Medsarticles. Medical Weblog

There is no cure for the common cold. There is no specific treatment that will make the cold go away more quickly. You can help to relieve the child’s symptoms in a number of ways. Paracetamol in appropriate doses can be given if fever is present. (Do not give children aspirin — it can have potentially serious side effects. Lozenges (the cheapest one from the milk bar is just as good as the very expensive ones from the chemist) or warm drinks will ease a sore throat and dry mouth. Nasal drops or spray will ease a blocked nose. Decongestants are sometimes useful, but you must be aware of side effects such as rapid heart rate, jitteriness and insomnia. You should always consult your doctor before using them.

It is a good idea for the child to take things easy, though he does not need to stay in bed. Let your child decide how much activity he wishes to engage in. Although it is likely that he will not be hungry, make sure that he drinks lots of fluids. His appetite will return as he starts to feel better.

There are a number of treatments that are not necessary. Because colds are caused by viruses, antibiotics will not help, even though they are often prescribed. Not only are antibiotics (such as penicillin) unnecessary, but they can be harmful by causing stomach upsets and diarrhoea. Parents should always ask the doctor if a prescription is really necessary — all colds will get better without antibiotics, and just as quickly. Cough medicines are of no benefit — the cough is due to irritation of the trachea or to excess mucus, and cough medicine does not affect either. Similarly, there is no evidence that vitamin C is of any benefit.

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The liquid which surrounds the foetus inside the womb is called amniotic fluid and because the baby drinks it and passes it out again, it is rich with foetal cells. This fluid can be used to test for certain genetic or inherited disorders in the foetus, including Down syndrome. It can also be tested in later stages of pregnancy to determine the maturity of foetal lungs, if there is a risk of premature birth.

Amniocentesis is usually done under ultrasound control. A small area on the skin of the lower abdomen is anaesthetised, and a fine needle is passed into the sac containing the amniotic fluid. A small amount of fluid is withdrawn for examination.

This test is usually performed on the understanding that if a serious abnormality is detected in the foetus, the pregnancy will be terminated. In early pregnancy, the risk of miscarriage after amniocentesis approaches 1%, but there is no risk to the mother herself, who may just feel some minimal physical discomfort. If performed later in pregnancy to assess maturity of the foetus, the risks of miscarriage is negligible. Because the incidence of congenital abnormalities increases with the age of the mother, this test is usually offered to any woman who becomes pregnant after the age of 37, whether she has had previous pregnancies or not. Check with your doctor for further details.

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In an attempt to relieve some of the anxiety and misunderstandings about solving sexual problems, and to illustrate the fourth perspective that underlies super marital sex, I present the twenty most frequent questions asked by spouses in my study. The questions express the innate wisdom and courage of-all of the patients, their vulnerability, and their infinite struggle to continue the development of their love maps and grapple with the complexities of marriage.

After reading and discussing the information and tests in the first nine chapters, practice being a sex-therapy team. Answer these together as if the person asking each question had consulted you in the sex clinic you built for yourselves in Chapter Eight.

Just before you get to the list, guess what is the number-one asked question, the single most often raised concern. It’s number one on this list of twenty. The other questions are not presented in any particular order, because they were raised at about equal frequency.

1. Why does he/she want more sex than I do?

The “frequency and interest” issue tops the list. The question may be asked in a variety of ways, such as “Why does he avoid me sexually?” or “Why am I so much more interested in sex than she is?” or “Why am I always the one who has to start it off or think of it?”

2. Why won’t he/she do oral love (fellatio/cunnilingus)?

3. Why does he/she have a “fetish” (for an object or activity)?

4. Why does or doesn’t he/she get turned on to pornography?

5. Why can’t I (he) slow down my (his) ejaculation?

6. Why can’t I (she) come quicker? (And why can’t I get and stay erect or wet?)

The “sexual reflex failure” questions were asked in many forms, but all contained the same concern for the breakdown or change in a natural sexual reflex, including pain in intercourse.

7. Why can’t she (I) come in intercourse?

8. Why can’t we come together?

9. Why does he/she talk (or not talk) during sex?

10. Why won’t she let me (why does he want to) have anal sex?

11. Are you sure he/she isn’t homosexual?

12. Why is sex so much better on vacation or when we are away from home?

13. How can I have sexual enjoyment when it goes against my religious principles or upbringing?

14. Is he/she having an affair (and that is why there is a sex problem)?

15. Can I ever get over the sexual abuse I experienced?

16. Does PMS (or other menstrual issues) affect sex?

17. Isn’t that sex fantasy sick?

18. Isn’t masturbation very bad (or very good) for you?

19. Why am I not sexually attractive to my spouse (or how could I ever be as sexually attractive as she/he would like)?

20. Is this normal? (Whatever “this” is.)

Even though it will take some time, sit down and try to answer each question out loud as a couple. Discuss it first before you give your answer. Keep your answer brief, related to the fourth perspective of super marital sex if you can, and be as direct as possible, if the question is too vague (and they all really are), restate it to a form you can answer.

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If you are considering reconstructive surgery, make sure you understand very clearly what can be achieved by it. Reconstructive surgery that surgeons are proud of is very disappointing for many patients. You are likely to be disappointed if you don’t find out beforehand exactly what sort of result you can expect, both in terms of appearance and of function. Ask to see ‘before’ and ‘after’ photos of patients who have had the proposed surgery. Remember that the appearance may be quite different when the part is being used or the position of the body is changed. For example, a reconstructed ‘lip’ that looks fine at rest may not move normally when you are talking. A reconstructed ‘breast’ that looks fine when the woman is clothed and standing up may look quite peculiar when she is naked and lying down. Ask exactly where you will be cut and how long the scars will be. For example, many patients asking about breast reconstruction are surprised to find that they will be left with a very long scar on their back. Often the normal breast is reduced in size to make it easier to match the reconstructed one. Ask about the function of the reconstructed part. For example, a reconstructed ‘breast’ and ‘nipple’ do not have the same sensitive nerve endings as a normal breast and nipple. Parts of them are likely to actually be numb or tingly. Obviously a reconstructed ‘breast’ cannot produce milk like a normal breast. Ask whether the reconstructed part will alter with time—can the tissues shrink, for example.

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Untreated, it can lead to heart failure, where the heart fails in its action as a pump and the blood is no longer pushed efficiently through the lungs and kidneys. The person becomes short of breath and fluid may be retained in the tissues, leading to oedema (swelling).

High blood pressure may damage the kidneys and lead to their failure and cause secondary effects which push up the pressure even further.

Damage to the arteries from the raised pressure is widespread throughout the body and, in the eye, may lead to impaired vision from small haemorrhages or a clot or thrombosis in the retinal vessels.

Damage to the arteries supplying the brain can cause strokes. Transient ischaemic attacks (TIA) occur when there is spasm or actual blockage of small cerebral arteries. These are like minor strokes but the symptoms do not persist.

A clot in a major brain artery causes a stroke or cerebro-vascular accident (CVA). Partial recovery from the paralysis, which is the main symptom, is usual.

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Cow’s milk contains about 14 different proteins, all capable of becoming allergens. Each may be broken down or digested into around 12 different substances and all of these can induce an allergy. This means there are over 100 different combinations in cow’s milk which may induce allergy in susceptible individuals.

The testing of food allergies may be difficult, as the original food may not be the problem but products from it.

Children with allergies to cow’s milk may have recurrent episodes of diarrhoea, sometimes with blood in the motions, or the allergy may result in eczema or even asthma.

If both parents have a history of allergy, there is a strong likelihood their children will be similarly affected. If the infant is to be artifically fed, a substitute for cow’s milk should be considered, at least for the first six months.

Goat’s milk is also capable of causing allergy and, unfortunately, so is soya bean. Plants contain protein, carbohydrate and oils, all of which are capable of being allergens. It is the oil of soya bean which is the main cause of allergy to this food.

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In most women, uterine contractions simply press the sloughed-off endometrial tissue down its usual path through the mouth of the womb (the cervix) and out of the body via the vagina. The woman prone to endometriosis, however, experiences another phenomenon: because she may have a contracted uterus or a right cervix, all the menstrual blood cannot easily How out through the vagina. Rather, some of the blood-filled endometrium is forced up through the fallopian cubes, pushes backward out of the tubes, and is sprayed into the abdominal cavity, where it may attach itself to pelvic organs, producing the condition of endometriosis. Menstrual cramps and pain—known technically as dysmenorrhea—the first symptoms of endometriosis, are the result of this retrograde menstrual bleeding.

Dr. John A. Sampson, a researcher and practitioner in Albany, New York, is responsible for naming the disease in 1927. Dr. Sampson theorized that this hacking up of endometrial tissue, which he called retrograde menstruation, was the most probable cause of endometriosis. Dr. Sampson proposed an explanation as to how the endometrial tissue is flushed out of the fallopian tubes and into the abdominal cavity; but there is still no explanation for why the endometrial tissue implants itself in these abnormal sites.

It has been proved that nearly all women will experience retrograde menstruation, but that many women will reject the tissue while others become victims of endometriosis. Their implants “suck.” Sampsons theory has yet to be disputed, although a number of other researchers have discovered immunological, hereditary, and structural connections, as well as a link between the amount of menstrual blood pushed through the tubes and the severity of the disease.

The tragedy of tins disease is that it can go undetected until it has done irreversible damage. Equally heartbreaking is a woman’s fatalistic attitude toward menstrual cramps. When endometriosis takes hold, it has a distinct way of invading every aspect of a woman’s life, and this invasion begins early on, with cramps. Most women who try to cope with monthly bouts of mild to severe and debilitating cramps will seek relief from the pain with familiar remedies: heating pads, hot water bottles, or over-the-counter painkillers like aspirin. They do not connect their cramps to any process other than menstruation.

It does not occur to them that they may have endometriosis because they do not know about it. Since they don’t know how endometriosis can incapacitate their reproductive system as well as other organs, they don’t seek medical help. But these women aren’t to blame. More than likely, they have been taught that menstrual discomfort, like contractions during childbirth, is not only natural but part of being a woman. Where seeking medical help for childbirth is understood, consulting a doctor for “just cramps” is often considered frivolous and self-indulgent.

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It is important to realize that the maxim ‘A change is as good as a holiday’ is not always true. Major events and changes in life—whether pleasant or unpleasant—invariably give rise to stress. Too much stress can, as seen, lead to physical illness. To avoid unnecessary ills, therefore, it is wise to order one’s life in such a way as to ensure that changes do not occur too rapidly or drastically.

It has been shown that it is the amount of change that matters—whether welcome or unwelcome—not necessarily the nature of the change. If possible, the individual should make preparations in advance to cope with the additional stress which major changes impose. If, for example, a person plans to retire, sell his house and move interstate, it would be wise for this person to retire one year, and move interstate the next. This avoids accumulating too many changes in a short space of time.

It is also as well for doctors to be aware that patients quite rightly are going out after what they see as their own best cures, and sometimes leaving conventional medicine far behind them. It is easy for us to dismiss some of the techniques described in this chapter as esoteric entertainments of little practical value. This, however, would be an unfortunate conclusion, as so many of the techniques described have helped many patients, particularly those with skin disorders. The physician should be able to understand and guide patients to the method of treatment most suited to their particular needs.

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A fatty acid molecule consists of a chain of carbon atoms with hydrogen atoms attached. The end of the molecule with three hydrogens (H) attached to the carbon (C) atom is called the methyl end. The other end is known as the carboxyl end. The chain has an even number of carbon atoms which stretches from four to 24 carbon atoms. If there are less than 8 carbons in the chain, the fatty acid is called a short chain fatty acid. Medium chain fatty adds have 8-10 carbons. If there are 12, 14, 16 or 18 carbons, it is called a long chain fat and these encompass most of the fatty acids in the human diet These are commonly found in chocolate, meat and processed fats. Fatty acids with more than 20 carbons are very long chain fatty acids. They’re found in breast milk, seafoods and some seeds and vegetables. Some medium chain fatty acids can be changed within the body to longer chain fatty acids.

There are saturated and unsaturated fats, cis and trans fatty acids, Omega-3 and Omega-6 fatty acids.

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So far this chapter has dealt with pain management in general. However, dyspareunia — painful intercourse — is a problem that needs to be dealt with more specifically because of the physical and emotional stresses involved. This section has been written to give you some insight into the possible ways that might help you to overcome or cope with this particular problem.

When a woman does not want her partner to know she suffers from dyspareunia she may try to ‘put up with it’ for a number of reasons. Some women may feel they would be letting their partners down while others fear that their partner may leave them for someone else. For those who try to keep dyspareunia a secret from their partner, there is the possibility that when you try to avoid intercourse because of the pain, he is going to interpret this as rejection. For a woman wanting to become pregnant, avoiding sexual intercourse because of the pain is not going to help so she may pretend that everything is normal.

Equally, there may be problems when your partner is aware of dyspareunia. He may try to avoid sex so that he does not hurt you and this in turn may leave you feeling confused — particularly if your partner does not say why he is avoiding sex.

On an emotional level, it can destroy your self image — if you let it. The combination of a chronic illness and sexual difficulties is a tough hurdle to overcome. Add to this a decrease in libido

(sometimes caused by the hormonal treatment) and the problem of infertility and you can appreciate why this condition can cause so much heartache.

Dyspareunia can also be a result of other physical problems. Hormonal treatment can result in a dry vagina because of a lack of oestrogen and it may cause thrush which should be treated by your doctor. Some women may experience vaginismus which is an involuntary painful spasm of the vaginal muscles as a result of anticipated pain.

In order to overcome dyspareunia you must communicate! Talk to your partner and share your feelings. Work together and be honest with each other. Help your partner to understand how the pain affects you. Understand that he has feelings and needs love and attention as well.

Relax and give yourselves time. Intercourse may be less painful if you take the time to become fully aroused beforehand. Deep penetration usually causes the most pain so experiment with different positions until you find one that is more comfortable.

Explore other satisfying sexual activities that do not involve penetration. Show affection to each other in different ways such as kissing, hugging, masturbation and massage.

If you are having difficulty coping with the many emotional and physical problems associated with dyspareunia do not feel too embarrassed to seek professional advice. Your gynaecologist or GP should be able to suggest appropriate sources of support.

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