You will need a partner for this and you will also need to allow him/her to help you; just sit there like a sack of potatoes and if you feel a little discomfort just try to bear it; it is an indication of how much you need those muscles moved.
Instructions for the helper
Areas of tension feel harder and resist the pressure of your fingers, so just work away in these areas and you will feel the muscles becoming less tight. Your fingers are bringing more blood to the area and allowing waste products to be taken away. Don’t be too concerned about technique, if your thoughts are gentle towards your partner and you desire to help him/her you cannot do any harm; just follow these simple rules and let your fingers take over.
• Don’t massage over broken skin or varicose veins.
• Don’t massage the front of the neck.
• Don’t poke hard into muscles that feel hot and swollen.
• Do relax when you are massaging.
• Do allow your partner to do the same for you.
• Do remember to do shoulder exercises every day.
Be as relaxed as you can; let your breath out as you drop your shoulders; balance your partner’s head, make sure his/her back is straight but slack, press her/his shoulders gently down.
J Support the forehead with one hand and move the muscles of the scalp just as if you were washing the hair with the other.
2 Continue to support the forehead and massage quite firmly at the base of the skull using the thumb and fingers to make small circular movements.
3 Now move onto the back of the neck using the thumb and index finger on either side of the neck bones; again using a circular movement.
4 Place your hands over the shoulders and use the thumb or heel of the hand to knead the muscles in a circular motion. Ask if there are any places needing extra attention.
5 Put one arm across the top of your partner’s chest and encourage them to relax forward onto it. With the other hand continue massaging down the side of (but not on) the bones of the spine. Work in a similar fashion around the shoulder blade. Use the other arm and repeat for other side of spine.
6 Stand in front of your partner, pick up the wrist and shake the hand letting it flop (don’t do this if there is pain in the joint); and ask them to imagine a wet sweater on the washing line. You will feel the arm become heavier when they think ‘heavy’. Give the hand a little shake then do the other hand and arm.
7 Stand behind your partner, support her/his head against your chest and stroke the brow with both first fingers from the centre outwards.
8 Finish off by stroking lightly and rapidly from the head down the back and then down the arms and hands.
Sometimes people are quite sleepy after a head and neck massage. Your partner might need a short rest before helping you.
For the very tense person, it is a great help if they can have a massage daily. The therapeutic value of massage is becoming more recognized in this country. Aromatherapy – massaging with the essential oils of plants – has been proved to have a beneficial effect on the nervous system.
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“Sally had several grand mal seizures and was placed on a medicine. She has had no more seizures since age three, but she has grown and gained weight. Her physician finds that Sally’s blood level has slipped below the therapeutic’ range. What should he do?”
This question of maintaining the level over time also needs to be addressed. In Sally’s case there are two alternatives. The physician could increase the dose, and thus the blood level, to keep it in the therapeutic range giving her greater protection against another seizure. Or he could leave the dose alone, let it gradually continue to decrease as she grows, and when she has been free of seizures for two years, then he can discontinue the medicine. There is not, however, necessarily a correct thing to do. Children who have been free of seizures for two years can discontinue medication with a high probability of remaining seizure free. That chance is higher if the blood levels are low at the time the medicine is stopped because a child who is sensitive to the level of medication is more likely to have a seizure when the level drops below the therapeutic range. Then the doctor increases the dose and waits another two years. If the child is unlikely to have another seizure, then it doesn’t matter if the blood level is low. Allowing the level to drop slowly is a form of testing. If Sally passes the test, her chance of having a seizure when we stop the medicine is low. If she fails the test and has another seizure, we believe that it is better for this to happen at a younger age. Therefore, our suggestion to this parent and this physician would be not to increase the medicine. We believe that the risks and consequences of another seizure at this age are outweighed by the possible side effects of a higher dose on Sally’s learning capacity. Other physicians (and other parents) may believe differently.
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Because pills have to be absorbed from the gut before they can work, anything that upsets absorption may interfere with their action. This may include a stomach or bowel operation years ago. Diarrhea and vomiting are obvious problems but taking them after a big meal may delay absorption. Some foods may slow their absorption more than others. Taking them on an empty stomach can irritate the stomach in some people. You must never take them and then not eat. Instructions for taking sulphonylureas vary depending on which book one reads. Most suggest with the meal – I interpret this as swallowing them when you have eaten some, but not all of your food – for example, between the cereal and the toast, or, at dinner time, between the soup and the main course. Wash your pills down with a drink of water or other non-alcoholic beverage.
If your pills are prescribed twice a day, then take them twice a day. With oral hypoglycemic pills this usually means with breakfast and with your evening meal – but if you are taking tolbutamide or glipizide it may mean with breakfast and lunch – so ask your doctor. It is rare to need more pills with the evening meal than with the morning meal. Too much sulphonylurea at night increases the risk of nocturnal hypoglycemia. But I do see one man who eats very little in the day and a great deal in the evening who needs 80 mg gliclazide with breakfast and 160 mg gliclazide with his evening meal. This sort of adjustment is only possible in someone who is monitoring their blood glucose carefully. If you take your pills at the wrong time, or take them all at once when you have been advised to divide them you run the considerable risk of hypoglycemia.
Getting the best out of your treatment
• Diet is the basis of all treatment for diabetes.
• If you are on additional treatment learn everything you can about it.
• If you are taking insulin:
1. Learn how fast and for how long each of your insulins acts – both theoretically and in your own case.
2. Gain confidence in adjusting your own insulin dose.
3. Consider advances in insulin injection techniques.
4. Consider whether you have injection site problems.
• If you are taking oral hypoglycemic pills:
1. Learn how fast and for how long your pills act.
2. Learn the maximum safe dose of your pills and consider making adjustments within this maximum.
• Do not be upset if you cannot control your diabetes on pills and diet. The need for insulin treatment is not a disaster and you will learn how to cope with it very quickly.
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