Medsarticles. Medical Weblog

MEDICAL PHILOSOPHY: CHANGES IN SIZE AND DESIGN

admin — Thu, 03 Jun 2010 14:57:17 +0000

Shakespeare speaks of the seven ages of man, but from the medical point of view man has been considered in three periods: childhood, when we practice pediatrics on him; the grown-up stage, when we have no special term for our procedures; and old age, when we now say that he is a candidate for geriatrics. But as Sir Thomas Browne points out, and as we are told that the Chinese reckon, we are nine months old when we are born. In many respects these nine months are the most important portion of our life, for we are then being formed in a pattern which cannot change.

The best you can do for the child during the first nine months in the moist climate of the mother’s womb is to take good care of this parent. If all goes well with her, the chance of a satisfactory child developing is as good as is anything desirable in this world.

There is no great transformation when the baby is born. It just seems so because of the spectacular aspects of birth. He still needs to receive oxygen and give up carbon dioxide, but he uses his own lungs instead of his mother’s; he prepares his own food in his digestive tract from now on; and for the first time bacteria begin to grow in his intestine, which has previously been sterile. How difficult to distinguish our friends from our enemies! We view bacteria with fear, yet evidently these intestinal ones have rushed to our aid. Later in life we find that these beneficent inhabitants of our alimentary depths may be persecuted by the wonder drugs just as the wicked bacteria are. The balance of nature has to be maintained here as in the great outdoors.

The baby’s skin has been secreting a fatty waxy material and continues to do so after birth. The kidneys have already been secreting urine. Of course the muscles, including the heart, have been working. Whether the baby has been thinking I will not pass upon, but up-to-the-minute psychologists have suggested that he has been. In fact, the birth of the baby merely modifies, in a continuous sequence, his bodily functions. One of the chief wonders of our incredible body is the unostentatious way in which it adapts its activities as needs arise.

In our second age of man, a combination of Shakespeare’s infant, “mewling and puking,” and his schoolboy with “the shining morning face,” I would say that the emphasis is on growth rather than development, though, of course, there are changes other than mere increase in size. In my youth, for example, I had the pleasure of knowing a young woman who, presumably because of some change in her pituitary gland at the age of three, had ceased to grow in stature. Later she was a beautifully proportioned and unusually keen-minded adult, whose only lack of development was in her size. Otherwise she had progressed as all normal children do. It is our bones that largely determine our size. Not until a little over a half century ago, when Roentgen discovered the X-ray, did we realize how the bones grow from centers of cartilage which we often cannot see at first, and that some of these centers have not finished their work even when the person has reached puberty. Adolescence, the period between puberty or sexual maturity and the time when the individual has achieved the wisdom to vote, does not mark but accompanies the final change in stature. But this period signifies little, for Goethe said that man is a perpetual adolescent. The years from birth to the voting booth are the formative ones, but we are pretty well equipped before we start these, as the primitive functions necessary to keep us alive have been laid down, with the sympathetic nervous system in command.

Yet we learn to assume some partial control over even these primitive functions. Breathing we can stop for a while, or hurry up. Our bowels and bladder we learn to take charge of. On the other hand, the infant is born with the instinct to milk nourishment from a nipple, using for this purpose muscles in the cheek which will later waste away with disuse. Once lost, this valuable function cannot be acquired again.

The use of most of the voluntary muscles becomes automatic, particularly the ones with which we acquire skills. As age advances, the acquiring of new muscular skills becomes more and more difficult. However, a few people with inherent dexterity seem to belie this rule. We cannot generalize accurately about adolescence either of the body or of the mind. We see boys who are giants on their school football teams or precocious intellectuals like Thomas Babington Macaulay, who, when a few years old, could recite Scott’s Marmion and knew several languages. But a few exceptional cases prove little. The progress of the great majority of us can be charted in advance.

*101/276/5*

GENERAL HEALTH

CHILDREN AND THERAPEUTIC NURSERY

admin — Thu, 03 Jun 2010 14:56:36 +0000

Through his research, Dr. Jerome Kagan, a psychologist at Harvard University, found two types of children: One, by the middle of the second year, is timid and shy, fearful and wary. The other is outgoing, sociable, and not easily frightened. Both types can come from similar families.

By school age, half the fearful children Dr. Kagan had studied had lost their timidity; 10 percent of the fearless had become fearful. This, Dr. Kagan says, shows that although biology may produce a child who tends to be vulnerable (fearful), environment can push him or her into the other column. In short, if parents knew what to do, they could overcome biology.

Dr. Paul V. Trad, assistant professor of psychiatry and director of the Child and Adolescent Outpatient Department at Cornell University Medical Center in White Plains, New York, teaches the parents of his difficult infant patients how to deal with them. One, a 32-year-old mother who works outside the home, had given birth to a baby daughter who cried all the time. We’ll call them Diane and Maggie.

“Every time Maggie cried, I’d think she needed feeding,” Diane says. “I’d try to feed her, and she’d cry more. I’d try to play with her, and she would cry more. Then I’d get anxious, and it would get worse.”

Diane and Maggie had what psychiatrists call a poor mother-child fit. Just because you’re the parent doesn’t mean you and your baby are guaranteed to like each other from the start. Some parents have to learn how to play with and love their babies.

Dr. Trad took videotapes of Diane playing with and feeding Maggie and then played them back. “It became clear that I was overanxious,” Diane says. “I wasn’t watching her. I didn’t wait for her signal. I was doing too much. Watching the tape, you can see her turn away – that’s a signal telling you, ‘Don’t press it.’”

Dr. Trad took Maggie on his lap and played with her to demonstrate how to watch for a baby’s signals. “It’s an adventure, learning about your own child,” Diane says. “Now I am able to respond to her, and she has become a relatively easy baby.”

But the adjustment is harder for babies born into what Dr. Stanley Greenspan calls multi-risk families. Dr. Greenspan is clinical professor of psychiatry at George Washington University Medical School in Washington, D and C. In one study, he and Dr. Arnold Sameroff observed families without “difficult conditions” and others with problems that included one or more of the following:

• The father was absent.

• The mother had suffered from mental illness at least twice in her life.

• The mother was not spontaneous (i.e., didn’t smile at or touch the child).

• The mother was highly anxious.

• The head of the household was unemployed or unskilled.

• There already were four or more children in the family.

If a family had none of these “risks,” the average IQ for the child was 118. If more and more risks existed, the child’s IQ dropped steadily, reaching 85 with seven or eight family problems. Generally, the high-risk families produced children with emotional problems.

*101/266/5*

GENERAL HEALTH

CHILD’S HEALTH/SKIN DISORDERS: ECZEMA PREVENTION

admin — Thu, 21 May 2009 07:25:02 +0000

When to see your doctor

• if you suspect that this is the first episode of eczema in your child;

• if the rash is weeping or bleeding;

• there is no significant improvement after a few days, despite the measures you usually take for your child’s eczema;

• if your child is having trouble sleeping due to excessive itching;

• if your child is generally unwell in addition to the rash;

• if you have any doubts that the rash is due to eczema.

Prevention

Avoid dressing your child in woollens and synthetics. Cotton garments are preferred for a child who has eczema. Avoid the use of soaps and bath preparations. Avoid overheating as this can make the itch worse. Avoid very hot baths or showers. If you suspect that your child’s eczema is due to a food allergy, but have been unable to find out which is the offending food, discuss the possibility and value of allergy testing with your doctor.

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YOUR CHILD’S HEALTH CARE: WATER SAFETY AND, SPORT AND SPORTING INJURIES

admin — Tue, 19 May 2009 06:11:06 +0000

WATER SAFETY

Drowning is almost always preventable. Always supervise your toddler or young child around water. There is no such thing as ‘drownproofing’ a young child. By all means, take your child swimming with you to get him used to water — most children can begin swimming lessons at preschool or early school age — but do not will not!

Make sure you can see your child all the time when near water. Do not rely on supervision by other children, or on the use of safety devices such as floaties — they will not prevent your child from drowning. Check all the gates and fences around your pool. Make sure that they are child resistant.

SPORT AND SPORTING INJURIES

The foundations of our fitness and well-being are established during childhood. Athletic activity provides children with the opportunity to develop self-confidence and interpersonal skills. Involvement in athletic events also exposes children to physical and emotional risks. Parents and sporting coaches have a vital role to play in preventing and minimising any sort of trauma or injury. Children who are involved with a sport often focus all their attention on participation and enjoyment. Fear seems to disappear as the game progresses. A child will often unwittingly go beyond the limits of safety. It is the responsibility of adults to anticipate potential hazards and enforce the rules.

Sporting injuries seen most often in children are bruises, cuts and grazes, as well as fractures of limbs. Head injuries can occur in children, but these are fortunately rare. Simple measures such as the wearing of protective clothing are often the most important in the prevention and treatment of sporting injuries in children.

*10\90\8*

YOUR MARITAL HEALTH/FINDING OUT WHO’S THE MATTER WITH US: HOT SEXUALPROBLEMS – SHORTENING OF REFRACTORY PERIOD

admin — Mon, 18 May 2009 12:35:09 +0000

SHORTENING OF REFRACTORY PERIOD: I think I could go again and again. We don’t, but I can have sex and then go into the bathroom and masturbate and then come back and have sex.

I just stop because we stop. I can get ready in a matter of a few minutes, no, seconds. I could do it over and over if I had to, ïî, I mean, if I wanted to.

Can you tell which is the husband and which is the wife? The first is the wife. Both partners are experiencing shortened refractory periods in part because of hyperarousal and in part because of their “hot running, keep on going” style of living. There is less of a refractory period following a hurried, less intense sexual experience than following a mutually involving, prolonged, emotionally intense sexual interaction. One hundred eleven men and 44 women reported this type of problem as occurring often in their sexual relationships. Remember that the problems mentioned here are re-norted at a higher frequency when the question is changed to “Have vou ever experienced this problem?” instead of “Is this problem characteristic of your sexual relationship?” When the first question is asked, all of us have some or many of these problems sometimes, and discussing them even before they are experienced can be good preventive sexual therapy.

*169\97\8*

THE DESEXUALIZATION OF THE AMERICAN MARRIAGE/A SEXUAL-SYSTEM EXAM: THE SEXUAL “CONNECTION”

admin — Mon, 18 May 2009 10:12:30 +0000

We just don’t connect. When I say up, she says down. If I’m horny, she’s not, and if she is, I’m not. She says it’s because of my “period.” She says I have worse periods than she does.

DISCONNECTION:

SENSE OF HUMOR, TRAGEDY, VALUES IS COMPLETELY DIFFERENT

HUSBAND

CONNECTION:

SENSE OF HUMOR, TRAGEDY, FAIRNESS, VALUES IS THE SAME FOR BOTH SPOUSES

0123456789 10

TENDING TOWARD TENDING TOWARD

CONNECTION DISCONNECTION

Do you laugh and cry with your spouse about the same things, reacting in the same fashion and intensity to life events (connection)? Or do you seem to be at different emotional levels, out of sync, with few examples of shared emotional response (disconnection)?

The dinner couple scored too far toward disconnection. Remember that some disconnection, a tolerance for different emotional levels at different times, is necessary in marriage, but this couple is out of balance, too out of sync. The wife felt a lonely sense of tragedy at her marital situation, surrender regarding the children, and compliance in sexual interactions. Her emotional reaction was unshared by her husband, who instead felt boredom, disregard, or lack of involvement with the children. He was invigorated by activities that had little to do directly with the marriage. While the wife cried alone at the dinner table and felt sad, the husband drove alone to the softball game and felt frustrated.

Disconnection was apparent in their sexual life. “I’d love it if she would do oral love more. You know. Suck on me down here. She does it, but it’s not like she wants to or anything. It’s kind of a gift or a trade-off. A little sucking for a little hugging.” The husband hoped for but did not find in his wife a connection, a shared sexual arousal in an important part of his sexual life.

The wife felt quite differently. She performed fellatio because she perceived them as a couple of “high order,” and things always seem to get done. The wife reported, “I don’t mind doing it, you know. Going down on him, I guess it is. But he makes it more of a prostitute thing. I like to be stroked and touched. It’s like he wants me to do it ‘to him’; we don’t do it together or anything. He just lies there, pushes my head down, and humps at me. I’m afraid I’ll gag or throw up. Just because he likes me to do it to him, he assumes I should like it when he does it to me. Well, I don’t. I can’t stand it.”

Our highly ordered couple is disconnected, going through the sexual motions, with both partners disappointed. Their dinner-table situation reflected the same pattern. The entire sexual system is out of balance, leaning first to too much order, then to too much disconnection.

*29\97\8*

PSORIASIS – TREATMENT

admin — Fri, 15 May 2009 09:52:58 +0000

It is hereditary and tends to run in families. It may be brought on, or made worse, by emotional factors, by injury or by infection. It may be mild or severe, be localised to one or two areas or generalised and affect the whole body. It may be stable and chronic or it may be unstable, rapidly flaring and active.

The treatment of psoriasis is well established although new treatments have been introduced for severe and resistant rashes.

Sufferers need to understand the aims and limitations of treatment, and the nature of their disease. The rash, being chronic and incurable, tends to come and go. It may be present unchanged for many years and the person comes to terms with it. Then it may suddenly clear, only to reappear months later.

Treatment may completely clear the rash but it will inevitably return as there is no permanent cure. But this shouldn’t discourage those who suffer from it, as control is possible.

It is uncommon on the face. Only one person in four with this condition will have it affect more than 5 per cent of the skin surface.

*537/71/1*

NIGHT CRAMPS

admin — Fri, 15 May 2009 08:25:48 +0000

Many people suffer in bed at night from painful cramps, usually involving the calf muscles or the small muscles in the sole of the foot.

These cramps are not usually related to any underlying problem but are thought to be due to mechanical factors.

With normal muscle tone, each group of muscles has an antagonistic group which pulls the limb in the opposite direction. When the muscles are completely at rest, as can occur in bed, normal contraction of some muscles may occur without the antagonists being activated and so the extreme contraction leads to painful cramping.

When you lie flat on your back in bed, the weight of the bed clothes may push the foot down. The same thing can happen when you lie face down and the foot is forced down. Should contraction occur in the calf muscles, the foot is already in extreme flexion.

One way of preventing this cramping action is to keep the foot in a neutral position, by having a pillow at the bottom of the bed, so the foot is neither down nor up. One way of stopping cramp is to force the foot into the opposite direction so the contracting muscle is forced to lengthen.

Quinine taken at night can certainly reduce the frequency of cramps. How it works is unknown, but it is effective.

*281/71/1*

COLDS, RESPIRATORY INFECTIONS – CROUP

admin — Tue, 12 May 2009 12:24:40 +0000

Croup usually develops suddenly and the child, well on gtyng to bed, might wake during the night with the typical croupy cough — a hard “brassy” sound — and have difficulty in breathing. The larynx is swollen and there is marked difficulty in breathing in.

In asthma, by contrast, there is difficulty in breathing out. Normally when we breathe in, the chest expands and the rib cage moves out. When there is obstruction to the free inward flow of air, the mobile chest of the child moves inwards when breathing in and rib retraction becomes obvious.

Sometimes the obstruction is so marked that the child needs a tracheotomy (opening made in the windpipe) so that he can breathe.

The child with croup may be well again next day, only to have the symptoms recur that night, particularly when the cold damp air comes down.

Children with distressed breathing due to croup may get great relief from breathing warm, moist air. This can be delivered by means of a special machine which can be bought or hired.

Filling the bathroom with steam by running the hot taps and closing the door and windows may be quickly effective.

*30/71/1*

YOUR CANCER YOUR LIFE – PATTERNS OF SECONDARY GROWTH (PART 2)

admin — Tue, 12 May 2009 12:08:02 +0000

When cancer cells lodge in lymph nodes or other parts of the body, they don’t always immediately start multiplying to form an obvious secondary growth. Cancer cells have the ability to lie dormant, sometimes for many years. You could think of them as seeds which are waiting for the right conditions before they start growing. It is this ability of cancer cells to lie hidden and dormant which makes it very difficult to know whether we have completely got rid of every cancer cell. The only real test is the passage of time—we must wait until every hidden cancer cell would have started to grow and make its presence obvious. This length of time differs for different types of cancer. With some cancers we can be very confident of a cure after only two years free of any signs of disease; in others, secondary growths can still develop twenty or more years later.

*38/40/1*