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One of the most common myths is that acne will disappear during pregnancy. Although this does occur in some women, others notice that their acne gets worse or appears for the first time due to sudden hormonal changes.Unfortunately, treatment options are very limited because many drugs used for acne are not safe during pregnancy. Simple measures are therefore very important. Moisturizers and moisturizing sunscreens should be avoided, and oil free makeup should be used.Topical antibiotics, such as clindamycin lotion, are safe during pregnancy, as are benzoyl peroxide and topical sulphur creams. Retin-A can also be used during pregnancy as it is not sufficiently absorbed into the circulation to cause any problems. Certain oral antibiotics such as erythromycin are safe while the tetracycline should not be used. The latter can cause problems in the bony growth of the foetus during the second trimester. If tetracycline is accidentally taken in the first trimester there are no untoward consequences.Ro-Accutane must never be used during pregnancy as it can cause major birth defects. If a woman has taken Ro-Accutane she should not get pregnant for at least one month after she has stopped taking the drug.Acne may worsen during breast-feeding due to the substantial oestrogen level decrease. During this period, all topical anti-acne preparations can be used. Oral erythromycin is also safe, but other oral preparations should be avoided.


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Tender breastsAfter conception, the breasts can become very painful and sore to touch. In addition to tender breasts you will also notice an increase in the size of your breasts as they prepare for the milk needed to feed your baby. The areola (the circle of coloured skin around the nipple) becomes darker and tiny bumps all around the nipple become more prominent. At this stage you will also notice that the blood vessels in the breasts become larger. This is normal and the tenderness can be relieved by using a maternity bra for better support.
TirednessAfter conception there are enormous changes in your body as it adjusts to your growing baby. At this time it is quite normal to feel tired and run down, and some women find it hard to go about their everyday activities.As the pregnancy progresses into the second trimester you will probably find that this is the most enjoyable time of all and easier to cope with. Feeling tired is normal and it is a sign that you need to take a rest. Don’t ‘overdo it’. Resting gives your body time to recuperate and adjust. Take time to put your feet up and have a little cat nap, or go to bed early. You will need all the rest you can get as after the baby arrives resting will be much more difficult.Take your time to do your normal daily work. If you have other children, divide the work amongst them and your partner. Asking your other children to help will also make them feel needed and minimize any feelings of rejection after the birth of your baby.
EmotionsFinding out that you are pregnant can cause many different emotional effects. You may feel absolutely overwhelmed and excited. There may be times when you also may feel frightened and unable to cope. This is quite normal, preparing yourself for the responsibility of being a mother and bringing a new life into the world.A woman may also feel that her partner will think that she is fat and unattractive. However, this is not the case. Pregnancy gives a glow and many men find that their pregnant partner is surprisingly attractive.
Fluid retentionFluid retention during pregnancy is a problem that many mothers-to-be suffer. Quite often, when standing for long periods or in hot weather, many women find that their ankles swell. This can be quite normal. Puffiness in the face and fingers may indicate that your kidneys are not coping with the waste products produced within your body. Also it may indicate that your placenta is not working efficiently.It is important to drink at least 5 to 6 glasses of water per day. Cutting down on your intake of water will not help reduce fluid retention. In fact water has a diuretic effect and will help your kidneys to function well during your pregnancy. If the fluid retention is severe then discuss this with your practitioner.*2/199/5*


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Margery had been a heavy smoker for ten years. She gave up two years ago. She had tried for a year to give up and the longest she lasted was three weeks (the famous three week crisis). She had no trouble with craving (some people don’t), but feeling depressed and ‘ill all over’ drove her back each time.
Before one Christmas she was made redundant and decided she could not feel much worse; it was a good time to try again. She ate lots of Christmas fare, chocolates, nuts and fruit and had more than her one sherry before dinner. Her glands and joints swelled and ached and she felt very depressed. She also had a few panic attacks; this had not happened before. After she got past the third week she knew she would make it but it was six months before she really felt herself. She has never regretted stopping and still feels it was like coming out of prison.


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At present there is no real consensus amongst doctors about the most effective way to treat someone who has non-epileptic seizures. Sometimes (though not usually in specialist epilepsy units) a very confrontational approach is used: the ‘snap out of it and stop trying to pull the wool over our eyes’ school of treatment. This does not work because it blames the person for something which is not their fault and ignores the very important fact that all seizures, whether they are organic or emotional, have a cause. Above all, it does not take into account that these non-epileptic seizures can be just as disabling and disruptive for the patient as a ‘real’ seizure.
Treatment of non-epileptic seizures needs to be carried out in a specialist unit. The first step is to start investigating the seizures. The more thorough the investigation, the less easy it will be for the patient rationally to reject the suggestion that their seizures are not due to epilepsy.
At the same time the patient will be reassured that although the attacks are not epileptic but emotional, they are nonetheless real, and are due to a build-up of tension and emotion. They are also told that non-epileptic seizures need to be treated just as do epileptic ones. But the best news as far as the patient is concerned is that the seizures are more easily cured and the patient can learn to control their own attacks.
Each patient is given a key nurse to whom they can talk at any time. The relationship between the patient and the nursing and medical staff is crucial, because it is only when trust has built up between them that the patient will feel able to talk freely about the tensions in their life and the difficulties they are having, at work or at home.
The next step is for the patient to be shown how to analyse the situations in which they have attacks, and to recognize that there may sometimes be emotional triggers for their attacks. This is done in very much the same way that people who have epileptic seizures are taught to recognize situations which may trigger a seizure.
They will be taught to analyse exactly what is happening to them just before an attack starts, in particular asking
What were they doing just before the attack?
How did they feel just before the attack?
What were they thinking just before the attack?
If they can recognize and record their emotions very precisely, they may be able to identify the thoughts that make them have an attack. Maybe they were feeling very tense; perhaps someone had been angry with them or spoken sharply to them and their feelings were hurt; or maybe some memory had come into their mind that was too painful to think about.
The patient is asked to think about the consequences of the attack too, and to note down in as much detail as possible not only what happened immediately after the attack, but how it may have altered the situation for them, and how they felt. If they were very tense beforehand, for example, did they feel much better after the attack? If they had been feeling very lonely or ignored beforehand, were people comforting them or paying them attention afterwards?
Usually, if they manage this sort of analysis honestly, most people can find some sort of connection between the likelihood of an attack occurring and their feelings, what is going on in their life or their relationships with other people.
They will be taught to recognize situations in which they are likely to have an attack, but to try to talk about how they feel instead of allowing their feelings to precipitate an attack. They will be taught a method of relaxation, and shown how to use relaxation whenever they feel they might have an attack. They are encouraged to admit that their attacks are emotional and not epileptic. And they are helped to talk about their problems and anxieties rather than their seizures.
Finally, they have to be helped to come to terms with an absence of seizures and decide how they are going to run their life seizure free. The family is always involved in this phase of treatment, for they too will have to decide how they are going to respond to the patient’s absence of seizures.
The success of the treatment depends a great deal on how much the person still needs their seizures. The problems that created the need for seizures do not just disappear once the attacks stop, and they still somehow have to be resolved. The sufferer has to learn how to get his or her emotional needs met more straightforwardly, and the family have to be taught how to offer the support the patient needs. If these strategies can not be worked out, non-epileptic seizures are a problem that can persist.
Non-Epileptic Seizures: A Diagnosis Checklist
Do the seizures fail to respond to drugs?
Is consciousness maintained during a seizure?
Does the person seldom hurt themselves badly during a violent seizure?
Do they feel better after a seizure rather than worse?
Do their seizures last for a very long time?
Do their seizures involve very complex bodily movements, thrashing about or waving of limbs?
If the answers to all these questions are yes then it is possible that seizures are emotional and not epileptic in origin. At any rate, this is a possibility that the doctor will want to consider.


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Patients with insulin-dependent diabetes always require insulin. The kind and amount of insulin are determined by the physician. Intermediate-acting insulin (NPH, globin, lente) is widely used. It reaches peak activity in 9 hours and activity extends over 24 hours. It is often used in combination with a short-acting insulin (regular, crystalline) which has a peak activity in 3 to 4 hours, and a duration of 6 to 8 hours. Long-acting insulins (PZI – protamine zinc, and lente) are used less frequently. Insulin must be given by injection because it would be digested and made inactive if given by mouth.
Patients with insulin-resistant diabetes can almost always be managed successfully with diet alone, or with diet and oral compounds. These compounds are not insulin, but sulfonylureas including tolbutamide (Orinase), tolazamide (Tolinase), chlorpropamide (Diabinese), and acetohexamide (Dymelor). Their action is to stimulate the pancreas to produce insulin.


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During the first few days after you quit, drink large quantities of water and fruit juices. Try to avoid alcohol, coffee and other beverages with which you normally associate your cigarette smoking.
Do something else with your hands. If you used to smoke while driving to work, do exercises with your hands when waiting for the traffic lights to change. If you used to smoke while watching TV, keep a soft drink to sip next to you or munch popcorn or peanuts instead of smoking.
Try to keep away from your smoking friends for a few days.
Don’t sit in your favourite smoking chair.
Change your daily routine: e.g., if you were habituated to a cigarette as soon as you got up, go for a walk instead or have a shower.
Don’t allow you to trick yourself. A few favourite tricks are: “One cigarette won’t hurt”, or “I’ll just have one to prove that I have really been able to quit”. Recognise these symptoms and remember that these are just a momentary weakening of your resolve. Such thoughts should be stamped out as soon as they arise.
Think positive. Keep reminding yourself that you are a non-smoker now. Keep reinforcing the benefits you stand to reap by staying away from cigarettes.


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It comes as a surprise to many that men can get breast cancer – a particularly unpleasant surprise both to the men that are diagnosed with it and their families. One in 1,000 men develop the disease at some point in their lives, which accounts for around 200 cases a year in the UK. Male breast cancer is governed by the same hormonal influences as female breast cancers and there are many similarities between male breast cancer and breast cancer in post-menopausal women. Incidence is more likely with advancing years, with most men diagnosed aged sixty-plus, and the condition being extremely rare under the age of thirty. As with female breast cancer, the incidence is lower in Japan and other Far Eastern countries, and more common in the UK and USA. There is a high incidence of male breast cancer in some African countries where the frequency of liver infections is high. Liver problems reduce the ability of the body to process oestrogens correctly.
Men with Klinefelter’s syndrome, which affects one in 300 men who have an XXY chromosome pattern instead of the normal male XY chromosomes, have hormonal anomalies, and the incidence rate is similar to that of women. A condition known as gynaecomastia is an excess of breast tissue in men, and is associated with male breast cancer in up to 40 per cent of cases. Chest radiation exposure, testicular injury or inflammation, undescended testes, a history of using drugs which raise prolactin levels, a family history of breast cancer (male and female) and obesity are all added risk factors.
As there is less breast tissue in men, lumps are usually found at an earlier stage than for women. However, the lack of intervening tissue also means that spread to the lymph glands happens at an earlier stage. Men are also less likely to report a lump in the breast area than women, and a delay of eighteen to twenty-four months is common.
Bloody nipple discharge is present in about 80 per cent of all male breast cancer cases.
Treatment for men is similar to that for women. This includes surgery, which may also require skin grafts, as there is less ‘surplus’ skin to work with, and sometimes Tamoxifen. There is some evidence that men do not tolerate Tamoxifen as well as women, and in one study one in five men stopped treatment because of unpleasant side-effects, compared to one in twenty women.


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We repeat, water itself is beneficial. The wreckage it causes in our bodies comes from the method of drinking it. When water is consumed in our meals and how.
Bad drinking habits, unfortunately, are often passed on to us by our parents. If, as children, we see a pitcher of water on the table at meal-time, we naturally continue this habit through our adult years. This practice can lead to arthritis, and we later wonder if we inherited the disease. No. We inherited the water fad.
Take a test family of four children, all girls. They grow up, get married, and scatter to their new homes in different parts of the country. They take with them their water habits. If their husbands were not accustomed to seeing water on the dinner table, the men will now be introduced to the water craze.
In the average American home the lady of the house may drink water with breakfast. Her husband does not, but he likes vichy water for luncheon at the restaurant near his office. Their young son drinks water for lunch, instead of milk. Their teenage daughter drinks a glass of water every night before going to bed. She has heard that it is good for the complexion. The whole family is wrong. And they are flirting with arthritis, paving the way to become victims of this dread disease.

How much Water do We Need Daily?
Science tells us our bodies require a cubic centimetre of water for every calorie which our foods produce. Therefore, if you eat a 2,100 calorie diet each day, you need approximately 2,100 cubic centimetres of water. This amount, put into the usual receptacle, is equal to eight glasses of water!
No one would be foolish enough to recommend that you “drown” yourself by drinking eight glasses of water every day. Besides, there is no need to, because other foods contain great quantities of water.
Milk, for example, is 87 per cent, water. Coffee has even a higher percentage. So that arthritics will drink less water, we have prepared a special chart. The figures and foods below will prove to you that you are receiving plenty of water at every meal. Read this helpful list, and use it as a guide:
Foods    Percentage of water
Egg    74
Curd cheese    74
Cream cheese    53-3
Cheddar cheese    39
Butter    15-5
Veal    71
Liver    70-9
Chicken    67-1
Round steak    67
Lamb    66
Frankfurts    64-3
Corned beef    57
Ham    53
Pork    50
Oysters    87-1
Codfish    82-6
Salmon    67-4
Tuna    57.7
Sardmes    47
Cucumbers    96-1
Marrow    95
Lettuce    94-8
Tomatoes    94-1
Celery        93.7
Radishes    93-6
Asparagus    93
Spinach    92-7
Cabbage    92-4
Cauliflower    91-7
Broccoli    89-7
Carrots        88-2
Onions        87-5
Potatoes    77-8
Green peas    74-3
Cantaloupe    94
Water melon    92-1
Oranges    87-2
Peaches    86-9
The above listing offers conclusive proof that water can reach our bodies in adequate amounts while we eat. There is never a need to drink eight glasses of water a day on top of all these waterbearing foods. Three glasses—taken well before meals—should be plenty.
Millions of Americans who are now living healthy, normal lives, drink as little as one glass of water daily. They do not become dehydrated, or suffer any ill effects. Remember, too, that saliva, stomach juices, bile, pancreatic, and intestinal juices all have the necessary water to break down your food by natural means. This is accomplished without help from an extra glass of water.
Your body often decides for itself how much water it really needs each day. When it has enough, your system passes off excess liquids. Approximately four and one-half pints of water are eliminated every twenty-four hours. Most of it in the form of urine. Water is also released in your exhaled breath. Or as perspiration through your skin surfaces.


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Tacit knowledge is more about solving problems than about knowing facts. This brings us to a very important distinction: the difference between the descriptive and prescriptive aspects of cognition and between the descriptive and prescriptive aspects of wisdom and competence. As we pointed out earlier, knowledge can be descriptive and prescriptive. So too can be pattern recognition and the attractors that embody it in the brain.
Descriptive knowledge is the knowledge about how things are. It is sometimes called “veridical knowledge.” Because things exist in the world independently of you, the observer, various statements about things can be judged as “true” or “false” regardless of your wishes and preferences. The statement “five plus five is ten” is true, and the statement “five plus five is twelve” is false. And if you wish that it were the other way around, then well, tough luck! Veridical, descriptive knowledge is the knowledge of the true nature of things.
By contrast, prescriptive knowledge is the knowledge not about how things are, but how they should be, and in particular it is the knowledge of what we must do to set them according to our wishes and our needs. Prescriptive knowledge is the knowledge of what needs to be done, the knowledge of the desired course of action. Unlike descriptive knowledge, prescriptive knowledge is not independent of you. Quite the reverse, it is knowledge about your needs and about the course of action that is best for you. Prescriptive knowledge is not the knowledge about the objective, “true” nature of things, but about the best course of action. Because the choice of such action is different for different people, I sometimes refer to it as actor-centered knowledge.
We humans are in command of the powerful mental machinery enabling us to acquire and store descriptive knowledge, but this machinery is secondary, ancillary, subordinated to our needs for the acquisition and storage of prescriptive knowledge. The evolutionary pressures that have shaped our brain and our body were directed at enhancing our survival and not our ability to establish the ultimate truth, even though the latter would be a nice facilitator of the former. And unless you are Diogenes living in a barrel, the primary objective for most people is to improve their lot, while finding the truth is a means to that end rather than the end in its own right.
With this in mind, it comes as no surprise that prescriptive knowledge is particularly valued, and so are prescriptive wisdom and prescriptive competence. People are more likely to turn to a sage or an expert for advice on what to do than for an explanation of how things are. The prescriptive power of wisdom and the prescriptive power of competence deserve a separate discussion.
To begin with, we need to understand where in the brain knowledge is formed and stored, and also how the difference between descriptive and prescriptive expertise is reflected in the brain machinery of knowledge. And for that we need to consider two major distinctions in the architecture of the brain: the distinction between the two hemispheres and the distinction between the front and back of the cerebral cortex. Both descriptive and prescriptive knowledge are based on pattern recognition, and the patterns are embodied in attractors. Since knowledge is stored where the information was first processed (remember, there is no designated, spatially separate warehouse of memories in the brain), the attractors embodying descriptive and prescriptive knowledge inhabit somewhat different neocortical territories.
Both descriptive and prescriptive knowledge are stored in the most advanced parts of the neocortex, known as the association cortex. Descriptive knowledge is stored mostly in its posterior subdivisions, in the temporal, parietal, and occipital lobes. By contrast, prescriptive knowledge is stored in the frontal lobes. Recent research has also shown that the two cerebral hemispheres play very different roles in knowledge acquisition and storage, in the formation of attractors, and in the machinery of pattern recognition.
In the next few chapters we will further explore the brain mechanisms of wisdom and competence and how these coveted traits depend on the two halves of the brain and on the frontal lobes. As we learn more about the frontal lobes, their intimate role in the acquisition and storage of prescriptive knowledge will become increasingly clear. And as we learn more about the differences and interactions between the two cerebral hemispheres and how they relate to new and familiar cognitive challenges, we will better understand what sets the wisdom patterns apart from other manifestations of the mind, how they come about, and what allows them to withstand the ravages of aging.


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There are some interesting differences between men and women with BDD. I’ve found that women are more likely to have an eating disorder, whereas men are more likely to have a problem with alcohol or drugs. Men are more likely to be single. While the sexes are generally similar in the number and areas of bodily concern, men are more likely to think that their body build is. too small, skinny, or not muscular enough, whereas women are more likely to dislike their weight and hips, thinking they’re too large and fat. While men and women are equally likely to have hair concerns, men are more prone to fear that they’re losing their hair. All of the people who worried about excessive body hair were women, whereas all of those with genital concerns were men. Men are more apt to use a hat for camouflage, whereas women are more likely to turn to cosmetics for cover.
These results are interesting because some of them echo normal appearance concerns and behaviors. Research findings indicate that women generally think their bodies are too large, whereas men tend to worry that theirs are too small. A study of college students, for example, found that 85% of the women wanted to lose weight, whereas only 40% of the men wanted to lose weight and 45% actually wanted to gain it. In the general population, concerns about balding are relatively common among men but not women, and women are more likely to use cosmetics than men.
Several treatment findings are also interesting. I’ve found that men and women are equally likely to seek nonpsychiatric treatment such as surgery or dermatologic treatment for their BDD concerns. They’re also equally likely to receive these kinds of treatment. This finding differs from what we know about the general population, in which women are more likely to receive cosmetic treatments than men.
The only other study that to my knowledge has investigated gender differences in BDD was done in Italy in a smaller series (58 people). This study, like mine, found that BDD was generally similar in women and men. And like my findings, women were more likely to have the eating disorder bulimia nervosa, and men were more likely to be concerned with their genitals. Unlike my results, however, the Italian study found that women were more likely to focus on their breasts/chest and legs, check mirrors, and camouflage, whereas men were more likely to focus on their height and excessive body hair. Certainly, we need more research on gender similarities and differences in BDD, not only in clinical settings but also in the general population and in different cultures.
I’m sometimes asked how many people with BDD are homosexual. I systematically assessed this in my series of 200 people with BDD and found that 5% were homosexual and 3% were bisexual. This percentage is somewhat higher than in the general population, but it indicates that the vast majority of people with BDD are heterosexual.

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