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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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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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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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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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.

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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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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.

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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.

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