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.

*51\97\8*

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.

*560/71/1*

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.

*303/71/1*

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.

*53/71/1*

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.

*60/40/1*

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.

*72\42\4*

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.

*84\198\4*

Highway hypnosis. Since hypnosis is not sleep, what is its relationship to sleep? When a person is driving a long distance on a highway, his eyes are focused only on the highway; he cannot look at anything beyond the highway for more than a few seconds. His eyes and his attention have to come back to the highway all the time. His awareness of the surroundings becomes narrower and narrower. This affects the content of his thoughts, which also become narrower. Although he is in a fully awake state, his awareness is submaximal and is continuously constricting to a narrower span. During this period of extremely limited awareness, it is as if he is in a trance state. He is dissociated from the awareness of his surroundings. Highway hypnosis is very dangerous. Eventually, if he does not pull over and stop driving, he will most likely fall asleep and lose control of the car.

After driving a period of time on a highway, a person goes into highway hypnosis, and very often highway hypnosis leads to sleep.

Hypnosis can lead to sleep. With the invention of the EEG machine, we now know that hypnosis does not equate with sleep. Schwartz, Bickford, and Rasmussen in 19SS reported that hypnosis and the awake state have identical EEG patterns. But typical sleep patterns on the EEG can be brought about in hypnotized individuals by means of appropriate suggestions. Hence, although hypnosis and sleep are two different states, given the appropriate suggestions of heaviness, tiredness, and sleepiness, one can pass from the hypnotic state to the sleeping state easily.

Dream state before sleep? David Foulkes, a US scientist, made a detailed study of the mental state of people falling asleep, and distinguished different phases. The first step is the loss of control over the flow of thought Thoughts begin to wander and go their own way. In the sleep laboratory, if the subject is awakened and questioned just before the appearance of a sleep pattern on the EEG, he reports that he has lost his orientation in time and space and is no longer aware of the reality of life around him. It is as if he is in a dream state resembling that of REM stage sleep, and sometimes it is impossible to tell them apart However, the EEG recording does not indicate any REM sleep and there is no rapid eye movement.

*86\174\4*

The little boy is playing. He falls and skins his knees, He screams. In an instant his whole being is overwhelmed with pain. For him there is only pain, his whole body, his whole world. Mother seizes him and holds him to her, kissing him on the cheeks. In a moment his distress is calmed and the pain passes, the sobbing dies down and he returns to his world of reality, and inquires about the thing he was playing with. Mother has quieted his distress, and the pain of his skinned knees does not disturb him unduly. Remember that this comes about by her kissing his cheeks rather than attending to the injured knees.

You may say that this is all very well for a child, but I am an adult, and I do not react like this. Perhaps so. But we adults react to pain with distress, only we do so slightly differently. We stop ourselves screaming; but the pain is still there. In a way we scream inwardly, and while this is happening, like the child, we feel consumed by the pain.

We can get some insight into this by comparing different cultural reaction to pain. The- Anglo-Saxon tradition is to present a stiff upper lip in the face of pain or disaster, on the other hand Southern Europeans have an accepted tradition of giving vent to their feelings. Such a woman in childbirth may scream when she experiences pain, and give full vent to her distress; her Anglo-Saxon counterpart may lie there silent, but tense and blanched, and in obvious distress. Both are suffering severe pain because the element of distress has got out of hand whether it is openly expressed or not. Another woman may be led to relax in her mind. Then there is no distress. And because there is no distress there is little discomfort.

*108\57\2*

Q. We hear so much about the endoscope these days. What is it, and what does examination entail?

A. The endoscopes suddenly swirled across the medical horizon in the late 1960s, and during the 1970s became the most widely used form of investigation by the gastro-enterologists, the doctors who specialise in disorders of the G.I. system. Indeed, they have revolutionised diagnosis and treatment.

The principle is very simple. The endoscope is a long, flexible solid tube made of fibreoptical material. This is pliable and can turn and twist and be bent into many different positions and directions. At the far end there is a light. At the near end, there is an eye piece.

The doctor places the tube down the patient’s throat, into his stomach and duodenum, or lower bowel if desired. The light illuminates the area. When viewing through the eye piece, the doctor can see by direct vision, the inside part of the organs under examination. The image is perfectly clear, despite the number of turns and twists the tube makes.

Q. Therefore, diagnosis is perfectly clear to the doctor?

A. Precisely. He can see if there is an ulcer on the walls of the stomach or duodenum. He can gain a good idea if there are other disease processes present also. What is more, if there is a lesion that is suspect, small instruments located on the side of the endoscope may remove small sections. This is called a biopsy, and is invaluable for an ulcer, specially of the stomach, which in fact may be an early stomach cancer. These are later examinated by the pathology experts and an exact diagnosis made. The amount of information that is yielded may be phenomenal.

Q. Is the procedure painful, and is it given under anaesthetic?

A. The process is not painful. It may be a little bit uncomfortable, and a general anaesthetic is not given. Usually food is restricted for the twelve hour period immediately preceding the examination. When you arrive, you may be given a fluid to gargle and swallow. This is aimed at partially anaesthetising the back part of the throat to make the examination less irritating. You may be given a mild sedative or tranquilliser to settle the nerves, and make you feel a bit lightheaded and sleepy. But you usually are not rendered unconscious. Later, you may have only a hazy recollection of what took place. However, about 40 minutes later, you will feel okay, with no ill effects. The throat may be a little bit uncomfortable.

Q. Does it take long?

A. In all, the examination itself takes about 20 minutes. The endoscope is about as thick as a pencil, and you will ‘swallow’ this. The end in your stomach has a light, and a wiping system a bit like a windscreen wiper in the car, which keeps the tip clear so the doctor can see clearly. The flexible fibres carry the picture around bends and corners to the viewing piece at the doctor’s end.

After the test, when you ‘come to’, you may feel a bit drowsy, but generally within 40-60 minutes you are back to normal. If a working person, you usually only require a day off duty. Ideally do not plan to drive your car for the remainder of the day — just to be doubly sure of safety.

Q. Is this test safe during pregnancy?

A. Unlike x-ray examinations, there are no risks to the foetus during an endoscopic examination. However, if you are breastfeeding, or taking medication, it is wise to tell the examining doctor about this.

Q. What happens after this examination?

A. As with the results of the x-ray, these are relayed back to the referring physician, and the patient will then be placed under the appropriate therapy.

However, unlike the x-rays, which are taken by a radiologist, a doctor who spends all of his time in taking and interpreting x-rays, the gastro-enterologist who performs the endoscopy is a specialist in the field of the G.I. system. Therefore, he will often commence treatment once he has made the diagnosis. This may be instituted at once, for the patient is still with him, and after the diagnosis is confirmed, it is often convenient to proceed with therapy.

Q. Is it necessary or desirable to have other tests carried out?

A. Before the advent of the endoscope, various other tests were available, for checking acid levels, but these are now rarely used, and then only for specific conditions. The endoscope has revolutionised diagnosis of ulcers, as well as other bowel disorders. Now it forms a vital part of the doctor’s investigations, and an increasing number of these tests are being performed — usually to the patient’s benefit.

*11\61\2*