Blog About Health & Medicine

The frequency of bowel movements varies greatly from individual to individual, and also depends on age, so it is difficult to give a precise definition for the word ‘constipation’. Babies may have as many as four or more bowel movements each day, especially if they are breastfed. On the other hand, some may have a single movement daily, or even less often. Constipation is best considered as a reduction in a child’s usual frequency of passing stools, often associated with pain and difficulty in passing a bowel movement.

Investigations

Sometimes the doctor will order an X-ray of the child’s abdomen to document the extent of the child’s constipation. If the doctor suspects that there may be neurological or other reasons for the constipation, he may order other special investigations, but this will be very uncommon.

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Many parents choose to bottle-feed their baby using humanised formula. Modern formulas are derived from cow’s milk, and are modified to resemble breastmilk nutritionally although they do not carry the same protection against infection.

Strict attention must be paid to sterilisation of equipment and only freshly prepared formula should be used, following the manufacturer’s instructions closely. Be accurate with amounts, as deviations from those recommended may give your baby diarrhoea or constipation. Always wash your hands thoroughly before starting, and make sure that the water has been boiled for at least 5 minutes then cooled before mixing. Prepared formula should be stored in the refrigerator for no more than 24 hours; after this time it should be discarded due to the risk of contamination. Never reheat formula after it has been used. When transporting milk, it is best to keep it chilled to prevent the formation of bacteria.

The amount and frequency of feeds will vary from baby to baby, and is best determined according to demand. Most babies will initially require feeds every 3-4 hours. Feeding time is usually around 20-30 minutes duration and your baby may need to stop halfway through a feed to be burped. You can prevent your baby from developing excessive wind by ensuring that you hold the bottle at an angle so that no air can pass into the teat. If your baby does not wish to finish the whole bottle, do not try to force him.

The same intimacy can be achieved between you and your baby while bottle-feeding, as with breastfeeding. The biggest advantage of bottle-feeds is that the father can share equally in the experience. Feeding is a time for closeness and pleasure for both parent and child, no matter which method you decide to use.

A small proportion of babies may be allergic to cow’s milk protein, and soya milk formulas may be a preferable alternative. If you feel that your baby cannot tolerate cow’s milk formulas, speak to your maternal and child health nurse, or your doctor.

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LOVE REACTION: Loss can emphasize the value of the presence of others, and the bereaved spouse may turn to the partner for a renewal of intimacy and love. If the partner is puzzled by such a need, by a request for romance at this time of sadness, or if the partner overtly or covertly rejects such a longing for love and its manifestation through sex, hostility and anger can result, worsening the grief reaction and even jeopardizing general health.

Sometimes the grieving partner “tests” his or her own relationship for love at the time of loss, making sure his or her most important source of social and intimate support is still intact. An unsuspecting partner may “flunk” this love test, never knowing that he or she has been tested, and the grieving partner sinks further into depression at what he or she sees as yet another loss.

SEXUAL WITHDRAWAL: Bereavement Brings with it a range of physical and emotional reactions. Nausea, disequilibrium, muscle and joint pain, chronic headache, sweating and chills, bowel and urinary disruption, and other symptoms of bereavement are not uncommon and may delay return to sexual intimacy.

Emotionally, guilt or self-blame regarding the loss may result in a self-imposed compensatory celibacy, a paying of penance for imaginary or real responsibility for the loss. The partner’s attempts to break through such withdrawal may be perceived as insensitivity, and the partner may become a target for projection of the blame and self-recrimination felt by the bereaved.

Sometimes a compulsive searching is part of the grieving process; searching for the lost person and the feelings lost because of the bereavement. This cognitive and emotional wandering results in a distractability that represents yet another form of sexual withdrawal. It may show in listlessness, lack of attention, fading in and out of attention, failure to listen, and long periods of passivity and for the marital partner.

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Love is an emotional experience, a deep feeling. It just happens. You don’t have to do anything about it, it sort of does everything to you. You have to let it happen.

HUSBAND

I referred earlier to the “smitten” aspect of the mythology of love. We expect love to happen to us, that we are somehow full of pre-planted love seeds that sprout spontaneously in response to a person who stimulates them. We feel that we ourselves have little to do with love, because it overwhelms us. Cartoon characters develop a silly grin, their eyes gloss over, and their heart may grow inside their chest, throbbing to the breaking point. We assume that we are stationary targets for love arrows, targets more than archers.

“I know he was probably the worst thing that could ever have happened to me, but I just could not help myself. Love is blind, and so was I. He turned me inside out.” This report from one of the wives illustrates the assumption of love as an involuntary reflex.

Psychiatrist Scott Peck states, “Of all the misconceptions about love, the most powerful and pervasive is the belief that ‘falling in love’ is love.” We do fall in “limerence,” but love itself, loving, is not a reflex, it is a volitional act. We decide to love. All love is a conscious decision, not a helpless mammalian legacy.

One of the key steps in helping couples discover super marital sex was to re-teach them about the voluntary nature of love. If they clung to the assumption of love as a helpless, “willing victim” state, then they were trapped into the conclusion that once the reflex mysteriously “went away,” it was gone for good. At best they had to wait for it to return again, to be rekindled by some mysterious evolutionary biochemical spark. You “do” love, you do not get it, for “it” is not a thing. Love is a dynamic, volitional process that takes place within a system.

“I lost it, and I don’t remember really when. Love just went out of our life,” stated one of the wives.

“Yes,” said the husband, “We sort of became brother and sister one day. It was probably gradual, but the light went out.”

Our “love light” is not automatic.

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The tongue can give the doctor a clue to diagnosis. Coating or furring of the tongue is not really diagnostic of any one condition.

It is often furred in smokers, in mouth breathers and in those with poor oral hygiene. And it becomes coated during the course of any feverish illness or even with a simple digestive upset.

The tongue becomes dry and coated in dehydration and this can be a good indicator of the fluid balance of the body.

Where the tongue is coated in some parts but smooth in others is called the “geographic” tongue as it looks like a map. There are usually no other symptoms.

It is believed that this is due to emotional factors and seen only in anxious individuals. It requires no treatment.

In the past mothers used to worry whether their children were tongue-tied.

The frenulum is a band of tissue under the tongue which anchors it to the floor of the mouth. True tongue-tie is rare. The frenulum is short and this prevents the child from extruding the tongue.

If the child can put the tongue beyond the bottom teeth there is no problem.

Some tongues have deep fissures or cracks and an older generation of doctors looked for this sign as one indication of syphilis. But some people have inherited this condition and with them fissures in the tongue are normal.

An ulcer at the side of the tongue can come from an ill-fitting denture or a broken tooth. It can also be due to cancer.

In some anaemias the tongue loses it papillae (the taste buds) and becomes smooth, shiny and sore.

Leukoplakia is a pre-cancerous condition. The tongue becomes dry with a thick, white deposit like dry, cracked, old paint. This is mostly seen in elderly heavy smokers with poor mouth hygiene.

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Many examinations, even in the non-clinical subjects, are oral rather than written. Why, then, do we become inarticulate with our patients?

Perhaps it’s because of lack of time — too many people to see in too few hours. Perhaps it is because of lack of teaching in this respect in the medical school — an over-concentration on disease rather than on people.

Whatever the reason, this lack of communication does exist.

Most doctors would be unprepared to enter into a debate with a patient as to the merits of one antibiotic over another, based on that patient’s reading of an article in a magazine.

But I do think that every patient has the right to expect a simple explanation of what the doctor thinks is wrong with him and what he intends to do about it. And what side-effects he may expect from the treatment.

It doesn’t take long — perhaps two or three minutes. But I think that these two or three minutes are the most important part of the consultation.

Most consultations with the doctor are for minor illnesses — the patient really wants reassurance. And if he doesn’t get it, he is dissatisfied.

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The substance used for bone scans is taken out of the blood by bone-forming cells, and concentrates especially in areas where the bone cells are very active. In this type of scan, abnormalities show up not as ‘holes’ but as ‘hot spots’—areas where more than the usual amount of radioactive substance collects. This is because bone cells are especially active around abnormalities such as fractures, infections, or cancer deposits. The scan picks up the problem indirectly by showing the bone cell reaction rather than the abnormality itself. The amount of radiation involved in taking a scan of all the bones in the body is actually quite a bit less than if all those bones were X-rayed.

Various radio-isotopic methods can be used to get ‘pictures’ of most organs. For different organs we use different substances, choosing one that will be concentrated in the particular organ we wish to study. In all cases the radioactivity does not stay in the body for long. It is passed out through the urine, faeces or air from our lungs. The amount of radioactivity involved in each test is very small, and doesn’t pose any danger to anyone you go near or touch. If you want exact details, ask the people who are doing the test. They should tell you how long it takes your body to get rid of the particular substance being used and which way it is eliminated.

One drawback with these tests is that you only ’see’ the parts of the organ that are functioning normally. The ‘holes’ or ‘hot spots’ can be due to any one of many things that interfere with that organ’s function. Cancer is only one of many possible reasons for abnormalities in these scans.

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Lymphangiography is another means of showing up lymph nodes. For this a liquid form of contrast is injected into the tiny lymph channels and gradually works its way up through them. For example, if the ‘dye’ is injected into lymph channels in the foot, within a few hours X-rays will show it in the channels as far up as the groin and abdominal cavity. The next day the nodes themselves will be filled with the contrast material, sometimes right up into the chest. Their size and internal structure can then be checked. Unfortunately, because lymph nodes which are packed with cancer don’t function normally, the contrast may not get into the worst affected nodes. This can be a major drawback of this test. It is less likely to happen with lymphomas than with other types of cancer. Combining both methods by doing a CT scan after injecting the contrast actually gives the maximum information.

The biggest drawback of lymphangiography is that it can be used to show up only certain groups of nodes. Unless the nodes we want to ’see’ are fed by channels which are accessible (to have the contrast injected into them) we cannot show them up by this method.

Thus, lymphangiography cannot be used to show the lymph nodes from many of the internal organs such as the bowel, bladder, womb etc. Often it is only during an operation that we can easily find out for sure whether or not these are affected.

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Mumps (epidemic parotitis) is an infection caused by a virus. This affects the salivary glands, especially the parotid gland which lies in front of and below the ear.

The incubation period is about three weeks. The illness usually appears as fever and enlargement, pain and tenderness of one or both parotid glands. There may be difficulty in opening the mouth and in eating and drinking.

The illness rarely lasts beyond one week, unless one of the complications sets in.

As in other viral infections the brain may become involved, causing an encephalitis.

In young men and boys beyond puberty, the testes may be involved. When orchitis (inflammation of the testes) is present, there is usually a high temperature and considerable pain.

As a rule, only one testis is involved but, occasionally, both may be.

Cortisone may be used in an attempt to reduce the inflammation, as atrophy (shrinking of the testis) may occur and it may lose its function.

Involvement of the testes before puberty is rare.

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Many of the changes discussed above that occur over the longer term with slimming make relapse a key issue in fat loss maintenance. Long term studies (i.e. over 10 years) show that the cure rate for obesity is usually no more than 5-10 per cent. Even 1-2 year follow-ups with females show a high attrition rate (i.e. 40-60 per cent) and the success rate for males is largely unknown. About 80 per cent of people who go on a fat loss program can lose 10-20 per cent of their weight in up to 20 weeks without too much pain. However, within 12 months, about one-third of those who have lost fat will have regained it. The problem is even worse for those following a very low energy diet. Regain occurs around 76 per cent of those who were successful at keeping weight off over the long term had built exercise into their lifestyle compared with only 36 per cent of those who had failed. More maintainers than regainers (73-40 per cent) had also developed a personal eating plan as a lifestyle habit, whereas more regainers had used structured ‘diet’ programs, followed prescription from doctors, or used advice from books or magazines. Regainers snacked more during the day, and used chocolate and candy more often as their usual snack.

The other major difference between these groups and a control group of women who had never had a weight problem was in psychological techniques of coping with stress. The controls and those who were able to maintain their weight usually dealt with difficult situations by problem solving or confronting the issue. Significantly more regainers on the other hand used escape/avoidance techniques such as sleeping, eating or not dealing with the problem, in response to stress. This is consistent with other research that suggests that unless adequate coping skills are developed, individuals who don’t make behaviour changes will return to their former negative pattern when a high-risk situation develops.

These three factors: lifestyle changes in eating patterns, regular exercise and successful coping techniques are now recognised as key factors for long term maintenance of fat loss. In addition, Stern and her colleagues have shown that weight cycling through ‘yo-yo’ dieting and ‘exercise cycling’ (i.e. exercising for a period and then stopping) may have long term effects on dietary fat preference and fat intake. These are, therefore, also long term dangers for maintenance and reinforce the fact that long term techniques of fat loss, to be successful, must incorporate long term changes in lifestyle rather than short term aberrations such as dieting or exercise ‘programs’.

Dr Tim Wadden, a psychologist from the University of Pennsylvania, has also analysed relapse and maintenance by studying the habits of those who are successful with fat loss over the long term. He suggests that:

• although diet may be important in helping to lose weight, those who develop a lifetime pattern of exercise manage to keep it off better

• greater maintenance occurs in women who do long, regular (although not necessarily vigorous) exercise like walking

• people who regularly eat just one fatty food have no increased risk of regaining. But those who eat two, might just as well eat six—all are a recipe for relapse.

• most successful weight loss maintainers:

- don’t count calories, but develop a personal eating plan

- exercise regularly

- closely monitor their weight

- monitor their food intake

• Best maintenance comes from setting realistic goals. In some severely obese people, there may be biological limits to big reductions. Satisfaction with more modest goals can improve the situation.

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