“He would come into my room at night, late if my mother was home, earlier if she was working. I’d wake up and he would be there, standing over my bed, whispering my name.” Sylvia, a schoolteacher who is in her third marriage, trembles as she recounts events that occurred almost forty years ago. “I wasn’t scared the first time,” she says. “I didn’t know what was happening, and even when I did, I didn’t understand it. I remember thinking it was just a bad dream. But it kept happening. There was nothing I could do to stop it. It wasn’t a bad dream. I know that now. But it was a nightmare that I still live with every day.”

At least once a month and sometimes as often as once a week, Sylvia’s father, a dock worker whom she describes as “a giant, a huge, powerfully built man,” sexually molested her. The incest, which involved fondling of her genitals and oral sex, began when she was six and lasted until her twelfth birthday. She never knew why it started or why it stopped. She always knew when it was about to happen, however. “I could tell by how he looked at me when I came downstairs to say good night,” she explains. “I’d go back upstairs, get into bed, and lie there, waiting, so scared, my heart pounding so loudly that you could have heard it in the next room.” Fear was only one of the painful emotions that washed over Sylvia during her father’s unwelcome visits.

“I’d go back and forth like a yo-yo,” she continues. “Sometimes it felt good. But then I would feel disgusted. I wanted to vomit, to scream, to scratch his eyes out. But I never did. It was out pf control and I was completely powerless to stop it. I was terrorized.” Eventually, young Sylvia discovered that she could “turn off my brain just totally block out my feelings and remove myself from the situation.”

That is precisely what she did each time her father molested her and what she continued to do forever afterward. In fact, Sylvia, who was forty-five when she came to us for sex therapy, completely blocked the incest from her mind, having absolutely no conscious memory of it. Then, after four months of therapy, the memories started coming back. After years of psychotherapy and participation in an incest survivors’ support group that helped her face and work through many of her emotional conflicts, Sylvia has recently begun to experience sexual desire.

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Contrary to popular belief, foods such as bread, pasta, and some baked goods are low in fat and calories. However, you have to be selective about what you add to these foods. For example, fat-laden cream-based or cheesy sauces are often added to pasta. Likewise, not all baked goods are low in fat; croissants, many sweet breads, and even some crackers are high in fat.

Look for whole-grain breads and cereals instead of refined products. Whole grains have more protein, fiber, and trace minerals such as iron, which are stored in the kernel’s bran and germ. During the refining process, the kernel’s bran and germ are removed.

If you choose whole-grain products, you will automatically increase the amount of fiber you eat. Foods high in fiber are good replacements for higher-fat food choices.

Fiber comes in two forms: soluble and insoluble. Soluble fiber is most beneficial for the health of your heart. Soluble fiber seems to regulate your body’s production and elimination of cholesterol. Good souses of soluble fiber are oat products, dried beans and peas, lentils, apples, and citrus fruits.

Insoluble fiber, because it travels through your digestive tract faster than soluble fiber, may prevent or relieve constipation. Some experts believe that because insoluble fiber moves through your body faster, it may reduce the time that potentially cancer-causing substances remain in your digestive tract. Insoluble fiber is found in whole-grain products and many fruits, vegetables, and cereals.

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Some women experience pains similar to labour pains from the seventh month onwards. These pains are known as ‘false labour pains’. If you have these pains, and they last a long time or are associated with a show of blood or water, then see your practitioner or go to the nearest hospital.

First stage

True labour pains occur in the lower abdomen and are cramp-like in nature. These pains usually last from 15 to 30 seconds and are spaced 10 to 20 minutes apart. When these pains start then the mother is in the first stage of labour.

It is common to have a ‘show’, a ‘show’ being the term used to describe the bloodstained mucous. This is followed later, especially after a labour pain, by water. This is known as the breaking of the waters. The waters, or liquor amnii, are produced by the thin lining membrane called ‘the amnion’. This fluid encases the unborn baby, protecting it from external harm. The waters are also important as they lubricate and cleanse the birth canal and help dilate the cervix.

Second stage

The second stage of labour is said to have started when the cervix is fully dilated (expanded). In this stage the contractions will occur every two to three minutes, they may even be more frequent and usually last one to two minutes.

The mother will now have a desire to bear down or push and at this stage she should be encouraged to pant, keeping her mouth open and not holding her breath.

There will be a bulging of the perineum and an increase in the flow of the bloodstained waters. Baby’s head should now be visible and be facing the mother’s anus. As the birth progresses the baby’s head will usually turn to one side.

With the next push, if all is going to plan, the most exciting experience occurs, the birth of the new baby. This newcomer to our world is wet and slippery and is still attached to the mother by the umbilical cord.

Third stage

The third stage of labour is the delivery of the placenta or afterbirth, up to 10 or more minutes after the birth of the baby. To encourage the expulsion of the placenta, the baby will be put on the mother’s breast. This breastfeeding will also help the uterus to contract and control bleeding.

The new child

The wonder of the creation of this new life will last a lifetime. Parents and relatives, after counting all the fingers and toes, are already looking closely at the baby’s ears, nose, and chin to decide which members of the family the baby takes after.

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Ramesh Sood was a building contractor who used to engage Banta Singh as a petty sub-contractor. At the time of measurement there used to be a big row between the two, and everytime Ramesh Sood swore he would not deal with the other man in future, and yet he repeated the same mistake again and again. When this row occurred between the two for the 4th time, the matter took a serious turn. Ramesh was on the verge of collapse, his body drenched with cold sweat. He was already a heart patient. The doctor warned him against any work which would accelerate his heart beat, and advised complete bed-rest. When Ramesh got the next contract, all his friends advised him to snap his connections with Banta Singh and keep him away from the next contract.

But Ramesh Sood was a confirmed Chestnut Bud Negative type. He engaged Banta Singh. Another row and this time the consequences were more serious. He got a paralytic stroke and had to be bed-ridden for 6 months during which time Chestnut Bud was given 3 times a day along with other medicines for paralysis.

When he finally recovered from the paralytic stroke, he had already learnt to benefit from the past experiences. He never employed Banta Singh again.

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If status epilepticus is the child’s first seizure, then the doctors will probably want to do a lumbar puncture (spinal tap) to look for infection. They will study the blood for possible chemical changes and, perhaps, do an EEG then or the next day. They may even do a CT scan.

If the child has had other seizures or has epilepsy, then looking for a cause of the status may be slightly less important.

The most common cause of status epilepticus in a person who has previously had seizures is that the level of medication in the blood is too low. This may be because the child is not taking his medication, or that it has been forgotten, or that an interaction with some other medication has lowered the level. Substitution of a generic drug that is less well absorbed may also result in status epilepticus.

In almost all instances, the status epilepticus can be controlled within one-half hour to one hour from the time the child arrives in the emergency room and treatment is started. Only in an unusual situation, when there is an acute process occurring in the brain such as infection or damage from a head injury, do seizures continue, and are they difficult to control. Treatment of severe prolonged status epilepticus can be enormously challenging for the physician, requiring large doses of medication given in an intensive care unit and sometimes requiring general anesthesia to stop the seizures.

The outcome of status epilepticus, even in these severe episodes, depends more on the cause than on the duration of the seizures. Rest assured that most children who have status recover and are just as normal as they were before the seizures. It appears to be very, very rare for children who have status without a known cause to suffer any permanent damage, even from prolonged seizures.

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Cholesterol and triglycerides have garnered most of the health news headlines in the past few years. Westerners have been told they have to follow a low-cholesterol, low-fat diet to reduce their risks for heart disease.

As a person with diabetes, you are among that very same group of persons who should be watching fat and cholesterol. As with the risk for high blood pressure, you have some strikes against you in the blood fat area, too. You probably have been eating a high-fat diet most of your life, are overweight, and have diabetes. The first line of treatment for above-normal blood fat levels is diet and exercise. Sound familiar? Your diabetes meal plan is designed to lower your overall fat intake. And your exercise programme helps burn kilojoules and fat. In some people, both can work to bring blood fat levels into the normal range.

Other recommendations for treatment of your diabetes apply in the blood fat area too: learn to cope with stress. Stop smoking. Be moderate in your alcohol intake or abstain completely.

When diet and exercise alone are not effective for lowering blood fat levels, your doctor can prescribe drug treatment. There are drugs to reduce both cholesterol and triglycerides, and sometimes these drugs are used in combination to increase effectiveness and reduce the potential for damage, especially to the kidneys.

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The fact is that any cholesterol we get from food is too much; our bodies just don’t need it. That’s because there are actually two different methods by which serum cholesterol is elevated: through the intake of dietary cholesterol and through the internal manufacture of cholesterol by the body itself in response to high intakes of saturated fat.

It’s important to understand, first of all, that cholesterol is not an essential nutrient, which means there’s no need for it in our diet. In fact, dietary cholesterol – the cholesterol found only in animal products – has been proven harmful to our arteries and has no known benefits at all. So even though cholesterol is a vital part of all of our cell membranes and is a precursor to many hormones and to vitamin D, we don’t need to eat a bit of it. Why not? Because our cells can make all we need – even if we’re on a cholesterol-free diet.

Every cell in your body is capable of making cholesterol, but by far the greatest amount is produced in the liver and intestines, which manufacture about 500 to 1,000 milligrams a day. Even if you never ate any cholesterol at all, your body would still produce whatever cholesterol it needed. Remember, too, that whenever you eat foods containing saturated fat (whether they contain cholesterol or not), your liver responds by automatically overproducing cholesterol – none of which is needed – and reducing its ability to remove dietary cholesterol from the bloodstream.

It’s clear that whatever cholesterol we do get from our food represents a surplus. And for most of us, sooner or later that surplus could contribute to cardiovascular disease. While most people can handle small amounts of dietary cholesterol with reasonable safety (up to about 100 milligrams a day, a little more than you’ll find in 3| ounces of skinless chicken breast or lean beef), Americans on average consume over 400 milligrams a day – a chronic cholesterol overdose. The obvious antidote is a simple but lifesaving one: Limit our intake of animal products, since they are the only source of dietary cholesterol. But that alone isn’t enough; it’s essential to limit our intake of saturated fat as well. Moreover, as we’ll learn shortly, to attain a truly safe serum cholesterol level we also have to increase our intake of foods that contain soluble fiber.

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Be as fit and healthy as you possibly can be going into surgery or treatment – low fat, balanced meals; no drug taking. Many of the contributors admitted to ‘drowning their sorrows’ immediately after the diagnosis as a way of coping with the shock. All admitted it didn’t help – the j hangover just slowed their preparation. However, if smoking and drinking alcohol is a pattern of normal life, pressure by others to give these habits up at this time may increase your stress. Some women on organic and natural therapies increased the quality of their diets and lifestyle. Drinking alcohol just before chemotherapy may interfere with the drugs and set you back. One specialist presents his patients with a bottle of champagne after all chemotherapy is finished – a terrific time to celebrate!

Organize and delegate the household management to family and friends. It is not often in life that so much assistance will be offered. Graciously accept it. Be ‘Goddess of your Kingdom’ and list all the chores that take most of the time, which will deny loved ones time with you, or ‘mental ease’. Ironing, cooking, cleaning, creche/school pick up/ duties. A ‘dirty’ house however is not the end of the world. Sometimes doing what you need to do (such as household chores) feels good if it distracts and makes you feel better. Just don’t exhaust yourself.

Inform work and organize sick leave if you need and want to. Some women like to continue working; delegate career projects; organise your salary entitlements or income protection insurance, if you have it. You will need to decide who needs informing of your condition at this stage, and how you will share the information. Cancer Councils have excellent resources to support organizations and their staff. Nominate someone to be the information contact point. The professional relationship will wear thin if your home /hospital is bombarded with zillions of calls from concerned colleagues. Find out from your doctor a realistic time for you to go back to work. Think about easing yourself back to work by going part-time.

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Signs and Symptoms

Patients with folliculitis have scattered pustules and small red papules centered around hair follicles. Lesions may be mildly pruritic or painful. Systemic symptoms are very rare.

Pustules are confined to hair follicles, typically in one region of the body such as the chest, thighs, or back. However, follicles throughout the body can become infected over the course of a few days. In bacterial infections, most pustules still have a hair shaft protruding from the center. There may be some surrounding erythema and slight swelling.

Main Causes

Staphylococcal Folliculitis: Staphylococcal infection should be suspected if erythema, swelling, and tenderness are striking. If needed, culture should be performed by shaving a pustule with a scalpel and sending the whole pustule for culture. Oral antibiotics are preferred when staphylococcal infection is suspected.

Gram-Negative Folliculitis: The gram-negative organisms Klebsiella, Enterobacter, and Proteus can also cause folliculitis. Infection typically occurs on the faces of acne patients treated with long-term antibiotics active against gram-positive organisms. Topical erythromycin is usually effective. Severe cases are treated using amoxicillin-clavulonate (Augmentin) or even isotretinoin (Acutane).

Hot Tub Folliculitis: Folliculitis acquired from wet objects such as hot tubs, whirlpools, loofah sponges, or wet suits is usually caused by Pseudomonas aeruginosa. Lesions appear on exposed areas of the trunk and extremities between 6 and 72 hours after contact. In immunocompetent patients, lesions typically resolve spontaneously within 10 days. Treatment is not required, but the source should be cleaned and new tub water properly sanitized. Pseudomonas in a loofah sponge is killed when the sponge is simply allowed to dry completely. Soaks in 1% to 5% acetic acid, topical silver sulfadiazine cream, or garamycin cream may be helpful. If needed, systemic fluoroquinolones can also be used.

Treatment

Topical antibiotics work well in most cases of superficial bacterial folliculitis. Antibiotics should be targeted against the presumed etiologic organisms. Therapy should be continued until lesions resolve.

If follicles are widely distributed, systemic antibiotics can be used.

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Alcohol and illegal drugs such as marijuana and cocaine can contribute to problems of initiating and maintaining sleep. Many other drugs used to treat a variety of medical conditions also possess the undesirable side effect of disturbed sleep. Barbiturates and other hypnotic drugs, for example, may produce sleep disruptions not only while they are being used but during the period of withdrawal as well. Some benzodiazepines have a short half-life (the period in which half the drug is metabolized), in some cases as little as four hours. This is desirable when control must be exercised over how long the drug acts in the body; the downside is that once the drug begins to wear off, sleeplessness may return. This phenomenon is called rebound insomnia. Interrupted sleep is also associated with the use of or withdrawal from those agents used in cancer chemotherapy and thyroid preparations, opiates, and anticonvulsive drugs.

Often a patient is reluctant to tell me about the use of controlled substances, especially the illegal ones or stimulants such as amphetamines. If I suspect that is the case, I will order blood or urine analysis tests. In extreme cases the use of EEG tracings can indicate the presence of drugs. My interest in ordering such tests is not to catch a patient in the act but to obtain as complete a medical profile as possible, so that I can understand the true nature of the problem and deal with it in the most appropriate fashion.

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