ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: SUGGESTIONS FOR WORKING WITH FAMILIES DURING TREATMENT

The data gathering completed, the task turns to helping the family make the readjustments necessary to reestablish a new balance. Here are some concrete suggestions for dealing with alcoholic families at this treatment stage. You are the most objective person present; therefore, it is up to you to evaluate and guide the process.
Concentrate on the interaction, not on the content. Don’t become the referee in a family digression.
Teach them how to check things out. People tend to guess at other peoples’ meanings and motivations. They then respond as though the guesses were accurate. This causes all kinds of confusion and misunderstandings and can lead to mutual recriminations. The counselor needs to put a stop to these mind-reading games, and point out what is going on.
The counselor must be alert to “scapegoating.” A common human tendency is to lay it all on George. This is true whatever the problem. The alcoholic family tends to blame the drinker for all the family’s troubles, thereby neatly avoiding any responsibility for their own actions. Help them see this as a no-no.
Any good therapy stresses acceptance of each person’s right to his own feelings. One reason for this is that good feelings get blocked by unexpressed bad feelings. One of the tasks of a therapist is to bring out the family’s strengths. The focus has been on the problems for so long that they have lost sight of the good points.
Be alert to avoidance transactions. This includes such things as digressing to Christmas 3 years ago in the midst of a heated discussion of Daddy’s drinking. It is up to you to point this out to them and get them back on the track. In a similar vein, it may fall to you to “speak the unspeakable,” to bring out in the open the obvious, but unmentioned, facts.
In making these patterns clear to the family, you can guide them into problem-solving techniques as options. You can help them begin to use these in therapy, with an eye to teaching them to use them on their own.
After a time of success, when things seem to be going better, there may be some resistance to continuing therapy. The family fears a setback and wants to stop while they’re ahead. Simply point this out to them. They can try for something better or terminate. If they terminate, leave the door open for a return later.
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ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: SUGGESTIONS FOR WORKING WITH FAMILIES DURING TREATMENTThe data gathering completed, the task turns to helping the family make the readjustments necessary to reestablish a new balance. Here are some concrete suggestions for dealing with alcoholic families at this treatment stage. You are the most objective person present; therefore, it is up to you to evaluate and guide the process.Concentrate on the interaction, not on the content. Don’t become the referee in a family digression.Teach them how to check things out. People tend to guess at other peoples’ meanings and motivations. They then respond as though the guesses were accurate. This causes all kinds of confusion and misunderstandings and can lead to mutual recriminations. The counselor needs to put a stop to these mind-reading games, and point out what is going on.The counselor must be alert to “scapegoating.” A common human tendency is to lay it all on George. This is true whatever the problem. The alcoholic family tends to blame the drinker for all the family’s troubles, thereby neatly avoiding any responsibility for their own actions. Help them see this as a no-no.Any good therapy stresses acceptance of each person’s right to his own feelings. One reason for this is that good feelings get blocked by unexpressed bad feelings. One of the tasks of a therapist is to bring out the family’s strengths. The focus has been on the problems for so long that they have lost sight of the good points.Be alert to avoidance transactions. This includes such things as digressing to Christmas 3 years ago in the midst of a heated discussion of Daddy’s drinking. It is up to you to point this out to them and get them back on the track. In a similar vein, it may fall to you to “speak the unspeakable,” to bring out in the open the obvious, but unmentioned, facts.In making these patterns clear to the family, you can guide them into problem-solving techniques as options. You can help them begin to use these in therapy, with an eye to teaching them to use them on their own.After a time of success, when things seem to be going better, there may be some resistance to continuing therapy. The family fears a setback and wants to stop while they’re ahead. Simply point this out to them. They can try for something better or terminate. If they terminate, leave the door open for a return later.*131\331\2*

ASTHMA CASE HISTORIES: ASTHMA AND DIET

I have had mild but chronic asthma for years. I won’t go into the boring list of medications I have swallowed over the years. While they relieved the symptoms, they did not prevent me from wheezing most days. I changed my diet after talking with a friend who said she had all but rid herself of her asthma after eliminating certain foods from her diet.
I was quite a big cheese eater and also drank a few glasses of milk a day. I cut out all dairy foods and within weeks my asthma had improved. My doctor, who is also a personal friend, says it is all in my head and does not agree that my diet has anything to do with my asthma. All I know is that I have experienced a significant decrease in coughing and wheezing since I cut out these foods. I reckon your body knows best, and now I don’t even miss these foods. I have also increased the amount of water I drink to about eight glasses a day. Maybe this is significant, maybe not, but I’m certainly enjoying life more since I’m dairy free and waterlogged!
*54\148\2*

ASTHMA CASE HISTORIES: ASTHMA AND DIETI have had mild but chronic asthma for years. I won’t go into the boring list of medications I have swallowed over the years. While they relieved the symptoms, they did not prevent me from wheezing most days. I changed my diet after talking with a friend who said she had all but rid herself of her asthma after eliminating certain foods from her diet.I was quite a big cheese eater and also drank a few glasses of milk a day. I cut out all dairy foods and within weeks my asthma had improved. My doctor, who is also a personal friend, says it is all in my head and does not agree that my diet has anything to do with my asthma. All I know is that I have experienced a significant decrease in coughing and wheezing since I cut out these foods. I reckon your body knows best, and now I don’t even miss these foods. I have also increased the amount of water I drink to about eight glasses a day. Maybe this is significant, maybe not, but I’m certainly enjoying life more since I’m dairy free and waterlogged!*54\148\2*

PROTEIN FOR PEOPLE WITH DIABETES

The third major constituent of food, besides carbohydrate and fat, is protein. In addition to supplying kilojoules, protein also provides the building blocks for growth and repair of muscles, bones and connective tissue.
Although protein is essential for life, most westerners eat too much of it. The meat and potatoes approach to food may have been needed in earlier days, but our modern lifestyle does not require such an emphasis on meat.
Indeed, as a person with diabetes, your intake of protein may be critical to your risks for development of complications affecting kidney function. Research has shown that the higher the amount of protein in the diet of a person with poorly controlled diabetes, the more likely the kidneys are to suffer increased damage over the years.
If you have been diagnosed as also having kidney function problems in addition to your diabetes, you may be advised to greatly reduce the amount of protein you eat. Even if you don’t have kidney problems, it’s important that you routinely be tested to find out if your kidneys are spilling protein – an early warning sign of kidney function problems. Another recommended test is a creatine clearance assay to determine how well your kidneys are functioning.
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PROTEIN FOR PEOPLE WITH DIABETES The third major constituent of food, besides carbohydrate and fat, is protein. In addition to supplying kilojoules, protein also provides the building blocks for growth and repair of muscles, bones and connective tissue.Although protein is essential for life, most westerners eat too much of it. The meat and potatoes approach to food may have been needed in earlier days, but our modern lifestyle does not require such an emphasis on meat.Indeed, as a person with diabetes, your intake of protein may be critical to your risks for development of complications affecting kidney function. Research has shown that the higher the amount of protein in the diet of a person with poorly controlled diabetes, the more likely the kidneys are to suffer increased damage over the years.If you have been diagnosed as also having kidney function problems in addition to your diabetes, you may be advised to greatly reduce the amount of protein you eat. Even if you don’t have kidney problems, it’s important that you routinely be tested to find out if your kidneys are spilling protein – an early warning sign of kidney function problems. Another recommended test is a creatine clearance assay to determine how well your kidneys are functioning.*16/210/5*

HEART SURGERY: WHEN IT IS REALLY NECESSARY

The problem of unnecessary surgery has been the subject of study for nearly a decade by the Rand Corporation, a policy research center in Santa Monica, California. In the early 1980s, Rand researchers checked the records of patients in one western state who’d had coronary bypass surgery. They found that, of 386 coronary surgeries performed there, 14 percent were unnecessary.
Given estimated average costs of 20,000 dollars per heart-related operation, it seems safe to project that Americans paid 1 billion dollars in taxes and insurance premiums just to cover those costs.
In the early 1990s, however, the Rand Corporation studied bypass surgery in New York State. The scene appears to have changed dramatically: It was found that among 1,500 operations, only 2.4 percent were unneeded. And, reports the New York State Department of Health Cardiac Survey, the death rate also dropped on the operating table- from 3.53 percent in 1990 to 2.51 percent in 1992.
The indications are that doctors keep acquiring skills and that the newer drugs and technology are gaining in their power to heal without injury. Some states keep track of cardiac surgeries. Through New York State Health Department data, in fact, you can discover a heart surgeon’s batting average-how many surgeries he or she performed and their outcomes.
At Columbia-Presbyterian Medical Center physicians have opened a new Heart Failure Center. Here, the doctors turn first to drugs to heal damaged hearts and reduce the battered heart’s workload. Dr. Milton Packer, the center’s chief, says that this approach has:
• taken 40 percent of heart failure patients off the transplant waiting list,
• improved the conditions of 70 percent of people with heart failure, and
• cut the mortality rate by 25 percent.
“Drugs are not as exciting as transplants or mechanical hearts,” Dr. Packer says, “but we have got to give drugs a chance to work.”
A growing number of patients seem to be opting for the drug-treatment-first approach.
One of them is Howard Mills, 48, a British citizen living in Redondo Beach, California. In November 1992, a viral infection had attacked his heart muscle, leaving it weak and flabby. Mr. Mills opted for medication over surgery. He became a patient at the UCLA Cardiomyopathy Center.
“I was taking a lot of different drugs,” says Mr. Mills, recalling the start of his treatment. “I could barely walk. But my heart and body came back. Now I can walk 4 miles an hour, I can swim, and I can ride a bike. I’m glad I escaped the transplant.”
*14/266/5*

HEART SURGERY: WHEN IT IS REALLY NECESSARYThe problem of unnecessary surgery has been the subject of study for nearly a decade by the Rand Corporation, a policy research center in Santa Monica, California. In the early 1980s, Rand researchers checked the records of patients in one western state who’d had coronary bypass surgery. They found that, of 386 coronary surgeries performed there, 14 percent were unnecessary.Given estimated average costs of 20,000 dollars per heart-related operation, it seems safe to project that Americans paid 1 billion dollars in taxes and insurance premiums just to cover those costs.In the early 1990s, however, the Rand Corporation studied bypass surgery in New York State. The scene appears to have changed dramatically: It was found that among 1,500 operations, only 2.4 percent were unneeded. And, reports the New York State Department of Health Cardiac Survey, the death rate also dropped on the operating table- from 3.53 percent in 1990 to 2.51 percent in 1992.The indications are that doctors keep acquiring skills and that the newer drugs and technology are gaining in their power to heal without injury. Some states keep track of cardiac surgeries. Through New York State Health Department data, in fact, you can discover a heart surgeon’s batting average-how many surgeries he or she performed and their outcomes.At Columbia-Presbyterian Medical Center physicians have opened a new Heart Failure Center. Here, the doctors turn first to drugs to heal damaged hearts and reduce the battered heart’s workload. Dr. Milton Packer, the center’s chief, says that this approach has:• taken 40 percent of heart failure patients off the transplant waiting list,• improved the conditions of 70 percent of people with heart failure, and• cut the mortality rate by 25 percent.”Drugs are not as exciting as transplants or mechanical hearts,” Dr. Packer says, “but we have got to give drugs a chance to work.”A growing number of patients seem to be opting for the drug-treatment-first approach.One of them is Howard Mills, 48, a British citizen living in Redondo Beach, California. In November 1992, a viral infection had attacked his heart muscle, leaving it weak and flabby. Mr. Mills opted for medication over surgery. He became a patient at the UCLA Cardiomyopathy Center.”I was taking a lot of different drugs,” says Mr. Mills, recalling the start of his treatment. “I could barely walk. But my heart and body came back. Now I can walk 4 miles an hour, I can swim, and I can ride a bike. I’m glad I escaped the transplant.”*14/266/5*

CANCER: THE CAUSES OF MALIGNANT MELANOMA

Determining the cause of malignant melanoma is one of the most pressing problems in cancer research today. The rapid rise of this potentially lethal cancer threatens a new epidemic. This could even be comparable to the epidemic of lung cancer which has been a feature of the twentieth century. Our understanding of the links between smoking and lung cancer is having an impact on the current trends in lung cancer and may as we have seen, gradually be bringing this epidemic under control. It is very important that we should learn from this experience and build some such understanding into our thinking about future risks like cutaneous malignant melanoma.
We know a great deal about the causes of malignant melanoma. The most important of these is ultraviolet light in sunshine. This interacts particularly dangerously with certain kinds of skin: the risk of malignant melanoma is highest in persons with a large number of moles, poor tanning ability, a tendency to develop severe sunburn, fair or red hair, blue or green eyes and pale skin. A family history of melanoma seems to be an additional risk factor.
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GUARDING AGAINST THE CONSEQUENCES OF INFECTIOUS – IMPORTANT EFFORTS

It is therefore most important that every effort be made to ensure the complete excretion of toxins in all cases of infectious disease. The following three main points must be observed:

Elimination through the skin. The patient should be encouraged to perspire by applying hot packs, taking hot showers etc. The Kneipp treatment might also be used.

Elimination through the kidneys. This can be encouraged by means of a simple kidney remedy, such as tea made from goldenrod or parsley, or any other natural remedy which acts to stimulate the kidneys. Onion poultices are also effective for this.

Elimination through the bowels. Fever usually tends to dry up the bowels. To stimulate movement, use simple natural remedies, for example linseed tea, psyllium seed, manna stick tea (Cassia fistula), soaked figs or prunes. A diet consisting solely of fruit juice is also excellent. While the infectious disease lasts, it is advisable to refrain from eating protein; nothing but fruit juices and veg­etable juices is indicated.

If you pay close attention to these three points, you can avoid the complications often experienced as a result of ineptly treated infectious disease.
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GUARDING AGAINST THE CONSEQUENCES OF INFECTIOUS DISEASES

Toxins in the system, which stem from infectious disease, must be eliminated or they will lead to future ill health. A case of mumps that has been neglected or not fully cured can lead to pancreatitis (inflammation of the pancreas) in later life. An inflammation of the middle ear may be a result of suppressed scarlet fever. Improperly treated tonsillitis can give rise to heart trouble, for example inflammation of the heart muscle (myocarditis) or the endocardium (endocarditis), which in turn can lead to valvular defects or even pericarditis, although this is less frequent. The kidneys can suffer too, and rheumatic fever is often the conse­quence of toxic infiltrations from diseased tonsils. Many other diseases can arise when toxins remain in the body following an infection.
*150/28/1*
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IMMUNE SYSTEM: IMMUNE CHEMICALS

Interferon, one of the substances secreted by various virus-infected cells, has been approved by the Food and Drug Administration for the treatment of a rare cancer called hairy-cell leukemia, a disease that until recently had no treatment. Interferon also has been found in clinical tests to fight chronic leukemia, kidney cancer, and Kaposi’s sarcoma, the cancer peculiar to AIDS victims.
Another T-cell substance, interleukin, has been described by the National Cancer Institute as one of the major advances against cancer in a decade. The institute’s Dr. Steven Rosenberg reported in December 1985 that, with interleukin, advanced cancers in one patient had retreated completely, and 11 patients had at least a 50 percent reduction in tumor size. “Here, really for the first time, we can use the immune system to attack a broad array of cancer,” he says.
Besides interferon and interleukin, scientists have identified other powerful immune system chemicals. One, tumor necrosis factor, seems to destroy cancer cells without hurting normal cells.
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NURSES AND DIETARY COUNSELING: STEPS IN COUNSELING

The diet history
An adequate diet history tells the counselor about the patient’s food habits and provides the basis for all counseling that follows. The patient’s chart gives much information that is pertinent to the diet, and these items should be identified before the initial counseling session:
Age
Weight, height, changes in weight status; desirable weight
Present illness: symptoms, diagnosis, important laboratory findings
Digestion: appetite, chewing, swallowing, nausea, vomiting, distention, cramping
Elimination: normal, constipation, diarrhea
Physical handicaps: lack of teeth, mouth soreness, need for self-help devices
Social relationships: occupation, family, residence, ethnic background, religion
Income: adequacy, need for financial assistance
The aspects of diet that you will need to question the patient about include:
Meal and snacking patterns: when, where, with whom, when skipped; away from home:
how often, type of facility
Food preparation: by whom, facilities for shopping, cooking
Previous modified diets: self-prescribed or by physician; how long; why; results
Mineral-vitamin supplements: prescribed by whom; kind Food likes and dislikes; food allergies 24-hour recall of food intake
When the diet history has been completed the counselor makes an evaluation with the patient. For example, the good characteristics of the present pattern as well as the deficiencies might be compared with the Four Food Groups.
Motivation and goal setting
Without the patient’s interest, motivation, and decision making, any efforts by the dietetic-nursing team in counseling will be wasted. Fear of ill health is an important motivating factor for some people; for example, the patient recovering from a heart attack is more likely to stick to a low-calorie modified-fat diet than is a person who appears to be healthy. The pregnant woman is motivated to accept a better diet as something she is doing for the well-being of her baby. The adolescent girl is motivated in terms of her figure, and the boy in terms of vigor for athletics, and so on.
Realistic goals are necessary if diet behavior is to be changed. Losing 50 pounds in 8 months might seem like an endless task, but a goal of “six pounds this month” seems easier to achieve. A child who thoroughly dislikes a food cannot be expected immediately to consume a recommended quantity of that food; a better goal might be one or two bites of the food. The diabetic patient who has not been eating breakfast may have goals related to time of getting up in the morning, or development of menus that have appeal at breakfast time, or others.
Instruction
The patient requires information on a diet plan that has been individualized according to his circumstances; food lists that apply to his diet; how to use the food lists; food selection in the market; reading labels; and details concerning food preparation.
At each point in the instruction the patient should be encouraged to ask questions. Following the counseling session the patient will strengthen his understanding of his diet by writing out menus from food lists; keeping a record of what he eats during the day; reading labels to determine whether a food can be used on a given diet. Such activities should be checked by the counselor for any errors or misunderstanding.
Behavior modification is a process now widely used to change the individual’s habits to those that are more desirable. With respect to diet it consists of keeping a detailed record of all behavior related to food and then identifying the changes that must take place. The program requires skilled therapists such as psychologists, dietitians, and nurses; it would not be initiated by dietetic technicians or nurses not trained in these skills.
Follow-up
Successful dietary change almost always requires some follow-up to the initial counseling. Patients should have access by telephone to the dietitian, dietetic technician, or nurse to answer simple questions or to allay fears. Visits to the clinic as necessary help to assure the patient that he is following his diet correctly, to encourage continued adherence to the diet, and to provide opportunity for additional information. Many hospitals provide classes for patients on a given dietary regimen; for example, diabetic patients, or pregnant women, or patients on renal dialysis. Such classes provide a common bond of understanding between patients, as well as furnishing information concerning the dietary regimen.
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THE HOUSEHUSBAND/’AT HOME’ FATHER AND CHILDCARE

THE HOUSEHUSBAND/’AT HOME’ FATHER

Many fathers now take on the role of staying home to look after the house and children, either by choice or because of the current economic situation. This is very often extremely rewarding for the man and the children, and this role reversal certainly should not be negative in terms of the children’s growth and development. Despite the fact that such role reversals are occurring with increasing frequency, ness’ is threatened, and others find that their new role is rejected by their male friends. They may also find it more difficult, because of entrenched attitudes, to access the usual community support networks.

CHILDCARE

Most families will need childcare at some stage, whether it is a few hours occasionally or regular daycare if both parents are working. There are many different types of childcare, and you need to decide which type will best suit your needs.

Some parents arrange for childcare in their own home. This has obvious advantages, with the child being looked after in familiar surroundings but is also the most expensive and difficult to organise. Family daycare is not dissimilar, with a small number of children looked after in a private home. Most daycare is in special registered premises (childcare centres or creches), and is either run privately or government subsidised. There is a welcome and long overdue trend for employers to provide daycare for the children of employees, either on site or close by.

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