•
Your answers to the above questions will determine the form of treatment your physician will advise, since treatment will depend largely on what is causing your malaise. For instance, if you have recently lost weight and noticed that your bowel habits have changed, the cause could be the fact that you’re worrying about one of your children who recently moved across the country to take a new job. At worst, you could be suffering from cancer or bleeding in the gastrointestinal tract, but this is a very rare cause of malaise. The more specific you are in narrowing down your symptoms and your recent health history, the better your physician can treat you.
If you’ve lost weight and are frequently thirsty, it’s a cleat sign of diabetes. And if you’ve recently traveled to an area where deer roam freely and you feel tired and under the weather, you may have been bitten by a deer tick; a rash will help alert your physician to a possible diagnosis of
Lyme disease. There is also always the chance that your discomfort is caused by menstrual changes that are leading you toward the onset of menopause. Then again, a general feeling of malaise may simply be due to physical deconditioning if you have recently adopted a more sedentary lifestyle.
Your age, of course, will have some bearing on your physician’s final diagnosis. If an elderly person complains of malaise, her doctor will be looking for signs of cancer, a blood disorder, or lymphoma. For people in their 40s, 50s, and 60s who are feeling unwell, a physician will probably investigate certain infectious diseases first.
You should keep in mind that the above are only a handful of the possible causes of malaise; there are, in fact, many different illnesses in which this symptom is present. Because of this, make sure your doctor has as much information as possible so she can prescribe the most effective and fastest-acting treatment possible. I feel that an investigation of both your recent and lifelong medical history is vital to ensure proper diagnosis and course of healing.
Special Mention for the Elderly
In an elderly person, other factors may be causing malaise. These can include thyroid disease, a rheumatological disorder such as temporal arteritis, polymyalgia rheumatica, heart disease, and interaction among several of the medications she is taking. Again, making sure she is as specific as possible about recent changes in her health will help guide her treatment.
*565\167\8*
•
Americans treat weight gain as a modern-day blasphemy of sorts, no matter whether they’re talking about 5 pounds or 50. I feel far too many men and women are totally obsessed with a process that I view as pure physics most of the time: weight gain is the body’s natural reaction when a person takes in more calories than his body needs. Most of the time, it’s as simple as that. Excess weight is one of the major contributors to America’s health problems and is so common because of the high-fat, high-calorie, sedentary life many people lead. When a person weighs more than 20% above his ideal weight, he automatically becomes more prone to developing high blood pressure, increased cholesterol levels, diabetes, and arthritis, as well as the psychosocial problems that go along with carrying extra weight, such as low self-esteem and emotional isolation.
As a physician, I become very concerned when one of my patients gains a lot of weight in a short period of time and/or morbid obesity develops.
However, the aging process works in such a way that a weight gain might actually be due not to an increase in body fat, but rather to an increase in the amount of water the body retains. This excess water can be the result of kidney, heart, or liver failure, and it accumulates most often in the abdomen or in the legs. Weight gain that results in fat and occurs without a corresponding increase in caloric intake can be a side effect of corticosteroid preparations such as prednisone, which are prescribed to treat arthritis or asthma. The face will commonly take on a round, moonlike look, and a hump may develop on the upper back. Prednisone can also raise blood sugar levels and aggravate an existing case of osteoporosis. However, the good news is that these symptoms and the weight gain will develop only in people who take high doses of the steroid for more than three or four months. Many times, however, an inactive thyroid is the first condition your doctor will check for. This can be diagnosed with a physical exam and a simple blood test.
*569\167\8*
•
If your doctor determines that the loss of a few pounds is due to the aging process, he will probably recommend that you do nothing. Of course, many people who have struggled with their weight their entire lives will be thrilled at the fact that the pounds have seemingly come off effortlessly. If this continues, however, and is accompanied by weakness and malaise, your doctor may recommend that you increase your caloric intake with nutritious foods—not high-fat, high-calorie junk foods—and that you also step up your exercise program. The reason? Muscle weighs more than fat, and exercise serves the dual purpose of reducing fat stores and building up lean muscle mass, which will ultimately increase your strength.
If the aging process is not the culprit, your doctor will tailor your treatment to whatever underlying medical problem is responsible. Again, as with malaise, it’s important for you to be as specific as you can when you describe your symptoms to your physician, since this is what will ultimately help him to determine your treatment.
I want to tell you a story about a patient I once had who was about 60 years old and who had spent her entire life fighting and losing her battle with chronic obesity. She had been on numerous diets without success. Unfortunately, she ended up developing breast cancer—which can be more common in women who are overweight—and she subsequently underwent radiation and chemotherapy. In the process, she lost 50 pounds. At the end of her treatment, she was heartened to find that her cancer had been totally eradicated. She was healthy and doing quite well, so after her treatment stopped, she decided to continue to lose weight until she had lost a total of 60 pounds. To lose the extra weight, she followed the advice of her oncologist, who had recommended a low-fat, low-calorie diet to prevent a recurrence of her cancer.
All was well until she suddenly became concerned that the real reason why she was losing weight was that her cancer had returned. She became scared and returned to her old eating habits; she promptly gained back 30 pounds. She told me she was afraid to lose any more weight because everyone thought her weight loss was due to her cancer; therefore, she felt that as long as she gained weight, she was cancer free. She did remain cancer free, but her weight went up and down for many years. The moral of this story is: Despite past health conditions, if you lose weight and feel healthy, listen to your body. It’s telling you everything is working as it should.
*573\167\8*
•
Diet and Exercise
Fat (especially saturated fat), cholesterol, complex carbohydrates, fiber, sodium, calcium. Caloric balance. Selection of exercise program.
Substance Use
Tobacco cessation.
Alcohol and other drugs.
Limiting alcohol consumption.
Driving/other dangerous activities while under the influence. Treatment for abuse.
High-risk groups. Intravenous drug users who share or use unstenlized needles and syringes.
Sexual Practices
Sexually transmitted diseases: partner selection, condoms, anal intercourse.
Unintended pregnancy and contraceptive options.
Injury Prevention
Safety belts. Safety helmets. Smoke detectors.
Smoking near bedding or upholstery.
High-risk groups. Back-conditioning exercises for persons at increased risk for low-back injury because of past history, body configuration, or types of activities.
Prevention of childhood injuries for persons with children in the home or automobile.
Falls by the elderly for persons with older adults in the home.
Dental Health
Regular tooth brushing, flossing, dental visits.
*577\167\8*
•
Screening
History
Prior symptoms of transient ischemic attack.
Dietary intake.
Physical activity.
Tobacco/alcohol/drug use.
Functional status at home.
Physical exam.
Height and weight.
Blood pressure.
Visual acuity.
Hearing and hearing aids.
Clinical breast exam.
High-risk groups. Auscultation for carotid bruits for persons who have risk factors for cerebrovascular or cardiovascular disease (e.g., hypertension, smoking, coronary artery disease, atrial fibrillation, diabetes), neurological symptoms (e.g., transient ischemic attacks), or a history of cerebrovascular disease.
Complete skin exam for persons with a family or personal history of skin cancer, frequent occupational or recreational exposure to sunlight, or clinical evidence of precursor lesions (e.g., dysplastic nevi, certain congenital nevi).
Complete oral cavity exam for persons who use tobacco or drink excessive amounts of alcohol or those with suspicious symptoms or lesions detected through self-examination.
Palpitation for thyroid nodules for persons with a history of upper-body radiation therapy when they were a child, for an increased thymus gland, or previous history of thyroid nodules.
*581\167\8*
•
Description and Possible Medical Problems
Since the primary function of the liver is to detoxify the blood, if the livet fails to do its job properly, the problem will immediately become evident through a routine blood test. An abnormal liver function test can be caused by many diseases, including hepatitis, viral inflammation of the liver, an injury to the liver, such as cancer or alcohol abuse, gallbladder disease, and certain medications, such as Cognex and Mevacor.
Treatment
Since each specific liver disease requires its own individual treatment, if your doctor discovers a problem with your liver, he will immediately order a regimen for you. This may include medication such as corticosteroids to reduce inflammation, a diet that’s restricted in protein, fat, and alcohol, and rest. Some liver diseases, such as viral hepatitis, can be highly contagious, so your doctor may recommend that your family members receive immune globulins against hepatitis.
*564\167\8*
•
If the wife has a shocked but bemused smile, the husband continues to talk dirty to her, using language of his own choosing and letting the wife’s response be his cue. He should experiment with different words and note which ones arouse her the most. For instance, he might say, “You really like my filthy cock inside your dirty little slit, don’t you? Admit it.” And if she nods emphatically and kisses him passionately, he should repeat that phrase several times, and then try others, developing a whole repertoire. The wife may then also begin trying some choice phrases.
If the wife becomes truly upset, however, the husband should discontinue the game and ask her to participate actively, explaining the benefits of this kind of game—how it is designed to appeal to her unconscious fantasies and be therapeutic. If she does not agree to play the game on the first occasion, the husband should keep trying.
*103/196/1*
•
Players: Husband and wife. Activists: Both. Setting: Bed.
Aim: Activate unconscious feelings of competition or resentment and direct them into a constructive channel.
Game Plan: Sometimes depression is involved with both feelings of oppression and an inhibition of self-assertion and competition. We learn as children that it is not all right to assert ourselves toward or compete with our brothers, sisters, or parents, for we will then meet with disapproval, condemnation, and the like. Hence the habit of allowing ourselves to be oppressed gets started.
In this game, a couple is asked to turn sex into a competitive sport (which at first seems opposed to everything that sex represents—i.e., the saying that was prevalent during the 1960s, “Make love, not war”). However, in this instance the competition, combined with eroticism, is being utilized to get at a particular kind of block related to a deep-seated fear of assertion.
*78/196/1*
•
“Darling, let’s make love,” the spouse proposes.
“Not tonight—I’m not in the mood,” the dummy replies.
“You’re never in the mood,” the spouse shoots back.
The dummy is silent.
“Talk to me.”
The dummy looks at the spouse but remains silent. “Talk to me.”
The dummy shakes its head.
“Don’t shake your head at me!”
The dummy yawns, holding a hand over its mouth.
“I hate you when you act like this!”
The dummy simulates rolling back its eyes.
“I hate you, I hate you, I hate you!” screams the spouse, who begins kicking and hitting and biting and scratching the dummy. The dummy lies back passively. “You make me feel like a monster sometimes. You make me feel like hitting you and hurting you until you do something!”
When the spouse lies exhaustedly crying, dummy says, “It makes me feel so superior and good to see that you’re a monster and I’m not. It makes me feel so good to know I’m completely innocent and have no hatred inside me whatsoever, while you are full of hate. But I will love you anyway, despite your faults, and just try to be patient until you see the light.”
*53/196/1*
•
The game can then be repeated and varied—or, a couple may simply begin having more sex without the game. And more sex will at least temporarily bring about a stronger bond that will enable the couple to begin communicating about things they have long kept pent up. “All you do is talk about the stock market,” she may say, “and that makes me feel angry and rejected.” He may reply, “I wish you’d take more of an interest in my work and stop being so demanding.” At the very least, a dialogue is started—and, once this dialogue has begun, the couple is ready for chapter 14, “Games to Restore Tenderness.”
Warning: Soon after the flame of intimacy is rekindled, there is a tendency to retreat to the original defensive postures—and both partners must be wary of that. It will be an ongoing struggle against giving in to this resistance, one that may last for weeks, months, even years. Defensive postures are just another kind of addiction—but, like all other addictions, they are hard to break. It takes a valiant effort to do so.
*28/196/1*