By K. Rakus. Centenary College of New Jersey.

IHUERI The spiritual school of universal energy may not have been the first to propagate the ideas of universal energy and the theory of chak- ras discount avana 100mg otc impotence mayo clinic, but it seems to be one of the precursors of the popularization of these theories in the W estern world discount avana 50 mg with amex erectile dysfunction jelqing, and was among the first to adapt them to the medical context. IHUERI (The International Human and Universal Energy Re- th search Institute) was founded early in the 20 century by a Sri Lankan, Dasira Narada. Following a career as a high civil servant, this doctor of philosophy began teaching the precepts of what would become IHUERI. In 1906, he withdrew from the material world to contemplate and to pursue his own spiritual life. His successor, Narada II, followed the traditional disciple-master relationship; he taught until in 1972, when he transmitted his knowl- edge and the leadership role in IHUERI to a Vietnamese by the name of Lvong Minh Dang, who took the title of Narada III. Taking advantage of the W estern passion for Far- Eastern philosophies and spiritual movements, IHUERI gradually es- 178 Medicine and Cults tablished itself in the United States, then in Europe. According to Master Dang, the teaching of universal energy has several objectives, including personal growth, alternative medicine and humanitarian aid. First, the follower must learn how to open his chakras to overcome universal en- ergy and to maintain good health; then he must also look after others, treating both minor illnesses and incurable diseases; finally, he must develop his love for suffering humanity, in order to evolve spiritually. According to the adherents of IHUERI, the first three levels of the teaching are centered on patient care. Louis, Missouri, are exclusively devoted to spirituality; the seventh degree trains disciples chosen by the Master to assist him and succeed to him. The program offered to members for acquiring mastery over the "universal and human" energy is articulated in five or six chapters and as many training courses, each recognized with an in-house di- ploma. At Level II, with a greater "opening of the chakras" (60%), the mem- bers can take care of up to twenty people per day. At Level III, the pivotal point in the training, the approach becomes more coercive. At this stage, the student benefits from a 100% open- ing of his chakras and can thus provide care for all diseases. The second part of Level III, which is pursued by fewer aspirants, opens up an unvarnished esoterical discourse. It is hardly surprising to discover, while reading the group’s "internal documents," that "to open your chakras" you have to recog- nize Dang as master, and that disavowing him would mean the closing of one’s chakras. The heritage proclaimed by Master Dang certainly authorizes the master to demand respect in every instance, since he is nothing less than the reincarnation the Empress Gia Long, sent to earth to complete 18 the work of Buddha and of Jesus. In fact, if IHUERI and its offshoots were satisfied just to teach spirituality and techniques of personal growth, no one would find any reason to object. W hat is more problematic is that Master Dang and his disciples target their recruitment on the medical field, and they claim that harmonization and the opening of the chakras cure all dis- ease, from the simplest to the most serious: Here is Master Dang’s "decree" of January 30, 1996: Master Dang authorizes to treat the AIDS and addiction: 1) All Centers of Universal Energy in every country; 2) All holders of Level 5; 3) All the trainees who have attended the special session on treating diseases by Chakra 6 (trainees who have attained Level 3 or Level 4 are authorized to treat AIDS and addiction only within their family); 4) All doctors, including those who do not work in the centers, even if they have only attained Level 3 or Level 4; 5) All trainees who are not part of a center’s staff must, after having treated AIDS and addiction, inform the nearest center. Despite having been nailed by the parliamentary report on cults, IHUERI has in no way lessened its proselytizing through all its related associations: IREHU, CREHU, HUE, Energy, Universal and Human Energy, Energy and Sharing, SEVA, CRYSTAL, and through associa- tions set up to "assist" victims of AIDS (Sidamour) and those who are 19 dying. In the great tradition of cults that want to achieve social recogni- tion, the followers of IHUERI collaborate with organizations such as W HO in providing humanitarian aid to developing countries — a tech- nique that enables them to proselytize in areas where a piece of bread can buy a conversion. Energo-Chromo-Kinesis Energo-Chromo-Kinesis, or ECK, is one of the most powerful cults in the medical world, where it recruits doctors, physical thera- pists, nurses and dental surgeons. Created by Patrick Véret in 1987, it has taken advantage of the confusion that arises from the fact that Véret was a member of the National Order of Physicians and was a practicing doctor until recently. Nearly 400 doctors thus became disci- 20 ples of Véret and have declared themselves energeticians. Its creators say that: Energo-Chromo-Kinesis brings everyone the tangible reality of his existence. It reveals the genetic programming that, like a program, makes us act consciously or unconsciously. Thanks to this genetic program, decoded by scientific techniques, the fruit of rigorous and objective research, each participant can find the very essence of his existence and of his overall destiny. Learning how to master them by using sound and color enables us to attain our maximum potential in a short time. They are unique in that they work through vibratory ex- perience and sensation that make it possible to be in harmony with oneself and one’s environment.

EXERCISE IN CORONARY HEART DISEASE PREVENTION Strong evidence exists to support the view that the health and fitness benefits of physical activity have a direct dose–response relationship discount avana 200mg visa erectile dysfunction pump amazon. Public health messages worldwide advocate the need for the general public to take up at least moderate amounts of physical activity purchase avana 200mg without prescription erectile dysfunction drugs and medicare. Extensive research has demon- strated that the benefits related to exercise training are also afforded to patients with demonstrable cardiovascular disease (see Chapter 1). CHD continues to be the foremost cause of death in both men and women in the UK, European Union and USA and, in addition, the numbers of patients 100 Exercise Leadership in Cardiac Rehabilitation chest pain, shortness of breath, dizziness, palpitations or general ill health, and should be referred for further assessment. Initial activities should be moni- tored and the medical staff should have a good understanding of cardiac signs and symptoms. Activity should be introduced and gradually increased as soon as the patient is stable and pain free. Initial mobility is around the bedside and includes activities of daily living, such as washing and toileting. If there are no adverse symp- toms or post-surgical complications, a graduated walking programme is usually the method of choice. Within phase I, distance can be pre-set using marked distances in corridors within the ward. Where appropriate, stair climbing should be introduced, and those requiring stair use at home should be able to climb stairs safely prior to discharge. Following CABG upper limb and neck mobility exercises should be carried out in order to maintain movement around the shoulder girdle and wound area. These exercises are required to prevent muscle shortening and adhesions develop- ing (Pollock, et al. Patients post-CABG can begin these exercises 24 hours after surgery (Pollock, et al. Pre-event mobility levels, age and other co-morbidities will also influence progression. It is important that progress is not only determined by local pro- tocol, but that these factors and their clinical state are considered. The RPE (Borg, 1982) scale should be introduced at this stage with activity restricted to less than 13 RPE (ACSM, 2001). It is important to introduce as early as possible exercise/activity self-monitoring skills and to reinforce them during phase I (see Chapter 3). Ideally, the same staff member should see the patient throughout phase I to allow for a reliable assessment of exercise tol- erance and to establish rapport. Prior to discharge, an individualised exercise and activity plan should be prescribed for phase II. In addition, resumption of sexual activity, driving and returning to work should be discussed. It is important to identify any miscon- ceptions and to discuss patient goals to ensure they are safe and realistic. An exercise consultation, prior to discharge, should be carried out in order to help the patient plan and adhere to phase II activity and exercise (see Chapter 8). Advice should be individualised, clear and concise, as patients often have dif- ficulty absorbing information in hospital. This may be linked to feelings of anxiety and depression, which can be a natural reaction following a cardiac event (SIGN, 2002). Similarly, family members are often frightened when their loved ones first go home, can be overprotective and limit activity. By involving family and friends in discussions, they too can be informed about appropriate levels of Risk Stratification and Health Screening for Exercise 21 surviving coronary events are escalating year on year. Although we all recog- nise the importance of primary prevention of CHD, there is no question that the role of CR is pivotal as a secondary prevention intervention, a concept recognised by numerous countries throughout the world as extremely impor- tant. Policy statements and practice guidelines across the UK, USA, Europe and Australia all advocate that comprehensive CR should be available to all patients with cardiac and vascular disease. As treatment options for the post-myocardial infarction (MI) patient have developed, there has been a resulting improvement in survival rates. It is imperative, therefore, that the exercise professional recognises the like- lihood of exercise-related incidents and takes all reasonable steps to ensure safe and effective exercise prescription for those individuals with diagnosed CHD. EXERCISING THE CHD PATIENT: THE NEED FOR ASSESSMENT AND RISK STRATIFICATION Exercise training in individuals with CHD has been the subject of numerous clinical trials, with the evidence strongly demonstrating that exercise-based cardiac rehabilitation is associated with a reduction in coronary mortality and morbidity. Despite the low incidence of adverse events, most international CR guidelines, nevertheless, recommend that, prior to recruitment to the exercise programme, patients should undergo a comprehensive assessment, including risk stratification.

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Management of cough should be determined by the type Dyspnea and the cause of the cough discount 50mg avana with amex impotence tcm, as well as the patient’s general 9 Dyspnea is a subjective sensation of shortness of breath condition and likely diagnosis cheap avana 50mg without a prescription erectile dysfunction neurological causes. When possible, the aim that is described in 70% of cancer patients during the last should be to reverse or ameliorate the cause, combined 6 weeks of life and in 50% to 70% of patients dying of with appropriate symptomatic measures. It is a common symptom associated with factors should be defined, and simple measures such as pneumonia, congestive heart failure exacerbations, and a change in posture can be very helpful. Breathlessness chronic obstructive pulmonary disease—all illnesses can trigger cough and vice versa. Nevertheless, dyspnea may be also precipitate vomiting, exhaustion, chest or abdominal a subjective symptom that may not match any objective pain, rib fracture, syncope, and insomnia. Sources of Suffering in the Elderly 313 Cough suppressants are usually used to manage dry Two organ systems are particularly important in cough. The most effective antitussive agents are the nausea and vomiting: the central nervous system and the opioids. Methadone can be the vestibular apparatus, and the cortex are all involved particularly effective at night, but due to its prolonged in the physiology of nausea. Other useful center from one or more of these areas is mediated measures include decongestants, antihistamines, and through the neurotransmitters serotonin, dopamine, corticosteroids. Serotonin seems to be important in the gastric lining and central nervous system, whereas acetylcholine and histamine are im- Gastrointestinal Symptoms portant in the vestibular apparatus. Cortical responses are mediated via neurotransmitters as well as through Nausea and Vomiting learned responses (e. Dopamine-mediated nausea is probably the easy to achieve with the appropriate use of medications. Etiology Pathophysiology Therapy Metastases Cerebral Increased intracranial pressure Steroids, mannitol Direct chemoreceptor trigger zone Antidopamine, antihistamine Liver Toxin buildup Antidopamine, antihistamine Meningeal irritation Increased intracranial pressure Steroids Movement Vestibular stimulation Antiacetylcholine Mentation (e. Constipation Oral medications: Constipation can be defined as the passage of small hard Dexamethasone 2–8 mg q 6–12 h 17 feces infrequently and with difficulty. Constipation is Diphenhydramine (Benadryl) 25–50 mg q 4–6 h Haloperidol (Haldol) 0. One study Hydroxyzine (Atarax) 25–50 mg tid-qid found 54% of its community-based elderly to report con- Hyoscyamine (Levsin) 0. Invasive evaluation with colonoscopy Trimethobenzamide (Tigan) 200 mg tid-qid should be considered in difficult, refractory, or compli- Continuous infusion: Dexamethasone 8–100 mg/24 h cated cases. First and foremost are opioid agents; many other Hyoscyamine (Levsin) 1–2 mg/24 h medications, including beta-blockers, calcium channel Scopolamine 0. Dietary factors: low residue, poor nutrition Motility disturbances: colonic inertia or spasm Sedentary living, weakness Depression Poor fluid intake have the potential to cause drowsiness and extrapyra- Confusion midal symptoms. Haloperidol is a highly effective Inability to reach the toilet antinausea agent and may be less sedating. Antihista- Change in setting, travel mines such as diphenhydramine can be used to control Structural abnormalities nausea but may cause sedation. Antihistamines also Anorectal disorders: fissures, thrombosed hemorrhoids Strictures have anticholinergic properties covering two mecha- Tumors nisms of nausea. Hypokalemia Hypothyroidism Nausea can also be caused by a slow gastric/intestinal Neurogenic motility, "squashed" stomach syndrome due to mechani- Cerebrovascular events cal compression of the stomach or constipation, and thus Spinal cord tumors prokinetic agents such as metoclpropamide should be Trauma considered as therapeutic modalities. Hyperacidity and Smooth muscle/connective tissue disorders Amyloidosis mucosal erosion may be associated with significant Scleroderma nausea. Consider the use of antacids, H2 bloekers, proton pump inhibitors, and misoprostol. Drugs and medications commonly associated with for transient or mild diarrhea may respond to attapulgite constipation. Octreotide is also an effective Anticholinergics means of reducing gastrointestinal secretions. Obstruction may be the presenting Narcotics symptom that heralds the diagnosis of cancer or may Nonsteroidal anti-inflammatory drugs occur later in the course of disease. Bowel obstruction Neuroleptics can be caused by multiple and often coexisting etiologies, Sympathomimetics: pseudoephedrine including intraluminal obstruction, infiltration of the Source: From Ref. The prevalence of bowel obstruction is as high as 40% suppositories, laxatives, and hyperosmotic agents, before in bowel and pelvic cancers. A multiple agent bowel can be particularly challenging to palliate if the cause of regimen must be begun coincident with the initiation of the obstruction cannot be removed. Operative management of of bowel obstruction may involve the surgical relief of severe constipation may be required in refractory cases.

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She parented her mother and sister to make up for the guilt she felt over having taken away the husband and father avana 100mg lowest price erectile dysfunction girlfriend. All the difficulties that this client exhibited were dealt with outside of herself discount 50mg avana free shipping impotence young men. Thus, when the stress, humiliation, and shame mounted, she would act out (ultimately on the two people she was parenting—her sister and mother), purge herself of her shame through aggression, and then become the symbol of perfection. She formed a pestle and mortar (penis and va- gina), exploding crowns on the trees, a bodiless person, and on and on. In this client’s case her inductive reasoning surrounded the belief that if bad things happen it is because you are bad. Overall, shame and humilia- tion are prominent as the child begins to struggle with complex problems. Thus, fixated as she was at the intuitive stage of development, rationaliz- ing was her main verbal defense, which made traditional therapy ineffec- tive. Yet with art therapy the thoughts and feelings she had hidden from consciousness were allowed symbolic expression, and the defense mecha- nisms of conversion and reaction formation were then articulated. In the end it is the typical and predictable sequences of behavior that I utilize to guide my use of the art, choice of media, and the ensuing direc- tives. For without a cornerstone to guide us we would be hard pressed to in- terpret the artwork in any manner other than a haphazard one. The art of art therapy is less about how pleasingly the drawing is ren- dered and more about the elements that are either drawn or disregarded. It has been suggested in psychological as well as art literature that individuals project their personality into their drawings. Lowenfeld and Brittain (1982) state, "The child draws only what is actively in his mind. Therefore the drawing gives us an excellent record of the things that are of importance to the child during the drawing process. In the same manner any person, regardless of age, whether versed or not in the art of drawing, utilizes an unconscious process that allows for more freedom than verbalization affords. Other drawings that this client pro- duced showed he was capable of drawing people, places, and environments. Unfortunately, as he emotionally decompensated, his drawings increas- ingly worsened until they took on an infantile quality (which is often char- acteristic of coartated schizophrenics). This is an important distinction to make, as interpre- tation revolves around not only the completed art project but also the cli- ent’s verbal statement regarding the rendering. As Lowenfeld and Brittain (1982) aptly state, To examine the picture without understanding what the child’s intention was, to make assumptions about personality from one example of artwork, or to assess competence in art on the basis of what is included or omitted from the product, does both the product and the child an injustice. This includes the client’s social and familial history (recent and remote), cultural identity, medical history (including medications), chronological age, presenting problem, substance abuse his- tory, developmental history, mental status, and of course his or her verbal- ization about the completed project. All of these elements are necessary for a correct interpretation of the product and an accurate understanding of the client’s mental health. DiLeo (1973) states, "valid appraisal of a child’s drawing is not possible without taking into account the age and developmental level.... Thesig- nificance of omission and exaggeration depends upon the level at which the child is functioning. Note the oversized head and the beginning of attentiveness to environmental detail (e. He then drew the figure’s left arm, worked his way down to the left leg, and in drawing the right leg connected the line to the hand area of the right arm. At this point he looked at the drawing quizzically, seeming to understand that something was wrong but not what or how to fix the problem. At this point I gave him a second piece of paper and instructed him to begin over. This could be due to the fact that children rely on primary processing un- til they move into a logical mode of reasoning at roughly the age of seven.

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