CHILD’S HEALTH/SKIN DISORDERS: RINGWORM (TINEA CORPORIS)

Ringworm is a very itchy fungal infection which is caught from animals and occasionally humans. It is quite common and does not necessarily indicate poor hygiene. It usually responds well to treatment.

Cause

Ringworm is caused by the fungus Tinea corporis, which is commonly caught from young animals, mainly household pets, or strays.

Clinical features

The rash initially appears as a very itchy, red ring on the skin, with a lumpy or raised edge. If you look closely you will see that there are scales present. The centre of the ring is usually clear. The rash grows gradually in size over several weeks, and may spread to involve other areas. If the scalp is involved you may notice a small bald patch with stubbles of hair present. The doctor may use a special light to help in making the diagnosis, or may examine some skin scrapings under the microscope.

Treatment

Ringworm usually responds well to treatment with special antifungal cream, but you need to be persistent and apply the cream twice a day for several weeks. Be sure to keep applying the cream for a week after the rash has disappeared, to prevent recurrence. Discourage your child from scratching the area. Treat all affected family members, and consult your vet for appropriate treatment if your pet is the guilty party. Ringworm is not highly contagious between humans, so you do not need to keep your child away from kindergarten or school. Your doctor may prescribe special antifungal tablets. These need to be taken under medical supervision.

When to see your doctor

• if there are several lesions present;

• if the sores are painful;

• if the rash does not start to improve after a week’s treatment;

• if the rash is spreading despite treatment;

• if there are bald patches in the hair.

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BABY FEEDING: CARING FOR YOURSELF WHILE BREASTFEEDING

Breastfeeding places additional physical demands upon you as a mother and you should pay attention to your own needs as well as those of your baby. Keeping your sense of humour and taking time out to rest and relax will go a long way towards keeping up your morale, as well as your milk supply.

A well-balanced diet is very important for mothers who choose to breastfeed, and you should follow similar guidelines to those given to women during pregnancy. Make sure that you keep up your fluid intake, especially during warmer weather, and avoid alcohol, caffeine and nicotine, as all these substances are passed on to the baby via breastmilk. Various medications and drugs can also pass freely into breastmilk, so always consult your doctor before taking anything while you are breastfeeding. Moderate exercise is beneficial to your general well-being.

Finally, accept any offers of help from others, whether it be with the cooking, the housework or babysitting. You also need some time for yourself to enable you to cope with the constant demands of a young baby.

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YOUR MARITAL HEALTH/GETTING FIXED UP SEXUALLY: THE EDU-SIG

I ask couples to get books, videotapes, audiotapes, and other materials they find interesting regarding sexuality. Some couples find carefully selected and mutually acceptable X-rated videotapes arousing and educational. Some find them degrading and dumb. It is a matter of personal and marital choice, but now is the time to experiment and learn. Try some old romantic films or comedies, whatever seems interesting to both of you.

Most of the couples invested in a video-cassette player and often watched comedy tapes together. Laughing can be one of the most powerful of aphrodisiacs. There would be much less suffering in marriage if we made more time for laughter and fun. Have you ever noticed the happy looks and laughter from people who are helping others? Have you seen the laughter and joy in the entertainers who gather for a charity event? Giving and sharing seem to be very healthy emotions, and they almost always result in hugging and holding. Again, we do tend to feel as we behave, so learn to laugh. Whatever type of tape you watch, discuss it and learn together.

‘ ‘We watch those tapes, and I think they stink. But we talk about them. I saw a few things to try, too,” said one wife.

“I used to sneak to watch the X tapes. I love to share them with her. We have learned to be real selective. They mostly stink. When we get a good one, one with something we both like, then we get turned on.” This husband was the initiator of the tape-viewing, but his wife added, “As long as you want to read those romantic novels with me and watch the old film classics, watch the romances, then I’ll watch the junk with you. We can learn from anything, I guess.”

Interest in sex is maintained only by thinking, reading, and talking about sex. If you speak only of work, school, problems, and bills, then sex will gradually leave the marital agenda.

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THE SEX PHASES OF COURTSHIP / CONCEPTIVE PHASE: CREATING THE SYSTEM

I could see that we were going to get married. Everyone else seemed to know it before we did. I don’t remember asking, really. The next thing I knew, we were talking about the hall, the band, and why her uncle would never come to the wedding because one of her aunts would be there.

HUSBAND

This phase is characterized by the awareness that two must be more than just one and one. The couple learns that career, children, family issues, religion, and money are not individual issues combined in some form of compromise. A true bond offers the opportunity for a “gestalt,” a relationship that is more than the sum of the two people within it.

“I would have never thought of being a lawyer until I met her,” reported the husband. “I knew I wanted to do something in government, but we talked it out a lot. It just sort of came up as something from both of us.”

“He brought out the fighter in me,” reported the wife. “My family had really asked just too much of me. He helped me find a new independence, a new way to be with my parents.”

Both of these statements illustrate the “and” factor, the birth of a new system in which the new whole is more than the sum of the parts, and the parts, the “partners,” are more than they ever were before.

The advantage of working with these couples for years is that I have been able to do a modified longitudinal study, a study of couples in distress and a study of the same couple in “high-level wellness.” I learned that couples which I will describe next, tended to be the best marital problem solvers. The thousand couples who successfully completed the therapy program were able to relive, to discuss and re-experience their courtship patterns and apply their lessons to their present marital system.

The super marriage for super sex became a generating marriage in which both partners continued to become much more than they would have been alone. Partners were able to draw from each other and give to each other, broad strokes contributing to a completely original artwork. What has your marriage produced that you alone would never have produced? For many of you, the answer will go far beyond just the biological gift of children. You yourself may have been given a new birth through your relationship. Strong marital systems seem to offer a continuous “birthing” place for both spouses, a place where wife and husband simultaneously create and are recreated by the marriage.

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SINUSES – GENERAL INFORMATION (TREATMENT)

Antibiotics are usually necessary, as also are nasal decongestants, either tablets or drops, local external heat and some form of pain relief.

If the infection fails to respond to the treatment, it may be that the germ is insensitive and a different antibiotic needs to be taken.

A more accurate treatment is to first take a sample of the pus before beginning treatment and culturing it to determine exactly what germs are present and to what antibiotic it is most sensitive.

If the infection fails to subside, and pus is present under pressure, then drainage is necessary and a specialist will be called in.

Chronic sinusitis is more common. This can cause pain, nasal blockage and discharge. Allergy with swelling of the nasal and sinus linings may be the underlying cause with secondary infections complicating it.

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DIET AND OBESITY – ENVIRONMENT AND THE BEHAVIOR

We start off with a particular genetic make-up. This we can’t alter. We are destined to be either fat or thin. But then comes the influence of our environment and the behavior we learn. We can learn to avoid being overweight even if genetically we have that tendency.

Unfortunately, the seeds of obesity are often sown in childhood. A fat “healthy” baby is likely to grow into a fat child and a fat unhealthy adult.

It is now believed that the number of fat or adipose cells in the body are determined in childhood and that later in life the cells may increase in size but not in number. Being overweight in childhood means more adipose cells are formed and later in life they tend to fill up with fat and so we become obese.

Mothers feed their children not only for them to live and grow but also as a sign of love. Sometimes they overfeed a child to satisfy some neurotic need of their own, and this may lead the person later on to seek satisfaction in eating for other needs besides hunger.

Being overweight is unhealthy at any age. Obesity can lead to an early death. Coronary artery disease, high blood pressure, diabetes, gall stones and osteoarthritis are all associated with being overweight. How does one go about losing weight? What I said at the beginning is true. Eat and drink less.

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IMMUNISATION – ANTIBODY RESPONSE

One attack of cowpox provokes an antibody response which prevents smallpox. This dread disease of smallpox is now believed to have been eliminated. The last recorded case of naturally transmitted smallpox anywhere in the world was in Somalia in October, 1977.

A localised outbreak of smallpox occurred in Birmingham in the UK due to accidental transmission in a laboratory researching the disease in 1978.

Because of the elimination of smallpox, no longer is immunisation required when travelling. It should never be given routinely to children as part of their basic immunisation, as the risks from the vaccine far outweigh any risk of disease.

The preceding table sets out the immunisation schedule recommended by the National Health and Medical Research Council to be adopted in all States.

In the past, each State had its own schedule and the provision of vaccine and vaccination programs was administered by the State Health Departments.

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DIAGNOSIS OF CANCER – INTERNAL CANCERS VISUALISING THE CANCER

Often, however, your doctor will not be able to give you the answer so quickly. For any problem that is more internal than those I have mentioned so far, more complicated methods are needed to get to see the source of the symptom.

There are instruments available now that allow us to see parts of the body that we previously could only see by operating or (indirectly) by X-rays. These instruments are basically long flexible tubes that can be passed into various passages. They have

sophisticated lighting system that can ‘see around corners’ and often also magnify any abnormalities that need closer checking. The specialist can also take specimens through them. This means of looking inside is called endoscopy (‘endo’ means inside, ‘scopy’ means looking at). In ‘upper gastrointestinal endoscopy’ we go through the mouth and see into the throat, gullet (oesophagus), stomach and upper part of the small intestine, and even, in some cases, into the tubes from the liver, gall-bladder and pancreas. \\ ith bronchoscopy, also done through the mouth, we can see down the windpipe (trachea) into all the major bronchial tubes of the lung. With colonoscopy we go through the anus to see the whole of the large intestine (colon). Cystoscopy is going through the urinary passage (urethra) to see the bladder and opening of the tubes from the kidneys. Most of these examinations are

usuailly carried out with the patient awake. They are uncomfortable but shouldn’t be painful. Your doctor will usually give you a sedative to help you relax. Of course, any of these can be done under a general anaesthetic but this is not quite as safe.

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HRT: HOW YOU SEE YOURSELF

Whether you decide to take hormone replacement therapy is a decision you will need to make after talking to your doctor, to your friends who may have tried it, and after weighing the pros and cons. There is little doubt that, taking the population as a whole, the benefits far outweigh the risks, but for you as an individual the balance may be different. It will depend, for example, on how you feel about the risks of breast cancer versus the risks of osteoporosis or heart disease, on how severe your menopausal symptoms are versus the side-effects you get on HRT, and on how you feel about taking hormones. How do you balance an immediate improvement in your quality of life against the long-term risks, especially of breast cancer? How much would you risk the possibility of side-effects now and breast cancer later to gain the many other benefits it brings? As a general rule, we tend to be more worried about taking a treatment that has an increased risk of disease than about failing to take a treatment that could decrease the risks of other conditions.

Oestrogen replacement therapy has been available since the 1940s, and its beneficial effects have been well documented since the 1950s. Yet, over 40 years later, fear and confusion among both doctors and their patients is still preventing the majority of women from receiving – or continuing with – a treatment that can enormously improve so many aspects of their lives.

The eminent British gynaecologist, John Studd, has described oestrogen therapy for post-menopausal women as:

‘probably the most important advance in preventive medicine in the Western world for half a century, with fewer heart attacks, fewer strokes, fewer osteoporotic fractures, less depression and an extra year or two of life.’

This is how some women sum up their own personal experiences of HRT:

‘I know many people feel women should be able to struggle on without it, or use more natural remedies. All I know is that it has made all the difference to how I feel, and to my life in general.’

‘After taking HRT for a few months I decided to stop, because I felt it was unnatural and I didn’t think I really needed it. All my symptoms came back and I started to feel quite unwell again, so I went back on it. I feel great now, but I’m not completely happy that I only feel really well if I keep taking die hormones.’

‘I was developing a lot of unexpected aches and pains, and intercourse was uncomfortable and ‘dry’, and I wasn’t really interested in it. My joints feel much more supple since I started taking HRT; and intercourse has become a pleasure again.’

‘I was given an implant after a hysterectomy at the age of 45. Before then I had been suffering from aching joints and tiredness. Now I feel fine. I know that a few women with implants can become ‘dependent’ on it because it makes them feel so good, but mat hasn’t happened to me.’

‘Taking HRT was my doctor’s idea, and I feel I’m lucky to have a doctor who believes in it and who has been prepared to keep trying to find the one that suits me best.’

‘I hope it will give me a good quality of life.’

‘I am my old self again.’

‘There is a new vitality about me that I thought had gone forever. I had some side-effects at first, but they soon wore off and my doctor has been tremendously helpful and supportive all the time.’

‘How does it make me feel? In a word – brilliant.’

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HYSTERECTOMY: QUESTIONS OFTEN ASKED

My gynaecologist advises a hysterectomy because my fibroids have grown since I started on hormone therapy fourteen months ago. What should I do?

Fibroids only need to be treated if they are causing symptoms such as heavy or painful periods, abdominal pain, or difficulty with bowel or bladder function. Treatment is also necessary if there is any suspicion that a fibroid is turning into cancer, as indicated by its rapid growth. This is a rare occurrence, affecting only about one woman in every 800 with fibroids. If your fibroids are growing but are not causing any of the symptoms mentioned or are not suspected of becoming cancerous, then treatment is not necessary. If you are nevertheless concerned about their growth, you should consider whether you can do without hormone therapy or whether an alternative type of hormone therapy is worth trying.

Do I really need a hysterectomy?

If you are uncertain you should seek a second opinion by consulting another specialist or asking your general practitioner for advice and for another referral. Don’t be steamrolled into making a decision. It is extremely important that you are satisfied you have all the necessary information and expert advice needed before proceeding.

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