Medical Weblog

Cause

If your child has trouble swallowing food or liquids it is most likely to be due to a sore throat, mouth infection or ulcer. Avoid giving him spicy or sour foods, and offer purees and soups instead of solid food which requires a lot of chewing. Ice blocks are often well tolerated, as are jellies. Swallowing difficulty may be associated with a serious underlying condition such as a weakness of the sphincter between the oesophagus and the stomach.

When to see your doctor immediately

• if your child is having difficulty breathing;

• if you suspect that he has swallowed or breathed in a foreign object;

• if your child is unable to swallow anything at all;

• if you suspect that your child has drunk some household chemical;

• if you suspect that your child has been stung or bitten by some insect.

You should also see your doctor if your child has a fever and is generally unwell for no apparent reason.

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Here some ideas regarding testicular cancer and sexuality. Most apply to cancer of the prostate as well.

1. Some, but not all, surgery may directly affect ejaculatory capacity. Remember, this surgery does not mean loss of psychasm or even loss of orgasmic contractions. There may be a loss of the ejaculatory fluid, but this loss has no impact on sexual capacity.

2. The type of rumor will determine actual physiological outcome. If their particular type of surgery affects fertility, some patients decide to freeze some of their sperm prior to surgery so they may decide to have children after. Many types of surgery do not affect fertility.

3. There is no loss of erection that accompanies testicular cancer treatment. Sometimes, prostatic cancer surgery affects erective reflex to varying degrees. Of course, anxiety, depression, and other emotions will affect your body, and that can affect blood flow to the penis.

4. Some patients report a diminished interest, arousal, or desire and other impact on their sexual-response system. If such states persist, ask your doctor about a serum-testosterone test to be sure your hormone levels an, within the appropriate range.

5. Short-term therapy, education, and reassurance can go a long way in pn>. venting or correcting the emotional setback that may come with this type of cell disease. Again, hire somebody who will work with you on this specific problem.

6. Even though we talk about cancer as a curse and call persons with over-growing cells “cancer victims,” sexual activity does not cause cancer, it does not directly cause any form of disease, even though intimacy can transmit some diseases. Guilt will only slow the healing process. Self, blame will only get in the way of a return to intimacy.

7. Loss of ejaculate or reduction of fertility due to the drugs or radiation used in treatment does not decrease virility or manhood. Remember our fourth perspective in all of this. Sex is not a measure of anything, it is a response growing from within a system of interaction between two people. Cutting anything on the body does not have to cut off sex.

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Here are fourteen of the assumptions regarding human sexuality. In each case, I have altered the assumption from the fourth perspective to illustrate this orientation to sexuality.

1.    Intercourse is the ultimate sexual act between a man and woman,

and intercourse means insertion of the penis into the vagina.

Anything less than penetration is not really intercourse.

FOURTH PERSPECTIVE: Intercourse with the penis inside the vagina is not the ultimate intimate sexual act, but one option among many intimate choices. When it becomes the ultimate act, we miss opportunities for forms of intimacy that involve equally intense pleasure and sharing and we become goal-directed and one-dimensional in our sexuality.

2.    Men are the “inserters” and women are “receivers” in sexual

intercourse.

FOURTH PERSPECTIVE: A more productive orientation to sexual intercourse and all sexual interaction is one of “merging” rather than “penetration,” of doing with and together rather than to or for.

3.    Genital contractions are orgasm.

FOURTH PERSPECTIVE: Genital contractions following sexual stimulation are pleasurable reflexes. The total experience of physical, emotional, and cognitive merging with someone we love is called a’ ‘psychasm,” and may or may not be accompanied by genital or pelvic contractions.

4.    Orgasm is the measure of sexual fulfillment.

FOURTH PERSPECTIVE: The number of orgasms is related to the number of neuromuscular responses to genital stimulation. Sexual fulfillment is a more complex interpersonal process involving all levels of human responsiveness.

5.    Women have more trouble having orgasm than men.

FOURTH PERSPECTIVE: There is no evidence that pelvic reflex is related to gender, but expectations can influence physiological responsiveness.

6.    Women respond sexually more slowly than do men.

FOURTH PERSPECTIVE: “Speed” and “time” are not the key variables in sexual response, and mental, emotional, and cognitive factors are person-, not gender-, related.

7.    Men have a refractory period and a period during which they

must rest before continuing. Women can go on forever.

FOURTH PERSPECTIVE: All neurological responses are followed by some period of refraction or rest. Gender is not predictive of the length of this rest period.

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Most of us, (including most doctors and medical scientists) are kept unaware that the “bacteria” theory of disease is simply NOT true, and there is evidence, that Pasteur himself has falsified his own records to advance his own career. Among the most important things Pasteur did not report are:

• All bacteria can very quickly change according to their environment, not only from generation to generation, but in a single lifetime. This means that a simple change of conditions (bacteria food supply) can create a new type of bacteria in a few minutes! Friendly acidophilus in our intestines could quickly become any other bacteria – if its environment changes. Any particular bacterium can become any other bacterium and revert back again, if the conditions (food supply) change.

• Bacteria need food to survive and multiply. No food -no bacteria. Bacteria can only feed on dead organic matter. (There is no bacteria known to eat any living cells). If the organism does not provide the necessary conditions for bacteria to multiply (there is no dead organic matter and toxins) such an organism is not susceptible to bacteria invasion and it does not get sick at all. Therefore, if you inject bacteria to induce a disease – only 40-60 % of the weakest organisms will develop a disease and among those who do, there will be several types of different symptoms {different diseases), depending on the particular combination of pre-existing conditions for each individual organism.

• Given time, bacteria can learn and adapt themselves to extreme conditions, by entering into a hidden state, undetectable by conventional types of microscopes. When you restore favourable conditions (food supply) once more, bacteria appears and starts multiplying again. In modern medicine such bacteria are known as “drug resistant”.

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In the same way, infection, producing clumps of bacteria and pus, may allow stones to form as the salts are precipitated out of solution.

Obstruction to the free flow of urine always leads to infection and may cause stones. Changes in the pH of urine, making it more acid or alkaline, can also lead to the precipitation of salts.

Prolonged immobilisation, such as can occur with a person laid up in traction for a broken bone or in paraplegics and quadriplegics, can lead to the demineralisation of bone.

Calcium comes out of the bone and is excreted through the kidneys. This excess calcium can form stones.

Calculi may be made of different chemicals, sometimes from a combination of two or more substances.

Calcium oxalate stones are usually rough with sharp projections and, because these irritate the lining of the kidney and cause pain and bleeding, are usually detected while still small.

Calcium phosphate stones, on the other hand, are smooth and may grow to a large size without detection. They may fill the pelvis or collecting chamber of the kidney and project into pockets of the kidney substance.

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A lateral process projects from either side.

Between two vertebrae is the intervertebral disc and it is this structure which is believed to cause most back problems.

The disc consists of an inner core of thick fluid, surrounded by tough fibroelastic cartilage arranged with interwoven strands.

From the late teens, the disc starts to degenerate — the inner core loses its fluid and becomes smaller and firmer, and the elastic tissue is subject to strain and may develop splits.

Whether the backache is due to normal degeneration or to injury is important not only to the sufferer and his doctor, but also to industry, insurance companies and the law, as most severe back conditions result in workers’ compensation claims.

It is this lack of agreement and lack of full knowledge of the pathology underlying the condition which leads to disagreements about treatment.

Backache may be the result of muscle strain or tearing or may come from injury or strain to ligaments or joints but it is now believed most back problems stem from a disorder of the disc.

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Christina’s Story: After working for an insurance company for five years, twenty-five-year-old Christina decided to do what she’d always felt suited her best—she became a police officer. Christina leads a high-stress life, and although she experiences pelvic pain, she has been told that she does not have endometriosis. Christina tells it this way: “I’ve had cramping my whole life, and days of heavy bleeding, and I can’t afford to be fuzzy-headed when it’s a matter of life and death. My doctor says I don’t have endometriosis, just cramps. My mother had a hysterectomy when she was fifty-two (two years ago) and the gynecologist told her that her abdominal organs were almost literally cemented together by endometriosis. He was amazed that her intestines weren’t completely obstructed. I want to keep this disease in control and wonder if there’s some way to ‘track’ it. If I can predict a bad day, I can be better prepared.”

There are many ways to follow the symptoms of endometriosis as they seesaw through the month, but first we need to differentiate between normal cyclical functions—that is, menstruarion—and abnormal conditions. Normal function includes an approximate twenty-eight-day cycle with some premenstrual pelvic pressure and bloating. Any menstrual cramps can easily be controlled with Midol or aspirin. Discomforting premenstrual symptoms will vary from person to person, sometimes including mid month low-range pain (mittelschmerz), indicating ovulation.

Christina can increase her awareness of the disease by using a calendar. Ideally, entries should begin with the first day of menstrual bleeding, which is an absolute marker. Each day, symptoms should be listed from good to bad. Over a two-month period, it will become clear when the side effects of high levels of prostaglandins are the most virulent. Those effects may include severe cramps, fainting, diarrhea, and pounding headache. There are also cases in which endometriotic tissue growing on the fallopian tubes causes a special dysfunction: during ovulation, the fallopian tube “misfires” and cannot draw in all the fluid surrounding the egg. Some of this fluid drops into the abdomen, causing tremendous pain. Furthermore, some women will experience psychological symptoms of premenstrual syndrome (PMS) along with die more physically debilitating problems associated with endometriosis.

Keeping a chart of her symptoms is vital for helping a woman and her doctor assess the severity of the disease and select an appropriate treatment.

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The overall aim of treatment is to inhibit or reduce the mitotic activity of the cells, so that they slow down their rate of reproduction or ‘turnover’. Along with this, the associated inflammation must be suppressed. Topical or surface treatment is the most logical form of treatment. The most useful substances for this are tar preparations and a closely related substance known as dithranol These preparations may come in various forms, and one of the most important considerations when using these substances is the choice of vehicle. That is to say, some bases, whether cream or ointment, are better absorbed than others, hence enabling the tar or dithranol to adequately penetrate the skin. The vehicle is particularly important when the preparation is intended for use on the scalp. If, for example, an ointment were to be used here, it may be difficult to wash out in the morning, and therefore cosmetically unsuitable; ointment, therefore, would not be used. The precise purpose of tars and dithranol is to reduce or inhibit mitoses, and therefore slow down reproduction of cells. Frequently, these preparations may be used in conjunction with salicylic or retinoic acids which are very useful in reducing the surface scaliness and allowing the preparations to adequately penetrate the tissues.

Topical steroids, ‘cortisone’ creams, are very commonly used in the treatment of psoriasis. The advantage of these preparations is, firstly, that they are cosmetically the most acceptable. Furthermore they are excellent for decreasing mitoses, decreasing surface scaliness, and reducing inflammation. However the weaker creams do not work effectively and the stronger ones, if used over large surfaces for prolonged periods, may occasionally result in side-effects. The other perhaps more important disadvantage is that the condition frequently recurs, or relapses, when their use is ceased. Ultraviolet light (UVB) is very useful as an adjunct to the treatment of psoriasis with these topical preparations: the UVB tends to decrease mitoses and reduce excessive cell reproduction. The sun is a better source of ultraviolet light than the artificial lamps available. Occasionally, however, sufferers with psoriasis are sensitive to sunlight, and then of course it should not be used. Systemic or oral treatment of psoriasis is also available for the more severe cases. This type of treatment should only be carried out by dermatologists who are prepared to carefully monitor the patient’s general health and carefully control the dosage of the drugs used. Oral cortisone has no place in the routine management of psoriasis because of its possible side-effects with continued use. Furthermore, with acute pustular psoriasis it may aggravate the condition. Various cytotoxic agents (like methotrexate), which in large doses are used for the treatment of certain cancers, may be most useful when used in low dosage. They act by inhibiting mitoses and slowing down cell reproduction. Methotrexate is used in very small doses which are given once a week. It is a very useful drug if there are no blood or liver abnormalities, which must be regularly checked for. Obviously it affects not only the skin but also the liver, bone marrow, bowel, and reproductive organs. It must therefore never be used during reproductive years unless appropriate contraceptive precautions are taken. However, if used with care and appropriate supervision, methotrexate is a most useful treatment for severe psoriasis. There are other similar drugs, such as hydroxyurea, which may be used if methotrexate proves unsatisfactory.

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Dietary fat substitutes have been designed to mimic the sensory properties of fat and enable the production of low-fat foods that can satisfy consumers. There are a number of ways to make a tat

Substitute. Some are made from carbohydrates and protein, whilst others are derived from other food components (e.g. Cellulose), or are completely synthetic compounds. Fat substitutes must be safe to use, must not affect the organoleptic properties of the food and provide some of the attributes of fat.

The biggest question is whether they provide dietary assistance for body fat management’ The answer appears to be yes when all high-fat foods are substituted for reduced-fat varieties or fat substitutes. If only a portion of high-fat foods (e.g. Only ice cream and biscuits) are modified, there is likely to be compensation in the form of extra fat or energy intake at other times in the day.

Based on current evidence it seems that a complete dietary overhaul to include low-fat options will be most effective for fat loss.

On a practical level, the use of the recently approved (though only in the US) fat substitute Olestra has been found to reduce feelings of deprivation associated with low-fat diets, as well as reducing the number of high-fat foods that were considered tempting’. Even so, Olestra has serious nutritional implications, as it has also been found to decrease the absorption of antioxidant carotenoids, vitamin E and other fat-soluble compounds. Oelstra is not yet available outside the US and its potential introduction to other countries will receive fervent opposition from dietitians.

It will be important to monitor a client’s use of fat substitutes, artificial sweeteners and reduced-fat foods to see if these dietary modifications are effective.

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Coping

The most important thing to realise is that you are not alone in trying to cope with this disease. There are many people ready to support you by listening, making suggestions and helping you to make choices about treatment.

Talk to your doctor. Tell her or him you feel alone. There are also self-help groups. The Endometriosis Association (Victoria) is a non-profit group set up to help all fellow sufferers. Do not be frightened to ask for help or advice.

For those entering a new relationship there is the problem of when to discuss endometriosis. You may think that a discussion ‘too soon’ in a new relationship will frighten off a potential partner. For those who suffer from painful intercourse there is the constant worry that a new partner may think that you are frigid or that you just do not find him sexually attractive.

Acceptance

For many of us it is necessary to talk through all of these emotions before we can come to terms with the fact that we do have a chronic disease and that this disease will probably cause disruption to our lives.

There is a light at the end of the tunnel. Once you have come to terms with your illness and accepted that you have a health problem you will feel better — both physically and emotionally.

You are going to face many hurdles and be forced to make choices or come to terms with decisions that will be difficult.

You may have to accept that you may never have children, that you may require further treatment at some stage, that your life may be disrupted at times, and that you will be faced with changes.

Decisions

With acceptance of your condition comes the need to make decisions. These decisions will undoubtedly affect your whole future and you really need to weigh up all your options very carefully. These decisions are going to affect your childbearing, your capabilities and your quality of life. Career and relationships will also be affected.

Understand that these decisions will not always be easy to make or to come to terms with.

As a guide, make sure that you are well informed and consider all your options carefully. Look at the side effects, the advantages and disadvantages, the possible outcomes, and your future.

Take time

Do not be rushed into making a decision. Do not be pushed into a decision that someone else has made for you. You are the one who must decide what you really want and what is best for you. You must list your priorities to include your options, treatment and personal needs. Think ahead.

Ask questions

Help yourself become well-informed by talking to your doctor, attending sessions run by self-help groups and using the resources offered by women’s health services.

Read as much as possible about endometriosis and talk to other sufferers. This will not only keep you well-informed but remind you that you are not alone.

Take control

It is your body and you have to live with your decisions. Carefully consider your doctor’s advice and take into account the information you have read. But remember the final decision should be yours.

Communicate

Talk to women who have been through similar experiences. Talk with your family and your partner, if you have one. Talk to your doctor. Get the best possible care. Do not be frightened to seek a second, third or fourth opinion before you make any final decision.

Be assertive

Remind yourself that you have the right to the best possible care and that you have the right to voice your concerns and opinions. Do not be pushed into any decisions that you feel uncomfortable with.

Set realistic goals. Take it step-by-step, day-by-day. Do not rush yourself or allow others to rush you into decisions.

Do not be afraid to ask for help. Seek help if you are finding it difficult to make decisions on your own.

You may come across many conflicting ideas about the best way to approach decision making. Remember to investigate all avenues, ideas and suggestions before you make choices.

Once you are well informed you should make a decision that you are happy with.

Decisions should not be put entirely on your shoulders. Encourage and involve others, including doctors, family, partners, friends, other women with endometriosis, self-help groups and women’s health centres, to help you make the right choice. Remember — you are not alone.

Infertility

This can cause heartache, disappointment and loneliness — but couples do cope. If you have been on the infertility merry-go-round at some stage you will need to ask yourself, ‘Have I had enough?’. When are you prepared to stop infertility treatment? Ask yourself how much is too much. How long can you continue to be disappointed when yet another treatment has failed? How long can you put up with the disruption to your life? If you agree to continue with infertility treatments, will these be at the expense of other plans you have for your life?

Realise that you may never have a child; try and accept this — getting help if you need it — and then re-evaluate your goals.

Accepting that you will be childless may actually signal success and show that you have come to terms with your limitations. You have recognised the need to go on with other aspects of your life.

But do not be pushed into making a decision one way or another. It is your choice so make your own decision, in your own time, for the right reasons for you.

Calling it quits

You have the right to decide when you have had enough so that you can come to terms with the impact of your endometriosis. It may mean that you will never have children if you decide to have no further treatment or investigations. If you have had enough of the pain, the treatments and the disruption that endometriosis can cause, then the final decision may be to have a hysterectomy.

It is important to remember that if you are not coping at any stage, do not feel ashamed or embarrassed to seek professional help.

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