Friday, December 6, 2013

Behavior Modification - When and How to Seek the Best Intervention

When It's Time for A Behavior Modification

Day after day many of us continue to struggle with mood problems or negative attitudes; what we really need is a bit of behavior modification, but it's possible that we might not be aware of it, or could be in denial. If you have noticed that you are often depressed or your moods have become extreme, recurrent, and difficult to break free of, or have found yourself over and over again engaging in destructive or restrictive behavior, it might be time for some form of behavior modification. However, the question is, how will you be able to tell what type of intervention is right for you?

Where to Seek Intervention

If you have no support system, and have to do this by yourself, there are many ways to approach this. First, you may ask someone you know who had already undergone intervention therapy for his/her negative behavior and has demonstrated changes in ways that seem positive to you. Another way you can do this is to check with local consumer groups or with a women's centers, if you are a female.

Other places you may call, are, the departments of psychology, counselling, education, nursing, or social work at a nearby hospital, college or university. If none of these sources is available or you don't have access to the internet --- and the "good old" Yellow Pages is your only guide --- Please bear in mind that the size of the advertisement and the flashiness of the layout in the yellow pages has very little to do with the skill of the Behavioral Therapist.

How to Select A Therapist Who May Offer the Best Intervention

Once you have made an initial selection, you should request a consultation. This will commit you to nothing but a single visit which will allow you to make up your mind whether you feel this particular Therapist would be able to help you with your problems or not. At the time of consultation, find out whether or not the Therapist is licensed or certified by the state. Inquire about the Therapist's educational background and therapeutic orientation. Also, think about whether or not you would feel comfortable in such an intervention program.

Pay close attention to the Behavioral Therapist's techniques and also to some of the things that seem to be his or her values -- see if they are compatible with yours. Find out how frequently the therapist will expect you to meet with him or her and how long the treatment is expected to last. Also, make sure you ask about the fees.

The Task Force on Consumer Issues in Psychotherapy of the American Psychological Association has prepared these nine important questions that you should be prepared to ask yourself and should be able to answer, after your initial consultation:

  1. Did I have positive feelings toward the therapist?Could I trust this individual?
  2. Was I treated as an ill person or a human being?
  3. Was I satisfied with the therapist's answers to my questions?
  4. Were the answers to my questions direct or evasive?
  5. Was I taken seriously?
  6. Was I treated with respect?
  7. Was I comfortable with the office atmosphere?
  8. Am I comfortable With the therapist's suggested plan of treatment?
  9. Were the fees for services reasonable?

If you find yourself having a negative impression of the therapist, there is no point of continuing the relationship. If you are having a rather hard time making up your mind, think about the meeting, perhaps even scheduling a second session before making a final decision. Remember, you are not obligated to enter treatment with this particular therapist. As a matter of fact, you are buying services from a professional, so the choice whether or not to enter treatment with him or her is yours. If and when you decide to enter treatment, please note that you have the right to discontinue therapy at any time.

Always remember that not because another person says a therapist is great, that simply means you will also find him or her to be a great person! In fact, that individual might have offered counselling that worked for their problems but might not be the best behavioral therapist for the type of behavior modification you might need. It's wise to ask for recommendation, but you should also be prepared to do your own follow-up or evaluation.

Tuesday, November 12, 2013

Diabetes Dilemma - Shoes Tips To Prevent Foot Complications

According to the National Diabetes Information Clearinghouse (NDIC) 2011 statistics, about 215,000 people younger than 20 years have diabetes (type 1 or type 2). This figure represents a 0.26 percent of all people in this age group. There are others who have not been diagnosed, however, no data is currently available for this group

Type1 diabetes previously known as juvenile diabetes and diabetes mellitus --type11, or adult onset diabetes, have both known to take a major toll on the feet of individuals. As a result, a large percentage of people with diabetes often end up with AKA (Above Knee Amputation) or BKA (Below Knee Amputation). For this reason, if you are diagnosed with either of the above types of diabetes, your choice of shoes is very important.

Again, because of the impact of diabetes on the nerve and blood vessels of the feet, if you are a diabetic, taking care your feet -- which includes avoiding flip flops, open toe shoes, tight shoes, and other types of footwear -- is of paramount importance!

Important Shoes Recommendation
Seams, rough areas, or torn pieces in any shoes that are worn by diabetics can cause excess pressure or irritation that may result in blisters which can exacerbates into sores or wounds over time; so you should always make sure you thoroughly inspect the inside of your shoes. You should also practice changing the pressure points off your feet throughout the course of the day, especially if you have been diagnosed with diabetic neuropathy. You can do this by simply changing or temporarily removing your shoes, after every 5 hours of wearing them during the day. This will also help to reduce swelling.

Always try to wear comfortable, good-fitting shoes that has plenty of room in them. You shouldn't buy shoes that fit too closely, hoping that they will eventually stretch over time. Closely fitted shoes will only create a tremendous amount of pressure on the feet, which is not good, especially when you have experienced nerve damage in the feet. Severe nerve damage in the feet may prevent you from being able to sense pressure from poorly fitted shoes.

The tip of your shoes should be at least 1/2 to 1 inch in distance from your longest toe. You should wear only shoes made of leather, or other breathable materials. Plastics, and other materials that don't breathe are not suitable choices. Thong sandals, pointed or open toe shoes, high heels, flip-flops, or other sandals, are not recommended either. It's better to wear shoes that can be easily adjusted. Preferably, they should have laces, Velcro, or buckles.

Special Designed Shoes for the Diabetic
There are shoes specifically designed for people who have been diagnosed with diabetes. These shoes are highly recommended. If you have medical coverage, you can purchase these special diabetic shoes through your insurance.

Based on finding, Medicare will cover the cost of one pair of these shoes plus inserts, for people with diabetes, if you can prove that you have a medical need for them. However, your insurance company will need proof that they are necessary and reasonable for protection of insensitive feet or nerve damage in the feet.

To qualify for a pair of these diabetic shoes through your health insurance there are certain steps that you have to follow. One of these steps for example, is that your doctor has to complete a certificate of medical necessity for therapeutic shoes and document the need in your medical records. If you don't have medical insurance, you will have to pay out of pocket.

To summarize, anyone who has been diagnosed with diabetes, a comfortable fitting pair of shoes based on the above recommendations, is very important. Another important thing to remember is that, a Diabetic shoes may not appear fashionable, but they are highly recommended, especially for people with diabetic neuropathy and other foot complications. Remember, It's not about fashion, your health comes first!

Wednesday, November 6, 2013

Invasive Breast Cancer - The Benefits of Exercise

Breast Cancer
Based on findings, carcinoma of the breast is one of the most prevalent forms of cancer in white females aged 40 years and older. An average of 183,000 new cases of breast cancer are diagnosed each year, which means that one of every nine females will have breast cancer at some time during her life, and the re-occurrence rate is very high.  Breast cancer is the leading cause of death in women between the ages of 40 and 60 years. Despite experiencing a decrease over the last decade, its incidence still remains high amongst women in the U.S. and other developed countries.

The primary risk factors for breast cancer include a positive family history, as well as a personal history of cancer, first menstrual period at an early age, menopause at a late age, reproduction patterns such as giving birth to a first child after the age 30 or no childbirth, lifestyle, and a diet high in fat.

Whereas factors such as childlessness, obesity due to high-fat diet in menopausal women and alcohol consumption, etc, increase the risk for breast cancer, physical activity and breastfeeding were found to be the preventative measures against its development.

Invasive Breast Cancer – The Benefits of  Exercise
Currently, there are two types of breast cancer:

1.Non-Invasive or Insitu

Non-invasive or insitu breast cancer means the cancer does not invade or multiply in other cells. Presently, an insitu ductual carcinoma of the breast has been found to be the most frequent form of non-invasive breast cancer. However, it’s believed that exercise doesn’t offer any benefits against the risk of developing this type of cancer. On the contrary, studies have shown that exercise can decrease the risk for invasive breast cancer.

Invasive Breast Cancer and Exercise
It was discovered that physically active menopausal women have a 14% less chance of developing invasive breast cancer compared to sedentary menopausal women. It was found that moderate to intense physical activity in general decreases the risk of developing breast cancer by 8% and 14% respectively.
In fact, based on finding, an expert report published by the World Cancer Research Fund (WCRF) in 2007, as well as in its updated version in 2010, confirmed that there is enough evidence on the protective effects of physical activity. However, this evidence is somewhat more convincing in the case of menopausal women, according to this report.  The important question is however, how does physical exercise help to decrease the risk of invasive breast cancer?

How Does Exercise Work   
Physical activity helps in many ways to reduce the risk of developing invasive breast cancer. In fact, there are several theories in support of this. It’s believed that a reduced cancer risk is mediated by regular exercise, which reduces levels of glucose and insulin and increases levels of corticosteroid hormones.

 Exercise also increases levels of anti-inflammatory cytokines and augments insulin-receptor expression in cancer-fighting T- Cells. Physical activity has also shown to increase interferon production, stimulates glycogen synthetase, augments leukocyte function, and improves the metabolism of ascorbic acid – all of which blunt the formation of cancerous tumors. Another logical reasoning is that regular exercise may exert beneficial effects on the process of provirus or oncogene activation.

Based on a 1997 article published in the New England Journal of Medicine, 25,624 premenopausal and postmenopausal women participated in a study designed to investigate the benefits of physical activity in women with breast cancer. The end result confirmed that physical activity protects against breast cancer, particularly among premenopausal and younger postmenopausal women. They found that vigorous physical training and even moderate exercise can interrupt the menstrual cycle, perhaps by suppressing the pulsatile release of gonadotropin-releasing hormone. This effect of physical activity may lower a woman’s cumulative exposure to estrogen and progesterone, thereby inhibiting carcinogenesis in the breast.

With all the above reports, studies, and scientific theories, hopefully sufficient evidence was provided here on the benefits of exercise in reducing the risk of invasive breast cancer, in particular from a hormonal standpoint. Although other contributory factors of breast cancer in general such as obesity, diet, lifestyle weren't adequately addressed, we already aware of the benefits of exercise when it comes to these.

Tuesday, February 26, 2013

Why Diabetes May Lead to Foot Amuputation

Type 1 or type 2 Diabetes can result in serious physical limitation. Damages to blood vessels in the feet as a result of diabetes mellitus, Juvenile diabetes or any other type of diabetes can often result in a reduction of blood supply to the feet. With an inadequate blood supply to cuts, small sores, abrasions, blisters, or even tears in the skin, healing tends to be much slower than normal, and these openings in the skin may gradually develop into deeper ulcers or wounds even with proper medical interventions.

People with diabetes may also develop what is known as diabetic neuropathy -- a condition that may cause them to eventually lose all the sensation in their feet due to severe nerves damage. If all the sensation is lost in the foot this may further complicates the situation which may eventually lead to foot amputation.

Below are several reasons most people with diabetes have such high rate of foot amputation:

  • People with diabetes should get their feet examined by their health care providers at least once per year to learn whether or not they have nerve or blood vessel damages. Yet, the majority of them don't usually do so.
  • Some of these individuals have been walking around the house bare- footed or in an open pair of slippers, instead of wearing a comfortable pair of close-up shoes. Open shoes makes people with diabetes more susceptible to cuts. With no sensation in the foot, if they should step on sharp objects lying around the house, or scrape their feet against sharp edges they might not be able to feel it. 
  • They might have been trying to get rid of calluses or bunions by pricking or cutting on them, not realizing that diabetic sores heal much slower than the ordinary.
  • There is also the possibility that some diabetics aren't checking their feet and toes daily, although they already knew that they had some nerves or blood damages or current food problems. Most diabetic don't carefully examine the top, sides, soles, heels, and between toes for sores, bruises, cuts, blisters, ulcers. They don't take into consideration that these issues with their skin may be present, but because they have no sensation in their feet, they may not notice it. 
  • Those who are unable to check their own feet due to poor vision or physical limitations, fail to ask family members or caregivers to assist them where necessary. They also do not know that there are special mirrors that they can use to check the sole of their own feet.
  • Many of these individuals have not been using lukewarm water and mild soap(strong soaps may damage their sensitive skin) to gently wash their feet and between toes daily.
  • Because they may have lost sensation in their feet, they aren't able to sense the true temperature of their bath water, and it's possibly that no one had ever advised some of these individuals before, not to place their feet in bath water before testing the temperature with their finger, elbows, or even with thermometer. As a result, they ended up with serious foot burns.
  • Moist areas promotes the growth of fungus and bacteria, which may lead to athletes foot and other serious infections; this may diabetics do not know. As a result, they fail to gently and thoroughly dry their feet, especially between the toes.
  • They do not know that if the feet or in-between toes or too dry, this may cause the skin to crack which may possibly lead to other serious infections, so they have not been applying lotion, petroleum jelly, lanolin, or oil to their feet. At the same token, they do not know that while feet should be greased, between toes shouldn't -- they should remain free from moisture.
  • Many people who have been diagnosed with diabetes do not know that they shouldn't keep long toe nails, because they might tear and cause serious problems. Another important thing they neglect to do is to ask a Podiatrist if it's okay for them to trim the nails or what's the proper or safest way to do this.
  •  Even though they were diagnosed with diabetes, many of these people continue to wear shoes that are either too high, too close(longest toe should be at least 1/2 inch away from tip of shoes) or have inner seams that may cause blisters or calluses
Proper foot care is something that all pre-diabetics as well as all individuals with diabetes mellitus, juvenile diabetes and all other types of diabetes should practice. Because diabetes can cause nerves and blood vessel damages of the feet, people with diabetes are usually more susceptible to developing foot wounds which may eventually lead to foot amputation.

(C)  I. McFarlane 2013