Patient Education.

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The petition below came to me from  www.change.org of course most of the petitions are idiotic, to me this was blasphemy. Here is a young unmarried girl whose periods were late.

She was upset because her doctor warned her about pregnancy and sexually transmitted diseases, well that is what every physician would do considering that Chlamydia is the largest killer in India. with i-pills being advertised girls have become lax about protected sex.

The issue might seem gender biased but the implications of Chlamydia is definitely more for a woman likewise the trauma of an abortion is experienced by the uterus and the not male reproductory system.

Of course the only thing the girl could complain is if her problem is not addressed. And it is normal to check the sexual history of a person when they turn up with delayed periods, it is also normal to ask for menstrual history.

Also a doctor only gives medical advice looking after or care taking is the onus of the patient, unless the patient is a inpatient.

If this girl had been married then the history taking would gone in another direction.

My doctor gave me moral advice instead of looking after my health!

I am a young unmarried woman and I visited a gynaecologist because my period was late.

She immediately started questioning me. She asked me whether I was married, whether I was having sex with my boyfriend and whether my parents knew.

She told me that if I had sex, I would get pregnant or catch a sexually transmitted disease. She did not give me the medical advice that I needed.

I felt uncomfortable and unsafe around her.

Unfortunately, there are many doctors like her, who treat single women with suspicion or refuse to treat them at all.

sharmila, no one should be denied health services. That is why I have joined hands with other single women to fight for our health rights and dignity.  

We have drafted 10 commandments that gynaecologists should follow in order to treat single women with respect and in a professional manner. 

Sign this petition and ask gynaecologists to follow these guidelines.

It is the duty of doctors to take care of their patients, irrespective of personal bias. Many doctors follow this duty, but the ones who do not, put their patients’ lives at risk.

sharmila, doctors should treat medical issues, not give moral lectures. With your support we can break the stigma about single women and sexual health.

Thank you for your support,

Pooja on behalf of Haiyya

(Name Changed)

 

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World Vitiligo Day

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Smooth  white  patches on various parts of the body caused by lack of natural pigment is known as vitiligo, and June 25th of 2011  the world vitiligo day was created to create awareness of this condition. Since then they have broadened their activities to handling bullying, social neglect, tremendous psychological trauma and disability.

Vitiligo is defined as a skin disorder characterized by smooth, white patches on various parts of the body, caused by the loss of the natural pigments.

There could be other symptoms, like

  • Premature greying of the scalp, eyelashes, eyebrows,.
  • Whitening or loss of colour of the mucous membrane inside the mouth.
  • Loss of colour or colour change in the retina (eye)

Vitiligo can affect any part of the body, but de-pigmentation usually develops first on the areas of the skin like feet, arms, face and lips. The de-pigmentation could be

  • Focal or limited to one or few areas of your body.
  • Segmental Loss of skin colour usually on only one side of the body
  • Generalized that is wide spread.

There is no definite age when it manifests, though in most cases 20-30 is the age when the patches begin either on the face above the eyes, or on the necks. Sometimes, armits, elbows, genitalia, hands or knees may be the first effected area. There is no gender or racial predilection seen.

When a person suffers from vitiligo there is no melanin in the skin, melanin is produced by the melancocytes and is responsible for the skin colour. The normal pigmented skin cells get replaced by flat cells, creating white patches with irregular borders.

Most vitiligo suffers are otherwise healthy and have normal skin texture and sensation. However people with autoimmune disorders like hypo  or hyper thyroidism, Addison’s disease, Vitamin B12 deficiency seems to have greater incidence of vitiligo. Poor oral hygiene has be linked with incidence of Vitiligo.

The course of the disease is quite difficult to predicit from spontaneous regression; it can go to progressive spread. Vitiligo cannot be cured, it can only be managed. But it is not contagious and not painfully.

The goal of the treatment would be restore the skin pigmentation. Since treating any skin disease is long drawn process and impact of therapy may not be visible for several months. The various treatments available are.

  • Topical steroids are quite effective in re-pigmentation however it takes almost about 3months before effects are seen. The steroid has to be applied three times daily on the skin. There could be adverse effects like thinning of the skin or streaks of colour on the skin.
  • Topical immune-modulators are also prescribed. People with small areas of pigment loss on the face and neck see results with this.
  • PUVA which is a combination of Psoralen which renders a person more sensitive to light and UVA rays are used to darken the light areas of skin. Psoralen could be either topical or oral. Since Psoralen renders the skin sensitive to light, the person also becomes more sensitive to sunlight so it is necessary to use sunscreens.
  • De-pigmentation of the normal skin to match the white patches is done if other treatment procedures fail. This is considered only if more than half the body is affected by vitiligo. The medication used is called Monobenzone which is so potent that contact with other people should be avoided for at least two hours or they might land up getting bleached.

Non invasive management of vitiligo include make-up, skin products should ideally include UVA and UVB for protection from sunburns.

Surgery may be considered in very severe cases, skin from healthy area is taken and grafted the procedure is not only laborious it is also expensive and could cause tissue scaring. Most people with Vitiligo need lot of emotional support to deal with the chronic skin condition.

Studies are being carried out to stimulate melanocytes with a drug called afamelanotide, prostaglandin 2 is another component that is being tested and it is found useful when the vitiligo is localized.  Oral Tofacitinib which is used in the treatment of rheumatoid arthritis has shown the potential to reverse colour loss.

Studies in alternative medicine has shown that Gingko Biloba could return skin colour, minor studies with alpha-lipoic acid, Folic acid, Vitamin C, Vitamin B12, and phototherapy could restore skin colour.

Hypnotherapy has proved helpful in many cases.

Vitiligo is non- infectious, whitening of the skin either locally or the entire body, it cannot be cured, but can be managed with medications and UVA therapy. In many cases hypnotherapy is known to help.  Options like Gingko Biloba has also proved useful and more studies are conducted on it.

World Clubfoot Day 2017

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A club foot is a deformed foot, which twisted such that the sole cannot be placed on the ground. The medical terminology for this is Talipes Equinovarus and is a congenital deformity, which causes one or both feet to turn upwards. The cause for this is not known, however current research does indicate genetic factors.

Clubfoot has the tendons on the inside shortened, the bones are of unusual shape and the the Achilles tendon is tightened. If it is left untreated it would appear as if the person is walking on their ankles. The arch is more pronounced and calf muscles tend to be underdeveloped.

Usually the defect is diagnosed at by visual examination at birth, sometimes it can be diagnosed before birth. Most children exhibit only clubfoot while sometimes it is accompanied by other problems like Spina Bifida.

The risk factors, genetic history plays an important role, and the gender distribution is greater in male as compared to female.

The cause is as of now is unknown, and the intra-uterine placement of the foetus does not play a role. One possible cause is a disruption in the neuromuscular pathway. Some environmental pointers have been suspected like mother being a diabetic or a smoker. There has also been a link between early amniocentesis and clubfoot.

Elements of treatment include

  • Manipulation and casting. The baby’s foot is gently stretched and manipulated into a corrected position and held in a place with long-leg caste i.e. toes to thigh.
  • Achilles tentomy.

The clubfoot is not going to get better on its own, treatment is a must. Near normal foot is required such that the child can play and wear normal footwear.

The affected foot is about size or a size and half smaller than the normal foot. The calf muscle of the affected foot will also stay smaller.  The child has a tendency to feel sore at the legs, or feel tired quicker than his/her peers.

Clubfoot despite being congenital, of unknown origin seen predominantly in male, may or may not be associated with other disabilities is manageable the child can go on to live a normal life once the defect is addressed.

http://globalclubfoot.com/world-clubfoot-day/

https://www.miraclefeet.org/get-involved/world-clubfoot-day-2017/

Life with MS —

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#LifeWithMs

world Multiple Sclerosis day is 31st May.

Multiple sclerosis is a disease of the central nervous system, the white matter that surround the nerve fiber hardens, and term

Multiple sclerosis is a disease of the central (cerebrospinal) nervous system. In this disorder, the white matter surrounding nerve fibers becomes hardened. The term multiple sclerosis (MS) literally means “many scars.” The hardened areas of nerve tissue are called plaques. The symptoms, severity, and course of multiple sclerosis are highly variable, depending partly on the sites of the plaques and the extent of the deterioration of the white matter. The deterioration of white matter in the nervous system slows nerve impulses leading to nervous system incoordination.

 

Multiple sclerosis,(MS) is an immune disorder, where the immune system  of the body is directed against the central nervous system, (CNS) though the precise antigen that are sensitized to attack are not known,  it refered to as immune mediated rather than auto-immune.

The fact sheet of MS is as follows – common in the age spectrum of 20 -50yrs, more in women than in men, though people of all ethnic origins are known to have it , the dominant ethnic community seems of European descend. The susceptibility  appears to be passed genetically.  The incidence rates higher further away from the equator, this leads to the belief that exposure to sunlight could impact the MS risk.

The manifestation is through various symptoms and that depends on the area of central nervous system that is affected. There could be visual disturbance, blurring of vision, double vision, optic neuritis, involuntary rapid eye movement, and sometimes, loss of total eye sight. Since the neuromuscular system is challenged there could loss in balance, tremor, difficulty in walking, giddiness, clumsiness, weakness and fatgue. Altered muscle tone can produce spasms or muscle stiffness. A person with MS may experience tingling a burning feeling in the area of body facial and/or muscle pain. Speech could be disturbed, like there could be slurring, or slowing of rhythm. There could be increased sensitivity to heat, short term memory may be challenged, concentration and judgement or reason could be altered depression is another common symptom.

The MS-Society  says that people with MS on an average have 7 years less than the longitivity of the general population, the cause of death im most cases is same as what happens to most MS free population, that would include  cardio-pulmonary disorder or cancer. What is effected however is the quality of life., though people do not become severely disabled, they do experience symptoms that cause pain, discomfort and inconvenience.

It is difficult to predict the progress of MS in peole, the severity of disease varies  about 20%  with MS exhibit no symptoms or exhibit mild symptoms. About 45% exhibit moderate issues.   The course becomes unpredictable as the signs of onset are very benign and more disabling or devastating, from medical perspective it is regarded as incurable.

The patterns can put into 4 types.

  1. Relapsing- remitting MS seen in about 25% of the MS sufferers, the relapses are unpredictable, the relapse occurs with either new symptoms manifesting or aggravation of existing symptoms. The remission or recovery can occur either in days or months, and it might be partial or total recovery. This is a pattern seen in younger people.
  2. Benign MS is seen about 20% of the cases where a person has one or two attacks with complete recovery, this does not worsen with time, the disability is not permanent, and is associated with less severe symptoms at onset.
  3. Secondary progressive MS seen in about 40% of cases and is the commonest, it onset may be the relapse-remission  pattern  as the disease progresses the disability increases.
  4. Primary progressive MS seen in15% of the cases is characterized by slow onset and progressively worsens. There is accumulation of deficits and disability.

The symptoms of MS are usually first noted between the ages of 30 and 50. Women develop the disease almost twice as often as men.

 

The risk factors that could indicate a greater chance of developing a severe form are

  1. Age – over 40yrs on the intial onset of symptoms.
  2. If the symptoms affect more than one area of the body.
  3. The intial symptoms affects the mental, urinary or motor controls.

As cure is not identified we go with managing, and prognosis can be predicted.

  • The frequency of symptom attack.
  • The duration between the attacks.
  • The percentage of recovery from each attack.
  • The involvement of sensory impulses like tingling, vision loss or numbness.

The treatment of MS is more symptomatic and  aimed at reducing the underlying inflammation caused by immune system attack on the nervous system.  The aim of therapy is more rehabilitative and focused to improving quality by improving coordination, and developing coping strategies. There is a need to change attitudes, lifestyles and the patient will have to avoid heat. Maintainance of genral health is important and also proper diet, rest and exercise and priorities to conserve energy.

I found Edgcar Cayce’s take very interesting, to him MS was resultant of chemical imbalance due to failure of the glandular system producing the substances that NS requires for self maintainance. His focus was glands associated with the liver, Edgar Cayce noted that nervous system does not function in isolation from rest of the body. the cycle of nutrition supply and removal ofwaste product had to be constant, any lapse in this would result in the detoriation of nervous system. Though he was not able to pinpoint the precise detoriation.

Though Edgar Cayce’s MS  reading are oriented towards physical pathology, he also emphasizes on mental and spiritual patterns, many begin with this karmic condition and that mental and spiritual attitudes of the afflicted person would be addressed if there was to be healing.

Glands are believed to be spiritual centers of the body, the key centers of the body/soul connection, presumably soul patterns from past lives can play out in this manner.

Emotional make up of MS patients exhibits a certain amount of mental hardness, stubbornness and inflexibility.

Edgar Cayce suggest the intial step as change in person’s attitude, an understanding of why the symptoms manifested. This understanding can help the individual heal. He then recommended massages, wet battery vibrations where gold chloride was the primary solution used. He also recommended dietary changes where friend and highly processed food was avoided and diet was balanced with vegetables and fruits. Sea food was considered beneficial, primary meats were acceptable.

Please note this article is just for information. And not for self diagnosis or therapy.

Overview of Crohn’s disease.

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Crohn’s disease is a chronic inflammatory bowel disease that is IBD.

Crohn’s disease is characterized by inflammation of the digestive or gastrointestinal tract, it can affect any part of the GI, from mouth to anus, but it is more commonly found at the end of the small intestine part

of the intestine especially colon and ileum, it is associated with fistulae and ulcers. Crohn’s disease can also affect the

  • eyes
  • skin
  • joints

The exact cause of Crohn’s disease is not know, though there is a hereditary predilection is very prominent. The physio-pathology shows that the immune system of the body refuses to recognize the normal intestinal flora and triggers an attack. The symptoms are

  • terrible stomach ache, though the individual is mobile and can sustain normal food,
  • diarrhoea
  • weight loss
  • There could additional symptoms like oral ulcers, bowel blockage and anal fissures.

The disease is graded as

  • mild to moderate
    • frequent diarrhoea
    • abdominal pain but can walk and eat normally
    • so signs of dehydration or fever.
    • Weight loss less than 10%
  • moderate to severe
    • frequent diarrhoea
    • abdominal pain and tenderness
    • significant weight loss
    • Significant anaemia with fatigue, dizziness, short breathe and headache.
  • Severe to very severe.
    • Severe persistent vomiting.
    • High fever
    • Evidence of intestinal obstruction or abscess.
    • More than severe weight loss.

Diagnosis is done through Barium X-ray, colonoscopy or Biopsy. After stool analysis, and sometimes imaging tests like CT scan or MRI are used.

Difference between Crohn’s disease and Ulcerative colitis.

Crohn’s disease Ulcerative colitis
Inflammation may develop anywhere in the GI from mouth to the anus Limited to large intestine, colon and rectum
Most common site is end of the small intestine Occurs in the rectum and colon involving a part or entire colon
May appear in patches Appears in patterns
May be present through the entire thickness of the bowel wall Inflammation is seen in the inner most wall of the intestine
About 67% of the people in remission will have at least one relapse over 5yrs About 30% of the people in remission will experience a relapse

When it comes treatment it is usually management. The goal of the treatment is control inflammation. Achieving and maintaining remission

The possible medications are —  antibiotics, amino-salicylate, corticosteroid, immune modifiers, biologic therapy. Then there are non-prescription over the counter anti-diarrhoeal medication, pain relievers, but these should be taken along with the prescribed medication and substituted for.

Alternate healing modalities are also known to work.

Metaphysically Crohns disease comes from inflexible opinion, fear of letting go things from the past, holding on to old beliefs and ideas that they feel fear and guilt about, insecurity, fear and nervousness when confronting the unknown, strong belief of not being good enough.

Below is the script for self help for crohn’s disease, please note this is generic, your specific script can be created only once your core belief is identified.

Sit is a quiet place, where you can relax.

  1. Breathe and breathe out, the deeper you breathe, more you relax, the more relax it is easier to heal.
  2. Breathe in and breathe out,…
  3. Breathe in and as you breathe out direct the breathe out through your eyelids
  4. Breathe in and as you breathe out direct the breathe out through your eyelids you may feel dark pools in front you, it is okay to feel it.
  5. Breathe in and as you breathe out, direct the breathe out through your eyelids, feel the tiredness leave your eyelids.
  6. Breathe in and breathe out through the eyelids, feel the muscles between your brows relax.
  7. Breathe in and as you breathe out let the tiredness in your limbs leave.
  8. Breathe in and as you breathe out the tiredness in limb leaves, making your limbs heavy.
  9. Breathe in and as you breathe out, feel the heaviness in your limb.
  10. Breathe in and breathe out, letting the neck muscles relax
  11. Breathe in and breathe out, letting the neck muscles relax.
  12. Breathe in and centre yourself…. now tell yourself, it is okay to express your feelings, you are willing to let go of the past, you are willing to let go beliefs and ideas that are no longer relevant, you have the courage and enterprise to face the unknown for it is an adventure, and you are more than capable of dealing with it. you are willing to flow with the flow of life and accept the challenges that come. You are willing to move on freeing  yourself from the shackles of the past.

Stay with this belief and slowly open your eye, on the count of 1 – as you begin to awaken 2—higher up, higher with 3 and 4 , eyes open and feeling very good about yourself at 5… 1-2-3-4-5 .

 

 

 

 

 

 

World Hypertension Day

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May 17th is the World Hypertension Day and people are having celebrations about it.

The imp me wonders are they celebrating having hypertension, that is the lifestyle that got them there, or are they pharma companies celebrating the increase in sales, now that the imp has voiced her mischief, let us go  World Hypertension Day Awareness drive. The theme for the year like last year and the year to come is  Know Your Blood Pressure and #KnowYourNumber.

Since there are going to numerous talks, articles and what not about hypertension, I shall just go to the metaphysics and alternate pathways of handling hypertension.

Blood pressure is defined as

The force exerted by the blood against the walls of the blood vessels and the magnitude of this force depends on the cardiac output, and the resistance of the blood vessels. An increase in blood pressure is hypertension and a decrease is hypotension.

Some key points.

Hypertension is increased blood pressure against the blood vessel,  the pressure is considered high if it over 140 and 90 mmHg. That is millimetres of mercury.

The diagnosis is made the pressure as the heart pumps out blood that is systolic and/or the pressure when the heart relaxes that is diastolic is high, at a given second.

The patho-physiology or the physical presentation could be;

  • decreased cardiac output
    • Altered stroke volume.
      • Myocardial contractions are disturbed
      • Alteration in the vascular chamber volume.
    • altered heart rate
  • increased peripheral resistance
    • altered vascular structure
    • Altered vascular function.

Causes of hypertension are:

Primary or essential hypertension is seen in adults with no identifiable cause. This is usually develops gradually over the years and some common symptoms seen are:

  • smoking
  • being overweight or obese
  • lack of physical activity
  • too much of salt in the diet
  • Too much of alcohol consumption.
  • Stress
  • Age

Then there is secondary hypertension which is usually a manifestation of an underlying disorder. These systemic disorders are:

  • Kidney or renal problems
  • Adrenal gland problems
  • Thyroid problems
  • Certain defects in blood vessels, which usually congenital
  • Some medications, including birth control pills, decongestants, OTC pain relievers
  • Obstructive sleep apnoea
  • Drugs like cocaine and amphetamines
  • Alcohol abuse or alcoholism.

Metaphysically I am referring to Louise Hay here, like the patho-physiology puts it, the emotional pathway also talks about hypertension being a fall out of long standing unresolved emotional issue.

Blood is the life energy within a body, movement/circulation of love and vitality through the body, when the blood pressure increases, there is anger, stress, feelings are not being expressed adequately this creates an inner pressure.

In the emotional-physical translation, hypertension is about anger and frustration about unable to do something.  It could stem from being frustrated, overwhelmed and out of control about life. there is also a tendency to be a perfectionist, high personal and social standards and intolerance when those are not met, there is a huge trust issue and intrinsic rigidity. Many times there are associated self sabotaging habits like irresponsible eating, lack of proper exercise.

These usually have its root in emotionally stressful homes where high levels of expectations and performance were expected. Our inability to cope up with parental frustration has left us incapable of handling what triggers our anger. Many of us have learnt the lesson of rigidity since we come from families with rigid religious or political beliefs. We transfer these cope up mechanisms into our adult life, our workspace, abusing ourselves emotionally.hypertension

Handling hypertension through alternate methods would mean, healing the life style and behavior.

  • Altering the belief system and enhancing the new belief. – The core belief is very important here, it could either be resistance or inability to let go. Both situations bring about rigidity and stress.
  • Some form of physical activity to ensure body movement.
  • Relaxation technique or meditation.

Of course these go hand in hand with the physician’s treatment.

Chronic Fatigue Syndrome Awareness

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May 12th is the Chronic fatigue syndrome (CFS) awareness day. This is a debilitating disorder and characterized by fatigue, that does not go away even on rest and has underlying medical condition that can explain it. CFS is also known or myalgic encephalomyelitis, or systemic exertion intolerance disease.

The cause of this syndrome is not really known though causes have cited, sometimes, individually and sometimes as combination of factors. This inability to be pinned down to a single cause makes it difficult to confirm the diagnosis and the diagnosis is usually by ruling out other causes of fatigue.

The syndrome has been accepted as a real diagnosed medical condition recently and is seen to commonly affect women in their 40’s and 50’s. Currently there is no cure or treatment so conventional medicine focuses on relieving the symptoms and managing the disease.

cfs 2Some of the cited causes are:

  • Viral infection as a trigger as many people develop CFS after having a viral infection. The Herpes Virus 6. Epstein – Barr virus and mouse leukaemia viruses are implicated though conclusive links have not yet been established.
  • Immune system in the people who have chronic fatigue syndrome appears impaired slightly though it is not clear if the impairment is enough to cause the disorder.
  • Hormonal imbalance in the levels of the hormones produces by hypothalamus, pituitary or adrenal glands are seen, its exactly significance of this abnormality is still not known.

The symptoms of CFS are quite vague and could be symptoms of many illness, such as infections, or psychological disorders, it becomes necessary to see the physician if excessive fatigue persists

  1. Memory loss or decreased concentration.
  2. Tiredness despite a night’s sleep.
  3. Chronic insomnia, and sometimes daytime drowsiness the CFS mimics sleep apnoea here.
  4. Muscle pain and tiredness
  5. Frequent headaches
  6. Joint aches without redness or swelling.
  7. Frequent sore throat
  8. Tender lymph nodes in the neck and armpits.

CFS effects different people in different way, so the treatment is tailored to an individuals specific set of symptoms. There is no definite cure as of now, the treatment would be more towards relieving the symptoms and improving quality of life. Many of the CFS patients are also depressed so sometimes antidepressants are prescribed and sometimes sleep aids are prescribed to improve the quality of sleep.

Though there is no definite treatment for CFS, therapy is found quite helpful. Usually the steps in therapy focus on.

  • Pacing oneself so that a balance is maintained, too much of activity on a good day can lead to a bad day.
  • Graded exercise also helps. Exercise would have to begin with just a few moments in a day and slowly increased.
  • Psychological counselling can help to handle the limitations created by CFS; self management in turn helps in handling the disease.

CFS aggravates with activity and does not recover with rest. Edgar Cayce the pioneer of holistic healing came up with effective treatment of CFS with a group of therapies, which addressed the systemic issues of the condition. The term he had for this was C.A.R.E which stood for circulation, assimilation, relaxation and elimination, these were the areas where the body was assisted so that it could become more normal, and the improved body functioning would help the body increase its vital energy  and to heal itself. C.A.R.E included hydrotherapy, diet, spinal manipulation, exercise, electrotherapy, and castor oil packs.CFS 1

Metaphysically CFS develops as a result of being disconnected from our emotions,  and emotions are the bridge that connects the mind and body, this disconnect results with lessening of life energy resulting in chronic fatigue and/or depression.

the feeling of running on empty usually emerges from a pattern created in the childhood, particularly in women, where candid expressions of certain emotions like anger, suddenness or sexual energy is not acceptable, the individual learns to suppress it, or depress it, causing a disconnect  from the emotional energy this gives rise to fatigue and disconnect from life. on the emotional plane there is lack of clarity, a scattered mind, that is emotionally run down and overwhelmed, there is also an inability to work priorities.

We need to identify that particular belief that has brought about the disconnect and then work at reconnecting the mind and body, hypnotherapy allows us to reach to the core trigger belief fastest. Once the belief is identified, it can be reframed.

A common affirmation that seem to work is it is safe to express all that is within me, I love, honour and accept all aspects of who and what I am, as a result I am energized expressed and filled with love.