Monthly Archives: May 2009

SUDDEN INFANT DEATH SYNDROME (SIDS): IMPACT

Impact

Parents and other family members are understandably devastated by SIDS. They feel anger, guilt, frustration and above all, grief. Anger is often directed towards health professionals, for somehow not preventing this from happening, or towards family or friends. Parents will re-examine every moment over the last few hours or days of their child’s life, searching for some clue as to what may have contributed to the death. They will also feel guilty, wondering whether, if they had done things a little differently, the baby might still be alive. They may feel guilty that they did not check on the baby before going to sleep themselves, or that the cot was not in their room, or that they did not wake the baby for a midnight feed. Some of these thoughts are rational, others are not. They are a normal part of the grieving process, and will come up irrespective of any reassurances.

The parents can be reassured that there is absolutely nothing that could have predicted the death of the baby, and nothing that could have been done to prevent it. In each state there now exist branches of the SIDS Foundation, which provides counselling for bereaved families, as well as funding SIDS research and conducting community education about SIDS. It is frequently of enormous assistance to families to talk with trained counsellors from this organisation. The tragedy will also have a devastating effect on siblings, as well as on members of the extended family such as grandparents, and counselling should be considered for these family members too.

Some parents form even closer attachments to surviving children, or to subsequent babies. While this is understandable in the short term, it can be problematic for both those children and the parents in the longer term. Alternatively, pare it may grieve for the dead child to the extent that they neglect the emotional needs of surviving children. There is considerable variation in the way families handle the grieving process. Some may feel the need to talk about their sorrow, while others bottle up their emotions. Others will concentrate on ‘getting on with life’, making themselves very busy, as if to avoid having time to think about their feelings.

Sometimes the death results in increased tension between the parents. This can be due to a number of reasons, from different ways of handling their emotions, to disagreements about having future children. It is very important that families be supported through these times in ways that are appropriate to them, taking into account and respecting the fact that all individuals will have differing needs. Sometimes referral to a trained professional such as a psychologist, social worker, grief counsellor, or seeing a sympathetic family doctor is of immense help, while others may be helped by a minister of religion.

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WHAT THESE SUBSTANCES MAY DO TO YOUR BABY

Alcohol Daily consumption of alcohol during pregnancy, as few as two or three drinks a day, can lead to problems with your baby’s development and growth, the risk of prematurity and even congenital abnormalities including heart problems. Babies of alcoholic mothers are at increased risk of suffering from foetal alcohol syndrome. Babies affected by this have stunted growth, mental retardation and abnormal facial features. Alcohol is best avoided entirely during pregnancy. If you drink more than 2-3 glasses of alcohol per day and are unable to cut down during pregnancy, we suggest you discuss this with your doctor.

Smoking Women who smoke during pregnancy tend to have smaller babies. The chemicals breathed in include nicotine, and interfere with the baby’s growth. Statistics show that, on average, the baby of a mother who smokes during pregnancy weighs around 200 g less than average. (If a baby is significantly underweight when it is born, it is less likely to thrive and remain healthy.) It is also at a higher risk of developing complications at birth, and there is a significant risk of it being born prematurely. Passive smoking may also affect the baby before it is born, so it is advisable for the mother’s partner to refrain from smoking in the house. If you are unable to stop smoking during pregnancy, we suggest you discuss this with your doctor.

Painkillers Check with your doctor before taking any medication during pregnancy. Painkillers in particular can be harmful to the baby in many different ways. Try relaxation techniques, yoga or massage as an alternative for pain relief.

Drugs of addiction These can cause severe problems during pregnancy and birth, and the baby may also be ‘addicted’ and suffer severe withdrawal symptoms after birth. The baby is usually underdeveloped and may become severely ill. It is important that you let your health professional know if you are using any drug of addiction during your pregnancy.

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YOUR MARITAL HEALTH/SEX AND PROBLEMS OF DAILY LIVING: TIMELESS LOVING

I just don’t know where time goes, but it goes somewhere. It moves ‘ faster and faster. If you talk to anybody, they will tell you that time seems to be going faster and faster, seasons merging into seasons. No matter what else we do, there just isn’t much time for sex if there isn’t much time for anything.

WIFE

Our concept of time is tied directly to our concept of life and living, how we view our world, those we love, and what we hope for and expect out of life. I have discussed the time issue in earlier chapters, but there is one central point the couples raised that can help all of us view time in a somewhat different way.

“When we are actually having sex,” reported one wife, “while we are doing it, there is no time at all. I mean, time doesn’t stop or go, it just isn’t. Now, after we have sex, we sometimes lean over and check to see what time it is, but during our sex, that is the only time there is no time.”

This wife and other spouses interviewed indicated that sexual intimacy, the total involvement and merging with another person, is not tied to the time dimension. As pointed out earlier, modern physicists, including Einstein and other so-called new physicists, have documented that time is not a concrete, easily measured “thing.” It is, rather, a highly abstract concept that depends on where we are, whom we are with, and what we are doing. During super sex, we are with the person we love, doing what we want to where and when we want to do it. Our consciousness is altered We are more into someone, responding to that someone rather than carried along by the ticks of a clock.

Perhaps time seems to be going so fast because we watch it so much. The abstract, subjective nature of time is reported by the following spouse with cell disease: “I have learned to sit and do nothing or to make love with my husband. Then time stands still or seems to go slowly. When I first learned I had cancer, I started to do everything I could to stay active every moment. I think I was speeding up time”, because the more I did, the less time there was. Now just sitting, even being bored, seems to make more time.” We do not have to be victims of time if we set the rhythm of our own living.

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AFTER THE OPERATION – DECISIONS ABOUT YOUR PERSONAL LIFE

The exact figures are different for different cancers, but they all tend the same way. The outlook is best if it is confined to the organ it started in. It is less good if it has spread to the nearest lymph glands. It is even less good if it has spread into adjacent tissues. It is worst of all if it has spread through the blood, in which case hopefully an operation aiming at cure would not have been attempted. Ask your surgeon for the figures which apply in your particular case.

I know I’m asking you to be very brave here. It may seem much easier to say: ‘Well, I’ll just hope for the best—I don’t want to know what my chances are.’ Don’t forget you can still hope for the best when you do know what your chances are! There are disadvantages to being ignorant. It can mean that you miss out on having additional treatment which might improve your chances. It also means that you cannot realistically plan your personal life. I feel very sad when I remember how often people who have been referred to me for extensive cancer have said things like this: ‘My surgeon told me three years ago that he’d got it all. I’ve just kept on leading a normal life. If only I’d known this was likely to happen I would have . . . taken that overseas trip I’ve planned for so long . . . left that job I hated so much and gone back to studying .. . made up with my brother-in-law so I could see more of my sister . . . learnt to drive a car . . . left my husband then instead of waiting till the kids were older . . .’

Perhaps these people would have made the same decisions if they had known the true situation. Perhaps not. Be brave and ask the questions I suggest. Then, you can make decisions about your personal life which do take into account what is likely to happen in the future. Try to keep this information in perspective. Some people go to extremes—they either allow themselves to be overwhelmed by it or they dismiss it from their minds altogether. Remember that, whatever the statistics say, you can still hope that you will be the lucky exception. Most of us thrive on hope and why not? Just try not to let that hope develop into a fixed and unrealistic belief that you will be the exception. Such a belief could prevent you from making the most of whatever life you do have left.

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HYPERTENSION – CAUSE OF HYPERTENSION

A rise in blood pressure may be due to other conditions. Most forms of kidney disease can cause it, including congenital anomalies of the kidneys or the arteries leading to them.

It may be due to chronic infection or inflammation of the kidneys. Disorders, particularly tumors, of the adrenal glands, which lie above the kidneys, may also cause hypertension.

Many of these secondary cases can be treated and cured and so, particularly in the young, they should be looked for before the decision to treat the high blood pressure.

The doctor should take a full history, then carry out a complete physical examination and, as in most other medical conditions, this should reveal the true diagnosis.

Special examinations may then be necessary to confirm or deny the diagnosis but do not replace the need for history and examination.

Special tests may not only reveal underlying causes but also any damage to other organs.

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ACNE

Acne is mainly a problem of teenagers. The overactivity of the oil glands in the skin is due to the action of androgens or male sex hormones.

These are produced in both sexes but, in the female, are dominated by oestrogens or female sex hormones.

When there is an excess of androgens in the female, acne or excess body and facial hair may result.

Diet is no longer regarded as being of great significance in treatment. Local applications of sulphur-containing lotions have been abandoned, as, in some people, it has caused an increase in the number of blackheads.

Sometimes the strongly oestrogenic forms of the Pill have been of benefit in controlling the acne of young women.

Oestrogens given to young men will certainly reduce or clear their acne but at the price of interfering with testicular function. This may cause enlargement of the breasts, a female type of distribution of body fat and a decrease in sexual desire.

The tetracycline group of antibiotics have been widely used for some time. These are given in small doses over a prolonged time. Local applications of benzoyl peroxide or retinoic acid (tretinoin) have replaced other local applications and seem to offer better results.

Young women taking tetracyclines for acne should have adequate contraception if they are sexually active. This drug can, in early pregnancy, lead to disturbance of bone growth as well as causing staining of the baby’s teeth.

The scars left from acne may be unsightly but can be improved by the treatment known as dermabrasion. The superficial layers of the skin are abraded.

Never squeeze a pimple; it only makes it worse, spreading the infection and leading to scars.

No teenager needs to suffer from severe acne as treatment is now available.

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ENDOMETRIOSIS: A SHOCKING CURE

A very distressing—and far too typical—letter came us recently from a woman in Ohio, written on the eve of her twenty-sixth birthday. Karen described her tangled history with endometriosis, beginning with her final decision: the prior week, she wrote, she had signed a document giving her doctor the right to perform surgery to “clean up the endometriosis and save as much of my organs as possible.” Her letter went on to detail her story:

For two years she had suffered from cramps, bleeding, and intense abdominal pain. One afternoon a cyst ruptured as she was driving to work. Miraculously, she got herself out of the car and Ragged down a good Samaritan who took her to a hospital, where she was given emergency surgery.

At this point, Karen did not know she had endometriosis. After surgery, her doctor put her on tranquilizers for her continuing pain; then he followed up with hormone treatments to quell her menstrual cramps. She subsequently had two miscarriages and her doctor ran some tests on her, including a laparoscopy (the surgical procedure that enables doctors to see into the pelvic area). It was then finally that he discovered endometriosis!

“My doctor was very comforting.” Karen said in her letter, “and I’ve always trusted him. He said there was a slim chance that I’d need a hysterectomy, but he’d try to save what he could. Of course, I heard the words I wanted to hear: he’d save me. I woke up from surgery and he told me the news. He hadn’t saved anything and he’d given me a hysterectomy. That ended it for my ever having children and I wasn’t yet twenty-six years old! I felt as if I’d been butchered, like a human sacrifice! But if he said I needed a hysterectomy, who should I believe? He also said that, in another month, I would have to go on estrogen supplements since he had removed both my ovaries, too. Was he wrong? What would you do?”

This woman’s castration was presented to her after the fact as the only answer to her problem. Her surgery was needless. Had she seen a specialist in endometriosis, we feel certain that she could have had a chance at recovery. Touting her doctor may have given her a measure of comfort, but this was not enough. As we see it, when her doctor operated, he did not have the expertise to understand that the internal bleeding was caused by endometrial masses. Doctors who do not have a trained eye can miss the condition in its earliest stages, even when it is literally at their fingertips. They may mistake it for something else—an infection or even cancer. This doctor’s choice of treatment – complete hysterectomy—harks back to what was common practice over a decade ago for such “far-gone” cases. That this physician subsequently prescribed hormones in the form of estrogen replacement so soon after surgery indicates another gap in his knowledge.

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PSYCHE AND THE SKIN: HYPNOSIS

Hypnosis is essentially a state of mind, one which is usually induced in one person by another. It is attained by strict attention to either an object or to the repetitive spoken word. It results in a state of mind in which suggestions are not only more readily accepted than in the awake state, but are also acted upon much more powerfully than under normal conditions. Under hypnosis, one has access to the unconscious mind without the barrier of criticism normally presented by the conscious state. The actions and behaviour of a hypnotized subject may be compared with those of a person suffering from temporary absent-mindedness. Absent-mindedness is a state of mind that may come on suddenly and unexpectedly. It lasts for an indefinite period and then passes off equally suddenly. In such a state a person may start to do a job, and will do it just as efficiently and as thoroughly as in his normal state of mind. Yet when the absent-mindedness suddenly terminates, he will look and say ‘Good heavens, when did I start doing this?’ The state of the hypnotized person is, in many respects, similar to that of the absent-minded person, the basic difference being that under hypnosis a person’s receptiveness to suggestion is tremendously enhanced. However, at no time is there loss of control. Your personality is always there, but maybe likened to an ‘observer’. Techniques for painless childbirth are essentially hypnosis techniques. Acupuncture is also a form of hypnosis, although other factors may also be involved.

Two specific aims of hypnotherapy are ego-strengthening and symptom removal. Under hypnosis it is relatively easy to instil in a subject a sequence of simple suggestions designed to

remove tension, anxiety and apprehension, and to gradually restore the patient’s confidence in himself and in his ability to cope with his problem. Once this has been accomplished, one may successfully modify or remove specific symptoms, such as itching. The patient under hypnosis may also be guided, reassured, persuaded, and if necessary, reconditioned.

Depending on the nature of the patient’s problem, the patient may then be taught the technique of self-hypnosis, and in certain circumstances, can be given a code word which, when recalled under appropriate circumstances, will facilitate the self-induction of a hypnotic, relaxed state. Some patients prefer the use of a tape-recording made for them by the therapist, which they can use when circumstances demand it.

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DIETARY FAT AND HOW TO REDUCE IT

Summary of main points. Fat in food is a mixture of saturated, poly- and mono-unsaturated fatty adds, with different proportions in different foods.

• While saturated fats have the most detrimental effect on health, all fats and oils are currently thought to increase body fat.

• Reduction of fat should be the primary goal of any fat loss program, within a balanced diet.

• Client education should involve:

— assessment of dietary fat intake for obvious as well as hidden fats

— analysis of food choice and food preparation methods

— recommended food selection and preparation for dietary fat reduction

— information on how to read food labels and ingredient lists

— explanation of nutritional claims about fat in foods.

• Reducing fats in the diet is the single most important factor for fat loss.

The nutritional issues are intended to highlight the nutritional mediating component considered in the model of obesity (i.e. fat/energy intake).

As such, we will consider dietary fat and how to reduce it in detail in this chapter, then the alternative; increasing dietary carbohydrate and fibre. Reducing fat intake is regarded as an important part of a healthy eating pattern.

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TREATMENTS TO HELP MANAGE PAIN: TAI CHI AND YOGA

Tai Chi was developed in China generations ago and consists of a series of slow, dance-like steps.

Using correct breathing, controlled stretching and gentle artistic movements, and it is a graceful way of keeping fit without much effort.

According to the Chinese this art of gentle relaxation and controlled body movements increases the body’s tolerance against disease and illness and helps rejuvenate the whole person.

It claims to relax the mind and body, improve circulation, loosen stiff joints and tone up muscles.

If you find vigorous exercise difficult or painful then you may like to try this gentle form of exercise.

Yoga

There are many different varieties of yoga, the most familiar in western countries being Hatha which involves physical postures that balance and harmonise the body systems. It is believed that yoga stimulates your natural powers and therefore gives you greater control over your well-being.

Yoga postures — known as asanas — flex the joints, stretch and tone the muscles and improve the body’s circulation.

The maintenance of slow and rhythmic breathing while the postures are being performed helps relieve body tension and therefore increases the effectiveness of the body positions.

Asanas should never be strained but should be practised slowly and gracefully.

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