Archive for May, 2009

CHILD’S HEALTH/SKIN DISORDERS: FROSTBITE

Thursday, May 21st, 2009

Frostbite is the name for the condition of the skin when it has been exposed to extreme cold, and has turned white and cold.

Cause

Direct exposure to extreme cold freezes the tissues in the area temporarily. Clinical features

The most commonly affected parts of the body are the fingers and toes, although other extremities such as the nose and earlobes can also be affected. The skin is white and cold, and your child may complain of tingling and numbness in the affected area. Frostbite may occur after a child has played in the snow without wearing adequate clothing such as waterproof gloves and shoes. It may also occur in an instant if your child touches very cold metal.

Treatment

The quicker the frostbitten area is warmed up, the better. The quickest way to do this is with a warm bath, but make sure you do not make the water so hot that it will scald your child. The rewarming process may take up to half an hour, and your child may start to complain of pain as the frostbite reverses. A pinkish-red colour should return to the affected area if rewarming has been successful. Be very careful to rewarm the area slowly and gently. Do not place the frostbitten part directly in front of a heater, as the skin is very sensitive and can readily burn.

When to see your doctor

• if blisters appear in the frostbitten area;

• if the above measures are not effective;

• if your child is drowsy, shivering;

• if your child was exposed to extreme conditions of cold.

Prevention

Frostbite can be avoided by ensuring that your child is dressed warmly, including hat, gloves and warm socks and shoes. When you go to the snow, make sure that your child has waterproof clothing.

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THE NUTS AND BOLTS OF HEALTH CARE FOR YOUR CHILD: SECOND OPINIONS

Tuesday, May 19th, 2009

Sometimes parents will not be entirely happy with the diagnosis, treatment or advice offered by a doctor. This is perfectly natural, and does not necessarily mean that the doctor is wrong. It is important to be open and frank and discuss your uncertainties with him. If you still do not feel completely comfortable or satisfied, you should consider obtaining a second opinion, from another general practitioner, a paediatrician or other medical specialist, or at the children’s hospital. You may particularly want to do this if you are worried about the condition of your child, or if the doctor has recommended hospitalisation, special tests or a costly or complicated course of treatment.

Obtaining a second opinion is standard medical practice, and while some doctors may be defensive when you raise the issue, they should agree, and even recommend someone whom you might see. In fact, it may be the doctor who raises the possibility, if he senses that you are not entirely happy. It is helpful if he writes a letter to the other doctor, or calls and arranges the appointment. Often the second doctor will wish to know details of earlier consultations, or the results of tests or X-rays. It is then customary for the second doctor to write back to your referring doctor with his opinion.

If the second opinion confirms the advice given by your usual doctor, then this should renew your confidence in your doctor. If the second opinion is different, then you will need to decide how to proceed.

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YOUR MARITAL HEALTH/FINDING OUT WHO’S THE MATTER WITH US: HOT SEXUAL PROBLEMS – PELVIC-REFLEX ADDICTION (MALADAPTIVE HYPERSEXUALITY)

Monday, May 18th, 2009

PELVIC-REFLEX ADDICTION (maladaptive hypersexuality): I can’t get enough. I can sit in my car in the shopping mall and see a good-looking woman. My hips will hump a little and I might move my hand down and rub my penis. I would screw every good-looking woman in the world if I could. I think I do in my own mind. One partner would never be enough for me. Maybe not even one at a time.

HUSBAND

The loss of intimacy in sexual interaction and the replacement of intimacy with thrusting and contractions was reported by 244 of the men. They felt that their sexual experience had become pelvic and that they were addicted to their need for pelvic release. Sex for them was not sex if there was no pelvic contraction.

I can get it done well. I am very responsive . . . hyperresponsive . . . a nymphomaniac maybe. I love to do it. I ride him fast and hard. It’s like I devour him. I’d like to get every stud I could. You know what they say. The more the better.

WIFE

One hundred and two women reported the problem of pelvic-reflex addiction. Their vocabulary revealed a genital focus, an emphasis on contractive release that distracted them not only from intimacy but sometimes from daily life activities. Whether or not men and women can truly be “addicted” to sex is not clear and is now debated in the research literature. My couples indicated that there was a habitual focus on pelvic contraction at the expense of partner or relationship focus that resembled the dibilitating life distraction of alcoholism and other substance abuse.

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THE DESEXUALIZATION OF THE AMERICAN MARRIAGE/A SEXUAL-SYSTEM EXAM: A SEXUAL “BALANCING ACT”

Monday, May 18th, 2009

I work, I wash, I clean, I cook, I parent, I give up!

WIFE

I help out around the house.    

Husband

Big deal! I’m used to dust.

SUGGESTED GRAVESTONE EPITAPH BY ERMA BOMBECK

IMBALANCE:

UNEQUAL DIVISION OF TASKS: RESPONSIBILITY FOR MARITAL SEX TO ONE PARTNER

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TENDING TOWARD    TENDING TOWARD

BALANCE    IMBALANCE

Do you feel that your marriage includes a shared approach to the problems of daily living, including the erotic life of your marriage (balance)? Or, does it seem that one of you is more responsible for things, that it is one partner’s house, one partner’s “job” to initiate sexual encounters (imbalance)?

Remember the idea of “flowing” in systems as you score your marriage on this item. All marriages must have imbalance or there could be no growth in the system. Sometimes one partner has to carry the entire burden, perhaps because of illness or work obligations on the part of the spouse. Super marriages are well enough balanced to have plenty of imbalance. As a child learning to ride a two-wheeler, eventually a safe range between imbalance and corrective balance is maintained. Some falling is needed for learning to occur.

You very seldom hear about a woman who is home “babysitting” her own children, but wives will sometimes report that their husbands are “babysitting,” as if his children were not really his but instead some type of marital obligation. It is still rare to hear a woman state, “I even did the wash” or “I cleaned up his kitchen for him.” Sex rules may be changing, but if my couples are any indication, not very quickly.

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PSYCHOSOMATIC ILLNESS – INTRODUCTION

Friday, May 15th, 2009

There are many physical illnesses which are due, not to altered structure or infection, but to alterations in the function of the body.

These are called the psychosomatic disorders and emotional stress is the prime cause.

Psyche is the mind and soma the body. Psychosomatic illness means there are physical symptoms present — real symptoms, not imaginary ones — but the underlying cause is usually unresolved anxiety or fear.

The cause may be real and appropriate, such as the fear of losing one’s job or the inability to cope with the sudden changes in society. The fear may be imaginary, such as a fear of going blind or developing cancer.

Sometimes, the anxiety is non-specific and is deep in the subconscious mind. It may come from unresolved anxiety of fear which developed in childhood or early adult life. That anxiety may be hidden or forgotten but still unresolved.

We have a primitive defence mechanism which enables us to respond rapidly to danger.

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DANDRUFF

Friday, May 15th, 2009

Seborrhoeic dermatitis is a common skin disorder of unknown cause but believed to be inherited.

It is common in infants and may involve most areas of the body. Cradle cap is a form of seborrhoeic dermatitis.

It is uncommon in childhood, but again makes its appearance in middle and late adolescence when there is great activity in the skin’s sebaceous or oil glands. This is also why acne is common at this age.

Dandruff is a form of this dermatitis. There is little inflammation and the skin of the scalp is rarely reddened but there is an increased turnover in the number of skin cells. More dead cells or scales are shed, flakes of dandruff may be combed or brushed out or may drop on to the shoulders and the scalp is often itchy. There are available from the chemist or even the supermarket a number of shampoos, lotions and creams which are effective in controlling many cases of dandruff.

The doctor can usually rapidly control the more severe cases by the use of cortisone applied to the scalp in the form of creams, ointments, lotions or a gel. Once the scaling is under control, a weaker cortisone or non-cortisone preparation may continue to keep it at bay.

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CONVULSIONS — FEBRILE

Tuesday, May 12th, 2009

Under the age of five or six, children have an immature nervous system and many of the nerves have yet to develop their fatty insulating sheaths.

The effect on the brain of a high temperature from an infection may produce a convulsion whereas in an older child or an adult it may cause delirium.

These seizures are identical with fits from epilepsy, but only 2 to 3 per cent of children with febrile convulsions go on to develop later epilepsy.

There are good reasons for putting children who have had a febrile convulsion on drugs in an effort to prevent a recurrence with the next feverish episode as 30 to 40 per cent of such children will go on to have more.

Once the nervous system is mature, the drugs can be stopped.

A convulsion in a child may be a frightening experience for the parent and many panic.

If a child convulses with no history of epilepsy, there is a good chance that it is a febrile convulsion, particularly if the child feels hot to the touch. Rapidly reducing the temperature may stop the convulsion.

One way to do this is to strip all the clothes from the child, sponge him down with tepid or lukewarm water and fan him dry.

As the water evaporates from the skin, it takes heat out of the body and so cools it. Placing the child in a cold bath may cause constriction of the blood vessels in the skin and so heat may not be lost so rapidly.

Once the temperature drops, the convulsion usually stops and medical advice can be obtained.

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YOUR CANCER YOUR LIFE – DESTRUCTION OF NORMAL TISSUES; METASTASIS (ABILITY TO SPREAD)

Tuesday, May 12th, 2009

This is one of the most frightening things about cancer. Cancer cells have the ability to separate from the original or primary growth, and get into blood or lymph vessels. They can then travel through the blood or lymph system to far distant parts of the body where they lodge. These cells can, in turn, multiply to form what we call secondary growths.

Cancer cells have one other characteristic feature which is not shared by normal cells. They can invade and destroy surrounding tissues. For example, a cancer growing in a bone will replace and destroy normal bone, softening and weakening it. A cancer growing in the liver will destroy normal liver cells, reducing the liver’s ability to carry out its normal job of clearing waste products from the bloodstream. A cancer growing in the lungs will damage normal lung tissues so it is harder to breathe and the transfer of oxygen into the blood is less efficient.

Normal cells exist peacefully side by side with their neighbours. Cancer cells damage and destroy them.

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HRT: IF I AM UNABLE OR UNWILLING TO TAKE HRT, WHAT ELSE CAN BE DONE ABOUT OSTEOPOROSIS?

Friday, May 8th, 2009

The most effective way of reducing your chances of an osteoporotic fracture are to build up your bone mass during your youth by taking plenty of exercise (which strengthens bones), by eating a diet high in calcium, by avoiding drastic dieting and by not smoking. This ensures that you reach the menopause with your bones as strong as your basic genetic make-up allows.

From the menopause onwards you need to continue with exercise, and with calcium in your diet. Many women worry about putting on weight at this time, so they cut down on the dairy products that contain calcium to protect their bones, which is a pity. If you take very little calcium in your diet, calcium supplements may be helpful. Bones also need a small amount of vitamin D, and for most people, the best way to take in vitamin D is to expose your skin to sunlight: about 30 minutes a day in winter and summer is ideal, long enough for the vitamin to be produced in the skin, not long enough to run the risk of skin cancer. Large doses of vitamin D (as are found in some tablets, for example) can actually be harmful to bones.

If you have osteoporosis of the spine, your doctor will be able to tell you about a new treatment called etidronate, marketed by Norwich Eaton under the brand name of Didroncl PMO. This is a non-hormonal treatment, so it is suitable for many women who cannot take HRT. It has the advantage that, taken regularly, it can lead to a small buildup of bone that has been lost. It is taken on a cyclical basis – 14 days of etidronate followed by 76 days of calcium supplements. This cycle is then repeated over and over for three years or more. Didronel PMO appears to have few side-effects (mainly minor stomach upsets) but, being non-hormonal, it does not give any improvement of menopausal symptoms. It is only available on prescription, is particularly suitable for older women, although there is no upper or lower recommended age, and is intended as a treatment for osteoporosis of the spine, not of the hip. Didronel PMO is also likely to be helpful to men who suffer from osteoporosis.

Whether or not you decide to take hormone replacement therapy to prevent or delay osteoporosis, is a decision you will want to make after thinking about it carefully. Although it is never too late to start, for it to be most effective you should take it for at least five years, preferably starting within two or three years of the menopause. If you are at a high risk of developing osteoporosis, a much longer period may be necessary for you, and you will need to balance the slightly increased risk of developing breast cancer (if you take it for 10 or 15 years or more) against the risk of developing a condition that can cause considerable pain and deformity.

For decades, women suffered in silence from osteoporosis, while their doctors regarded it as just one of the consequences of old age – inevitable, unpreventable, untreatable and boring. It has recently been described as ‘a preventable disease that is not being prevented, a treatable disease that is not being treated’. Even in 1990, out of the 2 nulhon women in the UK who suffer from this condition, only 76,000 received any treatment at all, and 90 per cent of those received only calcium and painkillers. Only a tiny minority received HRT.

Things are changing at last, however. More and more women have heard of osteoporosis, and know what it is. Doctors have a clearer idea of how to diagnose and treat it. It is becoming a high-profile disease, the subject of hundreds of research projects in the UK alone. That this is happening is due almost entirely to the work of the National Osteoporosis Society. Founded in 1986, it now has over 14,000 members, with local groups in most parts of the country. The Society aims to keep osteoporosis very much in the public eye, to raise money for research, to make sure government ministers and the Department of Health are constantly aware of the enormous amount of work that still needs to be done in research, bone scanning, treatment, prevention campaigns, etc. The National Osteoporosis Society has regular programmes to up-date doctors about osteoporosis so that they can help their patients more. It runs information campaigns on osteoporosis in pregnancy, osteoporosis in men, the importance of screening and of HRT, and, very importantly, to make sure that all sufferers receive treatment.

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HYSTERECTOMY: WHAT TO LOOK FOR IN A PRACTITIONER

Friday, May 8th, 2009

An essential quality in any health practitioner is good communication skills. He or she should listen carefully to what you have to say and give you a clear explanation of the possible or likely nature of your illness or disease. Together you should discuss the proposed approach to tests, diagnosis and treatment, including what the proposed approach entails; the expected benefits, common side-effects and risks; whether the intervention is conventional or experimental; and who will undertake it. Your practitioner should raise with you, or you should ask about, other options for investigation, diagnosis and treatment. Another important attribute of a practitioner is the ability to convey information in an effective yet sensitive manner and to recognise what you have gone through already and may yet go through. A practitioner who is unable to put him or herself in your shoes is less likely to understand your preferences or needs. If there are language difficulties between you and your practitioner, encourage the doctor to arrange for an interpreter to be present or, if this is not possible, bring someone with you who can translate.

Once a diagnosis has been arrived at, you should be informed of any uncertainties about that, or about the outcome of any treatment proposed. You need to be sure that the outcome expected from the treatment is compatible with what you want from treatment. For example, if you still desire children and you do not have a life-threatening cancer, a hysterectomy is not a sensible first option for you. The doctor may want to discuss the likely consequences if you do not choose to have a proposed treatment. The expected time to recovery and financial costs are matters that you may also need to discuss. In addition, it is particularly important that you satisfy yourself that the doctor is experienced and skilful in the job to be done, and that any significant risk of long-term physical, emotional, social, sexual or other outcome is known to you.

The issue of what constitutes a ‘significant risk’ received lengthy consideration during a recent Australian High Court decision (Rogers v. Whitaker [1992]). The case concerned a woman who was blinded by the treatment she received, a less than one in 1000 chance in her particular case. The presiding judge defined the risks to be discussed by a doctor with his or her patient as those which, in the circumstances of the particular case, a reasonable person in the patient’s position would be likely to attach significance to if warned of the risk.

In practice, some doctors seem to think they should have control over what is discussed. A 1993 study of over 1000 doctors, conducted for Australian federal health authorities, found that 84% considered there were circumstances in which they would be justified in withholding information.14 Some of the reasons given seem questionable at best. About a third of the doctors said they would consider withholding information if they thought a patient might refuse treatment, while between a third and a half would consider withholding information if they regarded the patient as a poor decisionmaker. Only half of the doctors surveyed said they always discussed the risk of death or serious disability where it occurred at least as often as once in every 100 cases. For lower risks of death or disability (one in 1000 was specified) less than a quarter of the doctors said that they always discussed these with patients. On a more hopeful note, another Australian study of doctors found that the most significant changes to medical practice over a recent five year period were ‘taking more time to explain risks’ and ‘spending more time on patient record keeping’.

Before making decisions about treatment, it is a help if your doctor draws a picture of the suggested treatment approach if this is possible (and it certainly is where surgery is involved), and gives you written materials to take home and think about. If you are unsure, ask more questions. If you are still undecided, ask for time to make up your mind. Don’t be hurried. Except in the case of a diagnosed cancer, time is on your side.

If you need to go to a clinic or a hospital for treatment, the practitioner should provide you with clear information about any pre-treatment requirements (such as stopping the Pill a month before major surgery, stopping smoking at least a week beforehand, and refraining from food and drink from the night before a general anaesthetic). You should also be given details of your continuing health care, for example post-treatment check-ups, once you are discharged from a clinic or hospital.

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