Health News and Information

Each individual has a unique story about coming to terms, at last, with spinal cord injury. People talk about “coming to terms with,” “accepting,” “coping with,” or “adjusting to” disability. It doesn’t matter what words you use to describe “owning” your disability. What matters is that you did it, and now you can redirect your energy toward other areas of life: relationships, family, creativity, or work.

You took the first steps in this direction during your rehabilitation, but the issue of adjustment usually comes up again from time to time, especially when passing from one life stage to another. In going through these passages (marital commitment or commitment to a single life; parenthood; choice of vocation; midlife changes; adapting to old age) new issues will arise. To deal with them successfully, you need to see yourself as a person worthy of receiving the investment required to forge ahead.

The physical effort required by disability is required often, sometimes daily, as you live in a world constructed for people without disabilities. Physical needs have to be met before you can enjoy the fun things in life, such as having dinner with friends or attending a concert. As one recent article on adjustment stated, “You can’t go out and look at the stars without taking care of the wheelchair or without attendant care.”

People with a disability encounter many definitions that try to box them into a category: crippled, disabled, person with a disability, physically challenged.

Looking at yourself, you can assess the attributes or abilities you still have and acknowledge those you don’t. And, as part of the creative discovery process, you may find ways to do those things you thought you’d never do again.

Jerry, who was injured while mountain climbing, had a difficult time even thinking about no longer being a part of his pals’ touch football team after he became paraplegic. He ached to be out on the field with them. One day he decided to talk with his friends about playing with the team in whatever way he could. His friends were excited about the prospect of Jerry’s comeback and set about redesigning their game to include their old friend.

The qualities that defined you as a person without a disability still define you, as a person who happens to have a disability: your sense of humor, purposefulness, friendliness, shyness, thoughtfulness, naivete, joyfulness, garrulousness, or ability to articulate. Ownership of who you were before your spinal cord injury now extends to who you are as a person who happens to have a disability.

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The ideal clinic should be able to:

- Deliver a weight-loss programme that is tailored to the individual.

- Offer regular and ongoing support.

- Embrace treatment modalities ranging from patient self-help groups and publications to commercial weight loss programmes.

- Offer lifestyle change support from specialist nurses, dieticians and physicians.

- Provide access to specialist dietetic advice.

- Offer specialist advice on increasing physical activity levels.

- Prescribe modern weight-loss pharmaceutical agents.

- Advise on the application of bariatric surgery techniques.

Such weight-loss programmes can be delivered in either primary or secondary care. The correct approach to individual patient management varies depending on the level of expertise and the facilities available.

An ideal clinic would be at a dedicated and specific time when obese patients would be able to make an appointment to see their clinician. Some patients, often for reasons of embarrassment, prefer not to attend surgery during normal routine clinic times because they think they would look out of place in the company of much leaner patients in the waiting room setting. However, this might not be practical and many clinics that are already delivering weight management services are ‘rolling clinics’ that obese patients are invited to attend during normal general medical clinic times.

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We shall never know to what extent marriages bring happiness until marriage becomes as free as friendship, at least in the period of trial before children are born, so that we may be sure that no extraneous influences hold couples together. In the meantime we shall have to content ourselves with a good deal of guess-work. But an exact determination of the proportion of successful and unsuccessful marriages is not essential to the present discussion. Regardless of how much disagreement there may be as to the proportion of marriages that are successful enough to be worth preserving, it will be fairly easy to obtain agreement on the proposition that very few of even the “successful” marriages involve an ideal companionship, but rather that most of them represent a sort of modus vivendi—a way of getting along in spite of certain incompatibilities. In fact, only the uninitiated, adolescent romanticist expects anything else out of marriage.

Now, quite to the contrary of what might be expected from the preceding pessimistic remarks, we are going to take sides with the naive adolescent. He is right in what he expects, and society is wrong in not fulfilling his expectations. It is true that the institution of marriage is highly unsatisfactory today, but there are definite reasons for its being so, and by the same token it will be possible for us to remove the causes of its failure if we are willing to face the facts and all their implications.

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