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ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: ADMINISTRATIVE TASKS

Now to sound a very different note. An inevitable and necessary part of a counselor’s work is adminstrative. Writing notes in the chart…. Contacting agencies or counselors for previous records…. Dictating discharge summaries…. Contacting the referring party or others to whom a client will be referred….This is often perceived as a pain in the neck and the portion of one’s job most likely to get short shrift. However, attending to these details is an important part of good clinical care. Alcohol treatment is almost never a solo act, but instead involves the efforts of a team. How effectively the team functions often depends on the counselor who orchestrates and coordinates the various efforts.
The client’s chart or medical record is one very important vehicle for communicating information. This is especially true in a residential facility, with multiple staff working different shifts. There are often questions as to what should and shouldn’t go in a chart. To handle things that should be noted but are particularly sensitive, some agencies have adopted a set of confidential files, separate from the main record. Although not wishing to dismiss lightly the concern for confidentiality, nevertheless, it can be a red herring. In thinking about what to include in the chart, ask yourself “What do others need to know to respond therapeutically?” Rarely does this have anything to do with “deep dark secrets. ” More often it has to do with the everyday nuts and bolts— worrying over a date for discharge, preoccupation with an upcoming court appearance, a strained family meeting. The chart is not the place for putting forth verbatim accounts of individual sessions. But notation of any general themes, plus any modification of treatment plans is needed.
In addition to charting, it will also fall to the counselor to present cases at team planning meetings. On such occasions, a little preliminary thought helps: Are there special questions you have that you’d like to discuss with others? Along with these formal routes of communication, there are also informal channels. Take the opportunity to brief others.
Beyond orchestrating the activities of the treatment team, it falls to the counselor to be a liaison, and sometimes an advocate, with external groups such as employers, welfare workers, the courts. In these situations you must have the client’s permission before acting. Also, it is important not to do for the client what he can do for himself. Generally, it is more therapeutic to do a lot of handholding as the client takes care of business, rather than, in the interest of efficiency, doing it yourself.
*124\331\2*

ORAL ANTIBIOTIC THERAPY FOR OSTEOMYELITIS

Oral antibiotics with excellent bioavailability have potential use in managing osteomyelitis, and benefits include reduction in overall treatment cost and complications related to intravenous catheters. Some trials of oral fluoroquinolone therapy suggest similar efficacy with parenteral regimens, particularly when the pathogen is a gram-negative bacillus. However, oral fluoroquinolones appear less successful against S. aureus and Pseudomonas aeruginosa. Other oral antibiotics with good bioavailability that have been considered for osteomyelitis include clindamycin, co-trimoxazole, and some beta-lactams.
Some authors suggest switching to oral antibiotics after an initial 2 weeks of parenteral treatment. A drawback of oral treatment may be the potential for decreased compliance as compared with parenteral treatment. Close follow-up is recommended. Nevertheless, there are few controlled trials comparing oral and parenteral treatments for most clinical situations.
*132/348/5*

HOW DOES THE HEART PUMP THE BLOOD?

The heart has four chambers in a series, which pump the blood collected from the body to the lungs and then receive the purified blood (filled with oxygen) from the lungs and again pump the same to the whole body. These chambers are called right atrium (RA), right ventricle (RV), left atrium (LA) and left ventricle (LV). For a better understanding let’s call them chambers 1, 2, 3 and 4.
‘Chamber 1′ gets about 70 millilitres of blood almost every second from the entire body through two major veins (tubes carrying blood to the heart). This blood accumulates and is passed on to ‘chamber 2′ through a valve which opens only in one direction allowing the collected blood to pass in that direction. ‘Chamber 2′ contracts, thereby closing the valve between the first and second chambers, but opening another valve which pushes 70 ml. blood to both the lungs.
The blood now reaches the lungs for purification i.e. removal of carbon dioxide and filling up with oxygen. The lungs collect oxygen from the air that we breathe in through the nose.
Once the blood is purified it is sent to ‘chamber 3′ through some tubes and accumulates there. Then this blood is pushed to ‘chamber 4′ through another valve which only opens in the direction of ‘chamber 4′. No sooner the blood reaches ‘chamber 4′ this valve closes.
‘Chamber 4′ is the strongest and the most useful chamber of the heart as it has to pump blood to the entire body. Once the 70 ml. of blood comes to ‘chamber 4′, it contracts vigorously resulting in building a high pressure (above 120 mm of mercury). This opens another valve and pushes the blood to the main artery of the body called the aorta. Since the blood pressure inside the aorta is about 120 mm of mercury (mmHg), ‘chamber 4′ has to create a pressure of more than 120 mmHg to push the blood into this tube. The aorta now branches and re-branches to supply this blood to the entire body.
The first branch that the aorta gives blood goes to the heart, Usually two branches are available to the heart  -  one on the right and another on the left to supply blood to the heart muscles, especially the muscles of ‘chamber 4′. These two branches – the right coronary artery and the left coronary artery (more popularly called left main) divide and re-divide to supply the blood that they get from the aorta to the heart muscles. Immediately after its origin, the left main divides into two branches called left anterior descending (LAD) and left circumflex (LCx) to supply to the left part of the heart.
The condition of the heart is like that of a cashier in the bank. The cashier handles crores (one crore is equal to 10 million) of money everyday, but he cannot use it for himself or for his personal requirements. He has to depend on his own salary which forms a small part of the cash that he is handling. Likewise the heart also handles so much blood everyday through its chambers but can utilize only a fraction of it for its own use.
One must remember that once all the chambers of the heart contract a round, 70 ml. of blood is pushed. Since the heart chambers contract 72 times in a minute, a total of about 5000 ml. of blood is pushed to the whole body in 72 installments.
The aorta, supplying blood, first circulates the blood to the entire body. It immediately gives a branch on the right side to supply blood to the whole of the right hand. The next branches are to the brain and left hand. It takes a turn below, and gives a series of branches, called arteries to the chest walls. Once it enters the abdomen it supplies blood to the liver, kidneys, spleen and intestines (both large and small). Finally it divides into two branches to supply blood to the legs.
*5/283/5*

ARTHRITIS RELIEF SYSTEM: BIOECOLOGIC APPROACH TO ARTHRITIS

The bioecologic approach to arthritis control is the safest available method of treatment because it does not introduce drugs into the body that Professor A. H. Corwin, Professor Emeritus of Chemistry at John Hopkins University, refers to as “selective poisons.” But the self-help system that used to determine which allergens produce your arthritic response may place some stress on some individuals. If you have a serious medical problem other than your arthritis – if you have heart trouble, diabetes, asthma, epilepsy, or a recent history of serious emotional problems such as severe or suicidal depression or violence or self-destructive behavior – you must protect yourself and others by being tested under the supervision of an ecologically trained physician or clinic.
At the very least, if you have any serious doubts about the overall state of your health, you should consult with and be examined by your physician before beginning the self-tests.
Remember that many doctors are unaware of the effectiveness of our approach and may try to dissuade you from this course of action even after giving you a clean bill of health.
Also remember that many kinds of non-arthritic symptoms often are themselves unrecognized allergic reactions or allergy-like responses, which will disappear along with your arthritis when trigger substances are eliminated.
In any case, use your good common sense. After all, you wouldn’t sign up for a vigorous physical fitness program, no matter how good you believe it might make you feel, if you were still recovering from a heart attack or a broken leg! When in doubt, consult your physician.
Besides common sense, you will need to call on your intelligence and your self-awareness. I am going to ask you to be a detective and to look for clues in your own body. You will need to be alert to reactions as you work your way through the Lifetime Arthritis Relief program. When it is appropriate, ask for help from a friend or relative who cares about you and will check on your condition several times each day to see if you need any assistance and to follow your progress and learn about your observations.
If you are like most people, you will be surprised to learn that you probably already know the cause of your arthritis! It has been my experience that at least three fourths of the patients who come to my office will bring invaluable diagnostic-clue-laden information with them. Some cases are very easy for me; others can be a little “tricky”; and some are difficult and complex.
Patients often reveal their allergies and their addictions. “I’ve never been able to tolerate milk.” “My knees hurt like the devil about two hours after I eat pork.” And one might say, “I love tomatoes so much that I could eat them with every meal.” And sure enough, one has a severe reaction to the dairy-products tests, one has “pork arthritis,” and the other shows extreme sensitivity to tomatoes. “Food X always relieves my headache.” “I start to ache if I skip a meal.” “I feel wonderful if I fast.” “Two ounces of beer and the pain in my knuckles and elbows disappears.” “I can’t stand fresh paint, hair spray, and bus fumes.”
If at first glance the process seems too complicated or arduous, read it over again and think about it, because it really is easy. Remind yourself that a few weeks of effort are a very small price to pay for many years of good health and freedom from pain and possible crippling. Once the food-allergic arthritic person’s body is thoroughly free of the effects of the specific group of offending foods (after a period of food elimination that gives you a much-needed biologic rest from allergy stress), you, like most other food-sensitive patients, will find that you can tolerate many of them in the near future without suffering reactions.
Your comfort and health are now to a great degree in your own hands. One advantage of the bioecologic approach to arthritis and other allergic-ecologic disorders is that it gives you – the one who was always on the scene in the arthritic body (rather than a doctor or a pharmacist) – the full-time, major responsibility for improving your own health and well-being in a conservative, drug-free way.
*16/295/5*

ARTHRITIS RELIEF SYSTEM: BIOECOLOGIC APPROACH TO ARTHRITISThe bioecologic approach to arthritis control is the safest available method of treatment because it does not introduce drugs into the body that Professor A. H. Corwin, Professor Emeritus of Chemistry at John Hopkins University, refers to as “selective poisons.” But the self-help system that used to determine which allergens produce your arthritic response may place some stress on some individuals. If you have a serious medical problem other than your arthritis – if you have heart trouble, diabetes, asthma, epilepsy, or a recent history of serious emotional problems such as severe or suicidal depression or violence or self-destructive behavior – you must protect yourself and others by being tested under the supervision of an ecologically trained physician or clinic. At the very least, if you have any serious doubts about the overall state of your health, you should consult with and be examined by your physician before beginning the self-tests.Remember that many doctors are unaware of the effectiveness of our approach and may try to dissuade you from this course of action even after giving you a clean bill of health.Also remember that many kinds of non-arthritic symptoms often are themselves unrecognized allergic reactions or allergy-like responses, which will disappear along with your arthritis when trigger substances are eliminated.In any case, use your good common sense. After all, you wouldn’t sign up for a vigorous physical fitness program, no matter how good you believe it might make you feel, if you were still recovering from a heart attack or a broken leg! When in doubt, consult your physician.Besides common sense, you will need to call on your intelligence and your self-awareness. I am going to ask you to be a detective and to look for clues in your own body. You will need to be alert to reactions as you work your way through the Lifetime Arthritis Relief program. When it is appropriate, ask for help from a friend or relative who cares about you and will check on your condition several times each day to see if you need any assistance and to follow your progress and learn about your observations.If you are like most people, you will be surprised to learn that you probably already know the cause of your arthritis! It has been my experience that at least three fourths of the patients who come to my office will bring invaluable diagnostic-clue-laden information with them. Some cases are very easy for me; others can be a little “tricky”; and some are difficult and complex.Patients often reveal their allergies and their addictions. “I’ve never been able to tolerate milk.” “My knees hurt like the devil about two hours after I eat pork.” And one might say, “I love tomatoes so much that I could eat them with every meal.” And sure enough, one has a severe reaction to the dairy-products tests, one has “pork arthritis,” and the other shows extreme sensitivity to tomatoes. “Food X always relieves my headache.” “I start to ache if I skip a meal.” “I feel wonderful if I fast.” “Two ounces of beer and the pain in my knuckles and elbows disappears.” “I can’t stand fresh paint, hair spray, and bus fumes.”If at first glance the process seems too complicated or arduous, read it over again and think about it, because it really is easy. Remind yourself that a few weeks of effort are a very small price to pay for many years of good health and freedom from pain and possible crippling. Once the food-allergic arthritic person’s body is thoroughly free of the effects of the specific group of offending foods (after a period of food elimination that gives you a much-needed biologic rest from allergy stress), you, like most other food-sensitive patients, will find that you can tolerate many of them in the near future without suffering reactions.Your comfort and health are now to a great degree in your own hands. One advantage of the bioecologic approach to arthritis and other allergic-ecologic disorders is that it gives you – the one who was always on the scene in the arthritic body (rather than a doctor or a pharmacist) – the full-time, major responsibility for improving your own health and well-being in a conservative, drug-free way. *16/295/5*

COMBATTING ASTHMA IN CHILDREN: ANTI-INFLAMMATORY DRUGS – STEROIDS: BRONCHODILATORY DRUGS

Another major group of drugs used in the treatment are bronchodilator drugs. These drugs provide relief by dilating the bronchial tubes, and hence their name. They include
1. beta-agonists or adrenergic drugs like salbutamol and terbutaline,
2. xanthines   like   theophylline,   deriphylline   and aminophylline and
3. anticholenergics like ipratropium which is inhaled. Our nervous system, which controls all our bodily functions, has two main sub-systems—the sympathetic and the parasympathetic nervous systems. These two nervous systems also control the bronchial tubes. The sympathetic system opens or dilates the bronchial tubes, while the parasympathetic system closes or constricts them. When the systems are in balance, air flows in and out of the bronchial tubes normally. Bronchodilatory drugs act through the sympathetic nervous system and dilate the bronchial tubes.
*62\260\8*

COMBATTING ASTHMA IN CHILDREN: ANTI-INFLAMMATORY DRUGS – STEROIDS: BRONCHODILATORY DRUGSAnother major group of drugs used in the treatment are bronchodilator drugs. These drugs provide relief by dilating the bronchial tubes, and hence their name. They include1. beta-agonists or adrenergic drugs like salbutamol and terbutaline,2. xanthines   like   theophylline,   deriphylline   and aminophylline and3. anticholenergics like ipratropium which is inhaled. Our nervous system, which controls all our bodily functions, has two main sub-systems—the sympathetic and the parasympathetic nervous systems. These two nervous systems also control the bronchial tubes. The sympathetic system opens or dilates the bronchial tubes, while the parasympathetic system closes or constricts them. When the systems are in balance, air flows in and out of the bronchial tubes normally. Bronchodilatory drugs act through the sympathetic nervous system and dilate the bronchial tubes.*62\260\8*

TYPE 1 DIABETES: ILLUSTRATIVE CASES – UNCOMPLICATED TYPE 1 DIABETES WITH PREDIABETIC PHASE AND C-PEPTIDE SECRETION

A 42-year-old Caucasian woman reported that she had an elevated blood glucose transiently in 1980 and gestational diabetes (GDM) in 1995, which required 50 U of insulin daily. For 9 months after delivery, she was managed on diet alone but in 1996 was placed on insulin because of HbA1 c of 7.1 %. Pancreatic islet cell antibody tests were positive. Since then she has maintained HbAlc values in the range of 5.8-6.2%. Usual insulin doses are 5 U NPH before breakfast and 5 U NPH at bedtime with premeal lispro insulin, 1-3U. Her weight is steady at 60 kg; total insulin dose/24 hr = 0.33 U/kg. Blood Dressure and lipid profile are normal. She has had fasting c-peptide levels of 0.6-0.8 ng/dl. She has no retinopathy and urine microalbumin levels are 5-7 mg/24 hours. She has hypothyroidism that is well controlled on 0.125 mg of L-thyroxine/day.
Comment. Type 1 diabetes may follow GDM, particularly in nonobese Patients with positive islet antibodies. The presence of hypothyroidism is another clue to an autoimmune process in the thyroid and pancreas. This Patient has maintained excellent glycemic control on low doses of insulin ’0-33 U/kg), probably because of the presence of residual insulin secretion as shown by fasting c-peptide levels of 0.6-0.8 ng/ml. Although laboratories may vary, we have found that a fasting level of < 1.0 ng/ml is insistent with type 1 diabetes, although higher levels are usually found type 2 diabetes. Experience has indicated that the patient may have a gradual loss of insulin secretion in the future. If so, her insulin requirements will rise and precise glycemic control will be more difficult. Bedtime insulin glargine with premeal lispro or aspart may be tri or she may be placed on insulin pump therapy.
*68\357\8*

TYPE 1 DIABETES: ILLUSTRATIVE CASES  - UNCOMPLICATED TYPE 1 DIABETES WITH PREDIABETIC PHASE AND C-PEPTIDE SECRETIONA 42-year-old Caucasian woman reported that she had an elevated blood glucose transiently in 1980 and gestational diabetes (GDM) in 1995, which required 50 U of insulin daily. For 9 months after delivery, she was managed on diet alone but in 1996 was placed on insulin because of HbA1 c of 7.1 %. Pancreatic islet cell antibody tests were positive. Since then she has maintained HbAlc values in the range of 5.8-6.2%. Usual insulin doses are 5 U NPH before breakfast and 5 U NPH at bedtime with premeal lispro insulin, 1-3U. Her weight is steady at 60 kg; total insulin dose/24 hr = 0.33 U/kg. Blood Dressure and lipid profile are normal. She has had fasting c-peptide levels of 0.6-0.8 ng/dl. She has no retinopathy and urine microalbumin levels are 5-7 mg/24 hours. She has hypothyroidism that is well controlled on 0.125 mg of L-thyroxine/day.Comment. Type 1 diabetes may follow GDM, particularly in nonobese Patients with positive islet antibodies. The presence of hypothyroidism is another clue to an autoimmune process in the thyroid and pancreas. This Patient has maintained excellent glycemic control on low doses of insulin ’0-33 U/kg), probably because of the presence of residual insulin secretion as shown by fasting c-peptide levels of 0.6-0.8 ng/ml. Although laboratories may vary, we have found that a fasting level of < 1.0 ng/ml is insistent with type 1 diabetes, although higher levels are usually found type 2 diabetes. Experience has indicated that the patient may have a gradual loss of insulin secretion in the future. If so, her insulin requirements will rise and precise glycemic control will be more difficult. Bedtime insulin glargine with premeal lispro or aspart may be tri or she may be placed on insulin pump therapy.*68\357\8*

INTAKE OF ALCOHOL AS A MODIFIABLE RISK FACTOR FOR CORONARY HEART DISEASE DEVELOPMENT

Alcohol intake is also a known risk factor of coronary heart disease – directly or indirectly. It has become associated with heart disease in many ways. Alcohol leads to increased triglycerides, owing to its similarity of structure with glycerol, a component of triglycerides. Many good laboratories do not take blood samples for lipid profile test (which includes triglycerides) if the patients have consumed alcohol in the last 12 hours.
Alcohol also adds huge calories to the patients. Many people eat a lot of fried items while drinking. This also adds to fat, cholesterol and calories. Alcohol is often associated with increased stress and bad interpersonal relationships in the family. Alcohol is also one of the major causes of liver disease and failure, besides gastritis and neurological damages.
There has been some confusion about recommending of alcohol in some newspapers and medical journals. It has been shown that alcohol can increase the HDL levels in the blood, but it also increases the triglycerides – it does more harm than benefit to the patients. One must see all the effects rather than one isolated parameter.
Moreover, many of these research studies are carried out in countries where the temperature is very low and alcohol is used in considerable quantities. The extrapolations are not justified with regard to alcohol. Many studies have also shown that alcohol also leads to an increased incidence of heart disease.
*18/283/5*

INTAKE OF ALCOHOL AS A MODIFIABLE RISK FACTOR FOR CORONARY HEART DISEASE DEVELOPMENTAlcohol intake is also a known risk factor of coronary heart disease – directly or indirectly. It has become associated with heart disease in many ways. Alcohol leads to increased triglycerides, owing to its similarity of structure with glycerol, a component of triglycerides. Many good laboratories do not take blood samples for lipid profile test (which includes triglycerides) if the patients have consumed alcohol in the last 12 hours.Alcohol also adds huge calories to the patients. Many people eat a lot of fried items while drinking. This also adds to fat, cholesterol and calories. Alcohol is often associated with increased stress and bad interpersonal relationships in the family. Alcohol is also one of the major causes of liver disease and failure, besides gastritis and neurological damages.There has been some confusion about recommending of alcohol in some newspapers and medical journals. It has been shown that alcohol can increase the HDL levels in the blood, but it also increases the triglycerides – it does more harm than benefit to the patients. One must see all the effects rather than one isolated parameter.Moreover, many of these research studies are carried out in countries where the temperature is very low and alcohol is used in considerable quantities. The extrapolations are not justified with regard to alcohol. Many studies have also shown that alcohol also leads to an increased incidence of heart disease.*18/283/5*

HOW THE PILL REALLY WORKS! (INTRODUCTION)

With four decades of knowledge of the many side-effects of the Pill, there are still too few doctors who adequately warn their patients of the many potential risks and serious problems associated with taking the Pill. In 1995 Professor John Guillebaud, a noted English expert on Family Planning, wrote, “Although not risk free, the Pill’s benefits far outweigh its risks. Another way of saying this is that the Pill is safe — but some women are dangerous.”
Such double speak lulls doctors and women into a false sense of security, assuring them that the newer generations of oral contraceptives are now perfectly safe. Unfortunately, nothing could be further from the truth.
Hormones are very powerful substances. Begin tampering with nature’s finely tuned messengers of life’s processes and you are asking for trouble. This is especially true for young women. A woman’s psyche is intimately connected to her monthly flow of hormones.
*126/165/1*

HOW THE PILL REALLY WORKS! (INTRODUCTION)With four decades of knowledge of the many side-effects of the Pill, there are still too few doctors who adequately warn their patients of the many potential risks and serious problems associated with taking the Pill. In 1995 Professor John Guillebaud, a noted English expert on Family Planning, wrote, “Although not risk free, the Pill’s benefits far outweigh its risks. Another way of saying this is that the Pill is safe — but some women are dangerous.”Such double speak lulls doctors and women into a false sense of security, assuring them that the newer generations of oral contraceptives are now perfectly safe. Unfortunately, nothing could be further from the truth.Hormones are very powerful substances. Begin tampering with nature’s finely tuned messengers of life’s processes and you are asking for trouble. This is especially true for young women. A woman’s psyche is intimately connected to her monthly flow of hormones.*126/165/1*

CONTROLLING FATIGUE IN RHEUMATOID ARTHRITIS (RA): GET ADEQUATE REST

Individuals with RA require more rest than they did before they developed the condition. Adequate rest takes many forms, including physical, emotional, and local rest.
Getting adequate sleep is imperative because sleep provides a healing factor for the body and the mind. We recommend ten hours of sleep daily, particularly during periods when the arthritis has flared up. You may prefer to sleep eight hours at night and take two one-hour naps during the day. If getting adequate sleep proves difficult, ask your doctor to recommend or prescribe pain or sleeping medications to help you.
We can sometimes rest physically and emotionally at the same time – this happens when we sleep, for example. Taking a fifteen- or twenty-minute break in the morning and afternoon can also make an incredible difference in productivity. Learning and performing stress reduction and relaxation techniques during tense times may be particularly beneficial. During these breaks try to relax your mind and body. If you can manage to lie down with your feet elevated, you’ll increase the benefits of the break. Taking these prescribed breaks routinely each day may allow you to avoid the severe exhaustion that occurs when you become overly fatigued.
From time to time it’s a good idea to reflect on the day’s activities. Think about what you did during the day and when you felt most tired. This review exercise will allow you to schedule strategic rest breaks during the day which will help you avoid becoming overtired. If necessary, discuss these recommendations with your employer; he or she will probably agree that this is time well spent. It is to everyone’s benefit for you to retain your energy so you can be as efficient and productive as possible.
Local rest means resting specific parts of the body. Getting local rest will help you protect your joints from undue stress; this can be achieved by wearing splints, which can be fabricated to protect the wrists and hands, and by using techniques designed to reduce joint stress.
*48/209/5*

CONTROLLING FATIGUE IN RHEUMATOID ARTHRITIS (RA): GET ADEQUATE RESTIndividuals with RA require more rest than they did before they developed the condition. Adequate rest takes many forms, including physical, emotional, and local rest.Getting adequate sleep is imperative because sleep provides a healing factor for the body and the mind. We recommend ten hours of sleep daily, particularly during periods when the arthritis has flared up. You may prefer to sleep eight hours at night and take two one-hour naps during the day. If getting adequate sleep proves difficult, ask your doctor to recommend or prescribe pain or sleeping medications to help you.We can sometimes rest physically and emotionally at the same time – this happens when we sleep, for example. Taking a fifteen- or twenty-minute break in the morning and afternoon can also make an incredible difference in productivity. Learning and performing stress reduction and relaxation techniques during tense times may be particularly beneficial. During these breaks try to relax your mind and body. If you can manage to lie down with your feet elevated, you’ll increase the benefits of the break. Taking these prescribed breaks routinely each day may allow you to avoid the severe exhaustion that occurs when you become overly fatigued.From time to time it’s a good idea to reflect on the day’s activities. Think about what you did during the day and when you felt most tired. This review exercise will allow you to schedule strategic rest breaks during the day which will help you avoid becoming overtired. If necessary, discuss these recommendations with your employer; he or she will probably agree that this is time well spent. It is to everyone’s benefit for you to retain your energy so you can be as efficient and productive as possible.Local rest means resting specific parts of the body. Getting local rest will help you protect your joints from undue stress; this can be achieved by wearing splints, which can be fabricated to protect the wrists and hands, and by using techniques designed to reduce joint stress.*48/209/5*

A HISTORICAL PERSPECTIVE ON OCD TREATMENT: SOUND ADVICE FROM SAINTS WHO SUFFERED OCD

Saint ignatius of Loyola, Saint Therese of Lisieux, and John Bunyan are all celebrated for their unique spirituality. As discussed in Chapter 3, these three luminaries also suffered OCD early in their lives. Of special interest is the fact that Ignatius, Therese, and Bunyan incorporated into their writings what amounts to behaviorally sound advice for OCD: exposure to obsessions and prevention of compulsions.
The approach of Saint Ignatius (1491-1556), founder of the Jesuits, is strongly introspective and analytical. Ignatius emphasizes the cardinal importance of identifying the nature of the thought that one is experiencing. Some types of thoughts come from Satan, the traditional purveyor of all bad thoughts. One specific type is that which we now call obsessions. Once it is recognized that Satan is at work, and that obsessions are the problem, Ignatius recommends preserving peace in the mind by ignoring these particular thoughts. In a letter to a friend suffering apparent obsessions, Ignatius writes:
It is necessary therefore to ascertain the nature of the condition we experience. … If the enemy discovers a conscience that is overly tender, he endeavors to torment, suggesting sin where there is none, anything to be able to disturb and afflict us. . . . If it is this kind of temptation that besets us, we must bear up against it without any vexation, and await the consolation of the Lord with patience. . . . Pay no attention whatsoever to the bad, impute, and sensual
thoughts.
This excellent advice is consistent with modern behavioral therapy: once it is recognized that an obsession is the problem, try to bear it with patience and avoid fighting it.
John Bunyan, whose Puritan spirituality influenced Protestantism, including modern-day Evangelicalism, to a degree that cannot be overestimated, wrote two pamphlets, The Doctrine of the Laic and Grace Unfolded and Some Gospel Truths Opened, only a short time after recovering from his lengthy OCD crisis. In them he says:
Know it for a truth that the greater you see your sins to be, the more cause you have to believe. . . . You must come to Christ with the fire of hell in your conscience; come with your heart hard, dead, cold, full of wickedness and madness; come as a blood-red sinner. Throw yourself down at the foot of Christ and say, “Lord Jesus hear a sinner, a sinner that deserves to be damned.” Resolve never to give over crying until you find that he has washed your conscience with his blood.
The important point here is that Bunyan encourages maximum exposure to obsessions. In fact, putting a remarkable spin on tormenting thoughts, Bunyan suggests that having sinful obsessions is actually good for you, because “the greater you see your sins to be, the more cause you have to believe.” Bunyan’s advice is to keep coming to God with the full weight of your obsessions until you feel peaceful, or, in behavioral terms, to keep exposing yourself maximally to obsessions until habituation takes place.
Bunyan also emphasizes response prevention. Having learned from painful personal experience that efforts to reform, performances of certain rituals, and reassurances gained from reading scripture were of no help for his OCD, he cautions against the use of compulsions.
Have care of putting off your trouble of spirit in the wrong way: by promising to reform yourself and lead a new life, by your performances or duties, [by being] content with any knowledge that you can attain to by yourself. They that are saved are saved by Grace through faith; not for anything they can do themselves.
Therese of Lisieux, called by a recent pope the greatest of modern-day saints, developed a spirituality centered on abandonment and trust. Like Bunyan, she discovered through personal experience that obsessions do not respond to acts of will. What worked was surrender to God. In Story of a Soul Therese writes: “Even though I have on my conscience all the sins that can be committed, I go, my heart broken with sorrow, and throw myself into Jesus’ arms. . . . What pleases God is the blind hope that I have in His mercy.”
Therese’s cousin, Marie Guerin, suffered sexual obsessions. In a letter to Therese, Marie admits her shameful thoughts and requests counsel. Therese responds affectionately with advice that is behaviorally sound.
I understand everything, everything, everything, everything! You haven’t committed the shadow of any evil; I know these kinds of temptations so well that I can assure you of this without any fear. . . . We must despise all these temptations and pay no attention whatsoever to them. . . . Don’t listen to the devil. Mock him.
*68\223\2*

A HISTORICAL PERSPECTIVE ON OCD TREATMENT: SOUND ADVICE FROM SAINTS WHO SUFFERED OCDSaint ignatius of Loyola, Saint Therese of Lisieux, and John Bunyan are all celebrated for their unique spirituality. As discussed in Chapter 3, these three luminaries also suffered OCD early in their lives. Of special interest is the fact that Ignatius, Therese, and Bunyan incorporated into their writings what amounts to behaviorally sound advice for OCD: exposure to obsessions and prevention of compulsions.The approach of Saint Ignatius (1491-1556), founder of the Jesuits, is strongly introspective and analytical. Ignatius emphasizes the cardinal importance of identifying the nature of the thought that one is experiencing. Some types of thoughts come from Satan, the traditional purveyor of all bad thoughts. One specific type is that which we now call obsessions. Once it is recognized that Satan is at work, and that obsessions are the problem, Ignatius recommends preserving peace in the mind by ignoring these particular thoughts. In a letter to a friend suffering apparent obsessions, Ignatius writes:It is necessary therefore to ascertain the nature of the condition we experience. … If the enemy discovers a conscience that is overly tender, he endeavors to torment, suggesting sin where there is none, anything to be able to disturb and afflict us. . . . If it is this kind of temptation that besets us, we must bear up against it without any vexation, and await the consolation of the Lord with patience. . . . Pay no attention whatsoever to the bad, impute, and sensualthoughts.
This excellent advice is consistent with modern behavioral therapy: once it is recognized that an obsession is the problem, try to bear it with patience and avoid fighting it.John Bunyan, whose Puritan spirituality influenced Protestantism, including modern-day Evangelicalism, to a degree that cannot be overestimated, wrote two pamphlets, The Doctrine of the Laic and Grace Unfolded and Some Gospel Truths Opened, only a short time after recovering from his lengthy OCD crisis. In them he says:
Know it for a truth that the greater you see your sins to be, the more cause you have to believe. . . . You must come to Christ with the fire of hell in your conscience; come with your heart hard, dead, cold, full of wickedness and madness; come as a blood-red sinner. Throw yourself down at the foot of Christ and say, “Lord Jesus hear a sinner, a sinner that deserves to be damned.” Resolve never to give over crying until you find that he has washed your conscience with his blood.
The important point here is that Bunyan encourages maximum exposure to obsessions. In fact, putting a remarkable spin on tormenting thoughts, Bunyan suggests that having sinful obsessions is actually good for you, because “the greater you see your sins to be, the more cause you have to believe.” Bunyan’s advice is to keep coming to God with the full weight of your obsessions until you feel peaceful, or, in behavioral terms, to keep exposing yourself maximally to obsessions until habituation takes place.Bunyan also emphasizes response prevention. Having learned from painful personal experience that efforts to reform, performances of certain rituals, and reassurances gained from reading scripture were of no help for his OCD, he cautions against the use of compulsions.Have care of putting off your trouble of spirit in the wrong way: by promising to reform yourself and lead a new life, by your performances or duties, [by being] content with any knowledge that you can attain to by yourself. They that are saved are saved by Grace through faith; not for anything they can do themselves.Therese of Lisieux, called by a recent pope the greatest of modern-day saints, developed a spirituality centered on abandonment and trust. Like Bunyan, she discovered through personal experience that obsessions do not respond to acts of will. What worked was surrender to God. In Story of a Soul Therese writes: “Even though I have on my conscience all the sins that can be committed, I go, my heart broken with sorrow, and throw myself into Jesus’ arms. . . . What pleases God is the blind hope that I have in His mercy.”Therese’s cousin, Marie Guerin, suffered sexual obsessions. In a letter to Therese, Marie admits her shameful thoughts and requests counsel. Therese responds affectionately with advice that is behaviorally sound.I understand everything, everything, everything, everything! You haven’t committed the shadow of any evil; I know these kinds of temptations so well that I can assure you of this without any fear. . . . We must despise all these temptations and pay no attention whatsoever to them. . . . Don’t listen to the devil. Mock him.*68\223\2*

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