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A home economics teacher a few years younger than I discount ovral 300mcg with amex, Mary was about to leave teaching because of Parkinson’s disease generic 300 mcg ovral with mastercard. She told us about her doctor, Robert Feldman, a Parkin- son’s specialist at Boston Medical Center. We found him and his multidisciplinary team to be experts whose aim was to educate the patient about Parkinson’s disease and who knew how to treat the disease. Feldman, Blaine, and I talked together until we agreed on a course of treatment that was satisfactory to all of us. Thus, I have the security of knowing that if I have any imme- diate problems, my family doctor, close by, knows my status. I learned that I needed to take the responsibility of keep- ing myself as healthy as possible and to ask questions in the doc- tor’s office. I learned that doctors, too, are human: some find it difficult to say, "I don’t know," when they can’t diagnose an ill- ness. Parkinson’s is a progressive disease, but in most cases it progresses so slowly that it’s easy to ignore the first symptoms. They differ from person to person, but the ones I hear about most often are these: • Fatigue • Aches and pains that may be vague or may be severe enough to cause limping or all-over discomfort (they disappear when you rest for a while) • Slow movement: this makes you feel like you are in a slow- motion segment of a movie or are walking through water • Loss of the natural swing of your arms when you walk • Poor balance and falling (a feeling of awkwardness) • Tripping, caused by not lifting the feet sufficiently • Dragging a foot • Cramps or other weird sensations in the legs or the feet • Difficulty with handwriting: sometimes you feel that each letter must be drawn painstakingly. The writing may get smaller and smaller as you progress, and sometimes the lines of your writing slant downhill. If your suspicions are con- firmed, you can deal with your fears and find a Parkinson’s spe- cialist who will start you on a program of treatment. Go to the library, write to the national organizations concerned with Parkinson’s disease (see the names and addresses in the appendixes to this book), and join the nearest Parkinson’s support group. Enlist the support, the confidence, and the involvement of your spouse, close relatives, or close friends from the beginning. God give us grace to accept with serenity The things that cannot be changed, Courage to change the things That should be changed, And the wisdom to distinguish the one from the other.

Although groups of this nature undoubtedly already exist ovral 300 mcg fast delivery, their widespread availability generic ovral 300mcg without a prescription, perhaps as an adjunct to prepared childbirth classes, could make them accessible to more couples. CASE STUDY Ted and Emily were each 34 years old, had been married for five years, and were parents of an 8-month-old daughter, Sarah. When they first married, they were interested in having children, but, although not actively trying to prevent pregnancy, were making no particular effort to start a family. Once they decided the time was right, they were unable to conceive as quickly as they anticipated, raising fertility concerns. They were seriously investigat- ing testing, which Emily’s doctor had been recommending for some time, when Emily learned she was pregnant. Although Emily experienced more fatigue than she expected throughout the nine months, the pregnancy was uneventful. Both she and Ted attended childbirth classes and made plans to share the baby’s care and household tasks, since both intended to resume their careers. He enjoyed his work but often put in 12-hour days and was frequently called after hours and during the weekends for emergencies. He and Emily had been discussing his desire to return to school part-time to work toward his master’s degree in Business Administration with a view to earning his CPA. He felt this would open up many more career opportunities within larger firms or perhaps lead to opening his own accounting business. When they learned they were expecting a child, those discussions were temporar- ily halted. Emily had graduated from college with a degree in English but with her basic knowledge of computers and excellent writing skills, she found employment writing user manuals for a software firm.

While formulaic protocols and decision trees have "decision nodes generic 300 mcg ovral with visa," these are only metaphoric forks in the shortest roads to fixed ends cheap 300 mcg ovral mastercard. At such nodes, alternatives are excluded in a compulsory fashion depending on particular prescribed inputs. We have seen detailed reasons in the previous chapters why informal means/ends reasoning is different. Adapting to fluid contexts, it takes account of the non- classical internal structure of categories as well as their vague, shifting and overlapping boundaries. It selects metaphors for causation judged appropriate to the circumstances, rather than using only the billiard-ball model. It considers what level of causation to address, recognizing that proximate causation at the level of middle sized objects is only one among many types predisposing to an event. Such reasoning can conceptualize the pursuit of ends in terms of progeneration, nurtu- rance, adventure, exploration, acquisition and so forth; not merely as a journey with only cost and length needing to be minimized. Compared to formal procedures moving from concrete "facts" to fully known goals, informal reasoning looks differently at ends. Then intermediate motivators ("ends-in-view") can be sought, and roundabout approaches taken, to valued but not yet sufficiently desired long-term ends. Means, despised in theory, turn out in practice to have their own great satisfac- tions. Value of whatever kind is often recognized by informal means/ends reasoning FULL SPECTRUM MEANS AND ENDS REASONING 155 to be spread out over endeavor, not simply concentrated at its terminus. Furthermore, specific values attain their significance not by themselves, but in relation to one another. Informal reason considers the effects of harmony and disharmony on the mutual enhancement of particular ends. Instead of the "decision nodes" in algorithms, informal reasoning centers on what I will call "foci for judgment. They are locations of meaning in a metaphorical "cognitive space," not points in physical space or time.