Residents and fellows are physicians who have recently graduated from medical school but who are not yet practicing medicine on their own.

Residents are still in residency, that is, they are still in training to obtain their credentials in a specialty, usually in family practice or internal medicine. Most residents receive three years of training. Fellows are physicians who have finished their residency training and are now training in a subspecialty—for example, infectious diseases. As for nomenclature, “interns” are now called “first-year residents.” Residents and fellows are found in teaching hospitals that have the credentials for training specialists.

If you are in a teaching hospital, the physicians you are likely to see most often are residents in internal medicine or family practice, and fellows in infectious diseases or some other subspecialty. Their autonomy in making decisions about your medical care varies, depending on their training, the rules of the hospital, and the idiosyncrasies of the physician-of-record.

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If you fly, you know the challenges to getting airborne. Informing reservation agents of your special needs is the first step to ensuring a safe and comfortable flight. Be specific about your needs, such as requiring assistance to your seat, assistance when transferring between airlines, or a seat assignment in the bulkhead. Be sure to make these requests again at the time of departure so they are not overlooked.

Both the Air Carrier Access Act of 1986 and the Americans with Disabilities Act specify that the needs of persons with disabilities must be met both on the ground and in the air. This covers accessible parking neat the terminal; signs indicating accessible parking and access to the terminal; accessible medical aid facilities and travelers aid stations; accessible restrooms; accessible drinking fountains; accessible ticketing systems at primary fare-collection areas; amplified telephones; accessible baggage check-in and retrieval areas; accessible jet-ways and mobile lounges; flat boarding ramps, lifts, and so forth; information systems with both visual and oral components; and signs indicating the location of specific facilities.

You may want to get advice from people with similar disabilities who fly frequently. Some advise not consuming liquids before flights so that you don’t have a “call of nature” on the flight. Others advise waiting on the plane after landing until your chair or scooter comes up from the hold. If you leave the plane in a wheelchair provided by the airline, you could be stranded in the airport without your own means of getting about. If you use crutches, expect different rules for their storage, even within the same airline. Some stewards say crutches go in the overhead bins, while others allow you to stow them on the floor beside you. If you are flying coach class, try to get seating in the bulkhead row, the first row in the coach section. This offers more space and thus greater ease in getting in and out of your seat.

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“Jenny, although only nine, had many long-range questions: ‘Do big girls have these seizures? Can they have babies?’ Things like that. I arranged for Karen to have lunch with us. And the two just talked. They talked about seizures, about medication, about boys. What Karen provided for her was something I couldn’t provide; she was the role model Jenny needed. Actually, it was as good for Karen as for Jen; it provided Karen with a sense of self-esteem, a sense of helping.

“You know, out of this counseling come many good things, and sometimes it takes awhile to see all of them. Another young lady who had a rough time as a teenager, both with her very frequent mixed seizures and with an overprotective father, is now married and has a baby. The family recently had a real scare when they thought she had cancer. They really panicked, but Greta remained cool. She handled it far better than her folks. The diagnosis proved wrong, and when we talked about it recently she said, ‘You know, I went through so much in learning to deal with my epilepsy that it made me a much stronger individual.’

“One of the best things about this job is the friends you make with the kids. They’ll call you up years later, as Greta did, just to say ‘Hi!’ or to tell you they’re engaged, whatever. They’ve become my friends.

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Thus Vervain remedy brings orderliness in enthusiasm.

It is a routine remedy given for mental tension of any type.

In order to choose the correct remedy for ‘SLEEPLESSNESS’ in Bach Flower remedies remember: ‘VERVAIN’ is suitable in a case where the mind is always busy, day and night, thinking about work—his various schemes, both finished and unfinished and schemes yet to be started.

It is for a mind which is always preoccupied and over-enthusiastic of his schemes which keep him awake at night.

‘RED CHESTNUT’ is called for when the fear and solicitude for the welfare of a loved one prevents sleep.

‘WHITE CHEST NUT’ is useful when the mind is unable to get rid of any idea – when the same idea goes on circulating in the mind day and night.

‘SCLERANTHUS’ sleeplessness is caused by diverse ideas in a grass-hopper mind. Various ideas unrelated to each other keep the mind puzzled and awake during night.

‘CHERRY PLUM’ is the remedy for sleeplessness due to unbearable pain whether physical or mental or some unbearable sensation i.e. frequent urination or frequent thirst during night which keeps him awake for most part of the night. ‘MIMULUS’ would cover the sleeplessness due to fear of anything—fear of loneliness, fear of darkness, fear of dacoits etc.

For mental tension although Vervain is given as a routine remedy, it should not be taken as a panacea for all types of mental tension.

‘VERVAIN’ would be useful if the cause of the mental tension is over-enthusiasm, overwork, and a constant attachment to work without rest or respite.

‘MIMULUS’ would have to be called for, if the cause of mental tension is fear of some coming event i.e. an impending court decision of an important matter, an examination, the biopsy report of a swollen gland etc. ‘HOLLY is required if the cause of mental tension is jealousy; envy; hatred or suspicion. “IMPATIENCE” only could relieve extreme tension in a person who is temperamentally irritable and impatient.

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Hardyal was very badly addicted to wine. At the age of 40 he had three narrow escapes from road accidents. The entreaties of his grown up children and his wife failed to make him leave the habit, although he desperately wanted to do it. One day he walked into the dispensary with his wife and said, ‘Doctor sahib’ can you help me – an inveterate drunkard. I know, drinking has ruined my health. It has ruined me financially. I am tortured day & night by scolding from elders, entreaties by youngers and unkind remarks by neighbourers. I have spent a heap of money in this vice and a lot of money in trying to get rid of this habit by allopathic drugs. Nothing has helped. My family doctor has warned me that I have already developed an ulcer in the stomach and every drop of liquor that I would take now would act as poison. I am mortally afraid. Yet I cannot rid myself of this habit. Liquor has become a part of my body. Unless I take some liquor, the thought of liquor haunts me. Please doctor, can you do something for me?”

The case presented 3 clear-cut facets:

(a)    Age-long habit which could not be broken, despite efforts. Walnut T.D.S for 6 weeks was prescribed.

(b)    Mimulus T.D.S for fear, and   White Chestnut for persistent thought of liquor.

A combination of Mimulus and White Chestnut was given T.D.S. for 2 weeks.

After 2 weeks his condition improved and the combination was discontinued. Walnut alone was continued for 3 months to bring complete relief.

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Toxemia

Toxemia is not a word which is currently used. Today, the word pre-eclampsia is used and relates to a condition in which the blood pressure is raised and there may be associated swelling of the hands and face as well as the feet and ankles. Protein may also be passed in the urine. Toxemia is a serious problem that can affect women during pregnancy. There is an added strain on the mother’s kidneys and liver during pregnancy. Not only do these organs need to eliminate the toxins that are produced by the mother but they must also remove all waste products and toxins that are produced by the developing fetus. Other toxins that may be produced are also absorbed into the mother’s blood stream. If these toxins build up in the mother’s blood and the eliminatory organs are unable to remove them, then a condition known as toxemia may result.

If the expectant mother has a history of high blood pressure or kidney disease it is important that she advise her practitioner as this may lead to complications later in the pregnancy.

Symptoms that should be reported to your practitioner are: swelling of the feet and legs, high blood pressure, puffiness of the face and/or severe headaches or dizziness and any increase in your temperature.

Any or all of these symptoms could indicate a problem that needs professional advice and treatment.

Eclampsia

This is fitting which can occur when ‘toxemia’ is unable to be controlled. This is a major toxemia of pregnancy and is accompanied by high blood pressure. Eclampsia most often affects the kidney, liver, brain and placenta. This is a very serious condition and must be managed in hospital. The life of the mother and the unborn child could be placed at risk if time is wasted.

*14/199/5*

We all know ex-smokers who tossed out the butts and immediately thereafter started taking on pounds. Arnold McD. (known to all as “Mac”‘ came to us with exactly that story to tell.

He’d quit smoking three months earlier at his doctor’s insistence. In the intervening weeks, he had gained about a dozen pounds. Added to the “six or seven pounds I didn’t need in the first place, that meant Mac was carrying around twenty pounds he wanted to be rid of.

At forty-four, Mac bad reached the age when many of us start to examine our habits to determine how they impact on our health and longevity. Mac’s doctor had. too. and as well as telling him to abandon the cigarettes, he had told him it would be necessary for him to drop some weight.

Mac had tried by himself. “I had heard that some people gained weight after they stopped smoking, but 1 didn’t think it was anything that I couldn’t handle. Now I’m finding it isn’t so easy.”

Oddly, he reported, “I don’t think that I’m eating that much more. I know that doesn’t make sense, but it’s true.”

That’s why he came to see us.

He tested in the? moderate addiction range, so he appeared a good candidate for the Carbohydrate Addict’s Diet. We explained the diet to him and also talked about research on post-smoking physical changes, which often result in increases in the body’s tendency to hold on to or gain weight.

Mac said that lie didn’t quite1 grasp file bio logical underpinnings’, but he was willing to give the diet a try.

He may not have been a scientist, but Mac trusted that we knew what we were” doing. The first week he lost four pounds. We needed to slow down his weight loss, to bring it closer to the ideal of 1 percent of body weight per week. We advised him to increase his intake of low-carbohydrate foods at breakfast and at lunch. It worked, and several visits later his weight-loss rate was down to two pounds per week.

Mac lost his twenty pounds, then decided to “lose a few more while I’m at it.” At twenty-five pounds lighter, his weight leveled off. “I could probably lose more if I cut down on my Low-Carbohydrate Meals, but I don’t need to. I’m five- pounds thinner than 1 planned, 1 haven’t smoked in almost a year, and 1 look better than 1 did at eighteen.”

About three years after his first visit, Mac was in the neighborhood and stopped by to see us. His weight was holding constant, and he felt good about himself. He was even running stop-smoking groups for the organization that had helped him to stop in the first place.

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In the USA, doctors use a manual called The Physician’s Desk Reference which is much more detailed than anything we have access to in the UK. Drug companies by law are required to state the risks of their drugs in this manual. The Physician’s Desk Reference lists the side effects for HRT which include:

•   endometrial (womb) cancer,

•   undesirable weight gain/loss,

•   breast tenderness/enlargement,

•   bloating,

•   mental depression,

•   thrombophlebitis (inflammation of the wall of a vein),

•   elevated blood pressure,

•   reduced carbohydrate tolerance,

•   reduced glucose tolerance,

•   skin rashes,

•   hair loss,

•   abdominal cramps,

•   vaginal candidiasis (thrush),

• jaundice,

•   nausea,

•   vomiting,

•   cystitis-like syndrome.

Although research has not shown that women on HRT gain weight – other than the weight gain that would normally be associated with ageing

- I find that it is one of the greatest concerns of the women who come to see me. Their main complaint is the ‘sudden’ increase in weight (and increases in breast size by up to two cups larger) soon after starting HRT. I also see women not on HRT and the weight gain is definitely different between the two groups.

So this is a prime symptom that makes women want to stop taking HRT. They are also concerned about psychological changes — feelings of being suicidal, feeling ‘not there’ and headaches. Organizations like the Amarant Trust, the UK charity that promotes the use of HRT, have drawn attention to the fact that many British women who try HRT give it up after only a few months. It believes the reason is that women do not persevere for long enough, do not try alternative HRT products, and that their GPs do not spend sufficient time and effort explaining the therapy to them. There are, however, many GPs who have reservations about the over-prescribing of HRT. Many women feel perfectly well on HRT. But it is not surprising that others come to the conclusion that the side effects they experience are worse than the symptoms the HRT is designed to ‘cure’. And as the years roll on there is increasing evidence that taking HRT involves some serious health risks that many of us would rather avoid.

*12/101/5*

“Some of the new, state-run pre-school early-intervention programs like Child Find are helpful in getting the parents of handicapped children, and the infant or young child himself, involved with appropriate stimulation and physical therapy. Schools now are taking these handicapped children at a young age, at least for part of the day. These programs give the parents some hope, some respite, and more realistic expectations about their child’s progress and future.

“While counseling is fun and rewarding when you’re dealing with a teenager like Karen (who will be a winner if only she’ll get her act together), at times counseling can be even more challenging and more rewarding when you have a family with a severely-damaged child. Just think what you have accomplished when you help them to cope, to grow with the situation, to make the best of it, whatever that is, for themselves and for their child. If you look at the alternatives, such as the family breaking up, then you will have a single parent facing that future alone. Or the child could end up in a foster home with the family disintegrated. If you look at these bleak alternatives, then anything you can do to help the family to cope and to make a reasonable life for themselves and for their child is a success. If you define success in these terms, yes, we are usually, but not always, successful.”

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Moisturizers are mixtures of oil and water which trap water within the skin, making it more pliable, looking and feeling less dry, and smoother and softer. This allows make-up to be applied more evenly. Moisturizers can also plump up the skin, making wrinkles less visible. They do not, however, prevent wrinkles, treat wrinkles, or alter the ageing process. They are analogous to hair conditioners. Moisturizers work in three main ways:

- Moisturizers can have an occlusive action, whereby the surface of the skin is ‘glued’ down, preventing water evaporation. Heavier moisturizing creams provide a thicker glue, which decreases water loss. Thicker preparations include lanolin, petrolatum, paraffin and mineral oils. These products may block the pores, resulting in blackheads, whiteheads and acne but are useful for older people with very dry skin.

- Humectants are substances which draw water from the deeper layers of the skin to the surface. This means that the deeper layers become dehydrated at the expense of the surface. Collagen, elastin, glycerine, propylene, glycol, sorbitol, vitamins A and E and many other proteins act as humectants. However, if the surface of the skin is damaged, all the water escapes and both the top and deeper layers of the skin are left dehydrated.

- Liposomes are little capsules which bind to the surface of the skin and release moisture on to the cell membranes. Although this sounds very fancy, it is really just another way of applying a moisturizer.

Most moisturizers contain both glue-type substances and humectants. They draw water to the surface of the skin and keep it there, making the skin look plumper and smoother. Super-rich moisturizing creams and night creams contain a higher quantity of glue-like substances, and so trap in water for longer periods of time. On the other hand, they are responsible for many blemishes due to their suffocating effect on the skin. Despite all this, moisturizers do not alter the ageing process, nor do they repair the damage caused by excessive sun exposure.

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