Health News

The most important thing to remember about treating diarrhoea is to make sure that the child has enough to drink. The best fluid to use is an oral rehydration fluid such as Gastrolyte. This can be bought over the counter from the chemist. Make sure that you make up the liquid carefully according to the instructions on the packet.

If Gastrolyte is not available, then diluted lemonade or fruit juice can be used. You should use 1 part of lemonade or juice to 4 parts of water. An alternative is to mix 1 level teaspoon of sugar in 120 ml of water. Do not use full-strength lemonade or fruit juice — this may make the diarrhoea worse and can be harmful.

If you have a young baby who is breastfed, you should continue to breastfeed but offer extra oral rehydration fluid between feeds. For babies that are bottle-fed, oral rehydration fluid should only be given for the first 24 hours and then full strength milk reintroduced, but with extra oral rehydration fluids given between feeds.

Food can generally be given after one to two days’ treatment with oral rehydration fluid, especially if the child is hungry. It is generally best to start with bland foods such as plain biscuits, bread, rice, potato, or jelly. Other foods can be added gradually.

When to see your doctor

It is always wise to consult your doctor if your child has diarrhoea, especially if the child is under 3 months old.

*347\90\8*

Recent research confirms what some authors have been saying for many years. They claim that continued use of the term ‘colic’ to denote a specific pathological condition is probably incorrect. Repeated studies suggest that infant crying and fussing is part of normal development and that it gets better with time irrespective of any treatment. It most likely represents a transient phase in the maturation of the baby’s nervous system; he moves away from crying as a reflection of his underlying physiological state (hunger, irritation, overstimulated, tiredness) towards crying as a means of communicating with his care-givers.

In the younger baby, there seems to be a biological component to the crying, which is linked to his temperament, sleeping cycles, and feeding patterns (‘expressive crying’). Later, the crying and fussing is more likely to be responsive to the environment, and to reflect maternal responses (‘communicative crying’).

Maternal anxiety and stress do not cause crying and fussing, but can exacerbate them. It is perfectly natural for mothers (and fathers) to become concerned about a baby’s crying. Most adapt and are able to cope with it, knowing it is a phase that the baby is going through and that it will pass. Other parents perceive the baby’s crying as somehow a reflection on their own competence as parents (‘If I was a good mother, my baby wouldn’t cry like this’). It is very important for parents to understand that the crying seen so commonly in infancy has very little to do with their competence as parents. The most ‘together’, calm and competent mothers will also have babies who cry all the time.

*100\90\8*

There are many forms of loss other than death and illness. Separation, divorce, a child moving away, placing a parent in a nursing home, or change of job may be perceived as loss, even when there is apparent gain, and may disrupt sexual functioning. Here are some ways to maintain sexual intimacy at times of significant loss.

1. Remember that all of the above reactions are natural parts of the grieving pattern. We all go through them. We must go through them.

2. Just as sex is not separate from life, it is also a natural part of endings. Touch, intimacy, and fulfillment can help soothe the grieving process while allowing it to take its natural course.

3. Medicating away the symptoms of grief can have negative physical and emotional effects. The natural body response to intimate sexuality allows grieving without the numbing effect of artificial substances.

4. As discussed earlier, all love carries within it its own end. The more the loving, the deeper the grief. Seeing life and loving as cyclical does not prevent the pain of loss, but it does allow the hope of new beginnings.

5. Examine your feelings and those of your partner regarding mortality. Discuss your relationship and its future. No one is ever prepared for loss, but the process of losing can be less destructive if it is discussed directly and openly before it occurs. It is just as important to discuss love insurance to prepare for emotional endings, as it is to carry life insurance to prepare for the financial aspects of loss. If you are the bereaved partner, remember that no one else will ever feel the loss as you feel it. Don’t expect your partner to grieve to the depth that you do. Invite him or her to be with you during loss.

6. Your partner’s sexual needs remain even when you are hurting. Be aware of those needs and be available for sexual expression for your partner. One of the best antidotes for grief is giving, and that extends to the sexual relationship as well. As difficult as this may sound, it is one of the most important things you can do for a super marriage.

7. The emotional and physical symptoms of grieving will diminish. Contrary to popular mythology, there is no set sequence or set of stages for adjusting to loss. Time and touch, the touch of and by a loving partner, are the best that life has to offer at times of death, dying, and loss. We must lose lovers, but we do not have to lose loving.

*210\97\8*

I think my one and only, the person for me, must have relocated to the tundra region of Russia. He sure doesn’t seem to be housed anywhere around here.

WIFE

Monotropy, bonding with one person at a time, requires an enormous amount of emotional and even physical energy, especially because we can feel several emotions at one time while we are doing this bonding. If we add to this problem the myth that we must also search for the singular right person meant for us, we overstress the entire love system. The “one and only” concept is a myth that limits loving.

It is possible to live with and love almost anybody. I have said that love is volitional, not just emotional. It is inextricably tied to sex, and we have sexual attraction for many people. Love is something you do, and you can do it with an infinite number of people. As one wife stated, “So many men, so little time.”

Persons struggling with bonding are often limited because of their uncompromising stance regarding a partner. One of the rules of super marital sex mentioned earlier is that super marriages depend much more on being the right partner than on finding the right partner. Efforts to look for Mr. or Ms. Right will always fail, for it is your reputation with yourself that matters. Would you fall in love with you? That is the key question, and it puzzles many of my patients. We are more used to looking “for” than looking “in,” looking for lovers instead of discovering our own loving.

“Would I fall in love with me?” responded the wife. “Are you kidding? I have taste.”

It is true, as Martin Buber stated, that love is when we “happen to one another,” but we do not have to happen to one particular person pre-assigned to us by some universal dating service. We cannot happen to or with one another until we happen to ourselves. Susan Campbell, in her book The Couple’s Journey, a study of 150 couples, writes about “co-creative” relationships. Just as we can recreate and procreate with a large number of potential partners, we can also co-create with a large range of possible lovers if we look to how we choose to be, how we “happen” with someone, rather than spend our time looking for someone to “happen” to us.

*70\97\8*

Vincent’s infection of the mouth is called trench mouth because of the high incidence among the soldiers fighting in the trenches during World War I.

It was named after Jean Hyacinthe Vincent, professor of epidemiology at a military hospital in Paris.

Two germs which seem to thrive when oxygen concentrations are low are found in abundant numbers in the mouth during this infection, although it is still not clear whether they cause the infection or are only secondary invaders. Vincent’s stomatitis, as it is called, is often mistaken for tonsillitis or streptococcal infection of the throat, which responds rapidly to penicillin where Vincent’s infection shows no response to this antibiotic.

The onset is usually sudden, with malaise, a high temperature and a sore throat. The gums are usually reddened and bleed easily. The infection responds rapidly to the drug, metronidazole.

*580/71/1*

Then, in the latter three years, come the clinical subjects of medicine, surgery, obstetrics and gynaecology, and the various sub-branches such as psychiatry, paediatrics and dermatology.

In the past, students did not come in contact with patients until the fourth year of the course. But most medical schools have changed this by introducing students to patients very early in the preclinical years.

On graduation, the student receives the degrees of Bachelor of Medicine and Bachelor of Surgery. This follows the English tradition.

The MD (Doctor of Medicine), which is the qualifying degree in the rest of the world, is, in Australia and Britain, a post-graduate degree usually awarded for research.

However, the Australian MB, BS, is equivalent in standard to the American or European MD.

Following graduation, a new doctor cannot be registered until he has completed one year as a resident medical officer at an approved hospital.

After this time, the young doctor may elect to go directly into general practice. And this he may do immediately.

*323/71/1*

‘Aspiration’ means sucking up. Cytology, as you know, means the study of cells. We all know what needles are! Biopsy literally just means getting a specimen from a live person. The above terms are used to describe getting a specimen from a suspicious area with a needle. With aspiration cytology, a very fine needle is used and the specimen consists of separate or very small groups of cells. With a needle biopsy, a special type of slightly larger needle is used and a tiny solid sliver of tissue is obtained. If the lesion is just under the skin, the needle goes through the skin. Sometimes needle specimens are also taken through the vagina or rectum. Local anaesthetic (numbs the area but doesn’t put you to sleep) is used and the procedure should be no more painful than a blood test. If the specimen is to be taken from an area that is not an easily felt lump, the test may be carried out under X-ray control, to make sure the right spot is sampled. This applies, for example, in needle biopsies of the lung or some bones.

*75/40/1*

You may well ask: ‘If they can’t see cancer cells in the blood, why on earth do they do so many blood tests?’ Blood is a very complicated mixture and there are many different tests that can be done on it. It can be looked at under the microscope to check the proportions, numbers and appearance of the different types of blood cells. The number of red cells and their ability to carry oxygen can be measured. There are many tests to determine whether the blood can clot normally. A large number of different hormones, minerals, proteins and waste products can be measured, enabling us to check the function of many organs in the body. They don’t do every possible test on eadh sample of blood, but only the tests your doctor asks for. Abnormalities will only be found if the right test is requested.

How then does your doctor decide what tests to recommend when looking for possible blood-borne secondary deposits? Firstly, he or she searches for clues by checking your symptoms, and examining you carefully. Secondly, your doctor should know how your particular type of cancer usually spreads. Thirdly, he or she should consider whether or not the result of each proposed test would make a difference to your care. The doctor must combine knowledge about your type of cancer in general with knowledge about you in particular in order to best decide what tests to recommend.

These three considerations should be in your doctor’s mind continually from when he or she first sees you. They apply at every stage of the disease, but especially at decision-making points. These points include, of course, when the cancer is first found but also whenever a change in treatment is being considered. The change could be to start, stop, or change treatment directed against the cancer itself, or to alter symptomatic treatment (treatment directed at relieving symptoms, without attacking the cancer).

The most common sites for blood-borne secondary deposits are lungs, bones, liver and brain. Some types of cancer are more likely to go to one of these sites and some have other ‘favourite’ sites. Ask your doctor what the usual pattern is with your particular type of cancer.

*97/40/1*

There are several other conditions which affect a baby’s skin and may also cause a nappy rash. These are seborrhoeic dermatitis, atopic dermatitis, sensitive skin, or when the child has diarrhoea and frequent irritating stools.

Frequent nappy changes are necessary. Harsh laundering of the nappies should be avoided so that there is no excess detergent left in the nappy.

Nappies laundered and supplied by an outside agencyare often safest.

Plastic or rubber pants which cover the nappies are best avoided. Strong antiseptics applied either to the nappies or the baby may cause trouble. If thrush is present, the application of nystatin will clear this rash.

Simple, soothing and protective creams, like zinc cream or zinc and castor oil, are effective.

Whatever happens, don’t despair. The baby will grow out of the condition, even if it takes until he no longer uses nappies.

*72/71/1*

Drug treatment for obesity falls into a philosophical ‘no-man’s land’ when it comes to patient selection. On the one hand, it has been argued that obesity should be like any other lifestyle risk factor such as hypertension and high blood cholesterol and treated with drugs automatically if lifestyle measures fail. Blood pressure and cholesterol are just like body fat, the argument goes, because excess levels of all of them are mainly due to the interaction between a susceptible genotype and a ‘pathological’ environment and they all have serious health consequences. Drs Ravussin and Bogardus from Phoenix, Arizona, have highlighted the similarity with essential hypertension (with no apparent secondary cause) by labelling some obesity as ‘essential’ obesity. Protagonists in this argument say that obese people are discriminated against because obesity carries connotations of sloth and gluttony and all that is needed is a bit of self-help.

On the other hand, governments and medical insurance companies are very reluctant to pay for drug treatment of obesity. A simple calculation of the number of obese and overweight people multiplied by the cost of the drug sends them ducking for cover or bouncing the question back and asking which drugs should come off the subsidised list to allow the obesity drugs on and still remain within the budget. Needless to say, the full gamut of options between the two extremes are used to select patients for drug treatment.

One lesson which is slowly being taken from blood pressure and cholesterol drug treatment to obesity treatment is the concept of absolute risk. The question doctors are asking more and more before prescribing drugs is not ‘how high is the person’s blood pressure or cholesterol?, but ‘at this level of blood pressure or cholesterol, what is the patient’s risk of a heart attack or stroke?’ To answer the first question, one only needs to measure the parameter being treated, but to answer the second question one needs to look at the patient and factor in the patient’s age, sex, past history, smoking habits and the like. For blood pressure and cholesterol, there are tables available to insert all of these factors and come up with an overall assessment of cardiovascular risk to treat the blood pressure or cholesterol on that basis. Unfortunately, such tables are not available for obesity, but clearly, the assessment should include:

• body size, e.g. BMI

• fat distribution, e.g. WHR

• complications, e.g. diabetes, hypertension

• impact of obesity on physical, psychological and social functions

• other relevant factors such as family history of obesity and complications and personal history of weight gain and loss.

The overall extent of overfatness and its consequences can then be evaluated for each individual and this forms the basis for treatment decisions, especially those which can have significant negative as well as positive effects such as drug treatment and surgery.

*210\186\4*