Sometimes the cancer is not visible, and is usually diagnosed when a Pap smear comes back as abnormal. In these cases a ‘cone biopsy’ or ‘loop excision which takes a bigger sample of tissue is performed under anesthetic and the cancer is found in the removed tissue.
Before treatment is undertaken, further investigations are performed to determine how advanced the cancer is i.e. what stage the cancer is at. Several tests will be done which involve at least a chest x-ray, kidney x-ray and examination under anesthetic so that the bladder and rectum can be checked. If the equipment is available, a CT scan, MRI scan or PET scan will be undertaken.
If the tumour seems confined to the cervix and/or upper vagina, and is less than 4 cm in diameter, a radical hysterectomy and pelvic lymph gland removal is undertaken. The term ‘radical’ means that the surgeon operates widely around the possible area of involvement or extension of the cancer. Supporting ligaments of the cervix are removed, which involves displaying the tubes coming down from the bladder to the kidneys and making sure that they are not damaged as a result of this surgery. The upper vagina is also usually removed so that any microscopic spread, which is not visible to the naked eye, is removed with the specimen.
If the cancer has spread to the lymph glands, or the tumour has been found to be invading areas near the cervix, then pelvic radiation therapy combined with chemotherapy is usually given. In some cases, even when there is no obvious spread, radiation and chemotherapy are still used because there is a high risk of the cancer coming back in the area of the hysterectomy.
When the cancer is diagnosed later, i.e. when it is more than 4 cm in diameter or has spread to local organs, such as the middle or lower vagina, or the ligaments supporting the cervix, then the treatment is usually radiation therapy. This is given in two ways. The first is external therapy to cover the whole pelvis including the areas where the lymph nodes are located next to the pelvic bones. Nowadays, chemotherapy is given at the same time. The second is an internal treatment after the primary tumour has shrunk down to deliver high dose radiation directly onto the cervix itself.
If the disease recurs, then treatment is usually palliative and aimed at prolonging and improving quality of life. If it recurs after surgery in an area that has not previously been irradiated, then chemotherapy and radiation therapy is the treatment of choice and may cure some patients. If it recurs in the middle of the pelvis after chemotherapy and radiation therapy it may be curative. If the area is not able to have radiation, such as the lung or the liver, then chemotherapy may be given. The balance between the side effects and benefits of chemotherapy needs to be discussed extensively between the patient and the doctor.
*12/144/5*
The other secret of successfully staying clean is to make your drug or drink problem your first priority. Make sure that you concentrate all your efforts and energies upon it. For the time being, let other problems lapse.
‘I can’t possibly do that,’ you may think. ‘My partner is threatening to leave. I’m overdrawn at the bank. There’s my court case coming up next month. These are all far worse problems. I’ve got to do something about all of them urgently. They are much more important than my drug-using or drinking.’
This kind of thinking will keep you ill. It really will. Getting off drugs, and staying off them, is so full of possible set-backs that it simply has to be given absolute priority.
Think it out. If you go back to drugs and drink, what will happen? Your partner will almost certainly leave you eventually anyway. Your finances will undoubtedly get worse. You will make a worse impression at court, and you will probably get into more trouble with the law.
There isn’t a single problem that a drug or a drink will make better. They will only make your problems worse.
If, on the other hand, you manage to stay off drugs and drink, you stand a far better chance of solving the problems in the long run. You can demonstrate to your partner that you are clean and sober. You can go to the bank manager and tell him how you are recovering from the illness of addiction, and work out a plan to put your finances on a proper footing. You can show the court that you are finally doing something about the drug-using or drinking that got you into trouble.
All these ways of dealing with the problems depend on your staying clean. So it makes perfect sense to put your drug or drink problem first.
Besides, in the first few days of coming off drugs or booze you are simply not well enough to solve the other problems of living. You may feel capable, but the truth is that your thinking and your emotions are confused.
So for the time being, just concentrate on staying off drugs and drink. Put the other problems aside for these first few days.
*82\116\2*
Most of us want to fit in and be identified as normal, but how do we know which sexual behaviors or practices are considered normal? What or whose criteria should we use? These are not easy questions.
Every society sets standards and attempts to regulate sexual behavior. Boundaries arise that distinguish good from bad or acceptable from unacceptable and result in criteria used to establish what is viewed as normal or abnormal. Common sociocultural standards for sexual arousal and behavior in Western culture today include the following:
- The heterosexual standard. Sexual attraction should be limited to members of the other sex.
- The coital standard. Penile/vaginal intercourse (coitus) is viewed as the ultimate sex act.
- The orgasmic standard. All sexual interaction should lead to orgasm.
- The two-person standard. Sex is an activity to be experienced by two.
- The romantic standard. Sex should be related to love.
- The safer sex standard. If we choose to be sexually active, we should act to prevent unintended pregnancy or disease transmission.
These are not laws or rules, but rather social scripts that have been adopted over time. Sexual standards often shift over time, and many people will choose not to follow them. We are a pluralistic nation, and that pluralism extends to our sexual practices. Rather than making blanket judgments about what is normal or abnormal, Kelly suggests we view sexual attraction and sexual actions in relative terms by asking the following questions:
- Is a behavior healthy and fulfilling for a particular person? Is it safe?
- Does it lead to the exploitation of others?
- Does it take place between responsible, consenting adults?
In this way, behavior can be viewed along a continuum that takes into account many individual factors. Use these questions to help explore your feelings about what is normal for you.
*5/277/5*
Nausea is a common symptom during childhood, and occurs with many illnesses. Sometimes it occurs alone, at other times it is accompanied by vomiting. Nausea is rarely an indication of serious illness — it is most commonly seen in simple viral illnesses.
Nausea is best treated with simple measures, such as avoiding fatty foods or heavy meals, and encouraging the intake of frequent small quantities of fluids and bland foods.
Medicines and injections to prevent nausea should never be used in young children. They are rarely effective and can have very unpleasant neurological side effects.
As parents, it is our role and responsibility to care for and nurture our children. Children are especially vulnerable during times of illness, and in constant need of our support and reassurance at such times. Knowing that you care for him and that you are there to help him through the rough patch goes a long way towards putting your child back on the road to recovery.
We do not believe that medications alone are the answer to illness; TLC (tender loving care) also plays a vital role. A child who is given the attention he deserves while he is ill will have a better chance of a quick and complete recovery. As to whether or not chicken soup is effective in the treatment of illness, well… it can’t hurt! It is undoubtedly the love and devotion stirred into the pot that do the trick.
*206\90\8*
Becoming a parent must surely be one of the joys of life. There is little that can equal the pleasure of the dance between a newborn baby and parent. Then, as the baby grows and develops an increasing and amazing repertoire of capabilities, the parent can tune into the magic that is childhood. Of course it is not all smooth sailing, and there are everyday stresses and hassles as well.
Parents are human, and have needs too. Some parents are so concerned for and involved with their children that they neglect their own needs — for rest, relaxation and stimulation. Becoming a parent for the first time brings about an enormous and often stressful change in lifestyle for most people, and many fears and anxieties are experienced during the pregnancy and the first few months after birth. Parenting is hard work most of the time, but the rewards are many. Do not try to be a martyr. The best gift you can give to your children is to be a relaxed, fulfilled parent. Here are some thoughts on what may help you get through the day and still enjoy your child. These are in no particular order of importance. Trust your instincts You can listen to advice from family, friends and professionals, and read what all the experts write, but in the end you should rely on your own intuition as fo what to do in relation to your child.
All children are different Try not to compare one with the other, and respect individual differences.
Keep a sense of humour This may be the most important piece of advice to heed as we go through life, especially as a parent. The ability to laugh at a situation, and at oneself, is the very best form of therapy we can receive.
Relate to your children in a warm, gentle, sensitive way Ultimately this is always more successful than verbal threats or physical punishment.
Above all, love and enjoy your children The years fly past all too rapidly.
*38\90\8*