Lotrel

By O. Topork. Concordia University, Irvine California.

This simple intervention allows the therapy to continue while mak- ing subtle inroads into the dysfunctional communication style discount 5 lotrel with mastercard. It is far more effective to introduce small, positive changes in the context of therapy than to attempt to teach an abridged version of Communication 101. Beyond the obvious intent of allowing each partner time to speak and be listened to, the purpose of effective communication is to encourage part- ners to reach out to each other at a far deeper level than in the past. Keeping communication at a superficial level is what they have become accustomed to. Using new communication skills involves risk: sharing insecurities and vulnerabilities, listening to the emotion beneath the words, and sharing profoundly in the joys and struggles that are part of life. It is also important to encourage couples to find time daily to check in with each other on a feeling level, not just coordinate schedules, plan meals, or handle a myriad of details required in keeping a family running. This simple but significant commitment communicates a deep level of caring and concern. It connects couples emotionally on a regular basis, sharing the good feelings and pre- venting the negative ones from being buried, only to emerge more force- fully later on. CONFLICT RESOLUTION A universal fact of married life is that all couples have problems, and some are more skilled than others in resolving them. The more skilled in com- municating, the more willing to share feelings and risk vulnerability, the more nondefensive each partner is or becomes, the greater the likelihood the couple will satisfactorily resolve conflicts. Couples with children resist, in many cases, the temptation to quarrel in front of them. Although this is commendable, and certainly children should never be subjected to screaming matches or physical violence, it conveys an inaccurate message. Children who have never witnessed a minor squabble between parents, and more importantly, its subsequent resolution, develop the unrealistic expectation that adults never fight.

These reactions usually are beneficial and often life-sav- ing purchase lotrel 5, but sometimes the system malfunctions and produces an autoimmune problem. This is what appears to happen in MS, which therefore often is referred to as an autoimmune disease. Other autoimmune diseases include systemic lupus erythematosus (SLE) and rheumatoid arthritis. All autoimmune disease involve the faulty regulation of the immune system, which appears to be overaggres- sive and may need to be suppressed. Many things influence the immune system, including exposure to foreign substances, stress, and life itself. Susceptibility to autoimmune diseases appears to be at least partly genetic, so that, although MS itself is not a hereditary disease, a hereditary factor may make an individual susceptible to its devel- opment. Approximately 10 to 20% of people with MS have MS in their extended families, a higher rate than would be expected by chance. Clearly, people do not inherit MS, but they may inherit the possibility of developing the disease. The likelihood of developing MS in the absence of its presence in close family mem- bers is 1:2000 (0. If a parent has MS, the probability that a daughter will develop the disease is 4:100 (4 percent), whereas a son’s chances are 2:100 (2 percent). Again, If MS was solely a hereditary disease, this figure would be 100%, but it does show that genetics plays some role in the development of the disease. Although these numbers are small, they are larger than would be expected if there were no genetic connection. Thus, it appears that one does not inherit MS, but may have a substantial chance of inher- iting an immune system that may become overactive if it is stimu- lated in a specific way. MS is termed a multifactorial disease, which means that more than one factor is involved and that the factors must interact in a highly specific way to result in the disease process. A distinct possibility exists that viruses may stimulate the immune system and lead to the development of MS in susceptible 10 CHAPTER 1 • What Is Multiple Sclerosis?