A person with HIV infection is confronted with questions about medical care that are as confusing as they are important. What kind of physicians treat HIV infection? What kind of medical care is available? What kind of hospital provides the best care? This chapter outlines the options for medical care available to a person with HIV infection and provides some general guidelines for people considering those options; provides a general guide to hospitals and describes the rights people have when they are patients in a hospital; and outlines the alternatives to hospitalization.

In general, medical care is provided by different kinds of people offering different services in different settings. The providers of medical care are professionals: they are physicians, physician’s assistants, and nurse practitioners. The setting in which care is provided can generally be divided into two components: outpatient facilities and inpatient facilities. Outpatient facilities are individual physicians’ offices, clinics staffed by physicians who practice as a group, Health Maintenance Organizations (HMOs), and public health department clinics. Inpatient facilities, which are primarily hospitals and nursing homes, are generally used by people who need more intensive care.

In recent years, because hospital care in the United States is now enormously expensive, there has been a growing demand for alternatives to hospitals. These alternatives now include chronic care facilities (like nursing homes), home care programs, hospice care facilities and programs, and outpatient clinics. Some of the alternatives provide the services—including transfusions and other infusion services and same-day surgery—previously provided only in hospitals.

Financing for this complex network of resources varies: the principal modes of funding are Blue Cross/Blue Shield and other insurance companies, HMOs, self-pay, and the government programs for assistance with medical bills (Medicaid and Medicare). Chapter 10 will discuss how to finance medical care—since financing is obviously a major factor in deciding which option to choose.

Regardless of which option for medical care you choose, it is important to have:

—a close physician-patient relationship;

—the services of medical specialists as they are needed;

—the services of psychiatrists, psychologists, or support groups as they are needed;

—emergency medical services;

—a hospital with appropriate resources;

—such alternatives to hospital care as home therapy, chronic care facilities, and hospice care.

It is particularly important to have access to a physician or hospital or clinic that will provide the special medical resources and skills needed to treat people with HIV infection. The treatment of HIV infection is a fast-moving field: medical therapy now makes a substantial difference in the progress of the disease, and new treatments are continually being developed.

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Most advocates recommend taking HRT beginning when your periods become irregular and continuing throughout your life. At the least, you’d want to be covered during the ten-year period following menopause, when bone loss is the fastest. (Women who have their hormone-producing ovaries removed experience a similar rapid rate of bone loss for four to six years after surgery.) If you start taking HRT after you’ve reached menopause, you’ll still benefit, but your overall results will never be as good as if you had started a little before your last period. Impressive results have been proven after just six months of using HRT. But short-term use of HRT, while it may relieve your most troublesome menopausal symptoms as your body transitions, will not give you any of the major benefits of long-term use. In fact, when you stop taking hormones, bone loss starts up again right away. Within seven years (or sooner, depending on how long you’ve been on HRT), your bones will be the same as those of a woman similar to you who never took hormones.

On the other hand, even women over 70 who have never before taken hormone replacement can benefit from starting on estrogen, as can women who already have osteoporosis (particularly when used in conjunction with one of the therapies described in the next chapter). In fact, some studies show the best results in women the farthest past menopause (setting aside the group that hands down does the best: those who take it immediately upon reaching menopause). After age 65, most breast cancers that occur are less influenced by estrogen levels generally, and so will be less affected by the taking of estrogen supplements. So once you are far enough past menopause, your personal calculus of the risks and benefits of HRT may change. If you’ve avoided HRT to that point, but find you are still at high risk, you may want to reconsider.

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Self-image or self-esteem, as we have often said, is an important ingredient of success in later life. How does your child’s self-image change after a seizure? The answer to this may depend on his self-image before the seizure. The change, if any, will depend on the type of seizure and its immediate effects on him, on his developmental age, and on what, if anything, follows the seizure. Most important, self-image and self-esteem will depend on how your child and the seizure are treated by you, by your friends and family, and by your doctor.

The response of family and friends is perhaps the principal determinant of the eventual outcome for the young child and the principal factor under your control for children of all ages.

Accurate and honest information appears an important ingredient of any child’s self-perception, best documented for adolescents. In many studies, adolescents who were the least well-informed were the ones with the poorest psycho-social adjustment. Their adjustment did not correlate either with their seizure control or with their neurological normalcy. Adolescents who were most normal, who had no neurological abnormality, and whose seizures were under control often were most negative about their social adjustment because they were fearful about “being discovered.” Those individuals who had a seizure in public were better able to adapt than those who still feared being “discovered.” Children with epilepsy also had lower self-esteem, higher levels of anxiety, and feelings of less control than children with other health-related conditions.

Most of these problems can be prevented if your child is included in discussions of his epilepsy and its treatment.

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Dr. Bach called this remedy “the comforter and soother of pains and sorrows”.

This remedy is one of the most important components of ‘RESCUE’ remedy.

Broadly speaking, Star of Bethelhem is called for:

(a) To offset the after-effects of trauma – physical, or mental or psychic—new or old.

(b) When a part of the brain becomes paralysed due to sudden mental shock and the sensory nerves fail in their function – the eyes do not see when open, and the ears fail to hear—this remedy will reactivate the benumbed parts and restore their normal function.

(c) When the indicated remedy fails to act in a case which started after some traumic experience, this remedy removes the road-block and allows relief to take place. It would be, therefore, adviseable to keep in mind this

remedy in such cases where the indicated remedy fails to give relief and to go over the case history or even to ask the patient politely if ever in the past-near or remote he or she suffered from some great shock or stress of mind or from some big disappointment.

It may also be possible that a person may be unaware of some unconscious shock lodged deep in his system blocking everything, as it is difficult to visualise a person escaping traumic experience in today’s life of stress & strain.

STAR OF BETHELHEM given purely on the assumption of unconscious shock has often given beautiful results.

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Pinky was quite well up in studies and was one of the toppers in his class examinations. But he was terribly afraid of the University Exams. As the University Exam, approached, Pinky started fretting. Nervous diarrhoea with vomiting followed by severe headache became the order of the day for him. He began to seriously doubt if he would be able to sit for the exam. Rock Rose for the terror and Gentian for his doubts was prescribed T.D.S. After 15 days he felt re-assured and could face the prospect of University Examination with confidence.

Himanshu—12 years—was a chronic case of bed-wetting which did not respond to any treatment – allopathic, ayurvedic or homeopathic. He was also suffering from nightmares for the last 8 years.

He would suddenly get up with a shriek, look around with terror-stricken eyes and then go back into sleep. Sometimes, he was found sobbing during sleep, and at others he was found drenched in perspiration during sleep without any apparent cause.

Closed scrutiny of the case revealed the following facts:-

1. Himanshu was a very sensitive child, and was absolutely normal upto the age of 4 years, no bed-wetting, no nightmare.

2. At the age of 4 years he saw a horror picture on television.

Thereafter his temperament changed—he became fretful. All the present ailments i.e. bed-wetting, night-mares, started after that.

‘ROCK ROSE’ for after-effects for ‘terror* was prescribed T.D.S and continued for 3 months. Himanshu became normal and a happy young man sans bedwetting and nightmares thereafter.

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Nasal congestion

Often in pregnancy the mucous membranes inside the nostrils and sinuses swell and the symptoms of a head cold may be there all the time. This congestion is the result of the increase in blood volume and the changes in your hormones. Although breathing through your nose may be more difficult, it will not interfere with your labour.

A little eucalyptus and camphor on your pillow at night or a vaporizer in the room can often help. Cow’s milk can also be mucous forming and may aggravate the problem. Use soy milk instead.

Painful childbirth

Raspberry leaf has been used for hundreds of years for helping relieve the pain of childbirth. This herb has the ability to relax the smooth muscle of the uterus, making raspberry leaf useful as an aid to parturition. Drink one cup of raspberry leaf tea three times daily during the third trimester.

Shortness of breath

When you reach about 34 weeks and your baby is high in the womb, pressure will be placed on the diaphragm which may be moved out of place as much as 2.5cm (1 inch). This in turn can cause shortness of breath. Even bending over can be very exhausting. Sleeping propped up, or when sitting, placing a pillow behind your back, will help enormously. Shortness of breath is also a reminder of the need to take things easy, slow down and have a well deserved rest.

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Stability of diabetic management can be compared with the stability of a 4 legged table. This stability components (Legs) are diet, exercise, tablets (OHA) and insulin. Diet and exercise play a vital role in control of diabetes. But in a patient if diabetes is not controlled by diet and exercise then Oral hypoglycaemic agents (OHA) are usually the first line of drug therapy for the management of type -2 diabetes.

OHA POPULARITY

These pills are very popular among the diabetes patients because of easy administration and affordable cost of most of the pills

Attitude of Indian patients : In general the attitude of the Indian patients are that they are used to take these pills without any medical supervision. Some patients stop the pills after some time by themselves while other diabetes patients take the pills advised by other diabetes patient. Most of the patients of diabetes take these pills with or without self monitoring of blood sugar and goes to doctor only when super added complications occurs.

Why this attitude? This attitude may be because of the lack of knowledge and education for monitoring and / or lack of education regarding good control of diabetes under medical supervision. This needs a proper education for taking these pills (OHA) under medical supervision.

The other reason for this attitude might be day to day cost of medical treatment for an Indian patient. So the treatment under a medical supervision must be cost effective.

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In recent years ‘natural’ cosmetics have been widely promoted. These cosmetics are often falsely advertised as containing no chemicals or preservatives and as being totally safe for the skin. They incorporate products such as aloe vera, jojoba oil and placental extracts. But, as mentioned earlier, there are no such things as a truly natural cosmetic. Every cosmetic contains preservatives to control bacteria and fungi which would otherwise cause skin infection. Natural cosmetics are a sales gimmick which appeals to the widely held belief that if something is found in ‘nature’, then it must be good for our skin.

Aloe vera may have some beneficial effect on skin healing, but has not been shown to have any effect on ageing or sun-damaged skin. Aloe vera can cause allergic reactions by itself or via the preservative needed to put it into a cosmetic.

Many creams are artificially coloured and perfumed in order to mimic the effect of a fruit or plant. There are, for example, apricot, cucumber and passion fruit creams. These products can also cause allergic reactions.

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Once upon a time epilepsy was considered a chronic disease. People who had two or more seizures had epilepsy, and it was believed that they were doomed to seizures forever.

Now it is recognized that:

• 70 percent of children whose seizures are controlled for two years can go off medication and remain seizure-free. These children have either outgrown their epilepsy or have been “cured”;

• One in five children who have one tonic-clonic seizure and a normal EEG will have a second seizure, whether or not they are treated;

• Children who are otherwise normal, who have no evidence of prior damage or dysfunction of the brain, are likely to outgrow their epilepsy.

Benign epilepsy of childhood is a new concept, one not universally accepted, but one we are convinced by observation really exists. Our conviction is reinforced by the fact that the threshold for seizures increases as the young child’s brain matures and is more resistant to seizures, and also by the fact that genetic tendencies toward seizures are influenced by age—most children “outgrow” their epilepsy, whether treated or not.

How do you know if your child has benign epilepsy of childhood? After a second seizure neither you nor your doctor can be sure, but, if your child is neurologically and intellectually normal and if the EEG (brain wave test) does not show a lot of abnormalities, then there is good reason to hope. Only time will tell.

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The large, reputable cosmetic companies test their cosmetics very carefully. It is fair to say that very few side effects occur given the number of cosmetics used by the average person. However, new chemicals are constantly being introduced into cosmetics with uncertain long-term side effects. Cosmetics are not regulated by health authorities and do not have to undergo strict toxicity testing before being released on to the market. Less reputable companies may not have strict quality control, so the ingredients they use may be more suspect.

How are cosmetics tested for safety?

Because cosmetic companies have come under increasing pressure not to test their products on animals, many tests are now done on human volunteers. There are four main categories of safety testing which are routinely carried out by the larger manufacturers:

- Irritant reactions. The biggest problem with most cosmetics is that they can produce irritation or stinging when applied to the skin. New cosmetics are now routinely tested on human volunteers to check for such reactions. Cosmetics intended for the eye area or for babies must be less irritating than other cosmetics.

- Allergic reactions. Because cosmetics contain so many different chemicals, they can easily produce allergic reactions. The average cosmetic contains between ten and twenty chemicals, many of which can cause allergies in certain individuals.

The two main causes of allergic reactions are perfumes and preservatives. Most cosmetics contain some sort of perfume in order to mask the smell of the other chemicals. Preservatives are used in all cosmetics to prevent decay.

There is no such thing as a cosmetic which doesn’t contain preservatives.

Cosmetics are tested for allergic reactions by repeated patch testing on volunteers. Nonetheless, allergic reactions can still occur in susceptible individuals.

- Acne production. Many skin care products contain moisturizers which are likely to cause blackheads, whiteheads and even acne lesions. Testing cosmetics for acne production is very crude. Testing is not performed on the human face but on the human upper back or on a rabbit’s ear. Neither the ear nor the human back is an adequate predictor of acne production on the face.

- Bacterial count Preservatives are necessary in a cosmetic to prevent bacterial and fungal growth and to prevent decay. Bacterial counts must be lower in cosmetics for the eye area and in baby cosmetics. Without preservatives bacterial count would be unacceptably high, and so would the risk of serious skin infection.

Despite all this rigorous testing, however, the long-term safety of many substances used in cosmetics is not known. Some potentially dangerous ingredients have been incorporated into cosmetic products. A recent example was urocanic acid which was used in some moisturizers. This substance has been linked to the production of skin cancer in animals.

Dermatologically tested cosmetics

The more reputable cosmetic companies employ dermatologists to test their cosmetics. Cosmetics are tested in different ways, mainly for lack of side effects, especially irritant and allergic reactions. A cosmetic range which has been tested by a dermatologist is more likely to include suitable products for a wide range of skins. However, just because a cosmetic product is dermatologically tested does not mean that it will be suitable for acne skin or that it will prevent or treat wrinkles. Overall, dermatologically tested ranges are more reliable than those which are ‘adequately’ tested, and are labeled as being dermatogically tested.

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