Treatment
Because this behaviour is always transitory and self-limited, and there are never any consequences, no intervention is necessary. Parents should be reassured that it is harmless, despite the vigour with wich the activity the activity is pursued, and the best course of action is to ignore it. There is no effective intervention that will reduce the frequency or duration of the head-banging, or will result in making it disappear any more quickly than it otherwise would have.
Some parents, concerned about the consequences of head-banging, try to stop it by smacking the child, or otherwise punishing him. This will often have the opposite result to the desired effect. By drawing further attention to the activity, there is a very good chance that it will continue longer than it otherwise would have, because the behaviour is being reinforced by the parents paying attention to it.
There is nothing effective that can be done to prevent head-banging, because it is not known why some children exhibit this behaviour. It is important to simply ignore the behaviour so as to ensure that paying attention to it does not prolong it.
When to see your doctor
You may want to see your doctor for reassurance that the child is not hurting himself, especially if there is evidence of bruising or swelling. There is generally no need to seek medical advice.
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REACTIONS TO IMMUNISATION
Vaccines are extremely safe and effective compounds which have been thoroughly tested. They are in use worldwide. As with all medicines, some people do have unwanted reactions. These are virtually never serious, and pass quickly. We stress again that the benefits of immunisation far outweigh any risks.
Some children have mild reactions to immunisation, such as local redness and swelling at the site of injection, or mild fever and irritability. To reduce fever and reactions, paracetamol should be given according to recommended doses prior to the immunisation and afterwards if necessary.
PERTUSSIS (WHOOPING COUGH) VACCINE
A lot of controversy surrounds this vaccine, which is usually given in combination with diphtheria and tetanus vaccines. Pertussis is a serious and sometimes fatal infection of the respiratory system. Although it mostly passes without complications, young children have been known to become extremely ill and even die from whooping cough. Babies do not acquire natural immunity from their mothers after birth, and are most vulnerable. Antibiotics do not provide effective treatment for the disease. The pertussis vaccine is extremely effective in preventing the disease and reducing its severity. The major controversy surrounding immunisation is related to concern that it may cause neurological damage.
Recent figures show a slightly higher incidence of short-lived, unpleasant side effects such as fever, crying and swelling and redness at the injection site but more serious reactions are extremely rare.
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It is unknown and unfamiliar. The dawning sense of self is like living with a person we don’t know, living with a person whose values and needs are different. Having to welcome such a stranger into our life on such an intimate level is naturally frightening, even though the stranger is ourself.
This is one of the most confusing aspects of the working-through process. As we learn to face the attacks, the anxiety and the fear we may also have to learn to face the fear of change and the fear of the new emerging self. The carefully constructed defences of a lifetime have been torn down. Rebuilding on more solid foundations means we have to push past the new fears.
When the new fears emerge we will have already broken through many barriers and overcome many of the fears associated with the disorder. We will be able to push past these new fears also, but it must be done gently and intuitively.
The essence of who we are, the essence of our self, is intact. It has always been there and will always be there. Now we have a chance to get to know our self. Now we have the chance to develop and integrate it into our life.
The process is hard, but each step we take means we learn more about the process. In the beginning it is difficult; there is fear, there is anger, there is frustration. ‘Why do I have to go through this, why can’t I just be normal like everyone else?’ What is ‘normal’ anyway? Use the anger, the fear and frustration to push past these new fears. With each step we gain new awareness, new knowledge and increased strength.”The process becomes easier and more tolerable. This is life, this is growth, a continual evolution. Now we can work with it by letting go and flowing with it, not by trying to control it.
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So far, we have discussed putting limits on what your surgeon can do in an unexpected situation. The same considerations apply if your surgeon recommends, as the treatment of choice, a procedure that you are not prepared to undergo. You, as a responsible adult, have the right to refuse any form of treatment that you don’t want, even if such refusal could mean that your life is likely to be shortened. No one has the right to override your refusal to any procedure, even when it could temporarily extend your life.
Of course, this, like so many things, is easier said than done! Your surgeon may be hurried, impatient and irritable with you. Your surgeon may tell you that he or she simply can’t understand how anyone could make such a stupid decision. Your surgeon may appear to be insulted, disappointed or hurt because you are rejecting his or her advice. Don’t be deterred by such reactions. You do know that there are limits to what you are prepared to sacrifice in order to live a bit longer. You probably know that even dying could be a better alternative for you than some types of drastic treatment. Trust what you know about yourself. You do know what’s best for you.
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Small dilated blood vessels (telangiectasia) lead to a blotchy appearance and there may be areas of patchy pigmentation or depigmentation.
The elastic tissue degenerates and the skin becomes thin and more prone to injury. Solar keratoses are reddened patches covered by white scale and are common on the face and backs of the hand.
These small lesions are unsightly and may go on to develop into skin cancers. Cancer of the skin has reached epidemic proportions in Australia and will eventually develop in a third of us.
For this reason, we should all learn to cover up when the sun shines and to avoid the middle of the day when the sun is at its zenith and the rays are most potent.
Some chemicals applied to the skin can sensitise the skin to UV light and lead to a rash. Some drugs taken internally can do the same.
During the long summer, millions of us swim each weekend. We seem to have an abnormal fear of sharks but give little thought to the risk of drowning. Unfortunately, drownings are like road accidents — most victims have been drinking alcohol.
Be careful about swimming in rivers, pools or at the beach after drinking.
And if you are going near water, learn how to carry out artificial respiration, by the mouth-to-mouth method.
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These were used in the past in frail old women for whom operation might have been too dangerous. Now, with modern anaesthetics and resuscitative measures having improved so much, there are few patients who are considered too sick to risk operation.
Sometimes, they were used in younger women who still wanted to have more children and may be still used for that purpose.
For those with severe symptoms, operation is usually indicated. This repair operation is usually called the Manchester or Forthergill Repair, after Dr Fothergill, a gynaecologist of Manchester in the UK, who devised it.
As well, the lax tissue from the front and back walls of the vagina is cut out, like taking a tuck in a piece of material. The underlying tissues are pulled together with stitches. In elderly women who are no longer leading active sex lives, the opening of the vagina may be considerably tightened so as to lessen the chance of recurrence. This would make intercourse impossible.
In sexually active women, vaginal repair tightens the opening to what it was before childbirth.
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Man is a hairy animal. An adult has about five million hair follicles of which 100000 are on the scalp. Virtually the only areas spared are the palms of the hands, soles of the feet, and lips. Most of the skin surface is covered with short, fair, fine, and poorly developed hair known as vellus hair or ‘fuzz’. Certain specific areas such as the scalp, genital area and armpits grow coarser, thicker, coloured hair known as terminal hair. There is a marked difference between the hair in different areas of the body, making simple generalizations about hair growth impossible. Originally, hair had four important functions to fulfil. These included improved sensory awareness; heat regulation; sexual attraction and protection. Of these only the latter two are relevant today: hair still contributes to sexual attraction, and still protects the nose and eyes.
Hair grows from follicles, which are finger-like indentations of the superficial epidermis and dermis, each of which encloses at its base a small bud of dermis. The hair filament may be regarded almost as a secretion arising from the division of cells surrounding this bud. It is composed of the same type of keratin protein as the skin itself. However, it does not contain nerves, blood vessels or any vital ’sap’. There is therefore no truth to the supposition that dull, lank hair with split ends is due to escaping ’sap’, and that singeing the ends will prevent this.
Hair does not grow continuously, but in cycles. All hairs on all parts of the body grow, rest, and fall out according to a cycle which is repeated without interruption throughout life. The duration of various stages in the cycle varies from one part of the body to another, with the scalp being the longest of all — from three to six years. There are three distinct phases of the hair cycle: a prolonged hair growth phase (anagen); a short transitional phase (catagen); and a longer resting phase (telogen). With the growth of the new hair the old hair is pushed out of the follicle and is shed. At any time of the scalps cycle there will be anything up to 100 hairs shed per day. However, as different parts of the scalp will be at different stages in the cycle at any one time, no nett loss is usually detected. Hair grows faster during the summer, and women’s hair grows faster than men’s, averaging about 10 millimetres a month. However, with ageing, the rate of growth slows down.
*13\44\4*
More and more people these days realise the benefits of having breakfast. Scientifically, having breakfast has been proven to help you lose weight and to lower your cholesterol levels. We also know that eating breakfast can help to stabilise your blood sugar levels. It kick starts your metabolism and gives your body food when it really needs it. Missing breakfast can cause symptoms of fatigue, dehydration and loss of energy.
One of the things we notice when non-breakfast eaters start having breakfast is that all of a sudden they develop a morning appetite that they haven’t had since childhood. Eating breakfast becomes easier. In fact it becomes a necessity (which is what it should be). Our bodies require fuel to run on and yet too many of us expect to go about our work without topping up our fuel tank first.
If your breakfast leaves you starving by mid morning, have a closer look at what you ate for breakfast. Many breakfast cereals and breads have a high G.I. factor which means while they pick you up initially, they won’t last long. When the energy runs out and your blood sugar starts to drop, you feel hungry again. Eating a low G.I. breakfast ensures your breakfast is going to take you through to lunch time.
In the breakfast section you’ll find simple recipes from a quick milkshake to delicious mueslis and more adventurous dishes for a weekend breakfast—all guaranteed to sustain you through the day.
*145\33\4*
Technological developments in the area have led to a number of different machines now being available for directly or indirectly measuring body fatness. Some of these are extremely expensive and would not be used in the normal day-to-day counseling situation. Others are now becoming more portable and more accessible and provide at least an opportunity for adding to other measures. The current range of machines include: underwater weighing, bio-impedance analysis, etc.
Bio-impedance analysis (BIA). BIA, which measures body fatness through electrical conductivity of body tissue, was introduced in the 1980s. A tiny imperceptible current travels through the water compartment of the body, which is proportional to the fat-free mass (FFM), there being very little water in fat. The more FFM, the more current is conducted. The impedance (or resistance to electical flow) is then put into an equation in the BIA machine to calculate the percentage of body fat. BIA machines are now small and portable and usually involve the wiring of electrodes onto the limbs of the body. The electrical current is slight and nothing is felt by the person being tested.
New developments have now led to BIA measures being combined with ordinary weight scales. By standing on the scales an undetectable electric current is passed through the soles of the feet and a measure of body fat is computed along with body weight. The combination of the two provides an increased diagnostic potential. A good deal of research has been earned out with BIA and comparisons with other measures such as near infrared analysis (NIR, see below) and other criterion measures. Indications are that BIA is significantly affected by fluid content of the body, and although reasonably valid, has a low reliability if not measured under similar conditions on each occasion.
*68\186\4*
Diabetes (or diabetes mellitus, if you prefer the full technical name) is inherited by baby. If affects the way the body handles the main ( omponents of food, the protein, fat and carbohydrate elements. A hormone called insulin is normally produced by the pancreas, a gland situated near the intestinal system. In the diabetic child, it is believed an abnormal kind of insulin is produced, which fails to perform its normal function of converting sugars into a form in which they may be stored. But it also seems to interfere with the way in which food in general is handled by the body.
Early in life (the first few months), the mother may notice that her baby is very thirsty, drinking a lot of fluid (and often wanting more), and passing fairly large quantities of urine. Instead of a normal weight gain, the baby may actually lose weight, despite a fairly good appetite. The child seems continually tired, and fatigues easily. Crampy pains in the limbs or body are common. In some cases, the baby may dramatically slip into unconsciousness (< ailed a diabetic coma).
In older children in whom the disorder has not been treated, there may be a reduced rate of growth and poor development. There may be psychological problems. As such children grow older, more and more symptoms will gradually appear, and damage to the blood vessels and various organs takes place.
Treatment
Usually, an alert parent will soon detect abnormal symptoms and will seek medical advice. There are many tests, some simple screening tests which will soon give an indication of the problem. The urine is tested for sugar (or ‘glucose’, as the doctors say), and frequently there is plenty present. Blood tests are more accurate and will indicate if there are elevated levels. A test called the glucose tolerance test usually confirms the disorder. Various other investigations may be suggested.
Treatment is usually very satisfactory and will be worked out on an individual basis for each patient. For childhood diabetes, the use of insulin is usually necessary and may be necessary for the rest of the patient’s life. Parents are taught how to administer this, and soon become experts. Later on, the young patient will also learn how.
Special instructions will be given on food intake. There will be certain restrictions, and these will probably vary according to the nature and extent of activity of the child. Insulin needs may vary with exercise, and certainly if an infection takes place more insulin may be needed.
Most children with diabetes will be under the regular attention of a specialist or may attend the diabetic clinic of a major hospital which has the full facilities for treating the patient on a long-term basis.
In Australia diabetes is fairly common. There are believed to be between 75 000 and 100000 known diabetics; add to this the number of undiagnosed cases, and the figure is high. Many diabetics do not come to notice until their thirties or forties, or even later. This is called maturity onset diabetes. It is the most common kind. Patients are harbouring the disorder, but it is silent and for many years may cause no symptoms. Later in life, it may be diagnosed by chance when a patient visits the doctor for some unrelated condition and a urine test is carried out by the physician.
Diabetic coma
Occasionally the diabetic patient may slip into a diabetic coma. This may commence with marked thirst and passing a lot of urine frequently. Nausea, vomiting, abdominal pains and dehydration may occur. Breathing may be long, deep and laboured, and there may be headaches, irritability and drowsiness. This may increase until the patient becomes unconscious. The skin is dry, lips very red, blood pressure low, and pulse rapid. It may be preceded by an infection.
Any form of unconsciousness needs prompt medical attention and this is no exception. The sooner the patient is taken to the emergency care ward of a large hospital the better. There proper investigation and treatment may be carried out, and there are full facilities for performing the necessary therapy.
Hypoglycaemia (’hypo’)
Sometimes the diabetic may receive too much insulin, or may fail to eat the prescribed amount of food, or may exercise too vigorously, so that too much sugar is removed from the blood. This is called hypoglycaemia, meaning insufficient sugar (glucose) in the blood. Most diabetics (and their parents) are aware of this possibility and are usually cautioned well beforehand.
Symptoms include weakness, hunger, irritability, a faint feeling, perspiring, rapid pulse, mood changes, vomiting, feeling nervous, walking in an unsteady manner, feeling shaky and trembly; and finally the diabetic may be semiconscious. If left untreated this may lead to serious brain damage, and even death.
However, treatment is simple and very effective. Giving glucose quickly reverses the situation and symptoms may vanish. Sugar in almost any form is suitable, but never try to give anything by mouth to an unconscious patient. Patients learn to recognize the early symptoms and will usually carry glucose with them and self-medicate promptly if they feel symptoms developing. The sooner .m unconscious diabetic receives medical help the better, so taking .m unconscious person immediately to a large hospital may be the best action.
*92\87\2*
