CHILD’S HEALTH/SKIN DISORDERS: ATHLETE’S FOOT (TINEA PEDIS)

Athlete’s foot is the name given to a common fungal infection of the feet which is usually more common in teenagers.

Cause

Warm, sweaty skin is the ideal breeding ground for this fungus called tinea. It commonly occurs in summer, or in people (such as athletes) who always wear shoes and tend to get sweaty feet.

Clinical features

The rash usually appears as itchy, red, peeling areas, mainly between the toes. Cracks may appear in the skin which may weep or bleed. Small scales or tiny dots may appear on the sole of the feet, and sometimes can be mistaken for warts. The feet usually have a distinctive, musty odour.

Make sure the area between the toes is dried well after bathing. An antifungal powder or cream (available on prescription and in some cases over the counter from your chemist) should be applied twice a day, for at least 3 weeks, until the rash has cleared completely. Discourage scratching, as this will only make matters worse. Make sure only cotton socks are worn, and that they are changed twice a day. It is preferable to go barefoot or wear sandals, so that the feet are kept dry and exposed to the air. If shoes must be worn, leather is preferable to synthetic or rubber shoes, as they tend to ‘breathe’ more.

When to see your doctor

• if the feet are painful;

• if there is pus oozing from the rash;

• if the rash is spreading despite taking the above measures;

• if the rash does not start to improve a week after starting treatment.

Prevention

There is no proof that tinea is picked up from public swimming pools or showers but some people feel safer if they wear thongs or sandals in these places. The main way to prevent tinea is to keep the feet dry and change socks and shoes frequently, going barefoot or wearing open shoes as much as possible.

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SENIOR CITIZEN SEX EDUCATION: FEW QUESTIONS ABOUT MENOPAUSE

“Do men have menopause?”

A very small percentage of men over age sixty experience what some doctors call the male climacteric, and this relatively rare condition is related to a decrease in a certain hormone in the blood. If the doctor tries to provide the hormone and the symptoms don’t disappear or reduce, it is probably not the male climacteric that is causing the problem.

The symptoms of male climacteric usually include a combination of loss of appetite, distractibility, decrease in sexual urge or interest, edginess, fatigue, and some problems with erection. Of course, these problems happen to everyone sometime, so don’t be too quick to jump to conclusions about male climacteric. My experience teaches that this is a very rare condition that is not at all the same thing as menopause in women.

“Does menopause mean loss of sex interest?”

No. Menopause is just the reverse of a process that started early in your life as you developed fertility. Menopause is not a thing, but a process of several years, so fertility does not just stop one day. Menopause definitely does not end sexual interest or ability to want to and to be able to enjoy sex.

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YOUR MARITAL HEALTH/WIVES’ SEXUALITY: DO YOU KNOW YOUR WIFE’S TYPE?

The Figurine

I’m just not as strong as he is. I need him. He takes care of me like no one ever could.

WIFE

This is the fragile wife. The husband feels he is protecting her, and she assumes this role by acting weak, even physically sick or emotionally insecure. Sexually, she conveys an image of breakability, holding back her own assertive and expressive tendencies for fear of “blowing her cover,” for fear of letting her husband see that she is not as fragile as he thinks or perhaps needs her to be.

The Searcher

I have watched every time a talk show has anybody on about sex. I have tried everything. My women’s support group says my husband is just a sexist pig. Maybe they’re right, but I’m not going to tell him. I’m used to him that way. I call him Mr. Piggy.

WIFE

This wife has sensed that something is not well sexually and has turned to talk shows and sex manuals for direction. She talks more with friends about her sexual problems than she does with her husband. Most of her sexual knowledge is derived from friends, books, romantic novels. She assumes the role of Scarlett from Gone with the Wind, provoking, teasing, trying new techniques to encourage her husband to be Rhett and sweep her off her feet, up the stairs, and into bed. Unfortunately, some of these husbands continue not to “give a damn.”

The Super Wife

I never knew how strong I was as a person until I learned how strong we were as a couple.

WIFE

This is the model of the wife in a super sex marriage. She is aware of her sexual physiology, the forms and formation of her love map, understands the fourth perspective of sex, and integrates sex, love, and loving into her own unique and ever-changing role as a self-representing love partner.

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THE DESEXUALIZATION OF THE AMERICAN MARRIAGE: THE MIMS TEST (MARRIAGE INVESTMENT MINUTES)

Over a seven-day week, add the minutes you estimate you spend in the following activities:

1. Talking with your spouse with absolutely no one else around, not even the dog.

2. Discussing things related only to the two of you, excluding for now the kids, your parents, work, money, or other daily activities.     

3. Time spent just looking at one another, not talking, doing, fixing, or fussing—just looking.        

4. Time spent having fun together, playing together in a non-goal-directed activity, without another couple or the kids. (Not getting ready to play, but actually in mutually enjoyable recreation.)    

5. Time spent during the week making love, kissing, hugging, touching in privacy without interruption. This counts for only consecutive time, not a kiss here, a hug there.    

6. Time spent talking about the future of the marriage. This means your future together, not retirement funds, retirement home, and insurance plans.        

7. Time spent discussing world affairs, politics, issues of the day (this means actually discussing, not just one partner complaining or lecturing and the other serving as audience).    

8. Time spent just sitting together while each of you is doing something else, such as reading, sewing, listening to music (do not count TV-watching time, which is typically mutual hypnosis, not mutual relaxation).

9. Time spent eating quietly together alone, with no kids or pets or phones or TV.        

10. Time spent spiritually together, such as praying, contemplating, meditating, attending religious services as a couple.        

To promote discussion of MIMs, I estimate that total available time for relating is a maximum of thirty hours per week, or 1,800 available MIMs. Of course, no one gets even close to that amount in our complex and ‘ ‘hurry illness” society, but the 1,800 available MIMs provide a starting point when time for sleep and work is subtracted from minutes in the week.

Now, a penalty subtraction. Subtract the time you spend per week, either alone or with your spouse, watching TV. This TV addiction is one of the most detrimental influences on American marriage. It is a shared addiction, which is the worst type, because it sometimes covertly robs the relationship of available time for intimacy while both partners take unknowing part in the theft.

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OSTEOPOROSIS – TREATMENT

The problem in osteoporosis is an increase in the amount of bone resorption. Treatment has been tried to reverse this process and the best method is still a matter of argument.

There is no doubt that oestrogens given from the time of the menopause tend to prevent the development of osteoporosis but are less effective in reversing the process once it has developed.

The anabolic steroids were thought to increase the protein matrix but their use has been disappointing.

These drugs are derived from male hormones, but the virilising or masculinising effect has, to a large degree, been removed. They are widely used by weightlifters and those who take part in athletic field events to increase muscle bulk.

Calcitonin is a hormone derived from salmon and is now used to treat another bone condition, Paget’s disease. It is used also to treat osteoporosis but how effective it will be is still undetermined.

Vitamin D supplements have also been used but they appear to have some effect only where a definite deficiency of this vitamin can be demonstrated.

*522/71/1*

COMMON COLD – INTRODUCTION

Whatever happened to the common cold? The people who consult me with the winter sniffles, even those with whom I pass the time of day, rarely complain that they have ‘a cold’.

It seems more serious and deserving of sympathy to complain of ‘the flu’. Any respiratory infection is often called this, but most aren’t real influenza.

The common cold, or coryza, remains the commonest respiratory infection. It is an acute illness of a few days’ duration. It may be accompanied by a low fever and there is inflammation of the lining of the nose and throat.

There are more than 80 cold viruses and the immunity produced by infection with one virus may wear off after a few years. Those who suffer frequent colds are probably affected by a different virus each time; by the time they meet the original one again, the chance is that they will again be vulnerable, as any immunity will have worn off.

Why doctors are concerned to determine whether an infection is due to a virus or a bacterium is that bacterial infections can be treated with antibiotics whereas only a few viral infections respond to these drugs.

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BLEEDING DISORDERS; BOW LEGS

Blood clotting, which seems such a simple process is so complicated that some doctors have trouble remembering the exact mechanics.

Two or three routine laboratory tests can now identify most children with bleeding disorders.

Bow legs, usually associated with in-toeing, are so common as to be almost normal in a child under two.

It is often incorrectly thought that bow legs are due to the nappy forcing the baby’s legs apart.

Bowing occurs in the tibia, the main bone of the lower leg, not in the femur or thigh bone.

The cause is unknown but many doctors believe it is due to a baby’s habit of sleeping in the “knee-chest” position, that is, on his face, with his knees tucked under him and his feet turned inwards.

Most babies stop sleeping this way at around 18 months and so the condition corrects itself. However, if the bowing persists, correction may be achieved by strapping the legs together to alter the child’s sleeping posture.

In-toeing can occur when the baby sits on the floor with his knees turned in or when he sleeps on his face with his feet turned in.

There is no functional impairment from in-toeing, so correction is done only on cosmetic grounds. One way to help is to encourage the child to sit crosslegged on the floor and to avoid the other posture.

Out-toeing may be caused by sitting on the knees but with the feet turned in. Treatment is the same for in-toeing.

*14/71/1*

YOUR CANCER YOUR LIFE – RIGHT TO TREATMENT BY EXPERIENCED PRACTITIONERS (EXAMLE)

Every year, medical diagnosis and treatment become more and more complicated. No one doctor can possibly know everything about the diagnosis and treatment of cancer.-For this reason doctors specialise. Whenever you consider having any specialised diagnostic or treatment method you have the right to insist on referral to someone who is qualified and experienced in the use of that method.

For example, say you have a shadow in your lung which looks like cancer. You may be advised that, to make a diagnosis, a specimen must be taken with a needle passed through the skin and lung guided by X-rays. Make sure this is done by someone who has had plenty of experience with the method. An experienced person is more likely to succeed in getting a good specimen without puncturing your lung or causing undue pain.

You may have a cancer of the lower bowel and be advised to have this removed, leaving you with a colostomy (bowel ending in an opening on the abdominal wall). Ask to be referred to a surgeon who has done a lot of these operations. A well placed and well constructed colostomy is quite easy to look after, a poorly placed and badly constructed colostomy is a nightmare.

*23/40/1*

HORMONAL REPLACEMENT THERAPY: GETTING THE DOSAGE RIGHT

There is such a wide range of dosages available that your doctor should be able to adjust your prescribed dose to your symptoms. If your symptoms are mild, you will start on a low dose; if they are severe you will start on a higher dose. (The further you are from the menopause, the more likely you are to get side-effects in the early days of taking oestrogen, so a low dose would probably be prescribed for you initially.) If the low dose is not getting rid of the symptoms, ask your doctor if he can give you a higher dose; if the higher dose is producing unpleasant side-effects, ask for a lower dose. Women who have had a hysterectomy or oophorectomy will usually be started on a higher dose, as their symptoms will probably be more severe than women passing through a natural menopause.

If you have severe symptoms of breast tenderness, nipple sensitivity, leg cramps, continuing weight gain and feelings of nausea, you might feel better on a lower dose of oestrogen. If you develop acne, bloatedness, disturbances of your digestive system, a drop in libido, breast discomfort, and feelings of pre-menstrual irritability, then you might feel better on a lower dose of progestogen. However, before you rush off to the doctor, be prepared to stick with your initial treatment for two or three months, unless the HRT is giving you really awful side-effects; in most cases they diminish considerably, and often go completely after a few months.

Women who start HRT before their periods stop completely may find it takes longer to get the dosage exactly right This is because if you are still having natural periods, then you are still producing some oestrogen, even though its falling levels may be causing hot flushes, night sweats and all the rest If you take extra oestrogen in the form of HRT, don’t be surprised if you suffer some of the effects of this extra dose. Also, as your own level of oestrogen falls steadily, your HRT dose may need gradually to be increased in order to compensate.

The other group of women who may initially suffer side-effects from higher doses of oestrogen (tender breasts, for example) are those who are many years past the menopause and haven’t produced much oestrogen of their own for a very long time. If this happens to you, your doctor may suggest that you start on a lower dose, and then progress to a higher dose when your body has adjusted to the oestrogen. Alternatively, it may help if you take the HRT on alternate days to start with. You may also find that evening primrose capsules bring relief for breast tenderness.

As well as adjusting the dosage to menopausal symptoms, your doctor will want to consider whether you are at risk of osteoporosis or arterial disease. If you are, he will probably suggest starring at a medium or high dose, as the low dose may not give enough protection for some women.

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LAPAROSCOPICALLY ASSISTED HYSTERECTOMY

Surgeons gain access to, and remove, one or more of the reproductive organs in a number of ways. This is the basis for another method of classifying hysterectomy.

In recent years, another technique has been developed that combines elements of both the abdominal and vaginal approaches. It entails using the laparoscope, described in chapter 3, to gain access to the abdomen through several small (about 1 cm) pelvic incisions. The laparoscopic view of the inside of the abdomen is transmitted to a video screen and the surgeon manipulates cutting, burning or laser instruments within the pelvis according to what is seen on the screen. Direct vision laparoscopy tends to be used only when perception of depth is unclear, otherwise all surgery is performed while watching the screen.

After detaching the uterus and any other organs to be removed with diathermy, and closing blood vessels and realigning tissues using staples or sutures, the surgeon makes an incision near the top of the vagina where it meets the cervix. The unwanted tissue is then extracted through the opening in the vagina. This technique is called laparoscopically assisted hysterectomy or laparova-ginal hysterectomy. It has now been carried out on hundreds of women who would otherwise have had an abdominal hysterectomy. Laparoscopically assisted hysterectomy requires special equipment and a team of doctors and nurses skilled in gynaecological laparoscopy. It is considered to be suitable when:

• fibroids are of intermediate size

• endometriosis is a major reason for the surgery

• a reduced recovery period is important

• there is an early stage endometrial cancer and the ovaries are to be removed.

Margaret had a laparoscopically assisted hysterectomy instead of an abdominal or vaginal hysterectomy largely because of business pressures. A senior staff member of a company involved in a takeover bid, she was appreciative of the shorter hospital stay (one to four days instead of seven to ten days) and the reduced period of convalescence (one to four weeks instead of up to two or more months). After her convalescence it took her another few months to regain total well-being, but nevertheless she was able to contribute meaningfully at a critical time in her company’s business operations.

There is some evidence that laparoscopically assisted hysterectomy has a lower complication rate than either vaginal or abdominal hysterectomy, although this claim has been disputed and the results of clinical trials are awaited with interest. The operation takes somewhat longer to carry out than the other types of hysterectomy (one to two hours on average, although the French have reduced their operating time to less than an hour, compared with thirty minutes to an hour for an abdominal hysterectomy) and requires more costly instruments.

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