Doctorshealthsystems

During a child’s life a number of important transitions take place which are unavoidable and are part of growing up. These transitions can be positive or negative for the child, depending on the nature of the experience. Some events are always stressful (such as a death in the family), while others may be positive (such as a are experienced as positive or negative, depend on a host of factors.

Amongst the most important factors which determine how a child will experience and react to a new transition are the temperament and age of the child. A child who is shy, or lacking in self-confidence, will almost always find any transition or change in normal routine stressful. Young children who do not have the maturity or cognitive capacity to understand and anticipate transitions will often find them more stressful than older children, though this is relative and depends on the situation.

The family situation, and how parents cope with transitions, is also crucial because children so often model their behaviour on that of their parents. If a child sees that parents are highly stressed because of the changes, he too is likely to react negatively. If, on the other hand, the parents react positively, the chances are that the child too will take a positive approach to the change. The nature of the transition itself is important of course, as well as the amount of preparation the child has had in anticipation of the change.

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People often voice the fear that if they take strong painkillers now, they won’t work later. This is not true. There is no quota on painkillers that can leave you with nothing to fall back on once you’ve ‘used it up’. They will keep working. Admittedly, as I’ve already mentioned, you may need a bigger dose to get the same effect, but you can still get the same effect. So take the painkillers you need now, they will still work later.

Sometimes people are very reluctant to take a drug such as morphine because they think this is used only in the terminal stages. This is also not true. I recommended morphine often, to people with all stages of cancer, because it is a good painkiller. People who did indeed have incurable cancer often continued to take it with good effect, for many months. Don’t save strong painkillers for ‘the end’, use them when you need them.

Another reason you might have for taking insufficient painkillers to completely relieve pain is because you fear actual or anticipated side effects. We talked a bit about the actual side

effects earlier, and the need to find the balance between pain relief and side effects that is best for you. There are also the invisible, possible future side effects like kidney damage. This is

only a concern for people taking a lot of painkillers every day for many years, so it is not a real worry for you. Either you will recover from your cancer, in which case you won’t need to keep

taking painkillers or your cancer will not be cured, in which case possible kidney damage years hence is not really a concern. Either way, there’s no need to let this stop you from taking the painkillers you need now.

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These are usually soft and multiple. Hundreds may be present.

Fortunately these warts clear rapidly with whatever treatment is used.Podophyllin may result in a rapid clearing of most of the warts even after one application.

Diathermy, usually under general anaesthetic, is also effective.

They are usually, but not always spread by sexual contact.

The seborrhoeic or senile wart is different from those already mentioned.

This is an overgrowth of the basal cells of the skin, and it produces a round, raised, greasy, brown or black lump.

They are more common in the middle aged or elderly, and occur mostly on the back.

The greasy, raised protuberance can easily be scaped off with a fingernail or scalpel. And this leaves a slightly raised, reddened, sometimes bleeding surface.

Like the other forms of warts they never become cancerous but the appearance may be unacceptable.

And for this reason they can be removed. This is usually done by electric diathermy or by the application of liquid nitrogen.

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The wart can be removed by cutting it out, by curetting after softening by special ointments, by burning with electric diathermy or by freezing with liquid nitrogen.

Ingrown toenails are painful. This involves the big toenail on either or both sides. The nail should be cut straight across and not rounded as this may encourage the edge to dip in, and grow, cutting into the tissue at the side.

In the acute state, the offending piece of nail may be cut away by the sufferer, the doctor or the podiatrist.

Persistent or recurrent ingrown toenails do well with operation. This is done under local anaesthetic and usually involves wedge resection. The edge of the nail and the nail bed are removed and the wound allowed to heal.

If both sides are involved, a wedge resection on each side of the nail is possible, resulting in a nail narrower than before. When both sides are involved, the nail may be totally removed, along with the nail bed, so it cannot regrow.

Flat feet are often blamed for causing pain. The sole is flat at birth and the arch does not develop until the child begins to walk.

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Inflammation or infection in the urethra can occur from the pressure exerted on this tube by a baby during childbirth. Sexual intercourse may also cause pressure. Sometimes the pelvic congestion due to retained fluid before a period may lead to congestion and inflammation in the urethra.

The urethra is derived from the same embryonic tissue which forms the reproductive organs and, like them, is influenced by the hormone oestrogen.

After the menopause, when the amount of oestrogen is greatly reduced, the urethra can become thinned and more easily infected or damaged. For this reason, post-menopausal women often develop bladder irritation following intercourse.

Fortunately, treatment is effective. Oestrogen, given either by tablets or as a local cream or pessary, reverses the changes in the urethra and stops the recurrence of symptoms.

For those woman who suffer repeated attacks of bladder irritation every few months, the best means of prevention may be taking small, regular amounts of antibiotics to prevent infection in the urethra.

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How important are these statistically significant differences to real live people? This is a question that many doctors neglect to ask themselves or to allow their patients to decide. I have heard doctors claim that a treatment involving five different injections which caused nausea, low blood counts, hair loss and many other unpleasant side effects was ‘better’ than a treatment consisting only of tablets with very few side effects. The first treatment was ‘better’ because it produced a statistically significant improvement in the average length of life— three months longer than with the tablets. So when your doctor recommends a certain treatment, telling you that research has shown it to be the ‘best’, make sure you find out just what this means and what the alternatives are. Given all the information about each treatment, you may or may not agree with your doctor’s conclusion.

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What effect does fibre have on the G.I. value?

Dietary fibre is not one chemical constituent like fat and protein. It is composed of many different sorts of molecules. Fibre can be divided into soluble and insoluble types.

Soluble fibre tends to be viscous (thick and jelly-like) and will slow down digestion for this reason. Foods with more soluble fibre, like oats and legumes, therefore have low G.I. factors.

Insoluble fibre is not viscous and doesn’t slow digestion. Wholemeal bread and white bread have similar G.I. factors. Brown pasta and brown rice have similar values to their white counterparts. Sometimes insoluble fibre acts as a physical barrier which prevents the enzymes from attacking the starch. Whole (intact) grains of wheat, rye and barley have lower G.I. factors than cracked grains.

Bread has a G.I. of around 70 and lentils of around 29. Can I eat twice as much of the low G.I. food as the high G.I. food?

Yes, your blood sugar levels should be approximately the same after two serves of lentils or pasta compared with one serve of bread or potatoes. But, you will have eaten twice as many kilojoules (Calories). In practice, you will find that it is very difficult to eat a double serve of foods like lentils and pasta because they are very satiating and fill you up. If you can eat twice as much, it may be a good thing, because you are unlikely to have room for high-fat and less nutritious foods!

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Diet. Individuals on a high-fat diet have been shown to lose less fat in response to exercise than those on a high-carbohydrate diet.10 High intakes of dietary fat lead to a greater energy surplus which is then stored in depot fat cells, while blood fats and glycogen are utilised for energy. The benefits of exercise are thus at least partially negated by the effects of excess energy in the form of fat. Yet while this is known, it is often difficult to verify.

Recent research using radioactive isotopes has shown that people under-estimate the amount of energy consumed in their diet by around 30 per cent, and over-estimate the amount of exercise they carry out by about 40 per cent. The under-estimate of food intake is reportedly higher in women than in men and there are indications that women may unconsciously eat more after exercise, whether as a means of defence against fat loss or a reward for having carried out exercise. Particular attention therefore needs to be paid not only to the fat content of the diet as a whole, but to the compensatory energy intake following exercise in some women. It’s not dear whether different types of exercise have different effects on this level of compensatory eating.

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