Weight loss and diet plan for a healthy lifestyle.

Cause

These infections of the cuticle or nailbed are due to infection with bacteria or a fungus, which enter the skin through a crack in the cuticle of the nail. This is more likely to occur if your child bites or chews his fingernails.

Clinical features

The finger is swollen and red, and sometimes pus oozes from the nailbed or cuticle. The lymph glands in the armpit may also be swollen in reaction to the infection.

Treatment

If the infection is only mild, and no pus is present, soak the finger in an antiseptic solution and then apply iodine. If there is pus in the sore, your child will probably need antibiotics. If the infection is fungal, then your doctor will prescribe an antifungal cream which should be used for 2-3 weeks.

When to see your doctor

See your doctor if your child has any of the symptoms described above or you are worried.

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All children at some time have illnesses that require medical attention. Most will be relatively minor, such as the coughs and colds that are a normal part of growing up. Sometimes an illness may be more serious, so that prompt and expert medical attention becomes a matter of life and death. Access to good medical care for your child is very important, and parents need to choose a doctor carefully.

In some communities there is only one doctor, so there may be no choice. Most parents will have a choice of health care providers for themselves and their children. Some families will have gone to the same doctor or clinic for many years, and it seems natural that the children should also attend that doctor. While there are obvious advantages in the one doctor or clinic seeing all members of the family, many parents choose a different doctor for their children, for reasons outlined below.

If your family moves into a new community, you can obtain a list of local doctors from the Australian Medical Association or sometimes from the local hospital, or else ask friends, neighbours or the local maternal and child health or community nurses. Parents should not hesitate to ‘interview’ doctors to see whether they seem appropriate to provide medical care for their child. If you don’t have a good instinctive feeling about the doctor after talking to him, it may be wise to seek somebody else.

Here is a checklist of some of the things that you may want to consider in choosing a doctor for your child. The list is not intended to be complete and is not in order of importance. You may wish to add points you think are important.

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DIMINISHED AFTERGLOW: I don’t glow after sex, I just sort of smolder. I think it’s the origin of the word “burnout.” I feel spent.

HUSBAND

Absence of afterglow was reported in 907 of the husbands. They could not understand the idea of feeling invigorated after sex, instead feeling that sex had exhausted their energy supply, at least temporarily.

I feel a sense of relief, or completion, but I sure wouldn’t say a “glow.” It’s like a job well done. It’s getting off.

WIFE

Five hundred fifty-one women reported the lack of or diminished afterglow. More often than the men, they knew about afterglow, might have felt it following some of their sexual experiences, including masturbation, but reported a connection between partner and the afterglow phenomenon. It is difficult to glow alone after being sexual with someone.

DIMINISHED CONTEMPLATION: I just tune out after it’s over. I don’t feel like moving, thinking, talking, or doing anything but sleeping. I drift away.

HUSBAND

Four hundred fifty-three men reported the absence of or no understanding of reflection or contemplation following the sexual experience. The “energy release” model of early sexual research probably conditions many men to feel that an athletic event has ended when sex is over. It was new for most of the men to ask themselves about satisfaction, to reflect on the sexual experience rather than to forget it.

I’ve learned to tune out after sex. I used to laugh sometimes, cry other times, or sometimes get real philosophical. It was like I was on a drug after sex, like it was with some good pot. Now I don’t have the time or the interest. I just turn over and go to sleep.

WIFE

One hundred twenty women reported this problem, and the majority of the wives in the sample reported that the reflective phase of the sexual system diminished with length of marriage. Our culture’s linear view of time, the start/stop orientation we bring to sex, does not help us reflect. We tend to be prospective in our sexuality; foreplay is much more popular than after- or replay. Hot-running life-styles allow little time for looking back or prolonging experiences through reflection. We barely have time to enjoy the moment once, and seldom twice or thrice.

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We have never really talked. When I ask her for more attention, more feeling, she takes it as a criticism orputdown. We just can’t talk it over, work it out. She has no idea how I really feel inside.

Husband

Do you feel clearly understood in your marriage, sometimes even well beyond what you say or do? Do you feel “well sensed ” and listened to beyond words (attention)? Or do you seem to have to expend a great deal of energy just to get your feelings stated, and even then feel misunderstood (disattention)? This atten-tion/disattention issue is another example where it seems that attention must be much “better” than disattention. The purpose of taking this test is to learn a new view of the marital system that allows for constructive disattention, some relief from the vigilant state required for constant attention. It’s the strong relationship that can tolerate misreadings and occasional low empathy because it is counterbalanced with corrective reading and sensing of one another’s feelings. If you score this test by placing each item on a circle instead of a line, you see how systems theory works. Too much attention, for example, throws the circle off balance; it turns awkwardly and may steer off course. The same is true for too much disattention.

One of the husbands managed to learn this new scoring system by equating it to breathing. You need to inhale good fresh air, but you have to make time to exhale also. This “flowing” concept is at the heart of a systems view of intimacy.

Attention in this case does not just refer to talking and listening. Psychotherapy, marital therapy, and so-called sexual therapy focuses primarily on words, on talking, thinking, listening, and physically touching and being touched. Super marital sex adds “supersensory” communication. I am not referring to “extrasensory” perception, because sensing is not an “extra.” We all have

it, but we must learn to develop it. Supersensory marital communication can be practiced, enhanced, and strengthened. We can go beyond talk-and-touch therapy, and work toward our own forms of “marital telepathy.”

Physicists know that communication takes place on levels beyond the see and touch world. Physicist Fritjof Capra writes, “Throughout history, it has been recognized that the human mind is capable of two kinds of knowledge … the rational and the intuitive.” This part of the marital sexual system test refers to the intuitive dimension of marital interaction, a dimension too long ignored by professional therapists and health-care workers. All healing depends as much or more on intuitive communication and awareness than it does on the rules of rational, verbal communication.

Our example couple scored high toward the disattention end of the axis. Not only was the husband unaware of his wife’s pain, but she, too, failed to sense his difficulties. The husband stated, “I leave the table because I just don’t know what to do. If I try to help, I think she thinks I don’t think she is doing a good job, sort of letting us all down.” The wife responded, “He just does not give a damn. He’s just lazy and self-involved. He never gives one thought to how I might feel.”

When I presented a part of this report at a recent professional meeting for therapists, one of my colleagues stood up and said, “I tell my couples that the only way anyone is ever going to know how you feel is if you tell them. You must share your feelings and listen for the feelings of your spouse. Now you come along and tell us that there is some sort of ‘supersensory communication’ in marriage. There just is no such thing. We have to talk, listen, and do. This is a ridiculous idea . . . sensing. That’s when couples get in trouble, trying to sense instead of trying to communicate.”

I responded by saying, “You are making an important point, but if you will let me continue, I think I can document my ideas with case examples.”

The therapist answered, “Never mind. I can just tell what you are going to be saying, and I don’t want to hear it.”

The audience laughed at the obvious contradiction, referring to his “sense” of what I was going to do as a means of denying that sensing goes on all the time.

Again, some “rest” from constant attention is necessary in any system. Watching and listening or being watched and listened to all of the time can be as disruptive to the marital system as no attention at all.

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The nails are often affected, usually with evidence of psoriasis elsewhere but, occasionally, they alone are involved. In this case, the diagnosis may be missed and the problem thought to be due to fungal infection or some other cause.

The nail may show small pin-head size pits or the nail may separate from the underlying nail bed or it may be thickened and discolored.

Unfortunately, treatment produces little benefit. Psoriasis on the skin responds well, in most cases, to local applications but the nail seem particulary resistant.

Patients undergoing treatment with methotrexate often show an improvement in their nails.

It is worth repeating that most cases of psoriasis are mild and can be controlled by simple means. Self-medication should be avoided, as it may irritate the skin.

Sometimes a previously satisfactory treatment loses its effect. When this happens the sufferer will need to change to something else. Later, the original treatment may again be effective.

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The most common symptoms are abdominal pain and diarrhoea and the diagnosis may be missed and thought to be either an episode of mild appendicitis or the irritable-bowel syndrome.

Sometime ulcerative colitis may be suspected, if Crohn’s disease affects the large bowel. At times there is a fever and weight loss.

When the rectum and anus are affected there may be localised pain, bleeding and sometimes a fistula or track leading from the bowel and opening out on to the skin around the anus.

Involvement of large areas of the small bowel may lead to poor absorption of food, anaemia, vitamin deficiencies and malnutrition.

Treatment is not altogether satisfactory, as this is often so in diseases where the exact cause is not always known. Cortisone or its derivatives are often used as in any chronic inflammatory disorder.

One of the antibacterial sulpha drugs can be of value in acute flare-ups, but is of little use in long term maintenance.

It may be necessary to operate and remove the affected segment of the bowel when medical treatment fails.

Most patients can be kept in reasonable health and can live full and active lives.

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Almost one in three babies have episodes in which they cry vigorously, sometimes for several hours, draw up their legs and go red in the face.

It is usually assumed they have abdominal pain. This “three-month colic” usually starts in the first six weeks of life, nearly half having stopped by three months and 90 per cent by six months.

The cause is unknown, but is often said to be due to intolerance to cows’ milk. However, breast-fed babies seem as prone to get it as those artificially fed.

Cows’ milk proteins are thought to enter the mother’s breast milk and taking the mother off cows’ milk may be of benefit.

Many of these babies seem to settle with a mixture containing antispasmodic drugs with a sedative.

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You are probably wondering why your practitioner can’t tell by a blood test whether or not your cancer has spread through the bloodstream. Remember how tiny the cancer cells are? They travel fn the blood singly or in very small groups and there are only very few of them in the bloodstream at any one time. This means that the chances of actually seeing them in a small sample of blood are minute. The only way we can know they have been in the bloodstream is by finding secondary growths in other parts of the body.

There are also some types of cancer which develop in many different places throughout the body from the start. These cancers include leukaemias, myeloma and many lymphomas. Leukaemias and myeloma begin in the bone marrow. The bone marrow is where we form new blood cells. In a child it occupies most bones but in adults it is concentrated in the central bones—spine, ribs, skull, pelvis and upper parts of arms and legs. Because leukaemias and myeloma are cancers of certain types of white blood cells, they begin where those white cells are normally formed, which is throughout the bone marrow. With leukaemias, the cancerous white blood cells can be found in a blood sample whereas in most cases of myeloma they are not released into the blood and can be found only in a bone marrow specimen.

The lymphomas are a group of cancers which originate in the lymph system. Most of these appear in many different nodes at the same time. There are some types, such as Hodgkin’s disease, which tend to spread in a fairly orderly and predictable way from one group of nodes to another and, in some cases, can be successfully treated with radiation therapy directed only to the affected parts of the body.

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Imagine you are quietly going about your normal life, when suddenly you trip and fall. You stretch out a hand to save yourself, and the next thing you know you have fractured your wrist. Unfortunately, most Accident and Emergency doctors are so busy that they just don’t have time to explain that your Colles’ fracture is probably caused by osteoporosis, even less to explain what you might do about it. An X-ray will have shown up the fracture, but osteoporosis does not show up on an ordinary X-ray until one-quarter or more of the bone density has been lost, so if you have lost less than that so far the chances are that no one will notice that die cause of your fracture was osteoporosis, let alone tell you about it, and what you can do to stop it getting worse. A Colles’ fracture should be seen as a warning sign about die state of your bones, while still giving you time to do something about it.

Sudden or severe backache in the years after the menopause can have many causes, and it may not occur to your doctor that osteoporosis could be the cause in your case. He may arrange an X-ray (which doesn’t show anything wrong), possibly physiotherapy, probably painkillers, but eventually you get the message that you will ‘just have to learn to live with it’.

It needn’t be like that. Dual energy X-ray absorptiome-termachines, known as DEXA (or DXA) for short, are the best way to screen bones for osteoporosis, and are now becoming available all over the country, both on the NHS and privately. DEXA scanning is quite painless, and involves no undressing or embarrassment. DEXA machines scan your hip and spine, and produce a reading of your bone density, which will give a good idea of whether or not you have got osteoporosis, how severe it is, and what your chances are of getting a fracture; the lower your bone density, the more likely you are to sustain a fracture. Bone mineral density at the time of the menopause is the best predictor of osteoporosis, so in an ideal world, all women who are at risk of developing this disease would have a DEXA bone scan when they reached the menopause, and if their bone density was lower than it should be they would be advised on ways of reducing their chances of getting a fracture, including information on HRT. Until this happy day comes, don’t ignore any back pain you get, or a Colles’ fracture of the wrist, or loss of height – ask your doctor about osteoporosis.

You may see advertisements offering private screening for osteoporosis, and if this is on a DEXA bone scanner and will scan your hip and vertebrae, the reading will give your doctor a clear idea of your bone density and therefore of how likely you are to develop osteoporosis. Some companies are jumping on the osteoporosis bandwagon and offering screening that is less reliable; if you are in any doubt, ask your doctor. As a general rule, the only way to tell what the bone density is in your hip is to scan the hip, and the same with the vertebrae; scanning other parts of the body (such as the heel and wrist) does not give a truly accurate impression of your bone density in the important hip and spine areas. However, such a scan will show if your bone density is very low or very high; it’s those people in the middle who will need more precise measurement.

Scanning poses a difficult dilemma for the National Health Service. To scan all post-menopausal women would be prohibitively expensive, and large-scale dials have shown that it is not cost-effective to do this. To scan all women who are at risk of developing osteoporosis is still expensive, but if it can reduce the number of osteoporotic fractures (which currently cost the NHS over ?600 million a year) by identifying women who have a low bone density and offering them treatment, such as HRT, to reduce their chance of having a hip fracture, then considerable savings can be made. On the other hand, if millions of women take HRT for many years, that, too, is very expensive.

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More than 25 000 Australian women had hysterectomies in 1975 and at that rate it was estimated that at least four out of every ten would have this form of surgery by the time they turned sixty-five. Twenty years later, with an ageing population that includes a high proportion of older women, it is estimated that 30 000 hysterectomies are performed in Australia annually.

Current evidence suggests that 20-30% of Australian women will have a hysterectomy during their lifetime, usually between their mid-thirties and mid-fifties. About three-quarters of these are performed before women go through a natural menopause, that is, before their menstrual periods stop of their own accord. The Melbourne Women’s Midlife Health Project is documenting the situation in 2000 randomly selected Melbourne women aged from forty-five to fifty-five. The Project, undertaken by the Key Centre for Women’s Health in Society at the University of Melbourne, has found a 22% rate of hysterectomy among the women, and a peak age for the operation of just over forty years.

Another study, conducted by the Australian Institute of Health and Welfare, suggests that one explanation for an apparent downward trend in hysterectomy rates in Australia is the rapid introduction of the surgical procedures known as endometrial resection and ablation. This study has found that approximately 4000 Medicare benefit payments were made for endometrial resection in 1991-92, and in the same period the rate of hysterectomy (for heavy, uncontrolled bleeding) in public hospitals in Australia declined by one-third. Although the effects of endometrial resection on bleeding patterns are still being evaluated and the technique itself is still undergoing development, it appears to offer a credible alternative to hysterectomy for some women. Equally, it is fairly certain that hysterectomy will never be eliminated completely. For the several thousand women in Australia each year who are diagnosed as having cancer of the cervix or of the endometrium, survival itself may rely on a hysterectomy.

Recently, there has been a surge of interest in new treatment alternatives to hysterectomy, some of which are surgical, while others are psychological, medical and lifestyle-oriented. At the same time as we applaud the effort that is going into developing new or revamped treatment approaches, we believe that significant information gaps remain about their long-term safety and effectiveness. Research needs to continue and women must be informed of the current gaps in medical knowledge when making treatment decisions.

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