Medical Weblog

There is no specific treatment for whooping cough, but if the cough is severe and causes breathing difficulties, your doctor may recommend that your child be admitted to hospital for close nursing care. Coughing bouts can be quite frightening, both for the child and the parent. Keep your child in a warm room. A humidifier or steam from a kettle can help to loosen the cough. Make sure your child does not get too close to the kettle, or else he can get scalded. Keep your child as quiet as possible, to lessen the chances of triggering off a coughing spell. While your child is coughing make sure that you sit him up in case he womits; this will prevent him from inhaling any vomit. Stay near him or hold him on your lap while he is coughing, to calm him down and reassure him. Make sure your child is getting plenty of fluids, and offer easily digestible small meals frequently.

When to see your doctor

• if your child has a cough that lasts for more than 3-4 days;

• if your child has any of the symptoms described above;

• if your child has a prolonged fever together with the cough;

• if in addition your child complains of a sore ear;

• if your child already has whooping cough and is losing weight or looks dehydrated

Prevention

Immunisation against whooping cough is effective in preventing the disease and has also dramatically reduced its severity. Make sure your child is fully immunised.

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“Could you get it stuck in there? Can you get stuck together?”

A vagina and penis can never get stuck together. There are a lot of stories about sex that you will hear, and unless they come from someone you love, or from someone who somebody you love told you to listen to about sex, you really can’t believe any of it. These stories are just like ghost stories. Sometimes kids want to scare you or make you think that they know a lot about sex. You know that people who brag don’t really know too much or they wouldn’t have to brag or tell other people how to live.

    ”Is it right if a grown-up touches you?”

Sure, it’s right. Touching is human, but if someone ever touches the private parts of your body, or if they ask you to touch them, you should tell someone you love. They can talk about it with you. If you ever wonder if it’s right, you shouldn’t let it happen until you talk to someone you love. If someone is doing it and telling you not to tell, that means tell someone right away. Anytime someone tells you not to tell, you know something isn’t right. You should never do anything you can’t tell to people you love.

    ”How can you tell if a kid is a queer?”

First, “queer” means unusual, so we are all unusual, because me of us are completely alike. Sometimes, kids mean homosex, the bigger word for what they mean by queer or the words fag” or “gay” or other words like that. But you see, there is no way at all to tell if anyone is anything until you know that person r a very long time. People who say they are homosexual are not ally different from anyone else except in one way. They want to ve someone who is their same sex, what we call gender. Nobody lows why this happens because we really don’t know all about hy we become what we are. It’s just too complicated. We just ive to love who we are and accept people for who they are. Calling imebody any name is just mean and ends up hurting everyone. If you call someone a name, you can be sure you will end up having raieone call you a name, too.

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He thinks I am some kind of sexual perpetual-motion machine. He even tells people that once he turns me on he can’t tum me off. Absurd. I get to a point where stimulation actually hurts. Maybe all those other women can go on forever. I can’t.

WIFE

I have already discussed the “sexual witch” mythology, and myth seven perpetuates this view of women. Chapter Five pointed out that women have a refractory period, a time when sexual stimulation is ineffective or even painful. Men and women are not different on this issue.

Masters and Johnson state that “there is a major difference between male and female sexual response immediately following orgasm.” They go on to state that only men have a refractory period, but that “all females have the physical capability of being multior-gasmic.” They add, “Men, on the other hand, cannot have multiple orgasm.” This idea is based on the erroneous assumption that, as Masters and Johnson state, “An orgasm is an orgasm is an orgasm.” The couples, and your own subjective experience, teach otherwise. Orgasms and psychasms exist in varying degrees at varying times. We do not “climax.” Eric Berne writes, “Climax started off as a decent enough word, but it has been so overworked on the newsstands that it now sounds like the moment when two toasted marshmallows finally get stuck to each other.” We have been taught that women can “take a licking and keep on ticking.” They can’t, men can’t, because sexual response is like any other human response. It is cyclical, not phase-specific, unidirectional or gender-determined.

Masters and Johnson state, “From the viewpoint of physical capability, females have an almost unlimited orgasmic potential.” It would seem, then, that until absolute physical exhaustion results, women can experience a machine-gun-like series of orgasms but men have one and then go into “refraction.” Apparently it is men who must pause in sexuality. The women in my group were well aware of this idea, but felt that it was just not true for them. “I guess I could go on and on,” reported one wife. “But I don’t, never have, I can’t imagine how or why, and I gitess my husband could, too. But why? You could take a bath forever, too, but for what purpose?”

If one purpose of marriage is to share a range of activities, of transitional life events, then sex is only one of the many dimensions of life that spouses can experience together, physically, mentally, and spiritually.

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Dr. Carol Gilligan, in her book In a Different Voice, summarized the complex issue of gender roles. She suggests the same-gender caretaker experience of young girls predisposes them toward empathy through the sameness experience, an emphasis on relationship and a fear of desertion and separation. Autonomy becomes problematical for the woman who is so early, so long, and so strongly attached. The different-gender primary caretaker experience of boys results in lack of the “sameness sense,” less empathy, a devaluing of relationship, and fear of commitment and loss of autonomy.

The work of Drs. Pepper Schwartz and Philip Blumstein, in their study of twelve thousand American couples of varying gender orientation, also suggests that men are eroticized and women romanticized. This pattern was present in the report of my couples as well, but the interviews revealed that men knew there was another way to be, but needed permission, help, and support in learning this “other way.” Both genders needed help in stepping out of assignments and into choices.

I found a major difference in my interviews regarding eroticism and romance. It was not true that if one was less eroticized, one was more romanticized. It was also untrue that if one was less romanticized, one was more eroticized. I learned not to ask “Which are you?” in favor of “How much of each are you at what time, with whom, and why?” I found the answer depended as much on what had happened in the marriage as it did on what happened when the sperm met the egg and the genetic relay race began Marriage provides an opportunity for role change, modification, creativity, for what I call “cross-roling,” being a little of everything sometimes.

Ask yourself now how much of your marriage is dictated by “gender junk,” obligatory, involuntary sex role. How much of your marriage is freedom to evolve as self with another person? One husband described his wife as “wanting only sex. She does not want to hold. She wants me on and off. She says that’s how a man should want it.” This wife was trapped by the gender junk that can block intimacy.

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Arthrosis occurs when the wearing out occurs faster than the tissue can be replaced, the cartilage softens, develops cracks and may even wear completely through exposing the bone. Irritation to the bone then causes damage, small splits and overgrowth as the bone thickens and proliferates.

Small projections of bone (osteophytes) may project around the edges of the bone at the joint surface.

In the arthrosis which is mainly due to wear and tear the larger weight bearing joints such as the knees and hips are more commonly affected.

Any injury to a joint such as a torn cartilage in the knee or a fracture of a bone near a joint can lead to the early development of osteoarthrosis as can other joint disorders or deformities which throw unnatural strain on the joint.

The symptoms of osteoarthrosis are pain on using the joint, limitation of mobility and stiffness after rest or overuse. Early morning stiffness is uncommon but this symptom is a common finding in the inflammatory joint disorders such as rheumatoid arthritis.

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Crohn’s disease, which is also an inflammatory disorder of the lower bowel, may be mistaken for it at times.

Although nervous factors were once thought to be a cause of this complaint, it is now accepted that the associated anxiety and depression may follow the disease rather than cause it.

In treatment, a diet high in residue and low or absent in milk is helpful. While no specific medical treatment can give cure, control of the disease is usually possible. As in the other inflammatory disorders, cortisone is a non-specific treatment which reduces and usually controls the inflammation.

A sulpha drug, sulphasalazine, helps to control the disease but not because of its antibiotic action. Exactly how is uncertain. Immunosuppressive drugs have been used in some cases and have proved of benefit.

If large doses of cortisone are needed to control the disease, surgery seems to offer more advantages. Surgical management seems to control the joint problems as well as the bowel inflammation.

In most cases, the whole of the large bowel, including the rectum, are removed and the last part of the small bowel, the ileum, is opened out on to the abdominal wall and a bag is worn to collect the discharge.

In about 5 per cent of cases the rectum is not involved and then the anal sphincter may be preserved, so no external opening is required, the ileum being joined to lower rectum.

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The child may sit for hours staring at one object or repeatedly carry out some simple act.

Autistic children may respond poorly to some sounds, ignore others or sit listening to a sound such as music for hours, but with no outward sign of enjoyment.

Because of these factors, the children do not mix well with others. They resist any change in their routines. They often develop a marked attachment to an object and may handle it for hours on end.

Because the child does not develop the normal social and emotional ties with his family there is a great strain on the parents.

There appears to be no cure for autism. Many drugs have been tried, but are of little use. The condition is not due to vitamin deficiency and does not respond to the use of massive doses of vitamins.

Most of the efforts of treatment are directed to teaching and learning. This is difficult as these children seem to resist learning. But we all need some simple skills to manage in society. We need to know what we should and what we shouldn’t eat. We need to go to the toilet, we need to know how and when to wipe our noses. These simple skills about everyday simple problems may take years for an autistic child to learn.

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In practice, one major difficulty is that your practitioner may not even consider alternatives to his or her usual standard recommendation. In the last section we have discussed how you can obtain more information. Ask for alternatives directly: ‘What wet!Id happen if I don’t have what you recommend?’ ‘I realise you are recommending what you believe to be the best treatment, but what others are possible?’ ‘What about radiation treatment?’ and so on.

After assessing all the information yourself, you may well decide that what your practitioner first recommended is indeed the best choice for you. It might seem easier just to say: ‘Doctor knows best—I’ll do what he or she says.’ Don’t fall into this trap. Your practitioner has many reasons for recommending a particular treatment and I’m afraid that they do not all centre around you as a unique individual person.

Most practitioners have a series of set recommendations for various set types of patient. From their own experience and attitudes, and from the knowledge gained from their reading of the latest reports from all around the world, they decide on what they believe to be, generally, the best form of treatment for a particular type of cancer. Because practitioners are individuals with different priorities and beliefs, they do not all reach the same conclusions.

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There are different types of progestogen available, and various dosages within each type, so there is a good chance you will eventually find a combination of oestrogen and a progestogen that will give the advantages without the side-effects. Faced with a woman who has undesirable symptoms at the first attempt, many doctors still say, ‘Well, we’ve tried HRT, but it obviously isn’t going to work for you. Never mind’, and they just give up, without making any more attempts at finding an acceptable combination of the two hormones. If you feel that you need oestrogen (whether ID reduce menopausal symptoms, or to protect yourself from osteoporosis or artery disease), it would be a great shame if you gave it up after just a few months.

There are about 20 different combinations in which you can take HRT, so it’s highly likely one of them will be right for you. It just requires a little patience and perseverance from both you and your doctor. Usually, changing to a different progestogen will get rid of the unwanted side-effects, but if that doesn’t work, then reducing the dosage should work, or possibly taking it for fewer days each month. However, there is a minim urn dose needed to ensure the lining of the womb is shed each month, so you shouldn’t have too low a dose or for too short a time. Many women find that vitamin B6 or evening primrose oil helps reduce unpleasant pre-menstrual symptoms brought on by progestogen.

The good news is that research is being done into new and better progestogens. Until recently, this hormone could only be taken in the form of tablets by mouth. As much of the progestogen gets lost as it passes through the digestive system, quite a large dose has to be taken so that you end up with the amount you need, and this large dose is what causes most side-effects. Progestogen is now also available in a combined progestogen and oestrogen patch. It is called Estracombi, and is manufactured by Ciba-Geigy. In this- form, the two hormones are absorbed through the skin, and because the digestive system is avoided, a much lower dose can be given to achieve the desired effect, thereby reducing the side-effects. Before long, a completely new generation of progestogens will be available which produce fewer side-effects.

If progestogen in any form really doesn’t agree with you, under certain circumstances it may be possible to cut it out altogether. Your doctor would probably only suggest this if you already had osteoporosis and needed to take oestrogen but were finding the side-effects of progestogen so intolerable that you had to give up. The big disadvantage of doing this, however, is that you would have a small but definite risk of developing cancer or other disorders of the lining of the womb. You would need careful counselling about this, and your doctor would probably suggest that every one to two years you had a biopsy: a small piece of the lining of the womb would be removed and sent for examination to see whether there was any sign of cancer or other disorders. Nowadays, for women who have osteoporosis of the spine but who really cannot take progestogen, a new non-hormone drug called etidronate might be the solution.

If it is the ‘withdrawal bleed’ that is putting you off HRT, there is a third alternative, known as ‘no-bleed HRT’ (because the aim of it is that it should eliminate distressing menopausal symptoms without producing periods), or ‘continuous/combined HRT’ (because you take combined oestrogen and progestogen continuously). No-bleed HRT involves taking a small dose of progestogen every day, instead of for just 10-12 days a month. The theory is that this method eventually leads to amenorrhoea (a complete absence of periods).

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Myomectomy is the surgical removal of one or more fibroids from the uterus with the aim of providing relief from prolonged or heavy bleeding. It is an option worth considering for women who have not finished their families and who therefore want their uterus intact to preserve their fertility. Pregnancy rates of 40-59% following myomectomy have been reported. It is, however, a difficult operation which is more likely than hysterectomy to cause blood loss requiring transfusion and postoperative ill-health. For these reasons, women with fibroids are five times more likely to have a hysterectomy than a myomectomy.

In most women, myomectomy initially relieves bleeding symptoms. But, ten years after the operation, 20-30% have returned to their doctors with a recurrence of their earlier problems. The reasons for this recurrence rate are as uncertain as the reasons for the development of fibroids in the first place. There is some evidence to suggest that recurrence rates are higher when multiple fibroids are present or the initial fibroid removal is incomplete. The latter suggestion is, however, body disputed; and there is also support for the view that it is only necessary to remove that part of the fibroid protruding from the wall of the uterus to obtain long-lasting relief from heavy bleeding. It has also been suggested that some women have an inherited tendency to develop fibroids and that this has a big influence on the recurrence rate.

Abdominal or open myomectomy, where the operation is performed through a large (approximately 13 cm) incision, has been the procedure used for many years. Recently, several new approaches have been devised which make use of a hysteroscope inserted through the vagina (hysteroscopic myomectomy), or a laparoscope inserted in the abdomen (laparoscopic myomectomy). These procedures avoid the need for large abdominal incisions. (Similar techniques may be used to remove adenomyosis, a condition that is closely related to fibroids.) A vaginal ultrasound showing the position and size of fibroids is helpful in deciding which of the above approaches is advisable.

Open myomectomy is performed more often in Australia than hysteroscopic or laparoscopic myomectomy. Likely explanations for this include the suitability of open myomectomy for the removal of large fibroids and for the removal of fibroids from sites where they are often found, such as the outer wall of the uterus. Open myomectomy is also a more entrenched procedure than

either hysteroscopic or laparoscopic fibroid removal. Fibroids up to 8 cm in size can also be made smaller or destroyed using laser techniques or electrocoagulation.

Some doctors are becoming skilled in these techniques, making them increasingly suitable alternatives to myomectomy, particularly for women with heavy periods.

Whichever method is employed, the procedure should be conducted in a well-equipped clinic or hospital under general anaesthesia. During the removal of fibroids it is important that the surgeon minimises blood loss and the inadvertent formation of adhesions, and that he or she skilfully reconstructs the uterus. Some blood loss is inevitable as the uterus is particularly well supplied with arteries and veins. It is usual for surgeons to clamp blood vessels or to inject chemicals that decrease the flow of blood to certain areas of the uterus. Particular types and locations of incisions also help minimise blood loss during myomectomy as does the use of laser surgery or diathermy in experienced hands. In some cases, doctors may remove the endometrium at the same time as performing a myomectomy.

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