Treatment

The mainstay of treatment is a course of antibiotics. Your doctor may also prescribe an antibiotic ointment to be used 2-3 times a day. In between applications of the ointment, wash the skin gently with soap or an antibacterial solution, and pat dry.

• if the sore is surrounded by an area of red skin;

• if your child is also generally unwell or has a fever.

Always see your doctor if you suspect your child has school sores.

Prevention

Impetigo can spread rapidly to other parts of the body, merely from your child touching the sore and then scratching elsewhere. Try to explain this to your child, and encourage him not to pick at sores. Keep fingernails short and wash your child’s hands frequently until the infection has well and truly cleared up. Impetigo is also highly contagious, and your child should be kept home until the sores have healed. Keep a separate towel for the exclusive use of the child who has impetigo, and wash all linen thoroughly if stained with blood or pus from the sores.

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During pregnancy the milk ducts in the breast develop under the influence of hormones and breastmilk is produced and stored. This first breastmilk is called colostrum, a yellow, sticky fluid with high nutritional value. It provides special immunity which protects your baby against infection. During the first 24-48 hours after birth, colostrum is the only fluid which your breasts will produce. The breastmilk then undergoes a change, becomes whiter, and takes on a more watery consistency.

During each feed the composition of breastmilk changes. At the beginning of the

feed foremilk is produced, which has a higher lactose (sugar) content. 1 he foremilk tends to be thinner and satisfies your baby’s thirst. After a few minutes the hindmilk comes in, which is higher in fat content and settles the baby’s hunger pangs.

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“I want you to learn to juggle together, to jump rope together, to play jacks, do puzzles, play board games, and generally get back to being playmates,” I said to one of the couples who seldom smiled.

“Do you mean go to Toys ß Us and get games? We don’t have to. Our kids have enough to open their own store. Toys ß Them,” said the wife.

“No. I want you to get your own toys. These toys are for you. Keep them in your private place. I know you play with the kids, but now I want you to play with each other.” They looked at me, smiling-

At the next visit, they brought three beanbags and demonstrated their juggling skills. They laughed as they repeatedly missed the bags. “I love this,” said the husband. “I can’t remember playing, and certainly not with her. I play tennis and golf, but this is all different. We’re playing like kids, really playing, not just having recreation.”

The couple experienced this opportunity as different because it is based on the concept of “neoteny,” Ashley Montagu’s term for the return to some of the characteristics of childhood. It is a way to laugh, play, and salvage lost opportunities from the health of youthfulness. Perhaps we age because we don’t play as we get older.

I ask couples to keep a large family puzzle going at all times. Have it on a table in plain view. Put it together slowly. Everyone should work on it. You will be surprised how stress-reducing this can be, unless someone gets trapped into trying to beat everyone else by finishing it alone. The rule is that no one can put in a piece without someone else from the family present.

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He really used to come to see my parents more than me. In fact, I think they came to like him more than I did. He would just sort of show up. No more official dates or invitations. The quality of our outings went down severely. We started to save money. He didn’t pay for the dates anymore. We pooled our money and went to the Lick and Split Ice Cream Parlor to have small cones while we watched other people eat their banana splits.

WIFE

At this phase of bonding, the relationship is maturing. It has made it past the projective dimension, and the partners now start to show their true colors. “I never in the world would have told him about my period before. Now he knew when it was or when it should be better than I did,” reported one woman. “I told her,” reported one man, “I just can’t stand her cracking her gum. I lived with that for weeks before I told her.” Now the real feelings come out.

A couple can tell when they are in the acceptive phase by the occurrence of several breakups, patch-ups, makeups, and re-breakups. This phase seems to be an opportunity to test the system for the pressures of real marital life, to learn to make up and stay with it even at times of stress and strain. This testing is only effective, however, if both partners are free from the myth of romance. Romance, “hot love,” lasts only a few months. Researchers can trace this pattern clearly. If one or both partners cling to the myth of romance, that a relationship will remain hot, lustful, emotionally and sexually intense in the fashion of early bonding, then their goal is unrealistic. They will tend to do their “serial relating,” their breakups and makeups with several persons instead of learning to do them with one partner as is required for an enduring marriage.

Another danger here is that one partner may learn to give in, or to hold out for some form of later justice in marriage, letting things go for now. This strategy is a major mistake. Later justice never comes. The opposite of injustice is not justice, but love. Open sharing, conflict resolution, mutual effort at problem-solving, dealing with day-to-day issues of family, religion, money, kids, and work all must be processed during this crucial courtship phase. Marriage before this phase is a risky proposition. It is better to learn to divorce and remarry before you ever get married in the first place. Perhaps then we will not have to experience “serial divorce” in order to learn how to relate intimately forever.

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Should the ophthalmic branch of the fifth cranial or trigeminal nerve be involved, this can effect the eye. Blisters may form on the cornea, the clear window over the eye, and lead to ulcers and scarring. The inflammation may lead to loss of sensation on the cornea, predisposing it to injury. To protect the cornea it is sometimes necessary to sew the eyelids partially together.

At other times another portion of the nervous system, the geniculate ganglion, is involved and the blisters appear on the ear. This can be associated with vertigo or giddiness and may cause damage to the facial nerve and paralysis of the facial muscles.

The pain is usually superficial and burning in character. The skin in the region of the rash is often so sensitive that even the pressure of the clothes may be painful.

The treatment of shingles has never been satisfactory. Many different treatments have been tried, but few have stood the test of time.

In the initial stages, and later, the pain must be relieved. This can be done with the normally available pain relieving drugs.

Zinc oxide powder dusted on the lesions may relieve the local irritation, keep it dry and help prevent infection.

Cortisone is used in a short course, particularly in the middle-aged and the elderly. It has no effect on the acute illness but does seem to reduce the risk of developing the persistent neuralgic pain which may be so distressing.

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Several types of insulin are available which act for different lengths of time. Short acting forms last about six hours; intermediate forms about 12 and long acting about 24 hours. These may be combined in injections which are given once or twice daily.

The amount of carbohydrate eaten should be regulated. Those who are overweight need smaller amounts than those who are thin. The intake of protein and fat usually does not need regulation.

In the past, sufferers were required to weigh most foods, but now we work in portions. Each portion of food contains 100 g of carbohydrate and lists are available showing how much of each food constitutes one portion.

Many obese diabetics whose disease develops late in life can manage well with diet alone, if they lose weight.

For others, tablets are available. These work by stimulating the pancreas to produce more insulin.

It is important for the diabetic to learn as much as possible about the disease so that he can assume responsibility for his own management. Children should learn how to give themselves the injections and not rely on their parents. An intelligent patient can learn when to vary his insulin dose and how to control his diet.

Many organisations conduct camps for diabetic children and these are of benefit in teaching the child how to manage without his parents and how to lead a normal life despite the diabetes.

Insulin (100 units in each 1 ml) comes in long, intermediate and short-acting forms and the syringe, which has a capacity of 1 ml, is calibrated in units.

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The common infectious diseases of childhood are not now as frightening as they were to former generations.

This is because of immunisation and antibiotics.

Better nutrition has also contributed and those who are initially healthier have an advantage in fighting off infection.

But, because these illnesses are no longer common, we have become complacent and, unfortunately, some have forgotten about immunisation for children or see no need for it.

Although the diseases are uncommon, the germs causing them are still widespread in the community.

Some people, for philosophical, religious or medical reasons, object to immunisation for their children but, for the overwhelming majority, apathy causes rejection.

The germs, bacteria and viruses causing infectious illness stimulate the body’s immune system to make antibodies. These are chemicals which lock on to the germ, or the toxin or poison produced by the germ, and render it harmless.

This process starts when the germ enters the body and is recognised as being foreign.

The first time the body comes into contact with it, there are no antibodies to this particular invader and the body sets about making them. But this takes time. Meanwhile, the germ may multiply and cause the disease.

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I In cancers that are easiest to diagnose are obviously the ones on tin outside. Thus, if there is a sore that won’t heal on the skin, in tin mouth or anywhere else where it can easily be seen, it’s just a Blatter of the doctor looking at it. If it looks at all suspicious of Bancer a specimen is taken. This may sometimes be done by ó scraping some cells from the surface. However, such a iien may only contain a mixture of blood cells, germs and dead cells which cannot be identified. This means that it is often necessary to get a specimen from deeper down. This can be done with a needle or by actually removing a small piece of the lesion under a local anaesthetic.

Some cancers start very close to the surface and can be seen and felt as a lump under the skin by the patient and the doctor. Common ones are cancers of the breast, lymph nodes (primary or secondary), and testicle. A lump under the skin can be the first indication, of other cancers also, such as ones starting in fatty tissues, muscle, bone etc. Of course, there are many other possible causes besides cancer for lumps under the skin.

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It is also important to take plenty of exercise to burn off the excess calories and to strengthen your bones. The more bones and muscles are used, the stronger they grow, so from your middle years onwards the new buzz-words in your life should be ‘mechanical loading’, which means giving your bones plenty of work. As you use your muscles, the bone-building osteoblasts respond by building more bone; exercise is also thought to stimulate the production of calcitonin, thereby slowing the activity of the bone-dissolving osteoclasts. We have only as much bone as we need, and nothing will cause the skeleton to become stronger than it needs to be for your lifestyle. No amount of calcium tablets will compensate for ‘mechanical loading’ of the bones and muscles.

Exercise is something most of us do much less of as we get older, which is a pity, as it:

• helps to build up bones

• is good for the heart

• reduces depression and stress

• improves muscle tone and co-ordination, so reducing the risk of falling (which is one of the main causes of fractures)

• is an effective form of weight control

• improves sleep

All these things become more important after the menopause, so try to build some regular exercise into your life. If you have already had an osteoporotic fracture, you should take advice from your specialist or from a physiotherapist about what form of exercise you should and should not be taking. If you have no sign of this disease, then you should be having plenty of exercise that loads the bones and muscles. Swimming and yoga are very good for all the other aspects of your life, but as they do not put any strain on bones you would need to include some other forms of exercise as well, such as tennis, dancing, brisk walking, aerobics, fitness training, etc.

Just a word of caution: forget the old maxim ‘If it isn’t hurting, it isn’t working’; after about the age of 35 this is a harmful philosophy, so listen to your body, and when it says ’stop’, then stop before you do some damage you will regret.

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My sex life has deteriorated since having a hysterectomy a year ago, partly bemuse I find it difficult to get interested in sex. I don’t feel comfortable talking to my surgeon about this and I’m wondering who else could help.

Loss of interest in sex after hysterectomy may be due to reduced levels of sex hormones. This may, for example, result in less lubrication of the vagina making intercourse more painful for you. Loss of libido may also be due to feelings of depression caused by anxiety at losing the uterus and exhaustion due to the combined stresses of the condition for which you had the hysterectomy, the operation itself and the associated anaesthetic. Coincidental factors, such as relationship problems with a partner, reduced self-esteem or sexual difficulties that are unrelated to hormone levels, may be another source of difficulty. For instance, you and your partner may have drifted into a pattern of having sex which does not please you and which you are now rejecting, or your partner may have a medical condition which is making the achievement of erection more difficult for him. A general practitioner, endocrinologist, gynaecologist, psychiatrist or sex therapist may be able to help. Your doctor should be able to sort out who is best situated to provide this help, even if he or she cannot diagnose the cause of your problem.

Will I still menstruate after a hysterectomy?

No, menstruation will no longer occur. Whatever sort of hysterectomy you have will necessarily result in removal of the uterus complete with its inner lining, the endometrium, which is responsible for menstruation.

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