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.

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Description and Possible Medical Problems

The triglyceride level is nothing more than the amount of fat that is found in the bloodstream. A test to determine your triglyceride level will be included as part of a cholesterol test; triglycerides alone pose very little risk to your health. I feel the value should be 150 or less. Currently, there is a lot of controversy in the medical establishment over whether an elevated triglyceride level alone increases the risk of heart disease. Even though I believe that for good health the triglyceride level should be at 150 or less, an elevated triglyceride level will be treated only if it is extremely high, in excess of 800 milligrams/100cc, which is an indication of a pancreatic problem or advancing arteriosclerosis. Elevated triglycerides are often caused by heredity, but, like the HDL and LDL cholesterol levels, more often than not they’re a result of a high-fat diet, uncontrolled diabetes, and heavy smoking—particularly in women.

Treatment

The primary treatment for a high triglyceride level is medication, but again, only if the level is above 800. Your doctor will also prescribe a low-fat diet and moderate exercise program for you to follow. However, an underlying condition, such as diabetes, must also be treated in order to bring the triglycerides down to a normal level. I’ve found that in some rare cases a triglyceride level above 200 is caused by taking a medication such as Accutane, which is used to treat acne. In this case, discontinuing the medication will lower the triglyceride level to its previous state.

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Since, like many Americans, you may have been fighting excess body weight for most of your life, you may be heartened to discover that weight loss is a common part of the aging process. However, this weight loss begins when people reach their mid to late 60s, and it usually amounts to only a few pounds a year, if that. Even though your scale says you weigh less, any pounds that are lost due to the aging process are mostly lean body mass or muscle mass, not fat. This leaves most people with less strength than they had just a few years before. Since the process is usually slow, the weight loss usually goes unnoticed except for when they are weighed in at their annual checkup or observe a change in their physical stature.

The time you and your doctor should become concerned about weight loss, however, is when both your weight and your general health rapidly deteriorate over a short period of time. If you have lost 10% of your weight over a period of a month or two, I usually become quite concerned, and the younger my patient, the more concerned I become.

If a person who is quite overweight loses a couple of pounds without trying, the loss might not initially seem serious, but this too can be the sign of a medical problem.

As with the case of malaise, weight loss can occur because of either the normal physiological changes of aging or a more serious illness.

That’s why a complete medical history and physical exam with the necessary diagnostic tests are extremely important in any instance of unexplained weight loss. Thyroid problems may cause you to feel overheated, while cancer or a hidden infection may be responsible for a fever or night sweats. If you are coughing or feel short of breath, you may have emphysema ot lung cancer. There is also the possibility that if weight loss is accompanied by a cough, swollen glands, a fever, and/or a general feeling of malaise, you might have been exposed to the HIV virus, which can lead to the development of AIDS.

If you have tecently lost weight without trying, either a few pounds or 10 or more, you should ask yourself the following questions:

1. Over how long a time has the weight loss occurred?

2. Have I also experienced a change in my appetite or bowel habits?

3. Do I suffer from heat intolerance, nervousness, or heart palpitations?

4. Do I have night sweats, occasional fevers, or newly enlarged glands?

5. Am I coughing a lot lately? Do I suffer from shortness of breath?

6. Do I have a prior history of a serious illness?

7. Do I regularly use alcohol or tobacco?

8. Have I ever had an unsafe sexual encounter, shared a hypodermic needle, or had a blood transfusions?

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Laboratory/Diagnostic Procedures

High-risk groups. Fasting plasma glucose for the markedly obese, persons with a family history of diabetes, or women with a history of gestational diabetes.

Syphillis test VDRL or RPR for prostitutes, persons who engage in sex with multiple partners in areas in which syphilis is prevalent, or have contacts with persons with active syphilis.

Urinalysis for bacteriuria for persons with diabetes.

Chlamydial testing for persons who attend clinics for sexually transmitted diseases, attend other high-risk health care facilities (e.g., adolescent and family planning clinics), or have other risk factors for chlamydial infection (e.g., multiple sexual partners or a sexual partner with multiple sexual contacts).

Gonorrhea culture for prostitutes, persons who have multiple sexual partners or a sexual partner who has multiple contacts, sexual contacts of persons with culture-proven gonorrhea, or persons who have a history of repeated episodes of gonorrhea.

Counseling and testing for HIV for persons seeking treatment for sexually transmitted diseases; homosexual and bisexual men; past or present intravenous drug users; persons with a history of prostitution or multiple sexual contact; women whose past or present sexual partners were HIV-infected, bisexual or IV drug users; persons with long-term residence or birth in an area with a high prevalence of HIV infection; or persons who had a blood transfusion between 1978 and 1985.

Tuberculin skin test (PPD) for household members of persons with tuberculosis or others at risk for close contact with the disease (e.g., staff of tuberculosis clinics, shelters for the homeless, nursing homes, substance abuse treatment clinics, dialysis units, correctional institutions); recent immigrants or refugees from countries in which tuberculosis is common (e.g., Asia, Africa, Central and South America, Pacific Islands); migrant workers; residents of nursing homes, correctional institutions, or homeless shelters; or persons with certain underlying medical disorders (e.g., HIV infection).

Electrocardiogram for men with two or more cardiac risk factors (high blood cholesterol, hypertension, cigarette smoking, diabetes mellitus, family history of coronary artery disease); people who would endanger public safety were they to experience a sudden cardiac event (e.g., commercial airline pilots); or sedentary or high-risk males planning to begin a vigorous exercise program.

Hearing test for persons frequently exposed to excessive noise.

Fecal occult blood sigmoidoscopy for persons aged 50 and older who have first-degree relatives with colorectal cancer; a personal history of endometrial, ovarian, or breast cancer; or a previous diagnosis of inflammatory bowel disease, adenomatous polyps, or colorectal cancer.

Fecal occult blood colonoscopy for persons who have a family history of familial polyposis coli or cancer-family syndrome.

Bone mineral content for perimenopausal women who have an increased risk for osteoporosis (e.g., Caucasian race, bilateral ovary removal before menopause, slender build) and for whom estrogen replacement therapy is not recommended.

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Tetanus-diphtheria (TD) booster.

High-risk groups. Hepatitis B vaccine for homosexually active men, intravenous drug users, recipients of some blood products, or people in health-related jobs who are frequently exposed to blood or blood products.

Pneumococcal vaccine for persons who have medical conditions that increase the risk of pneumococcal infection (e.g., chronic cardiac or pulmonary disease, sickle-cell disease, nephrotic syndrome, Hodgkin’s disease, asplenia, diabetes mellitus, alcoholism, cirrhosis, multiple myeloma, renal disease, conditions associated with immunosuppression).

Influenza vaccine for residents of chronic care facilities and persons suffering from chronic cardiopulmonary disorders, metabolic diseases (including diabetes mellitus), hemoglobinopathies, immunosuppression, or renal dysfunction.

This list of preventive measures is not exhaustive. It reflects only those topics reviewed by the U.S. Preventive Services Task Force. Your doctor may wish to add other preventive measures on a routine basis, after considering your medical history and other individual circumstances. Examples of conditions not specifically examined by the Task Force include:

Chronic obstructive pulmonary disease.

Hepatobility disease.

Bladder cancer.

Endometrial disease.

Travel-related illness.

Prescription drug abuse.

Occupational illness and injuries.

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When the game becomes more actively played by both, it takes off on its own. The dirty talk will have a liberating effect on both partners, since this forbidden language, as well as the ideation behind it, are being repressed and hence are blocking both true love and sex. The language and the sex alike become more abandoned with each playing of the game.

The final step is to discuss the significance of the dirty talk—what it means to both partners, how it “feels,” and even where it comes from. This step is very important, for without it the game will simply be an enactment of the fantasies without resolving the block that creates the need for the fantasies. This reminds me of the male patient I wrote about in the book’s Introduction, who was seduced by the young woman who wanted him to talk dirty to her while she sucked her thumb. While such enactment of one’s sexual fantasies is gratifying, it is not therapeutic. Instead, it becomes a repeating pattern that feeds upon itself while never really achieving the ultimate satisfaction of a real connection.

Talking about the experience of using common language during sex—discussing one’s need to talk dirty or to hear dirty talk—leads to insight about how one’s natural feelings about sex got to be derailed and one’s capacity for unhindered tenderness was blocked. It moves the experience out of the level of compulsive acting-out to a higher level of awareness, trust, and bond-building. When that happens, sex transcends the realm of ritual and becomes rich with a deeper meaning.

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The two begin as they normally would when making love. When they are aroused, they sit or lie opposite one another and begin to bring each other to orgasm using either hands or mouth—whichever they deem best. (Hand sex may be best for couples who have problems accepting oral sex or with achieving orgasm through intercourse.) In either case, as soon as the sex—of whatever kind—begins, the race is on. The partners set about trying to make their partner come first, and so each, of course, tries to resist letting go. The first person to achieve orgasm loses—and thus, of course, the person who causes the other to come wins. To spice up the game, the winner may get a prize—i.e., he or she will be the other’s slave.

This game will provoke feelings that have lain dormant. Some people, when asked to make sex competitive, will scoff.

Others will suddenly have orgasms with a vengeance, whereas they previously had difficulty in obtaining them. Still others will take great pride in getting their partner (their opponent) to come first. In addition, the game puts each person into a conflict: to win the game the participants must try to make their mate come, yet on another level, the one who has the orgasm wins. Hence, either way they are both winning and losing. The person who comes first wins by losing; the other loses by winning. This conflict is not present in only this game, but also underlies the sexual block itself, and is unconsciously present whenever the participants have sex. All this game does is bring the conflict to the surface.

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By this time the real passive spouse will have at least begun to protest. “This is a ridiculous play!” The active spouse will then invite the passive spouse to the stage to play the dummy’s role, but will require him or her to undress first. They will do the scene again—but this time as the passive spouse would like to play it. When they do play out the new version, the active spouse will begin to embrace and kiss the passive spouse—a move which will lead to new and unexpected reactions and feelings on the part of both.

The passive spouse, in playing the scene differently, has the opportunity to do what every writer does—re-create life in one’s own image. In doing so, that person unwittingly begins to see the relationship in a new way and to try new approaches and responses.

This couple definitely will find that their sexual relations improve as they replay this script. Also, the play will leave an indelible impression that will require much further discussion—if not right at that time, then at some point in the near future. The scene can be repeated again and again and each time elicit new reactions and feelings, stimulating a resurgence of sexual passion and more-honest communication.

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Players: Bored husband and boring wife.

Activist: Husband, without wife’s cooperation or knowledge.

Setting: Home.

Aim: Prod wife out of her defensive posture and rekindle sexual passion and emotional involvement.

Game Plan: The wife comes home from work (or wherever) and finds a note on the front door. “Hello, my dearest wife. You have been elected queen for a night. Prepare yourself for the surprise party of your life and times!” She enters to find that the lights are low, the scent of incense is in the air, and the strains of soft, exotic music (or the romantic songs of her favorite crooner) fill the room. When she enters the dining room, she finds the table set with their finest china, napkins, and silverware, candles burning, and her favorite flowers in a vase at the center of the table. The aroma of steaming oysters (or her favorite food) comes from the kitchen. A bottle of champagne in a bucket of ice sits at the corner of the table.

“Good evening, my dear,” the husband says, popping out of the kitchen, dressed in a tuxedo. “Here, let me help you with that.” He takes her purse, her briefcase, her packages— whatever she is carrying.

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He shakes his head and looks at me with his handsome brown eyes. His voice has a slight whine in it, but his eyes have a mischievous glint, and I can see he is not really that perturbed. It is as though he is saying, “Yes, it was a bit strange, and I got teased—but wasn’t it exciting?” “What do you think, Doc?” He raises and lowers his eyebrows three times. “Is that weird, or what?”

Today people enjoy a sexual freedom that perhaps no other society has ever enjoyed: There are scarcely any rules, as long as the sex is between consenting adults. However, while having too many rules may be stifling, no rules can be baffling. What would have been seen as perverse and indulgent in the past is now viewed as diverse and creative. What was viewed with forbidden joy is now seen with trepidation, something infested with the ever-present specter of AIDS and other sexually transmitted diseases. What was once naive and sentimental is now often complex and clinical, surrounded by anxieties pertaining to harassment or rape. In the Hamptons, on college campuses, in marital beds, and in any other place where lovers meet, there is often an atmosphere of distrust between the genders.

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