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.

*64/312/5*

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.

*108\275\8*

Hemorrhoids

These are tortuous swellings of the veins under the lining of the anus and lower rectum – and the scourge of pregnant women. The swellings become more prominent when you strain at stool and can enlarge quite suddenly and fill with blood clots, which can be quite painful and may break down and bleed profusely for several days.

• One tablespoon of unprocessed bran, 3 times daily.

• Vitamin C, 1,000 mg., 2-4 times daily (helps keep stool soft and strengthens the walls of the blood vessels)

• Vitamin E, 200-400 IU, 1-3 times daily (helps prevent and dissolve clots)

• Vitamin E oil, applied topically to afflicted area, can reduce discomfort.

• Avoid coffee, chocolate, cocoa, and cola, as these can increase anal itching.

• When lifting objects, stoop instead of bending. This reduces abdominal pressure on hemorrhoidal veins.

Water Retention

• Vitamin Вб, 50 mg., taken 3 times daily can act as a natural diuretic.

Insomnia

When you’re pregnant, you need a proper amount of rest, but learn that this is frequently easier said than done.

• A glass of warm milk at bedtime. (Milk is high in tryptophan, which works as a safe and natural sedative and tranquillizer.)

• Chamomile tea, an old standby that still works.

• Supplements for sleep:

Tryptophan tabs 500-667 mg.         3 tabs, taken h hour before

bedtime with water or juice (no protein)

Chelated calcium and magnesium 1 tab, 3 times daily

Vitamin В6                                    50 mg., 1/2 hour before

bedtime

*8/137/5*

The ability to cope with failure is necessary to emotional well-being. The nourishing person sees his “failures” as experiences that he considers part of a learning process.

For the N person, the experience of failure is focused on the act itself: “Yes, I made a mistake, and it won’t be my last!”

The N person avoids poisoning himself because he does not believe that his self-esteem is at stake every time he ventures forth in some new endeavor. The T person, on the other hand, perceives failure as a reflection of his worth as a person. For him, failure is a blow to his idealized self and his acceptability as a human being.

TM NEVER GOOD ENOUGH

Those who poison themselves with embarrassment over their failures tend to fantasize that if they can perform well enough they will finally achieve an adequate sense of self-esteem. Their quest is futile, though, since the standards they arbitrarily select are almost invariably unreasonable, overdemanding, or perfectionistic. Ironically, any outstanding achievement they do experience tends to be viewed as a fluke. Similarly, any real acceptance by another is met with the attitude “He doesn’t know what I’m really like, or he’d feel differently.” Or the approving person is held in contempt for his low standards.

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This type of hair loss can occur very rapidly, causing marked anxiety. It can occur for a number of reasons:

- Iron deficiency. This is common in women who have heavy periods. It can also occur during breast-feeding, as the newborn baby extracts iron from the mother’s milk. Iron deficiency can also occur in vegetarians and people on special diets. The best source of iron is red meat. Vegetable sources have iron but in a form which is poorly absorbed by the body. Iron tablets are not as well absorbed as iron from meat but are necessary if significant iron deficiency occurs.

- Oral contraceptive pills. Oral contraceptive pills which are high in progestogen often aggravate hair fall. This is due to their male hormone-like activity. On the other hand, pills high in oestrogen promote hair growth.

- Pregnancy. During pregnancy the hair grows more rapidly due to certain hormonal changes. After pregnancy, however, the hair falls out, beginning six weeks to three months after delivery. It can last for three or four months but will eventually stop. Breast-feeding can aggravate hair loss, especially if iron deficiency occurs.

- Severe illness. Any severe or prolonged illness can also lead to hair fall. This tends to occur six weeks to three months after the illness but the hair will eventually completely grow back to normal without treatment.

- Weight loss. Sudden or dramatic weight loss is one of the most common causes of hair loss. The body interprets weight loss as a state of starvation and tries to preserve protein by stopping hair and nail growth. Once the weight stabilizes the hair will re-grow. Weight loss can sometimes be complicated by vitamin or iron deficiency which requires replacement therapy.

- Stress. Stress can also cause temporary hair loss. Once the stress decreases, the hair will re-grow.

*36/150/5*

Another element which must be carefully excluded in order to leave romantic love unimpaired is a vain, conceited attitude. If a man prides himself on his conquests or a woman delights in the spectacle of many men falling victim to her enticements, neither one of these is worthy of love. Too much pride and self-esteem separate rather than draw two people together. This characteristic, then, violates the essence of romantic love, which is to reduce social distance. An inferiority complex has the same effect by causing one of a pair to imagine that the other feels superior, when such is not the case. All rivalry or invidious comparisons between a man and his wife should be eschewed, for these can undermine the most promising romance.

Instead of these destructive attitudes, those emotions which intensify love should be fostered. Of these the most important is a tender, altruistic feeling. A regard for the happiness of the other not only enriches romance but helps a couple to overcome many of the difficulties of marital life. This feeling originates in the process of courtship, which, whether instinctively or as an unconscious development out of the effort to win affection, engenders something almost identical with parental feeling. This gives to the relationship between a man and a woman a quality without which mutuality, justice, considerateness and forbearance are impossible. The feeling of tenderness also insures against allowing the intensity of the sexual impulse to pass over into the realm of brutishness or cruelty.

*95\275\8*

The task of disentangling variations in cancer incidence which might be related to race from those attributable to geography is always going to present problems if each race stays in its country of origin. The best opportunity comes from the United States with its great mix of different immigrant races. The figures for the United States have been examined in detail by American epidemiologists and some startling variations have been found. These may of course still not be attributable purely to the racial differences but could reflect the cultural, dietary and economic differences between the different groups within the country. Having acknowledged that we must be cautious in interpreting the causes of the variations, we find that, in general, American blacks have a much higher cancer incidence (5,000 per 1,000,000 per year) than American Indians who represent the other extreme (2,000 per 1,000,000 per year). The overall descending order of cancer incidence among American races goes blacks, whites, Hawaiian, Japanese, Chinese, Hispanics, Filipinos and American Indians. However, this pattern is not uniform across all cancer sites, and for cancer of the stomach, for instance, the Japanese, Hawaiians and American Indians represent the highest-risk group while the whites are at lower risk. For melanoma of the skin, the white-skinned races are, as expected, most vulnerable, whereas blacks have a very low incidence indeed, as do most of the other races with more pigmented skins.

*26\194\4*

The Reward Meal is fundamental in helping to control the excess insulin production that seems to cause carbohydrate addiction. The Reward Meal will also provide you a key incentive to remain on the diet—the opportunity to eat the foods you love even as you are dieting and losing weight.

To use the Reward Meal to your advantage, follow these guidelines in incorporating it into your daily eating plan:

Eat a balanced diet. The Reward Meal is to be a daily feast, not a binge. Make it a delicious, well-rounded meal. Select foods from each of the four basic groups. Include milk and dairy products; meat, fish, and poultry; fruits and vegetables (include a salad); and breads and grains.

Reward yourself once a day at a time of your choosing. The only inflexible rule regarding the Reward Meal is that it must be eaten within a sixty-minute time period. You can set aside any hour of the day for your Reward Meal, but you must remember that it cannot be thirty minutes at one time and thirty an hour later. The Reward Meal must be continuous and not exceed one hour per day. Period.

Most of the people with whom we have worked report they find it most satisfying to save their Reward Meal for dinner, although a number of dieters have chosen lunch as the designated Reward Meal hour. In some cases they have chosen a Reward Meal lunch because it suits their working schedules and expense accounts. A few dieters have tried breakfast, but that is the least popular choice.

What is important is that the Reward Meal, whatever its designated time of day, suits your schedule and lifestyle. And remember, the Reward Meal doesn’t have to be at the same time every single day. The Carbohydrate Addict’s Diet does not require that you choose between sharing in the fun of eating and partying versus staying on your diet. You can do both. But don’t change your schedule on a whim. Except for special occasions, keep your Reward Meal in its regular spot. Make it part of your daily routine. Remember that you are changing your lifestyle, and keeping to a routine will help you do it.

Don’t change your Reward Meal to breakfast just because you wake up in the mood for pancakes. And don’t change your Reward Meal to lunch because you saw a new restaurant that looked like fun. We recommend that you save any changes in scheduling your Reward Meal for special occasions, like that buffet lunch at Christmas with your co-workers or the holiday family brunch.

Reward yourself with whatever you want. That’s right, anything. Include meats, poultry, or fish. Enjoy breads and pasta, rice, beans, potatoes, and fruits. Eat anything you like, whether it is low or high in carbohydrates—unless otherwise advised by your physician. Have the foods prepared the way that you like them. Make sure that your meal is well-balanced and sensible.

Feel free to include any beverage you like—drinks (diet or other), fruit drinks, milk, or your favorite beer, wine, or mixed drink. Top off your meal with a dessert that you really enjoy. Or more. Just remember to complete your meal within one hour.

Reward yourself with as much as you want. Reward Meal quantities are not limited. Have two desserts if you wish. Have more of whatever you wish. At your Reward Meal, there are no limitations on how much you eat as long as the meal is well-balanced and sensible.

During your Reward Meal, you may find that allowing yourself to eat as much as you want, of what you want, is not as easy as you thought it would be. When you eat your Reward Meal alone, you may feel guilty. You may feel as if you are doing something wrong. The people we have worked with often report that, in the beginning, they feel as if they will be punished for eating all of the foods that have been forbidden to them for so long.

You need to remind yourself that past diets failed to lead you to your ultimate goal—that is, permanent weight loss. If these diets had not failed you, you would not be reading this book now. To attempt to follow the rules of diets that have not succeeded in the past makes no sense.

Our most successful dieters remember that for the first time in their lives, they are treating their addiction. These dieters are willing to try a new approach to dieting, one that has been proved successful, rather than continuing to follow the tried-and-untrue rules of past failures. In some cases, the Reward Meal, the most exciting and enjoyable part of the Carbohydrate Addict’s Diet, presents the most difficult guideline of the diet. Dieters are not used to eating what they want, at any time, without fear of being punished. They feel guilty and perhaps frightened or concerned about indulging in the pleasure of the Reward Meal. Remember that the Carbohydrate Addict’s Diet treats the biologically based cause of your drive for carbohydrates and your excess weight. The Reward Meal is an essential part of the Carbohydrate Addict’s Diet.

Eating what you want at your Reward Meal will take some getting used to, but the Reward Meal is yours to enjoy. Tell that voice in your head to stop nagging and scaring you. Past diets did not work. Neither did the rules that they offered. Try this diet with an open mind and sit back and watch it work.

Eating your Reward Meal in the company of others presents another challenge. When you finally have calmed the doubting voices in yourself, along come friends and family to start the whole process all over again. Their questions, doubts, and concerns are predictable and are based on old diets that failed them as well as you. But people hold fast to established ideas, even if they are ineffective.

In the beginning, if friends or family remark that your Reward Meal cannot be part of a weight-loss program, you might want to tell them that you are trying a new approach that deals with the biologically based cause of carbohydrate hunger and weight gain. You will probably find that, in a little while, as the pounds begin to drop, they will no longer challenge your ability to enjoy previously forbidden foods; rather, they will want to know how they too can take part in this remarkable program. Until then, you need not defend yourself. Follow the program that was made for you. Let others do or say what they want. Soon enough they will be coming to you to find out the secret of your success.

Reward yourself with a wide selection. The selection is unlimited. Choose a well-balanced meal, which might include such foods as:

Apples, applesauce, apricots, apple juice, or cider

Bagels, bananas, beef, or bread

Cake, candy, hot or cold cereal, any kind of cheese, cherries, chicken, chocolate, cookies, crackers, cranberry sauce or juice

Danish or other pastries

English muffins or eggs

Figs, any kind offish, fruit pops, or French toast

Grapes or granola

Hamburgers or hot dogs (with buns)

Ice cream

Jams or jellies

Kale or any other vegetable; kumquat or other fruit

Lettuce, linguini, or lasagna

Macaroni or any other sort of pasta, matzo, meatloaf (with or without carbohydrate-rich filler materials), milk or other dairy products)

Nuts of any kind

Oranges or any other variety of citrus fruit

Pancakes (and syrup), peaches or pears or pizza, pie, popcorn, potato chips, potato, pretzels, pudding of any sort

Quail

Raisins, ravioli, rice, rice cakes, or rice pudding

Sandwiches—of any and all sorts; salads, sherbet, squash, and stuffing, just plain sugar

Turkey, tahini, or tonic of any sort

Ugli fruit

Veal, vanilla, venison, any vegetable you like

Waffles, water chestnuts, Wiener schnitzel, wild rice, or watermelon

Yams, yogurt (fruited or plain), or Yorkshire pudding

Zucchini or, say, a serving of zuppa inglese or zabaglione.

Just remember… You must eat your Reward Meal within sixty minutes—consecutive minutes, that is—per day. If you finish your Reward Meal before your sixty minutes are up, that’s fine. Just don’t let the meal go on longer than the one-hour time limit.

You must eat your Reward Meal at one sitting and you must not eat between meals. You may not consume anything at your other two meals except low-carbohydrate foods.

If you have finished your Reward Meal hour and you suddenly think of something you would like to have eaten, don’t despair (and, most important, don’t go back for more). Put the food away, and then eat the food guiltlessly at your next Reward Meal—no more than twenty-four hours away.

Don’t forget: Your next Reward Meal is always less than a day away. You get to eat anything you want every day. What a great way to diet. What a great way to live.

*34\236\2*

When the extent and consequences of your spinal cord injury are explained to you and your family, individual reactions will vary greatly. Some will react with tears, others with profanity, frozen shock, a feeling of emptiness, saintly acceptance, humor, stoic resolve, complete denial, anger, confusion, or a feeling that life is unfair. Many other feelings and consequent behaviors, some seemingly bizarre, can also be experienced. Don’t be concerned if you and your family are “all over the map” in your reactions to your spinal cord injury. Whatever feeling erupts or seeps through is a normal reaction to one of life’s abnormal events. You and each family member are entitled to feel however you do. This is to be expected, because each of you has different expectations, coping experiences, and relationships. Expressing your feelings may help to unload that big bag you feel is weighing you down. Paradoxically, you sometimes need to give yourself permission to lose control in order to maintain control.

At this early stage, family members need to accept and support each other wherever they are emotionally. You are experiencing one of life’s unplanned wilderness experiences; you are a frontiersman. You have no map for this new phase of life. You and those around you need to express all your feelings, including feelings of uncertainty. Doing so will bring much relief, and then you can concentrate your energy on the next difficult steps toward your recovery.

*26/156/5*