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.

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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.

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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.

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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.

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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.

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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.

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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.

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URINARY INCONTINENCE IN THE ELDERLY

When elderly people become incontinent of urine, this is usually assumed to be permanent. Such pessimism, however, is unjustified since about 80-90 percent of these cases can be cured, the Annals of Internal Medicine (104:429) points out. Even the incontinence that follows a stroke can, in many instances, be overcome.

Before anything can be done, though, the patient must be seen by a physician who has special training (usually a geriatrician or urologist) to have the cause of the incontinence correctly determined. Some cases, of course, are “surgical” and can be cured with an operation for such things as prostate enlargement or a uterus that has slipped down out of place. For patients not needing surgery, treatment with an appropriate medicine, biofeedback, or habit training cures over 70 percent.

Older people whose incontinence is caused by muscular weakness can do a lot to help themselves with exercises that tone up the muscles of the pelvic floor. The exercises involved tightening and relaxing the muscles repeatedly for 15 minutes three times every day, the U.S. Pharmacist (12#8:92) reports. By stopping and starting the flow of urine, victims of incontinence can learn to identify those muscles that need to be strengthened. The same muscles control the passage of stools. Identical exercises, incidentally, are employed by women after childbirth to tone up muscles that support the uterus. To do any good, these exercises need to be performed three times every day for at least three months. Victims of incontinence should be aware of the fact that both constipation and alcohol can interfere with the function of the pelvic floor muscles. They should also avoid drinking coffee, tea and grapefruit juice, all of which can suddenly increase the need to pass more urine. Cranberry juice is a useful substitute.

In addition, they should routinely empty the bladder before and after every meal and at bedtime, even if they feel no need to do so. They should always respond promptly to the urge to urinate, and must never ignore it. In a few cases, surgical repair may be required, especially if the bladder has become displaced by repeated childbirth or by removal of the prostate.

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CHILDREN’S HEALTH: SPRAINS AND DISLOCATIONS

Symptoms

Sprains: pain, swelling, tenderness, stiffness, internal bleeding.

Dislocations: visible malformation, inability to use joint.

Home care

A dislocation should not be treated at home.

A sprain can be treated by immobilizing and then resting the affected area.

Cold compresses applied to the area help relieve swelling.

Aspirin or paracetamol can be given for pain.

Precautions

-    A sprain that does not improve rapidly may indicate a bone fracture and should be examined by a doctor.

-    After a dislocation has been corrected, the joint may remain unstable for some time.

-    A severe sprain that is improperly treated can result in a permanently weak joint.

-    A sprain that is still swollen or painful to move is not healed.

-    Elastic bandages do not adequately support or protect a sprained ankle.

All joints of the body are surrounded by ligaments, the tough connective tissues that hold bones together. These ligaments can be partially or completely torn when the joint is forcibly twisted beyond its normal range of movement. A partially or completely torn ligament is called a sprain.

If the ligaments are badly torn the bones of the joint may become dislocated (slip out of position). Besides the usual symptoms of a sprain, a dislocation causes a visible malformation of the area, and marked or total loss of function of the dislocated parts. Even after the dislocation has been corrected, the joint remains unstable for weeks.

Sprains are common during childhood, but dislocations other than a dislocated elbow are rare. Sprains most often occur in the fingers, toes, ankles, neck, and back. Dislocations can also occur in the fingers, toes, kneecaps, and shoulders.

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PREVENTION AND HEALTH: SKIN CANCER

What is it?

There are basically two important types of skin cancer. The non-malignant type is the more common and is seen in fair-skinned people who expose themselves excessively to sunlight. It is easily treated and does not kill. The malignant type is called a malignant melanoma and is a killer. Skin cancers are most common on the face and other areas where the skin is exposed to the sun. Any skin damage that does not heal properly should be seen by a doctor. Also, should a pigmented patch of skin you have had for years start to become more pigmented, be suspicious and seek advice. One type of skin cancer starts as a pale, pearly, raised, translucent nodule that slowly enlarges and then ulcerates. The next most common type is a small, raised area or patch that can be reddened or darkened and hard. A common site for this latter type is on the lower lip.

What causes it?

Researchers at the University of Arizona (a very sunny site) found that the incidence of the malignant form of skin cancer jumped 34 per cent over a ten-year period. Since 1960 until the present day the incidence of the non-malignant type has also risen by a startling 500 per cent. Nearly half of all the tumours were found in people aged between 50 and 69. Malignant melanoma is rising in incidence at a rate of 5 per cent per year in the US.

Other researchers have found that pale-skinned, easily burned people with an estimated lifetime sun exposure of more than 30,000 hours have a twenty times greater risk of developing skin cancer than a comparable group with less than 10,000 hours of sun exposure. More than 200,000 cases of skin cancer occur in the US annually though the incidence is much less in the UK because there is less sun. Northern climates have less sun and so less cancer of the skin. For every 265 miles you go closer to the equator the incidence of skin cancer doubles.

Another form of skin change caused by sunlight is the breakdown of the normal connective, elastic tissue called collagen. This produces premature ageing of the skin and is a reason why Californian women so envy the skin of English women.

Prevention

• Use a sunscreen preparation if you are in the sun a lot.

• Be guided by the general rules for preventing sunburn.

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