Some people in the spinal cord injury community are fundamentally opposed to spending research dollars on rehabilitation research. This position is based on the notion that the cure for spinal cord injury is really close, if we’d just commit sufficient resources to cure-oriented research. In this view, supporting rehabilitation research is counterproductive, because it takes away money that could be more productively used in finding the cure.

This position is not based on reality. A critical reading of the latest research literature on healing the injured spinal cord shows that, although it holds promise, huge problems remain, and it will be many years before these problems are solved. Working toward a cure for spinal cord injury remains important, but not to the exclusion of research on innovative approaches to rehabilitation, including FES, assistive devices, and maximizing the functions of the respiratory system, bowel, bladder, and skin.

Is it reasonable to hope for a cure of your own spinal cord injury? Of course. Hope is an essential aspect of human psychological function. Without it, we’d have little ability to tolerate adverse events. Hope, however, can have beneficial or harmful effects, depending on how it is expressed and experienced. Certainly, a person with paraplegia should believe that a cure will be found someday, perhaps within his or her lifetime. This belief can be motivating and energizing. But some people try to deny the reality of their injury by focusing exclusively on the chance for a cure. If you expect a cure in the immediate future and wait for it – meanwhile, passing up opportunities to live more effectively with a disability – you may be doing yourself a great disservice.

Refusing to participate in medical treatment, therapy, and self-care activities that are necessary for effective rehabilitation, and ultimately for participating in the world of family, social life, and involvement in the community, would be detrimental for anyone with a spinal cord injury. We must continue with the research to improve the rehabilitation of people with spinal cord injuries while, at the same time, looking for curative treatments. To do otherwise is a retreat into fantasy.

*160/156/5*

You have to confront and acknowledge what you are now and what you don’t want to be before you can become what you want to be.

The nonphysical exercises you do at the end of each week are an imperative part of the process, an integral part of the diet.

Getting thin and staying thin take more than a diet. I cannot stress the nonphysical exercises strongly enough.

For the next five weeks, make a commitment to me and to yourself. Surrender—and just let go! One of the reasons my diet works so well is that you have nothing to think about except getting skinny. You relinquish the responsibility of making choices, eliminating the temptation to cheat. Don’t worry, nothing is leaving the planet—it will all still be here tomorrow. All the food you love, or think you love, will still be here whenever you want it.

Important: Any diet, including this one, should be supervised by a doctor. This regimen should not be followed by anyone who has diabetes, colitis, hypoglycemia, a spastic colon, ulcers, illeitis, enteritis, diverticulosis, or by anyone who is pregnant or breast feeding.

*64\251\8*

The primary cause of the failure of marriage is that compatible persons do not have an opportunity to get together in the first place. Marriage has broken down or is breaking down because we are trying to make the social machinery by which engagements could be effected in village life function in an urbanized world, and are trying to make the conventions and mores of a patriarchal, proprietary marriage system work in an age when marriage is based on romantic love and the free will of the individual. This may be more clearly expressed by saying that modern society places upon every individual the responsibility of seeking someone of the opposite sex who fulfills his ideal, and then puts every conceivable obstacle in the way of his finding such a person.

The chief of these obstacles is found in the social conventions and mores which make it difficult for acquaintance to be established between the sexes. In urban life, where one may find himself “all alone in a crowd,” the range of acquaintances even within one’s own sex may be limited enough. Then add all the social barriers that prevent easy acquaintance between opposite sexes and you have the reason why some strangely incompatible specimens are found united in wedlock. The number of persons from among whom one is expected to select a mate for a whole lifetime is far less than the range of choice of friends within the same sex, who may come and go and are not considered so vital to happiness. And the effect of this is seen in the fact that friendships on the whole are more spontaneously successful than marriages. Of course, one may seek an easy explanation for this difference in the fact that friendship is a less complicated experience than marriage, which is true, but this does not account for the fact that even when the comparison is limited to the field of ordinary interests and temperament, apart from sex, friendships show a striking superiority to marriages.

*109\275\8*

Vitamin A is a fat-soluble vitamin that occurs in nature in two forms: preformed vitamin A which is only found in certain tissues of animals, mainly the liver, and beta-carotene.  This preformed vitamin A is metabolized by animals from carotene (pro-vitamin A) in their food.

Vitamin A helps build resistance to infection and supports the integrity of the mucous membranes of the respiratory, urinary and digestive tracts. Vitamin A is also essential for the normal growth of strong bones and teeth in children and is necessary for fertility in both men and women.

It must be underst00d that many of the foods we eat each day contain vitamin A, and providing we eat sensibly, these foods are very safe.

Expectant mothers however should not eat large quantities of vitamin A rich foods, foods contributing more than 25,000 IU of vitamin A to the daily diet.

Crab                             9,800 IU per 453g

Liver                             8,000 -10,000 IU per 100g (3.5oz)

Halibut                         2,000 IU per l00g

Fresh salmon                 l, 359 IU per l00g

Liverwurst                     28,800 IU per l00g

Butter                           7,500 IU per cup

Cod liver oil                   5,000 IU per teasp00n approx.

Milk                             350 IU per cup

Cheddar cheese               1,197 IU per cup

Human breast milk         560 IU per cup approx.

Human colostrums around twice that of breast milk

*9/199/5*

We are the masters of setting unrealistic goals. And we are constantly frustrated, constantly wanting.

Because eating is an emotional response to an emotional situation, we get unclear messages from our bodies. Since most of us don’t even know where our stomachs are, we can’t hear our little cells yelling “Feed me. Nourish me. It’s my turn.” Instead we respond to the heart—only the heart.

As I said earlier, I’m not going to take your heart out of your stomach; I’m going to put your head and your body in. You are going to begin to think about food, really think about it.

I’m not going to ask you to give up the one thing that could make life work for you.

I’m going to teach you a way of eating that will allow you to be as compulsive as you need to be. I’m not going to make you change an aspect of your personality as inherent as the color of your eyes. I’m not going to make you stop eating, but I am going to make you start feeling.

*58\251\8*

Dermatitis is the most common skin disease in adults, and means inflammation of the skin. As mentioned earlier, dermatitis and eczema are the same condition.

Endogenous dermatitis

Endogenous dermatitis is the adult equivalent of childhood eczema. About ten per cent of children continue to have eczema into adult life, causing dry, scaly and itchy skin.

Dermatitis is not a food allergy. It is an inherited predisposition which makes the skin very sensitive to a number of environmental irritants including heat, dryness, wool, perfume, chlorine, soaps and detergents. The skin also reacts to internal factors, especially stress, which in adults is the most important aggravating factor.

Preventing endogenous dermatitis

Managing dermatitis as an adult is much the same as managing it as a child. Avoiding environmental irritants is very important, and by the time eczema sufferers have reached adulthood they are generally well aware of what these are. Like children, adults should not wash excessively. Showers should be short, less than two minutes, and should not be too hot. Adults should also routinely use bath oils and avoid soaps as much as possible. Mild soaps, however, can be used, and these include Aveenobar, Dove and Oilatum bar. Moisture creams should be applied after bathing. Aquatain, Aqueous cream, QV cream, 10% glycerol in sorbolene cream are all good products. Any moisture cream used should not be perfumed, and urea-based creams should never be used on open sores as they will cause stinging or burning.

It is difficult to avoid heating and air-conditioning in office buildings, but using a humidifier will compensate for the dryness.

Treating endogenous dermatitis

Topical cortisone creams and ointments are usually very helpful for endogenous dermatitis. Those who prefer natural methods may be reluctant to use cortisone creams, but it is virtually impossible to treat the condition without them. Topical hydrocortisone cream is very safe for the face, while stronger cortisone creams should not be used on the face but are fine for other parts of the body. At night, antihistamines can also be helpful.

As for children, it is important that adults avoid topical anesthetic and topical antihistamines as these can cause severe contact allergic dermatitis. Neither is calomine lotion useful.

Because dermatitis in adults is often related to stress, it can be worthwhile looking into ways of reducing stress such as meditation, relaxation therapy and hypnosis.

*44/150/5*

The connection between the internal and the external sex organs is the vagina, or birth canal. Vagina is a Latin word whose original meaning was sheath; presumably the designation came about in reference to the role the vagina plays relative to the penis in heterosexual intercourse. The vagina performs three separate functions: it serves as the passageway for menstrual flow, it couples with the penis during intercourse and is involved in other forms of sexual activity, and it is the birth canal.

The vagina resembles a collapsed tube of toothpaste when all the toothpaste has been squeezed out. It is a potential space; it is not always open. When a woman is neither sexually stimulated nor in the process of giving birth, the vagina is closed, with its two walls touching. These walls are composed of soft folds called rugae. The vagina is extremely flexible and expandable; it can open to accommodate a finger, a tampon, a penis, or a baby. In its resting state, it is about eight to ten centimeters (three to four inches) long; it tilts at a slightly backward angle from its bottom (external opening) to its top — an anatomical fact of some significance for the woman learning to insert a tampon or a diaphragm.

The upper two-thirds of the vagina has relatively few nerve endings and thus is relatively insensitive to touch. However, this portion of the vagina is sensitive to pressure. The cervix, too, is relatively devoid of nerve endings. Thus, the medical procedure known as the Pap smear, which involves removing cell samples from the cervical os, can be done with minimal discomfort for the woman. (The Pap smear will be discussed more fully in a later section of this chapter.)

The lower third of the vagina, especially around the entrance, is the most sexually sensitive part of this organ. A procedure which can be performed for therapeutic reasons or as part of self-discovery involves thinking of the vaginal entrance as the face of a clock. Having located the relative positions of 12, 3, 6, and 9 o’clock, the woman then explores which areas are most sensitive for her. Some women also locate a sensitive spot on the anterior, or upper, wall of the vagina, which may be related to the clitoral nerve system.

The vagina can have two types of moisture present in it. One is a product of the normal functioning of the hormonal system, for example, cervical mucus, and of the vagina’s self-cleansing mechanism. Vaginal discharge is thus a normal product; the amount varies from woman to woman, and the amount, texture, and odor varies with the phases of the menstrual cycle. The environment of the vagina is normally acidic, between 3.5 and 4.5 pH. This acidity works to reduce the possibility of infection. The other type of moisture produced in the vagina is the lubrication which is secreted as a woman becomes sexually aroused.

*98\265\8*

Fruits and vegetables – antidote to cancer

Researches conducted in ascertaining links between diet and cancer since 1970, have now conclusively proved that fruits and vegetables can serve as antidotes to cancer. According to Dr. Peter Greenwald, Director of the Division of Cancer Prevention and control at the American National Cancer Institute, “The more fruits and vegetables people eat, the less likely they are to get cancer, from colon and stomach cancer to breast and even lung cancer. For many cancers, persons with high fruit and vegetable intake have about half the risk of people with low intake.”

Some studies indicate that eating fruits twice a day cuts the risk of lung cancer by 75 per cent, even in smokers. The normal servings of fruits and vegetables are two fruits and three vegetables a day. Adding more fruits and vegetables to these servings can reduce the risk of cancer. One serving means 100-115g of cooked or chopped raw fruit or vegetables, 70-85g of raw leafy vegetables, one medium piece of fruit, or 170 ml of fruit juice or vegetable juice.

Sulphur – rich vegetables – reduce risk of cancer

A survey of dietary habits in China from 1973-1984 found, among other things, that people who ate more sulphur-rich vegetables like cabbage, cauliflower, garlic and onions had the lowest risks of cancer, in general.

Persons who avoid raw fruits and vegetables are more prone to stomach cancer. Several studies have found an array of fruits and raw vegetables to be so protective, that anyone worried about stomach cancer should simply increase the intake of raw vegetable and fruit salads. If a person does not consume raw foods daily, his risk of stomach cancer doubles or even triples, according to studies conducted in Japan, England and Poland. Raw vegetables of various types are powerful anti-stomach cancer foods, according to extensive research. Especially protective are raw celery, cucumbers, carrots, green peppers, tomatoes, onions and lettuce.

*27/355/5*

Jimmy did construction work. At fifty-six he was an interesting mix of youth and age. His hair was light brown dappled with gray; his face was boyish, but pale and tense.

“My doctor says I’ve got to take off some weight. He’s been telling me for years, but now it’s serious.” He went on to talk about his high blood pressure, his backaches, and his father, who died at age fifty-eight. “I have to take off at least thirty pounds,” he said.

Jimmy had tried diets in the past but, he told us, “I couldn’t work on cucumber sandwiches or child-sized portions. I get too hungry. It just doesn’t feel like real food. It’s not enough for me.

“And I can’t carry a measuring cup and food scale with me to the twentieth floor of a construction job. Or those exchanges—they wanted me to eat one exchange of this and two exchanges of that. I can’t live like that. I don’t eat exchanges, I eat real food that gets all the exchanges mixed together. It got really ridiculous, trying to figure out exchanges while the guys are ordering sandwiches from the deli.”

Jimmy’s Carbohydrate Addict’s Test revealed he had only a Mild Addiction. We told him about the three-meal-a-day plan, two of them low in carbohydrates, the third the Reward Meal. We explained the insulin connection, too, and he nodded in agreement. He’d try it.

Jimmy was between jobs, so for the first two weeks of the diet he had little difficulty following it. In fact, he was losing weight almost too quickly, at a rate of about three pounds a week. But then he was called back to work.

“Now let’s see how the diet holds up on the job,” he said with a laugh.

It proved to be a difficult challenge. A basic part of Jimmy’s work, we learned, was an almost ritual approach to eating. Breakfast with the guys was first. Then after a couple of hours of work came coffee break. Then some more work and lunch. In the middle of the afternoon came another break. Then everybody went home for dinner.

The sum total of this eating-working schedule was five mealtimes daily. Not surprisingly, Jimmy didn’t do as well the first week back on the job.

“Breakfast is no problem,” he assured us. “Bacon and eggs I love and I don’t really mind giving up the bread.

“The morning coffee break, though, that’s tough. I don’t know exactly what to do. For the first couple of days I just had coffee, but then I started adding rolls toward the end of the week. Lunch is okay, I bring that from home.

“The real tough one is the coffee break in the afternoon. By then I’m tired and cold and hungry and the thought of just coffee when everyone else is eating is impossible.”

Even with his rule breaking, however, Jimmy lost three pounds. Still, from experience we knew we couldn’t let him eat carbohydrates as often as he wanted to: it would inevitably lead to an appetite rebound and the end of his weight loss.

Given his rapid weight loss, we recommended that Jimmy follow plan A. This would help avoid hyperinsulinemia but still suit his needs. We recommended the following: his breakfast would remain the same Low-Carbohydrate Meal, and we reminded him that he’d have to forgo the rolls that he had added to his morning coffee break. He agreed, he could manage that. Lunch was to be as usual, low-carbohydrate foods. But Plan A added a Low-Carbohydrate Snack.

Jimmy was now able to follow a plan that included a snack at afternoon break, like a chicken leg and dill pickle. Jimmy suggested celery stuffed with cream cheese, a favorite snack of his. We told him that was perfectly acceptable, too.

It worked. Breakfast and lunch remained his Low-Carbohydrate Meals, dinner his Reward Meal. At the midafternoon break, Jimmy had some meat or his cheese and celery snack.

On his next visit, Jimmy told us a story about his daily throwing away of the bread that came with the deli sandwich he had started ordering for that snack. “So help me,” he said, chuckling, “I swear the pigeons know I’m coming now and they head for the trash can nearest me.” His weight dropped steadily—but not too fast. He reached his desired weight loss of thirty-two pounds in less than four months. And, two years later, his yearly check-in revealed his weight was still level.

The Carbohydrate Addict’s Diet had worked well for him. “I’m thinner than I was in high school, and my blood pressure is like that of a kid. That’s it for me—for life.”

*35\236\2*

The patella—also called the kneecap—is a small, flat triangular bone that is located on the front of the knee. It is only 2 to 3 inches wide, yet it is a critical part of the extensor mechanism, the group of muscles, tendons, and ligaments that work together to make it possible to straighten the leg and perform such essential activities as standing and walking. Because the patella is such an integral part of the extensor mechanism, we often use the broader label of extensor mechanism discomfort to describe patella-related problems.

The extensor mechanism consists of the quadriceps muscles, the quadriceps tendon, the patella, the patellar tendon, the tibial tubercle, and the lateral and medial retiniculum.

From the top of the knee, the quadriceps muscles hold the patella against the femur, or thigh bone. From the side, the patella is held in place by fibrous bands called retinicula. From the bottom of the knee, the patella is connected to the tibia via the patellar tendon. The back of the patella is covered with the thickest layer of articular cartilage of any joint in the body, which gives the patella special properties.

The patella moves as the leg moves—it glides up and down, and rotates on the femur until it’s in its track, the trochlea. The patella helps to keep the knee joint properly aligned, and it is also important for muscle strength by giving the quadriceps the extra leverage they need to cope with the enormous force that runs through the knee with each step or run. In fact, if the patella is removed, the force of extension is reduced by about 30 percent, which severely hampers the efficiency of the quadriceps and increases the force exerted through the joint. The patella also cushions and protects the other bones of the joint. For example, in the case of a fall or blow to the knee, the patella may prevent the condyles (bony knobs) of the tibia or femur from being injured.

Nonspecific knee pain or extensor mechanism pain is one of the most common complaints among patients. (Your doctor may refer to it as anterior knee pain or extensor mechanism discomfort.) It is characterized by a dull ache while walking up stairs or squatting, or the knee may suddenly give way or may catch when flexing. Very often, patients complain of grating and creaking when they extend or flex their knee or discomfort after sitting in one spot for a long time, such as when watching a movie.

At one time, kneecap pain was routinely diagnosed as chondromalacia, which is really a pathological condition characterized by the softening and progressive breakdown of articular cartilage. However, autopsy studies and surgery of patients without knee pain have shown that chondromalacia is very common, particularly among older people and, in most cases, does not cause problems. Therefore, we now use the broader term of anterior knee pain to describe patellar discomfort. What precisely does cause patellar pain? There are several potential culprits.

*28\185\2*