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Cause

Eczema has a genetic basis and tends to run in families. It is often associated with other conditions such as asthma or hayfever. Children with eczema have dry, sensitive skin which is easily irritated by certain chemicals (such as soaps or bubble-bath solution) and by contact with woollen or polyester garments. In some children diet seems to play a role in eczema, although it is often very difficult to find the offending food. Eczema is not contagious.

Clinical features

Eczema is a common condition in childhood. It is characterised by a very itchy, red rash, usually present in patches on the elbow creases and behind the knees, although it may occur on the face, neck, hands and feet. The rash may develop cracks and weep or bleed, especially when the child scratches excessively because of the itch. This may cause a problem with infection by bacteria which enter the skin via the cracks. In between attacks of eczema, the skin looks thickened and dry (lichenification).

Eczema usually begins at some time during the child’s infancy, often in the first few months of life, and may be present initially only on the face and scalp, or in the nappy region. Most children tend to ‘grow out of eczema by adolescence, but in some it will persist throughout adult life, usually flaring up at times of stress or after contact with irritating chemicals or other substances.

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From birth to 6 months, the baby must travel in an approved capsule or baby restraint. Many councils have bassinet lqan schemes, whereby you can borrow the bassinet for a nominal rental. Check with your local council, or with your local Child Safety Centre for more information. Older cars not fitted with anchor points for capsules can usually be easily modified.

When your child reaches 9 kg, and up to 4 years, a child safety seat (toddler seat) with its built in harness is the safest restraint to use. Check and adjust the restraints frequently, and make sure that the straps are always snug without being too tight.

From 4 years to about 11 years, a booster seat, initially with a harness (until about 6 years) and then with an adult lap/sash seat belt, offers the safest option for car travel.

Up to the age of 8-9 years, it is a good idea for the child to travel in the back seat of the car. Never nurse the child on your lap, and do not allow the child to stand up on the seat while the car is in motion.

Be aware that the laws governing the safe transportation of children in cars may vary from state to state and you need to be aware of the legal requirements in your state.

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EJACULATORY URGENCY: It gets like a fire drill. I can just feel like I am going to come and a bulldozer couldn’t stop it. I don’t care what I say or do, I am going to come.

HUSBAND

The ejaculation reflex is under much more control than men have learned, but running hot results in neurohormonal changes that diminish or prevent that control. Six hundred twenty-three of the thousand men reported the ejaculatory-urgency problem as characteristic of their sexual encounters, and again hyperarousal often accompanied this difficulty.

CONTRACTIVE URGENCY: I thought only men did this, I mean had this happen, or whatever. I just start to come. I get strong squeezing in my vagina. This happens mostly when he does oral love to me. I can’t hold back.

WIFE

Forty-six women reported this problem as typical of their sexual experience. Since the early perspectives of sexuality considered immediate, even out-of-control, sexual response in the woman to be desirable and a time and effort saver for the man, this problem has not been explored in prior sexual programs. I found in the couples now being treated that questions about such a problem lead to a higher percentage of reports than the 4.6 percent rate in the thousand couples included for this report.

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She expects me to kill all insects, catch all mice, and seek out the source of any sound in the night. Why me? I hate bugs, am afraid of mice, and would die of fright before any burglar could shoot me.

HUSBAND

Okay. But I’m the medical corps. All cuts, bruises, bangs, and bumps come to me. I hate blood. I just pour on peroxide, and squeeze tissue on all wounds. If he had a heart attack, I’d pour peroxide on him.

WIFE

Does your marriage have roles that are clear and of long standing, essentially unchangeable, so rigid that almost every problem is solved with marital partners filling and living up to their expected and assigned roles (order)? Or does your relationship lean more toward unclear, ever-changing roles, with each problem resulting in conflicts, readjustments, confusion, and role-reassignment (disorder)? Toward 0 is toward high order in your marriage and toward 10 is toward lack of order. There are not high scores or low scores (and 10 is not of more value or better than 0).

The woman at the deserted dinner table finds herself in a relationship of order, predictable role assignment and expectation. She prepares the dinners, calls the family for dinner, serves the dinner, and cleans up. Sexually, her role is to respond to her husband. He sees her as “broken” sexually due to what he perceives as her lack of spontaneity and passion, when in fact he is part of a highly ordered system that places both of them in their respective roles.

The wife accepts her husband’s role as “fourth child,” serving and cleaning up after him as much as her children.

When audiences hear the story of this couple, women get angry with the wife for her passivity and with the husband for his sexist ignorance. Men get angry at the husband for his neglect of his wife and his fitting the cliche role of “couch potato” and “boy child,” and at the wife for her maternal tolerance of her husband’s infantile and selfish behavior and her failure to represent herself. What these audiences are really bothered by is the “stuck system,” the unbending order that traps both partners in an unfulfilling marriage. Too much order (0) or total lack of order (10) always disrupts systems in nature, for there is no adaptability.

The husband in this couple felt he was responding to his wife’s sexual needs, but was in fact responding to his own misperceptions and misreadings of his wife’s needs for closeness and personal attention. “If she wants it, we do it. Where and when she wants it. I never turn her down” was the report of the husband.

The wife felt totally responsible for sex. “If I don’t mention it, we probably won’t do it. I find myself trying so much to guess when he needs it that I can’t tell if I ever need it.” They were trapped by their order, not in charge of it, not planning and adapting together, not aware of and responsive to a natural rhythmic flow that characterizes all of living and the Tao of marriage.

Systems thinking is relatively new in our culture. Give yourself time to understand it and how it applies to marriage and sex. It’s a new way of viewing marriage and sex, but it is the only way you will find super marital sex.

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Psoriasis is a miserable complaint because there is no cure and as it doesn’t kill anyone, it doesn’t have the “glamor” to attract money for research.

Few doctors see psoriasis as a challenge to their therapeutic skill and many leave their patients to their own devices, yet many people have turned away from life, hiding their skin and themselves from an insensitive world because of this disease.

Psoriasis is a skin disease of unknown cause. The fault appears to lie in the superficial skin cells which are produced too rapidly. The rash is usually dry, reddened and covered with silvery scales.

It is common on the extensor surfaces, such as the elbows and knees. It is also common on the lower back and can affect the hair and the nails and, sometimes, can affect the whole body. It may or may not itch.

Psoriasis usually starts in the teens or early 20s, but may appear for the first time in the elderly or it may develop in young children.

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These stronger cortisones, if used on the face may cause an acne-like rash around the mouth — peri-oral dermatitis — so the older hydrocortisone, which is weaker, is preferred for use on the face because it doesn’t have this side effect.

The pituitary gland at the base of the brain is the master gland producing hormones which stimulate the other endocrine glands to produce their own specific hormones.

A rise in the level of cortisone from taking tablets has a feed back or dampening effect on the pituitary. It produces less of its stimulating hormone and so normal production of cortisone from the adrenal is shut down. Cortisone is necessary to enable the body to deal with situations of stress.

Prolonged use of cortisone may upset this balance between the pituitary and the adrenal and so if the body is subject to stress, such as an operation, the adrenal may not have the capacity to produce hormones to deal with the stress.

After a prolonged course of cortisone, should an operation be required, a temporary cover of cortisone over one or two days may be necessary.

Short courses over one to two weeks can safely be stopped abruptly and the body rapidly regains its ability to produce the natural hormone.

Those on prolonged courses of cortisone should be given the smallest possible dose.

It has been suggested that if the total dose is given every second day in the morning this mimics the body’s natural morning surge of cortisone, and then on the second day, when it is not given, the body may produce its own.

Addison’s disease is failure of the adrenal gland — cortisone must then be taken for life.

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Respiratory infections: children suffer the same infective illnesses of the respiratory system as adults, but infecting agents which cause only a mild “cold” in an adult may cause a severe infection, like croup, in a child.

Aspirin and paracetamol may be used to reduce a fever, paracetamol being better-tolerated and less dangerous for infants under 18 months.

Decongestant drops might be necessary to reduce the nasal swelling before feeding infants on the breast or by the bottle. It is difficult for them to suck if they have to keep pausing to breathe through the mouth. Decongestants also can be taken by mouth.

Cough suppressants should be used cautiously for babies. They are either ineffective or, if they work, may suppress the cough reflex.

An adult can cough voluntarily, but a small child can cough only on reflex, that is, when a plug of mucus irritates the bronchi. If this reflex is impaired, the child might not cough up this material and it might block the bronchial tube and lead to collapse of a portion of lung.

CROUP: Croup is an infection of the larynx or vocal cords and may involve the trachea and bronchi as well.

It is usually caused by one of the para-influenza viruses or the respiratory syncytial virus, but also may be due to bacteria.

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Your practitioner will know where your particular type of cancer usually spreads. This is very important in working out what tests are needed and what types of treatment are likely to be best. With many types of cancer, the first secondary growths to develop tend to be located in the lymph nodes closest to the primary cancer. Examples include cancer of the breast, colon and tongue. Sometimes enlargement of these nodes is noticed by the patient before there is any sign of the primary cancer.

Other types of cancers tend to release cells into the bloodstream right from the start. These include some types of lung cancer and bone cancer. For each type of cancer there is a typical pattern for locations of secondary growths. Cancers spreading through the lymph system often form secondary growths in the nodes closest to the primary. Cancers spreading through the blood often form secondary growths in the lungs, liver and bones. Although, of course, the blood goes to every part of your body, for some reason the cancer cells are much more likely to lodge and form secondary growths in some organs than in others. Thus, for example, the lungs, liver and bones are common sites while the muscles, heart and intestines are not usually affected by secondary growths.

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Yes, in the sense that we all lose bone from about the age of 35 or so. As men start with much bigger, stronger bones than women, they are much less likely to get it, and so are women who have big bones. You are most at risk of developing osteoporosis if:

• you had a menopause (surgical or natural) before about the age of 40 or 45

• you have a medical condition that requires you to take cortico-steroids in high doses for several years

• you have had a Colles5 fracture of the wrist after the menopause, following a comparatively minor fall

• you have suffered from anorexia nervosa or bulimia

• you had amenorrhoea (absence of periods) for several years during your normal reproductive years

Other factors which increase your chance of getting osteoporosis are if:

• you are white or Asian

• you are small-boned, light in weight, and slender in build

• your mother, grandmothers or aunts had it

• you finished the menopause 10 or more years ago

• throughout most of your life you have eaten a diet low in calcium

However, people who don’t fall into any of these categories can get osteoporosis.

These are mostly things you can’t do anything about. There are some things you can do something about which contribute to osteoporosis:

• smoking (which lowers the natural level of oestrogen, and brings on the menopause up to five years earlier than it would otherwise have started)

• drinking large quantities of alcohol (which reduces the absorption of calcium from the digestive system, and slows down the activity of bone-forming osteoblasts)

• taking little or no weight-bearing exercise (bones get stronger when they are well used, and weaken when they are seldom used)

• dieting so severely that your periods (and thus your oestrogen production) stop

• continuing to have a diet low in calcium.

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Each year hundreds of thousands of women worldwide have their uterus surgically removed, many find the experience a landmark event. Some feel very positively about it, others have mixed feelings, and some experience intense regret. Deciding whether or not to have a hysterectomy and which type is most suitable can be difficult, especially when the views of trusted advisers are in conflict. In the case of Lisa, aged forty-two, friends, relatives, her partner and doctor held strong but differing opinions about the merits and drawbacks of the procedure. Some were enthusiastic about it, others thought there were other options, such as endometrial resection, that Lisa should investigate before agreeing to the removal of her uterus. Still others were adamant that hysterectomy was only to be considered in the most exceptional circumstances which, they assured Lisa, hers were not. She felt confused, a feeling made worse by criticism from her doctor that she was talking to too many people.

The distress of women who, like Lisa, are in the invidious position of having to decide whether to have a hysterectomy or find other ways of resolving their problems is evident. Even women who have an intimate acquaintance with the anatomy of the female pelvis can find the situation daunting. For example, when Sydney gynaecologist Caroline de Costa was contemplating a hysterectomy in 1992, she was nagged by fears right up to her arrival in the operating theatre.

The story told by de Costa, one of the few gynaecologists in Australia ever to have had a hysterectomy, reflects the anguish and ambivalence of many women contemplating the procedure. One of her fears was that she would feel enormous regret for the loss of her uterus and for her inability to bear any further children. She told herself this was ridiculous — at forty-five years of age and with seven children spaced over twenty-four years, why not put an end to the increasingly long, heavy and painful periods she was experiencing more and more often? De Costa also had a prolapsed uterus, had postponed her decision for several years and felt it was irrational to delay having the operation any longer. Another lingering concern was how she would actually feel, within her abdomen and pelvis, once her uterus was removed. ‘Perhaps there was something my patients hadn’t told me,’ she thought. ‘Perhaps I will feel a kind of black hole between my bladder and bowel.’

The experience of contemplating a hysterectomy over a long time, then going ahead with it, brought home to de Costa the emotional turmoil that many women in the same situation go through. It resulted in a change in the way in which she conducted her consultations. ‘I am certainly spending more time now in discussion with patients in an attempt to allay these fears,’ she said after making a full recovery and returning to her practice.

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