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If your life today is a product of your past experiences, then it stands to reason that your sex life today reflects your past sexual experiences. And if your early sexual experiences in particular were accompanied by feelings of failure, overwhelming guilt, shame, or humiliation, they may be contributing to ISD.”I had sex for the first time when I was sixteen,” Janet’s husband, Tim, explains. As you may recall, he purposefully set out to lose his virginity to a neighborhood girl with a well-earned reputation for being easy and experienced. “I was so nervous you wouldn’t believe it,” he continues. “It took forever to get hard, and then after I did, I ejaculated right away, maybe fifteen seconds after I was inside her. Man, was she angry about that.” Seven years later, her tirade and his humiliation are still alive in his unconscious memory, reopening old wounds and making him shudder each time he attempts to be sexual.Tim remembers apologizing and explaining that he’d never “gone all the way” before. “And she laughed at me,” he says, “and told me that she could tell I had no idea what I was doing.” Her words still echo in Tim’s mind. “She really hurt me. I guess that scar has never really healed.”Early sexual scars rarely do. “The problem was that I never got any better at it,” Tim says. “It doesn’t seem possible, but things actually got worse.” The performance anxiety he felt during his early disappointing sexual liaisons and the sexual problems he and Janet have encountered since marriage seem to support his claim. “After a while I started to think, ‘What’s the point of trying?’ “*102\261\8*


Coronary artery disease is the leading cause of death for both sexes. It is hard to separate the role of your sex in the development of coronary artery disease from other factors such as smoking, blood pressure, and cholesterol levels. Men and women who smoke or who have high blood pressure or hi blood cholesterol levels have higher risks of heart disease than others who control these factors.When you consider only the sex difference, men are more likely to have coronary artery disease than women-until women reach the age of menopause. Then the difference in risk between men and women shrinks.This difference certainly does not mean that women are “immune” from heart disease. In fact, 47 percent of American victims of fatal heart attack are women. In women, coronary artery disease develops, on the average, about 10 years later than in men.The female hormone estrogen may be one protector against heart disease. After its decline at menopause, women’s risks increase. The use of estrogen after menopause seems to reduce a woman’s risk of heart disease. However, it may increase her risk of cancer in the lining of the uterus (endometrial cancer) and possibly of breast cancer. There is evidence that smoking may reduce estrogen levels in women and may hasten menopause—results that add to its list of bad effects on the heart.Until recently, much of the research relating to coronary artery disease focused mainly on men (see page 336). New studies are under way to determine whether the findings are applicable to women as well.*224\252\8*


Is it safe to use hair dyes during pregnancy?Though blondes – and I suspect brunettes and red-heads too have more fun, they should be aware that hair dyes are absorbed by the scalp, and the chemicals in those dyes can be transmitted to the fetus. This is not to say that they will cause congenital problems in the fetus, but the possibility exists and should not be ignored.My advice: if you want to colour your hair during pregnancy, ask your doctor about the ingredients in the specific product you are using.
I realize that no food additives are good for you, but I’m wondering if there are any that you know of that should be avoided by pregnant women in particular?Avoid all those that have been implicated as possible carcinogens, particularly:• Saccharin• Cyclamates• Sodium nitrite and sodium nitrate (used in most luncheon meats, hot dogs, and smoked or cured commercial products)•  Artificial colorings (especially citrus Red No. 2, Orange B, Red No. 3, Red No. 40, and Yellow No. 5)•  BHT (butylated hydroxytoluene)I’d also recommend avoiding as many artificial flavorings as possible, as well as quinine (which flavors tonic water and bitter lemon), as this has been implicated in causing birth defects; sulphur dioxide and sodium bisulphate (which can destroy vitamin Bi); MSG (monosodium glutamate; BHA (butylated hydroxyanisole); phosphoric acid and phosphates (which can cause dietary imbalances and have recently been implicated as a factor in the spreading of osteoporosis).
How dangerous, really, are coffee and alcohol for pregnant women? My mother drank coffee and alcohol during her pregnancy and had no problems.Your mother was lucky; other pregnant women might not be. Animal studies have shown that large amounts of caffeine (which coffee, cocoa, chocolate, cola, and many medications contain) may cause birth defects. And alcohol, even in moderate amounts (a couple of whiskies a night) can result in low infant birth weight, as well as cause physical or behavioral abnormalities in the child.Coffee substitutes are easily available at your health store. As for alcohol, I’d advise staying away from it completely. (A wine glass filled with sparkling salt-free seltzer and a wedge of lemon or lime can be psychologically and socially satisfying – and safe.) I’d also recommend checking the labels of any medication you’re taking to be sure they don’t contain either of these two drugs.*15/137/5*


The more we studied the profiles of memory impairment in various types of patients, the more important the distinction between generic memory and specific memory appeared to be. Memory provides the content for our mental lives, but not all memories are equal. Some are much more resistant to the effects of any assault on the brain than others. The distinction between specific memories and generic memories is so important because it shapes our understanding of the fates of different kinds of knowledge in brain disease and brain decay. Knowledge that Paris is the capital of France is an example of singular memory. There is only one Paris and one France, so this knowledge refers to a single entity. By contrast, knowledge that tomatoes are usually red is an example of generic memory, since there are millions of tomatoes on the face of the earth and this knowledge applies to all of them.As a rule, generic memories are accessed much more frequently than specific memories. How often does an average American invoke the knowledge that Paris is the capital of France? A few times a month at most, whenever Paris is mentioned in the news, or when you plan your once-in-a-lifetime dream vacation. But you invoke the knowledge that tomatoes are usually red every time you walk down the supermarkets aisles or stick your fork into your daily lunch salad. Consequently, generic memories are much more robust than singular memories. Because of their high frequency of use, generic memories become committed to long-term storage more rapidly. As a result, they gain independence from the subcortical brain structures known to be particularly vulnerable in Alzheimer’s disease and other dementias. The relative invulnerability of generic memory becomes quite obvious if we consider two essential attributes of our mental life, which tend not to fade with age: language and higher-order perception. Although we tend not to think about these abilities as “memory,” they are. In order to use language effectively, we need to “remember” which word refers to which thing, since the relationship is in most instances a matter of arbitrary convention and cannot be deduced logically. A language in which the word “chair” means table and the word “table” means chair would be every bit as effective as the language we use. And needless to say, the memory of the meaning of words, which is the basis of our linguistic competence, is generic memory, since any given word refers to a whole class of similar objects. A white Art Deco table, and a black-lacquered Chinese table, and a decrepit, rickety table in your neighborhood coffee shop are equal members of the same category and you refer to them with the same word, “table.” Likewise, our ability to recognize objects for what they are is also based on memory. Haven’t you ever marveled at your own ability to come into contact with something you have never seen or heard before, and to instantly know what it is? You see an elaborately designed antique car on the street and you know that it is a car, despite the fact that you had never seen the likes of it. You hear a sound coming from outside, and you know that this is a dog barking, even though you had never heard a bark of this particular kind. To possess this ability, you must have a generic memory stored somewhere in your brain that captures the common characteristics of a whole class of things. You must have a previously formed pattern. Then, when you encounter an object containing enough of such shared characteristics, the generic memory will be evoked, and this is what object recognition is all about.Thus, both language and higher perception are based on generic memories. Certain kinds of brain diseases may wipe these memories out, causing the patient to lose the use of words and the ability to recognize common objects. You may recall that in psychological and medical parlance these two types of symptoms are known as “anomia” and “associative agnosia.” Such a breakdown of generic memories may be affected by stroke, traumatic brain injury, dementia, or some other brain disease. But the neocortex must take a direct hit for language or higher-order perception to suffer. Damage to the subcortical machinery alone will not affect them, since, as we now know, generic memories do not depend on this machinery. What’s particularly important is that language and higher-order perception are also resistant to the effects of normal aging. This is so, at least in part, because they are independent of subcortical structures. An important point follows. Since singular memories depend on both the neocortical and subcortical brain structures, damage to either of the two, or to the connecting pathways, will cause their decay. This is a case of neurological double jeopardy. By contrast, generic memories depend on only the neocortex. This means that it takes a much more targeted kind of brain damage to affect them. While not totally protected from decay (nothing is), generic memories have fewer neurological Achilless heels, fewer points of neural vulnerability. This is why generic memories tend to not decay with age and may even be resistant to the effects of dementia up to a point.The knowledge that frequent exposure to a particular kind of mental task speeds up the formation of a robust, long-term representation of the task and everything associated with it (including previous successful solutions) goes a long way toward understanding why certain kinds of memory are resistant to the effects of brain decay. But the formation of structural neocortical representation is not the only safeguard the brain develops to protect valuable information against the vagaries of neurological deterioration or illness. Other protection mechanisms are also at work. The discovery of such mechanisms was made possible by state-of-the-art methods of functional neuroimaging. These methods, which include fMRI (functional magnetic resonance imaging), PET (position emission tomography), SPECT (single photon emission computerized tomography), MEG (magnetoencephalography), and others, made it possible for the first time in the history of science to observe the landscapes of physiological activation in a working brain of a living person, as the person is engaged in various mental activities. The introduction of these methods has changed the face of neuropsychology and cognitive neuroscience in a way not dissimilar to the one in which the invention of the telescope advanced astronomy. No field of inquiry can thrive on concepts alone, and the introduction of powerful new technologies (themselves products of novel ideas in other fields) usually plays a decisive role in scientific progress.The application of these methods has led to the discovery of two additional protection mechanisms guarding frequently used knowledge represented in the neocortex. They are the mechanisms of pattern expansion and forging effortless experts. These two mechanisms work in concert.In pattern expansion, with practice, experience, and repeated use the brain areas allocated to a particular motor, perceptual, and perhaps also cognitive skill expand and take over the adjacent parts of the cortical space. This was demonstrated in a variety of skill-learning experiments in the monkey by Michael Merzenich and his colleagues at the University of California, San Francisco. Even more to the point, similar effects have been demonstrated in humans. Alvaro Pascual-Leone has shown that in the blind, the cortical representation of the finger used for reading Braille is larger than the cortical representation of the same fingers in Braille-naive seeing individuals. Likewise, the cortical representation of left-hand fingers is larger in string musicians than in other people. Such expansion makes the patterns more resistant to decay and to the effects of brain disease. To understand how this works, consider a simple Swiss-cheese model with a certain number of holes covering an area. If the number and size of the holes is kept constant, then the larger the total cheese-slice area, the larger the area spared by the holes will be.While it may sound both irreverent and simplistic, the Swiss-cheese analogy is not that far off. In a number of age-related brain disorders, the brain is affected by tiny, discrete lesions, which destroy nerve cells and disrupt the communication between them. In Alzheimer’s disease, the lesions are the infamous microscopic tangles and plaques, the debris of decaying and dying nerve tissue. In Lewy body disease, another primary degenerative disease, less prevalent and less well-known to the general public but every bit as malignant, the lesions are the microscopic Lewy bodies. In a different type of dementia, the so-called multiinfarct or small vessel disease, caused by a widespread disorder of brain vasculature, the lesions are tiny infarctions distributed throughout the brain. Whatever the etiology and pathogenesis of these lesions, they damage the brain tissue the way randomly thrown darts damage a bull’s eye. But the greater the overall area of a bull’s eye, the vaster will be its spared part—if not in proportionate then at least in absolute terms, which is probably what matters most for the preservation of a cognitive skill.*27\302\2*


Your options for medical care will depend on where you live. The kind of care specific to HIV infection is likely to be better in a big city: most big cities offer many options for treatment of HIV infection. Smaller cities and rural areas are likely to offer fewer options, and the physicians in these areas are likely to be less familiar with HIV infection. This is because most of the people who became infected in the early stages of this epidemic lived primarily in large cities like New York, San Francisco, Los Angeles, Miami, and Washington, D.C.; disproportionately fewer people living in smaller cities and rural areas were infected. As a result, physicians who trained or who practice in small cities or rural areas often lack experience in treating HIV infection.     As a consequence, when people with HIV infection who live in small cities and rural areas want medical treatment or periodic consultation about medical treatment, they often travel to the nearest physician or clinic specializing in HIV infection.     The options for medical care may also be substantially fewer for people who belong to HMOs, for people receiving Medicaid, and for people who have limited financial resources and no health insurance. HMOs and city health clinics offer medical services that vary in quality, some very good and some not so good. Some HMOs do not allow patients to see physicians other than those physicians who participate in the HMO, or do so only on a case-by-case basis. People enrolled in those HMOs therefore have no choice in what specialists they see. HMOs can also limit the hospitals people may be admitted to.     The process of selecting among medical options begins with finding out what your finances allow. This disease is expensive, and HMOs, insurance plans, and Medicaid will each pay for some things and not for others. In addition, HMOs, insurance plans, and Medicaid all differ in what they will and will not pay for. Many insurance plans especially restrict the outpatient services they cover. Medicaid covers a broad range of services but reimburses physicians at so low a rate that most physicians refuse to accept patients paying through Medicaid. Many employers offer a choice between joining an HMO or being reimbursed by the insurance company, and you may be able to switch back and forth as your needs dictate. In any case, you need to know your options. You can begin by finding out what your HMO, insurance company, or government medical assistance will allow, and then discussing these issues candidly with your physician or with a social worker.


When your child has had a second or third seizure, family and friends need to be informed. Your child has probably been started on medication and could experience side effects or even temporary changes in personality from the medication. The likelihood of your child having a further seizure is now high enough that family and friends should be informed. They should know what these “frightening episodes” look like and what they should do if another occurs. They should know about the various false myths about epilepsy. Most of the time your child will be normal. Make sure epilepsy is not blown out of proportion. Don’t let your friends and relatives dwell on it. If they understand, perhaps they can avoid the overprotection and restrictions that deprive your child of normal experiences.*180\208\8*


The best conditioner for the hair is natural sebum or oil that is present on the scalp. The main purpose of conditioners is to apply the ‘sebum’ where it is needed, which is generally at the ends of the hair rather than at the roots. Conditioners also make the hair smooth and shiny, and decrease the electrical charge that tends to make it frizzy. Some conditioners also contain protein which penetrates into damaged hair and temporarily mends the damaged surface.Chemical processing causes significant damage to the hair’s outer coat, which is called the cuticle. The cuticle is what makes the hair smooth and shiny, and stops frizziness. Once the hair has been permed, dyed or even excessively blow dried, the cuticle is destroyed, and split ends occur. A good conditioner will cover each hair with a film which replaces the function of the cuticle. If conditioners are not used often enough, the hair tends to become dull and frizzy. On the other hand, if they are overused, the hair becomes greasy and limp.Chemically-processed hair will benefit from a conditioner which contains protein. This will penetrate the hair shafts, protecting them until the next wash. Conditioners which you leave on your hair can also be used to make the hair less frizzy and shinier. They can also temporarily mend split ends.Conditioning treatments, which are left on the hair for a prolonged period, usually about twenty minutes, penetrate the damaged cuticles better and often make the hair appear healthier. These can be used once a week as a ‘treatment’.


Headaches are extremely common. In most cases, headaches bother the person who has them far more than they bother the physician who treats them. This is because headaches rarely indicate severe or progressive disease. Most headaches occur when the muscles that cover the top of the skull contract. These headaches, called tension headaches, occur off and on in everyone. They go away either by themselves or with simple drugs such as aspirin, acetaminophen, ibuprofen, or any of a multitude of drugs that contain combinations of these drugs.     A less common but more painful type of headache, called a migraine or a cluster headache, results when the arteries of the scalp contract. These headaches may be severe, may involve only one side of the head, and may occur along with nausea, vomiting, and changes in vision. Such headaches tend to recur and often require prescription drugs that relax the contractions of the arteries.     Another common cause of headaches is a generalized illness such as influenza or infections in the sinuses or ears. Sinus headaches are especially common in people with HIV infection, who frequently have sinusitis.     Finally, headaches may result from certain drugs, including AZT, trimethoprim-sulfamethoxazole, rifampin, ketoconazole, amphotericin B) and acyclovir.     All of these headaches go away by themselves, leave no impairment behind, and do not indicate any serious underlying disease.     Certain headaches, however, require a doctor’s attention. Like other focal neurologic symptoms and like fever and stiff neck (see below), headaches can be a symptom of an infection of the brain or the meninges. Headaches associated with infections of the brain or meninges have the following characteristics:1.  They are unusually severe or last unusually long.2.  Either the character of the pain or the location of pain makes the headache different from headaches the person usually has.3.  They occur along with problems with vision.4. They occur along with weakness of an arm or leg, with dizziness, or with impaired coordination.5.   They occur along with stiff neck, nausea and vomiting, or extreme lethargy or sleepiness.6.   They are severe and occur along with an unexplained fever.     The major infections that cause such headaches in people with HIV infection are toxoplasmic encephalitis and cryptococcal meningitis. Both these infections, as well as a multitude of other infections of the brain and meninges, are relatively easy to diagnose. They are also treatable. A less common cause of headaches in people with HIV infection is lymphoma.*131\191\2*


A spinal cord injury is a very visible disability. Unlike a person with diabetes or heart disease, you cannot hide your condition. A wheelchair or crutches, and any changes in physical appearance, are immediately apparent to others. The ease or difficulty of adjusting to disability depends not only on your own emotions and actions, but on other people’s reactions to your changed appearance.How you look to others is likely to be on your mind from the early days of rehabilitation. And how you cope with social responses to your disability is important to your success in living with a spinal cord injury.
StigmaPeople with visible disabilities are often stigmatized by cultural beliefs and language and treated as if their disabilities were a mark of disgrace, social inferiority, or moral or mental abnormality. Such prejudice generally arises from fear or anxiety. To ward off their own feelings of vulnerability, many people use stigma to separate themselves from “those disabled people” and thus to feel protected and secure, certain that they could never be “one of them.”Unfortunately, this prejudice is manifest as discrimination in jobs, education, and socialization, as will become more apparent when you leave the hospital and attempt to reenter the “real world.” But even during your inpatient rehabilitation, you need to understand that fears of social rejection and concern about how you look to others are based as much in social reality as on your own anxieties and altered self-esteem. Even if you feel great about yourself, others may be awkward, uncomfortable, or frightened by your disability.


Attractiveness is considered a great asset in our society. As a result, there has been a surge in the demand for cosmetic surgery. This is most obvious in the United States, but the demand is also growing here in Australia. Cosmetic surgery is now sought by people from all walks of life, not just television personalities and film stars.There have been many advances in the field of cosmetic surgery, both in surgical techniques and anesthesia. Many cosmetic procedures are now performed under twilight anesthetic in day procedure centers, so that hospitalization is not necessary. This also means that cosmetic surgery can be done less expensively, and that people can resume normal activities within a short time. Improvements in the area are continuing into the 1990s, particularly with the advent of laser surgery.
Face-liftingFace-lifting is the best known of all cosmetic procedures. Here both the skin and the underlying supporting tissues are pulled up against gravity and re-attached to the upper part of the cheek bone. Face-lifting lasts about ten years and is most suitable for sagging facial and neck skin. It is less effective for fine wrinkles and does not improve the textural changes that occur due to sun damage, that is, photoageing. Many people are disappointed with the results of face-lifting, because they have unrealistic expectations of what it can achieve.Major advances have occurred in this field, especially over the last decade. In the past, many facelifts looked rather unnatural and often produced unsightly scars as well as swelling and bruising. People often needed to take two weeks off work and hide from curious friends and neighbors. The older method of face-lifting relied on pulling the skin very tight under excessive tension. This distorted the facial features and did not last very long.A breakthrough occurred in the 1970s when surgeons took into account the fact that the facial skin is supported by an underlying structure called the SMAS. This membrane surrounds and supports the delicate facial muscles. By pulling up the SMAS against gravity, and attaching it to the top of the cheeks, facelifts became more natural looking and longer-lasting. Lasers, for example KTP lasers, are now used in face-lifting, causing almost no bruising or bleeding.Another major improvement in facelift surgery occurred in the field of anesthesia. Facelifts are now routinely performed under twilight anesthetic as a day patient procedure. This lighter anesthetic has minimal health risks, so that facelifts can be done more safely with much quicker recovery. In the United States, people can now return to work within four or five days with no obvious signs of recent surgery.Complications can occur with face-lifting, although major problems are rare. It is common to see swelling and bruising, and scars are often visible behind the ears at the hairline. Scars in front of the ears are usually virtually imperceptible.Anyone contemplating a facelift must remember that the procedure only lifts the skin up against gravity. It will not improve the skin’s texture and will certainly not remove wrinkles around the mouth. To do this, a chemical peel or dermabrasion is necessary.

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