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The person to whom you give a durable power of attorney for health care must be at least eighteen years old and willing to serve as your agent. Health care professionals—physicians and nurses who are involved in your care—are not usually considered appropriate.     The document assigning a durable power of attorney for health care generally contains the following: a statement that you are creating a durable power of attorney for your health care; the name of the person and any alternate person to whom you are giving durable power of attorney for health care; the conditions under which this document becomes effective; a statement of what authority you are granting this person; and a list of specific wishes. The durable power of attorney generally takes effect when two physicians, including the physician-of-record, certify that you are not capable of understanding or communicating decisions about your own health; it will apply as long as this condition continues.     This document can give the person with durable power of attorney the authority to withhold or withdraw any treatments or procedures—including mechanical ventilation (respirators or breathing machines), dialysis (artificial kidneys), antibiotics, operations—that sustain life. Medical treatment that would provide comfort or relieve pain is not included in a durable power of attorney for health care. The person to whom you give durable power of attorney may access your medical records and can place you in a nursing home. In the event of your death, the person to whom you give durable power of attorney can authorize an autopsy and can make decisions about your burial. The document assigning durable power of attorney can also include a section for any specific instructions you might have. For example, you could write, “In the event that I am in a coma, and have an incurable physical condition or lose my mental capacity, and have little hope of recovery, I do not wan treatment that will merely prolong my life.” You can also stipulate whether you do or do not want an autopsy and where you wish to be buried.     The document assigning durable power of attorney for health care must be dated and signed by you, by the person to whom you are giving durable power of attorney, and by two witnesses who are not interested parties. It is wise to have the document notarized by a notary public; some states may require this.     The original of the document assigning a durable power of attorney for health care should be kept by you or by your lawyer or by someone you trust. Copies of the document should be given to the person to whom you assign durable power of attorney, to any alternate person, and to members of your family. Your physician should know such a document exists; you may wish to consult your physician when drawing up the document.     Lawyers and hospital legal offices can provide examples of such documents that meet state laws.*215\191\2*

There are other forms of persistent DIMS that are not products of bad habits. Depression accounts for the greatest incidence of chronic insomnia attributable to psychiatric disorders. It has been called the “common cold of mental health.” Of course, a distinction must be drawn between clinical depression—a serious and sometimes debilitating condition—and sadness, which is a normal and transient reaction to unhappy experiences. The clinically depressed individual suffers a host of symptoms: anxiety, withdrawal from society, low energy, inability to function normally, loss of appetite and sexual drive. Often victims neglect their health and appearance. Physically they experience palpitations and shortness of breath. Their memory is poor, the ability to concentrate diminished; they are plagued with feelings of guilt, illogical thoughts, and a sense of isolation. Most patients with chronic insomnia show some type of depressed behavior; however, only a small percentage are actually diagnosed as having depression.Not surprisingly, depression affects circadian patterns. Several rhythms, including body temperature and circulating Cortisol, are abnormally advanced—they occur too soon—in the sleep-wake cycle. Secretion of prolactin and growth hormone is also affected. Some researchers feel that such disruptions in the various neuroendocrine rhythms could be related to the onset and intensity of mental illness. There may also be an association between the incidence of depression and the year-long cycle of melatonin. Statistics indicate that hospital admissions for depression are higher when patients have reached the low point in their annual melatonin rhythm.*114\226\8*

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The goal of treatment is to allow the child to lead as close to a perfectly normal lifestyle as is possible. This means no, or very few, absences from school, normal exercise tolerance, uninterrupted sleep at night, and a general feeling of well-being. If a child continues to have frequent attacks, and/or regular symptoms, it may be that he is not being treated appropriately, and medical advice should be sought.

In treating asthma, the first principle is to prevent attacks from occuring. If acute attacks do occur, the aim of treatment is to minimise their severity and duration.

From a treatment point of view, children with asthma can be grouped into one of three clinical categories:

Episodic asthma The majority of children with asthma fall into this group. These are children who have symptoms several times a year, almost always in association with a cold or viral infection. They may wheeze or cough for a few days, and respond quite rapidly to treatment. In between attacks, they are in good health, with no symptoms of asthma at all and enjoying an unrestricted lifestyle. These children usually only need to be treated for their acute attacks — in between attacks they normally do not need to take any asthma medications.

Persistent asthma These youngsters will also have a number of acute attacks each year, usually more frequent than those in the first group, but may also have symptoms in between attacks. They may have an intermittent cough, or else a wheeze triggered by exercise. Children in this group are usually given medication on a regular daily basis, in order to prevent acute attacks from occurring. Some children in this group will need to measure their lung function every day with a peak flow meter to make sure that their asthma is optimally controlled.

Chronic asthma This is the smallest group of children with asthma. Their symptoms are often ongoing, and they need to take several medications on a daily basis. These are youngsters who are usually under the care of a specialist. If they are old enough, they will almost invariably be measuring their lung function at least twice a day using a peak flow meter, and their doctor may want to order more complex lung function tests from time to time.

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I just hate the thought that there is a hole right in me. I leave my T-shirt on during sex now. I could never stand the thought of my wife actually seeing the stoma [surgically created opening into abdomen].”

HUSBAND WITH COLOSTOMY

An ostomy is a surgical procedure by which an artificial opening is created in the abdomen so that the urine or intestinal contents flow into a collection sac attached at the sight of the opening (the stoma). There are three basic types of this surgery. A colostomy is most often performed because of cell disease (cancer) of the rectum or colon and in some cases of inflammatory bowel disease and diverticular disease. An ileostomy is most typically done in the case of inflammatory bowel disease. An ileal conduit is constructed to divert urine to a sac because of impaired bladder function, removal of the bladder, or neurological damage in this area.

The effect of the above surgeries is varied, but in general the sexual-response system as viewed from the fourth perspective is left intact. Depending on degree of damage to nerves in the area of surgery, some men may experience erective problems, ejaculatory problems, or retrograde ejaculation. The ileal conduit procedure seems to have the most effect on erection, but even then more than one fifth of the men I interviewed (of a total of 122, including men not in the couples sample) reported no effect on erection. More than half of the men interviewed who had a colostomy (total 38) reported no erective or ejaculatory problems.

Women with ostomies may experience painful intercourse or some change in vaginal sensations. I found that postural adjustments helped greatly in many of the cases of coital pain, as some of the women were unintentionally compensating for the stoma and surgery by moving their bodies in ways that stressed different muscle groups. Of the forty women ostomy patients I interviewed, eight reported painful coitus that they attributed to the surgery. Thirteen, including these eight women, reported a change in vaginal sensations. As with the men, primary concerns were with appearance, partner acceptance, and odor that may come from the stoma.

I have found that the most effective counseling in these cases comes from partners of the patient talking to partners of other patients who have had an ostomy and resumed sexual functioning. This type of surgery requires some time before full physical stamina returns, so again the bywords are to take time, communicate, and move beyond the intercourse and mutual-orgasm orientation. I tell my patients that it is stamina more than stoma that will slow sex down at first.

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This term refers to the emotional and cognitive reaction to the readiness. The changes of readiness are pronounced, as you will learn in Chapters Six and Seven. But the system does not stop there. We can react to our body as much as our body reacts to our mind and emotions. Again, we are talking about a miraculous intimacy system, not a hedonistic hydraulic system.

“I just get so aroused when I see what happens to my body when I am ready to do it,” reported the husband. “I get red-like, full, eager-looking, like a real hunk, you might say. I never look better than at that time. I wish she could see me, but she never looks.”

“I’m not sure what you mean by how do I feel or think when my body gets ready. It just is ready to do it, to receive him. Do you think I should jump up, run to the mirror, turn on the light and look?” asked the wife.

“Sure, just as long as you run to the mirror with your spouse. Better yet, have a mirror and soft light nearby. See what it looks

like when the two of you happen with each other,” was the way I answered her.

The terms desire, interest, arousal, readiness, and excitement have been used so interchangeably that most of the couples found it useful to discuss their definitions. Try it in your own relationship; your communication will become not only wider, but deeper and more connected.

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For orthodox scientists, the most controversial are all spiritual methods, in which some external healer (or even the “patient” himself) controls the healing of the body by influencing the state of mind of the patient, and showing his (usually severely inhibited) “subconscious” mind how to perform the required repair job in the most efficient way.

I do not like to use the term “subconscious” here. In my experience, such a state of mind is in many ways superior to our normal conscious state we are used to in our everyday lives. In my opinion, a better description of it would be a “state of higher consciousness” or a “state of connection to a higher intelligence” or perhaps a “super-conscious” state. No words can adequately describe such a state, which in itself has many levels, some quite close to our physical body and some very far from it. Some initial states of higher consciousness are quite easy to learn, while access to advanced super-conscious states may require many years of or even a lifetime of practice with expert guidance.

Spiritual healing can be the most spectacular of all healing methods, but only when the healer is very gifted, that is, he has access as well as a command of higher states of consciousness. Examples of such healing experiences are so memorable, that many of them have been described in the most important documents of human civilisation such as the Bible and other scriptures, attracting generations of people over many centuries to create and support various religions.

In more recent times, the reader can find many cases of such healing from books written by professional spiritual healers, like Betty Shine for example.

Researchers and scientists hate, deny and ignore such healing, because they cannot “see” the healing mechanism using their instruments, and they cannot create such healing in their laboratories so they can study it. If only they could attain the “super-conscious” state themselves – they would not only understand the process of spiritual healing, but perhaps they would also change their job.

The last statement requires some explanation. Those scientists who negate the existence and consequences of the state of higher consciousness do so simply because they do not have access to it. On the other hand, those who are fully enlightened – never become scientists, because they see very little purpose in developing the physical sciences as we know them today.

To explain this, consider for example why the same scientists, representing the elite of human knowledge

Most of the healing techniques listed above, require visits to highly skilled and informed practitioners. This severely limits access of potential patients to them, especially when the medical education system favours certain doctrines and the legal system creates a tight monopoly for practitioners of such doctrines by making all other practices illegal.

For example, the newly amended Australian health legislation, effective from 1 July 1994, threatens to severely penalise doctors incorporating into their practice techniques of natural health such as nutrition, herbal medicine, homoeopathy, ayurvedic medicine and relaxation as well as meditation-therapy.

In many countries it is illegal to practice medicine without a licence issued by the system, supporting the prevailing medical doctrine.

In view of this, the best choice for all people is learn to heal themselves as well as learn how to avoid diseases in the first place.

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