CHILD’S HEALTH/SKIN DISORDERS: KELOID SCARRING AND MLLIA (NEWBORN FACIAL SPOTS)

KELOID SCARRING

Some people have a greater tendency to form prominent scars. If scars become pink, firm, lumpy and raised, this is called keloid. Sometimes keloid scars become limbs. Dark-skinned people are more prone to keloid scarring than Caucasians. There is no way of preventing this overgrowth of scar tissues, although some doctors recommend the injection of small amounts of steroids into the scar. If the scar is very unsightly, you may wish to discuss the option of plastic surgery with your doctor, although the results are not always an improvement over the original scar.

MlLIA (NEWBORN FACIAL SPOTS)

These are tiny white lumps (cysts) which appear on the face soon after birth, and are harmless. They occur in 40% of newborn babies.

Cause

They are caused by blocked skin pores.

They appear mainly on the nose and cheeks, but may be anywhere on the face. At their largest, they measure 2-3 millimetres. They do not hurt or itch, and are not infected.

Treatment

Milia are harmless and will disappear without any intervention. All that is needed is a little patience. Creams or ointments are of no use. The lumps will disappear within 2 months, and will not leave any scars. See your doctor if there is any redness or swelling around the spots.

Prevention

It may help to make sure your baby is not overheated. Make sure you gently wash the face each day. Milia are difficult to prevent, but nothing to worry about.

*321\90\8*

COMING HOME WITH YOUR NEW BABY: BUILDING YOUR CONFIDENCE AS A PARENT

The less confidence you have as a parent to begin with, the more likely you are to end up having feelings of not being able to cope. Confidence is built on a number of factors, which include previous positive experiences of being a parent. You may feel that you are the only one in the world experiencing problems with a new baby. Speaking to others who have been through a similar experience — and there are many — can be very helpful.

Enlisting the practical support of your partner, of grandparents, relatives, friends and neighbours is very important, as it helps ease the burden. Support given by your doctor or maternal and child health nurse can also be very reassuring.

When you are a new parent, everybody seems to want to give you advice. This will often come uninvited from people standing behind you in supermarket queues or at the bus stop. Even though people are generally well-meaning, the advice given is often conflicting or just plain wrong. Don’t waste your energy getting angry about people trying to tell you what to do. Listen to those whom you trust, assess the factual accuracy of what you are told, and make your decisions using your own common sense and instincts as your guide. After all, no one knows your child better than you do.

Society tries to idealise mothers and babies, from the Madonna and child right down to washing powder advertisements. External pressure to be seen as ‘coping’ is sometimes enormous. Being confident in yourself and knowing that you cannot be perfect will help you to see through these false expectations and values. We can only encourage you to follow your own feelings and trust your own judgment.

Parents who generally feel positive about things tend to take child-rearing more in their stride than those who are anxious and tentative. However, having a baby with an easy-going temperament makes it easy for any parent to feel that they are doing the right thing. On the other hand a fussy, intense and whingey baby who feeds and sleeps erratically will constantly raise doubts and guilt feelings in even the most self-assured or parents. It is all too easy to blame yourself it a baby does not settle. Often, however, very difficult behaviour can be attributed solely to the baby, and try as you may, you will not be able to pacify him. Understanding that the baby’s behaviour has nothing to do with your own parenting skills often allows you to take a more objective view of your child. This may be the first important step to gaining control of things again.

*74\90\8*

YOUR MARITAL HEALTH/GETTING FIXED UP SEXUALLY: THE SPOUSE SPA

Set aside one morning for the spouse spa assignment. It must be a morning and not a late-night encounter. You must be alone and in your private intimacy place. Hire a babysitter if you have to, and take some time off work. You must make this program a priority, for as I pointed out in Chapter One, failure to do so will eventually ob vou both of sexual fulfillment. On two different days, one day for each of you, give your spouse a complete spa treatment. Bathe him or her, wash, dry, and comb the hair, provide a massage that your spouse might like, and wrap her or him comfortably in bed. Bring food, turn on some music, and then read aloud a short story. Do some research for all of this. You will have to interview your nartner to be sure it is a spa day he or she will like and not your version of the day. Find a short story that conveys an important message about your relationship.

“Now you’re talking. I loved that day. I have never, ever enjoyed anything as much,” reported one husband. He was talking about being the spa-er, not the spa-ee, about providing his wife with this opportunity.

“I loved it, too, both parts,” reported his wife. “I don’t know why we didn’t think of it before. I don’t remember getting so turned on.”

There is no rule about not having sex at this time, but the focus is on the spa experience, not the sex. I have not found it helpful to delay sexual interaction in the treatment program, but I warn that anything that was wrong might still be wrong, so the sex just happens. The spa is not a test. If you are thinking of testing your sex, then don’t have sex. Just do the spa experience. If sex is delayed as some type of ultimate end goal, the “real” thing, it is taken out of its natural, intimate context.

*184\97\8*

COURTING, RE-COURTING, AND THE SUPER SEX BOND:THE RULES OF ROMANCE ROULETTE

It’s hard to think back to then, but it seems like we never really dated in the formal sense. We just sort of found each other, went out, and assumed we would marry. Come to think of it, I never asked her.

HUSBAND

The following five rules appeared repeatedly in the courtship stories of the thousand couples. Even those couples who had been childhood sweethearts, never dating anyone else, experienced aspects of each of the following rules. Do you remember any of this? Talk about it with your spouse. Take your own bonding history.

Rule One: You Always Lie to the One You Love

Never, but never, tell the complete truth too soon to someone who might be a possible bonding partner. Keep your emotional cards close to your vest. If things get serious, you can always modify any lies later. The idea now is to present yourself, not represent yourself.

The rule seems to mean to be careful, because if you start telling your real feelings too soon, you might develop even more real feelings without sufficient time to get ready for them. The truth is a serious thing, and no one tells the truth early in a relationship, because you should not get too serious too soon.

Rule Two: Declare Romantic Immunity

State early, often, and loudly that you are not looking for a commitment at this time. Of course, a commitment is exactly what you are looking for, but you must maintain immunity from being hurt yourself and be available just in case another, better partner comes along. If it gets out that you are looking for a serious relationship, it may weaken your position in the pursuer/pursuee game.

Rule Three: Always Be the Pursued, Not the Pursuer

Try to give your number and have the other person call you. You must create the illusion that your romantic options are endless and any person interested in you may have to wait in a long line. Never answer the phone with “Oh great, I was hoping against hope that you would be calling.” Answer instead with, “Yes, I think I remember you.” All of us have only a limited number of people to choose from, but we must never let that be known to each other.

*44\97\8*

SCHIZOPHRENIA

Until the development of the major tranquillising drugs, schizophrenia was responsible for a large proportion of admissions to mental hospitals.

It is a severe psychological illness and yet there are some psychiatrists (not in the mainstream of psychiatric thought), who say that schizophrenia is not a disease but only a label we put on people who handle life differently from the rest of society.

There are many different forms of this disorder but what they have in common is that the personality does not seem to be integrated. Thinking, emotion and conduct do not co-ordinate, yet there is no impairment of intelligence.

Anxiety and depression can occur in schizophrenia as they can in any of us. There is often a withdrawal into oneself and one’s thoughts and feelings become more real than the outside world. Delusions, wrongly interpreting others’ behavior and hallucinations, usually voices rather than seeing things, are common.

The disorder of thinking is an important part of the schizophrenic process. The sufferer may miss the point, misinterpret cause for effect, dwell on irrelevant material or accept inconsistencies.

The first onset of this disorder is usually in the young, and may be present in the teens or early twenties.

Schizophrenia is commonly spoken of as split personality but this term is more properly applied to some forms of hysteria. Two opposite personali¬ties are not the result of schizophrenia, which tends more to produce a splintering of the personality and a loss of reality.

Changes in attitude to the management of those with this disorder and the use of drugs has meant many who would previously have spent most of their lives in hospital can now return to the community and support themselves at work.

*553/71/1*

CONTACT DERMATITIS – GENERAL INFORMATION

The cause may be recognised on the history alone but, for an accurate diagnosis, patch testing is often required.

In this, the offending chemical and others under suspicion are applied to the skin under a cover, and then assessed, if irritation results.

Most cases respond to simple treatment, provided the offending substance is removed from skin contact. This may entail wearing gloves or modifying one’s job.

Where this is impossible, minimal contact may result in a mild rash which can be controlled with treatment. Compromise may enable the worker to stay in his job rather than having to abandon it.

Contact dermatitis may occur in those with skin problems such as atopic dermatitis, eczema or psoriasis, it may complicate both.

The golden rule for any rash is that, if it itches DON’T scratch. If you do, it will only get worse. Seek treatment instead.

*296/71/1*

DWARFISM

Achondroplasia is the commonest cause of dwarfism. It is a genetic disorder due to a dominant gene.

The children of a sufferer will have one chance in two of being affected. If both parents are achondro-plasiacs, all the children will be affected.

However mutations may occur in the genes and so a sufferer may appear in a family without history of this abnormality.

The problem involves the bones, particularly the long bones which are shortened and the typical achondroplasiac dwarf has short arms and legs, a normal trunk and a large head.

The condition can usually be recognised at birth. These children develop normally with strong muscles. Mental and sexual development are normal

Achondroplasiac women, should they become pregnant, will require caesarian section for delivery of the baby as the pelvic bones are too narrow to allow normal birth.

*45/71/1*

YOUR CANCER YOUR LIFE – SYMPTOMS OF THE PRIMARY GROWTH (GENERAL SYMPTOMS) GENERAL INFORMATION

There are other ways in which a primary cancer can make you feel listless and weak. Such symptoms do not necessarily mean the disease has spread. Some cancers release hormones or chemicals which alter the normal balance of various minerals in the blood. In this way, particular types of cancer can result in abnormally high or low levels of calcium, potassium or sodium. Such imbalances make you feel weak and are sometimes associated with other symptoms such as nausea, diarrhoea or constipation, excessive thirst and passing large amounts of urine. Successful treatment of the primary cancer will get rid of these imbalances and therefore these symptoms, provided the cancer hasn’t spread. Of course, the symptoms would not be relieved by removal of the primary tumour if secondary deposits were already present.

Loss of appetite and weight can also occur when there is only a primary cancer that hasn’t yet spread. This happens especially when the primary cancer is in the stomach or upper part of the abdominal cavity (liver, pancreas, spleen, etc). However, it can happen with a primary cancer anywhere.

*53/40/1*

HORMONE REPLACEMENT THERAPY: BREAST CANCER

As a general guideline, the chances of developing breast cancer increase with the length of time you take HRT, and also the higher the dose of oestrogen. There appears to be no significant risk to women in the population at large who take it for less than five years, but the risk increases slightly between 5 and 10 years, and taking it for more than 15 years gives a higher risk still. (It is this long-term risk that has attracted media attention, though often the scare-mongering headlines are quite unjustified medically.) This can cause problems, because long-term oestrogen use is important for preventing osteoporosis, heart attack and stroke; and many women also feel so good on it that they would be very reluctant to give it up after just a few years.

Cancer is a very real fear for doctors and patients alike. Nobody wants to get it, but the risk needs to be put into perspective. Under the age of 50, deaths in women from breast cancer out-number deaths from coronary heart disease and stroke combined. However, after the age of 50,

this ratio is reversed, and far more women die from a heart attack or stroke than from breast cancer. Oestrogen reduces by 50 per cent your chances of having a heart attack or stroke.

The risks of developing breast cancer as a direct result of taking HRT are small when set against the protection it confers against osteoporosis and arterial disease, although it is important to say here that if you take progestogen in the therapy, then some of the protection against heart attack may be reduced. Progestogen’s effect on breast cancer is not clearly known; some researchers have concluded that it offers some protective effect, others that it may have a negative effect, and others still that it has no effect at all. More research is clearly needed here.

It is thought that oestrogens neither increase nor decrease the risk of cancer of the ovaries in post-menopausal women compared with those who do not take it; and oestrogen and progestogen appear to have no effect on the incidence of cancer of the cervix.

One important thing that has been noted is that, although there is a higher rate of breast cancer among women who take HRT than among those who don’t, their survival rate is also higher. In other words, if you develop breast cancer and are on HRT, you have a better chance of surviving than if you develop breast cancer and are not on HRT. This is possibly because regular screening of women on HRT picks up any breast problems in the very early stages, when treatment is more likely to be effective. Some studies have also suggested that tumours linked to oestrogen therapy might be less virulent and invasive than other types of tumours, and that these particular tumours respond to treatment better than tumours not linked to oestrogen therapy.

A tremendous amount of research is being carried out into all aspects of HRT and the menopause. Hopefully, the time will come when doctors will know more clearly which particular sub-group of women would be more at risk of developing breast cancer if they took HRT, so that they can leave it well alone, and the rest can take it with confidence and safety.

*63\42\4*

HYSTERECTOMY: PELVIC FLOOR EXERCISES

The muscles around the pelvis are very important in supporting the bladder, urethra, vagina and rectum. Regular practice of pelvic muscle exercises can help to strengthen these muscles. The first step is to identify the correct muscles to exercise.

• To identify the muscles around the rectum, sit or stand comfortably and imagine you are trying to control diarrhoea by consciously tightening the ring of muscles around the anus (back passage). Hold this ‘squeeze’ for four seconds. Relax and repeat several times.

• Now go to the toilet and start passing urine. Try to stop the flow of urine in midstream. Once this is done recommence urinating until the bladder has emptied. The muscles used to stop or slow the flow of urine are the front pelvic muscles which help control the bladder.

• Some women find they can identify the correct pelvic muscles by inserting a finger into their vagina and then contracting the pelvic muscles to squeeze the finger. If there is no sensation of squeezing around the finger you may be exercising the wrong muscles. Note that you should not bear down as if trying to pass a bowel motion as this strengthens the wrong muscles. Do not despair if you do not seem to be making progress for several days; it may take a week or more to begin to identify the muscles that need to be exercised to strengthen and tone the pelvis.

The second step, having identified the target muscles, is to repeat the following series of exercises at least four times each day. Note that they should not be done while passing urine. With practice you will find that you can do them at any time — while waiting for a bus, watching television or setting the table.

1. While sitting or standing with thighs slightly apart, contract the muscles around the rectum followed by the front muscles around the vagina. Hold this contraction while counting to five slowly. Relax these muscles then repeat four more times. Try to be aware of the squeezing and lifting sensation in the pelvis that occurs when these exercises are done correctly.

2 While sitting or standing, tighten the muscles around the front and back passage together. Hold this contraction for just one second and relax. Repeat this exercise five times in quick succession. It is a good idea to return to the first step once every week or so, to check that you are using the correct muscles.

*77\198\4*