Patient Education
Patient Education
Patient Education
3 Childrens health
Allergy in your baby
What is allergy?
Allergies are sensitive reactions that occur when the bodys immune system reacts in any unusual way to foods, airborne dust, animal hair and pollens. This results in conditions such as hay fever, eczema, hives and bowel problems. The condition is also called atopy. Allergies are common in babies and children. They usually disappear as the child grows older, but sometimes can continue into adult life. Unlike most of the common illnesses (such as measles and chickenpox) an allergy can have many symptoms, and these vary widely from child to child. Allergies are not infectious.
Is allergy inherited?
Allergy cannot be passed from generation to generation, but children from families that have a tendency to allergy have a greater chance of becoming allergic. However, anyone can become allergic.
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Asthma in children
What is asthma?
Asthma is a common chest condition that affects the small air passages (bronchi) of the lungs, which are very sensitive. During an asthma attack these breathing tubes become narrow from spasm of the muscles in the wall and the secreting of mucus. This makes it harder for the air to flow in and out of the lungs.
low air f
swollen lining
Call an ambulance if your child is: finding it difficult to breathe unable to talk turning blue getting worse quickly drawing in the chest wall While waiting for the ambulance, give your child 4 puffs of reliever medication (such as Ventolin) every 4 minutes by a spacer device.
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The children need much understanding and support from the family, teachers and therapists as their difficult behaviour is not intentional. Help for the family Work as a team within the family. Work as a team with teachers and community contacts. Try to join a support group. Get frequent breaks from the child.
Medication The use of medicines for ADHD is controversial but there are very effective medications available. Your doctor will be able to advise on the best option. If the prescribed drug proves helpful, it may be necessary to use it for years.
4 Adolescent health
Acne
What is acne?
Acne is inflammation of the sebaceous (oil) glands of the skin. At first these glands become blocked (blackheads and whiteheads) and then inflammation can lead to red bumps (papules), yellowheads (pustules), and even deep, tender cysts. Acne is a common disorder of adolescence. It appears usually on the face, but can extend onto the neck, chest and back.
Treatment
This varies according to the severity and persistence of the problem and the persons skin type. Severe cases require specialist referral. Diet Avoid any foods that seem to aggravate your acne (such as chocolate or milk), but special diets are not advised. However, have a sensible, nutritious diet. Soap and washing Special soaps are unhelpful. Use a normal soap and wash gently and oftendo not scrub. Cosmetics Avoid oily or creamy cosmetics and all moisturisers. Use cosmetics sparingly. Water-based lotion-style cosmetics are preferred. Hair washing and shampoos
These make no difference. Blackhead removal This is not recommended; avoid picking and squeezing. Exercise This is not of proven value. Ultraviolet light This can be very beneficial (includes sunlight and controlled artificial ultraviolet light). However, avoid extreme exposure to ultraviolet light. (This includes avoiding sunburn.) Lotions, creams and gels Many preparations are useful. These include sulphur, salicylic acid, azelaic acid, benzoyl peroxide and retinoic (tretinoin) lotions. Antibiotics Those taken by mouth are of proven value, especially longterm tetracyclines. Topical antibiotic preparations are also effective. The pill Women who have acne and require oral contraception can benefit from some pill preparations. Ask your doctor.
A word to parents
Your son or daughter hates acne and finds it embarrassing. It is not due to the way the skin is washed or what is eatenit just happens. It will not help if you are overanxious and nag your child; give support and encouragement instead, especially in following your doctors instructions.
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9 Infections
AIDS and HIV infection
What is AIDS?
Acquirednot inherited Immunebodys defence system Deficiencynot working properly Syndromea collection of signs and symptoms recurrent thrush in the mouth mouth sores
Being responsible
HIV carriers have a responsibility to inform their sexual partners and colleagues at risk, including medical attendants, about their HIV status.
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Standard drinks
The 0.05 level To keep below 0.05 blood alcohol level, a 70 kg man or woman should not exceed: 2 standard drinks in 1 hour 3 standard drinks in 2 hours 4 standard drinks in 3 hours
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Anal fissure
What is an anal fissure?
It is a crack or tear at the margin of the anus that extends from the skin into the soft lining of the anus. It can affect all ages and tends to occur in women and infants. added to the formula, and fluids should be increased. Treatment includes applying a local anaesthetic ointment to the anus whenever the child shows a desire to defecate, until healing occurs.
Adults usually recover in about 4 weeks, especially if the fissure is small. More severe cases may not heal without the benefit of a small operation.
The secret is to avoid constipation and answer natures call to stool when it comes instead of putting it off. Stools are kept soft by drinking several glasses of water each day, by a high-fibre diet and by regular exercise. Some people may find it necessary to use laxatives such as ispaghula (Fybogel, Agiolax).
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Angina
What is angina?
Angina (also known as angina pectoris) is the name given to pain in the chest that comes from the heart when it is short of oxygen. The heart is a large muscle that pumps blood about every second, and if it cannot get enough oxygen from its own blood supply (the coronary arteries) it will develop a cramping pain rather like a cramp in the calf of the leg. The main cause of angina is a narrowing of the coronary arteries by a fat-like deposit called atheroma. It is a common problem and affects over half a million Australians.
artery wall open area (lumen)
normal
artherosclerosis
Is angina dangerous?
Angina is a symptom that serves as a warning that the muscle of the heart is not getting enough blood and there is a risk of a heart attack. Angina does not usually cause any damage to the heart.
Anticoagulation therapy
Why is blood clotting important, yet dangerous?
Coagulation (the forming of clots) is a very important function of the body, especially when we get a cut and need to stop bleeding. However, clots forming inside blood vessels are dangerous because they can travel to the brain and cause a stroke or to the heart and cause a coronary attack.
What is anticoagulation?
This is the process of preventing clots in the blood by giving substances that tend to thin the blood by neutralising one of the clotting mechanisms. These substances are called anticoagulants. Important types are heparin (given by injection) and warfarin (given orally).
Remember
Keep to a consistent diet. Do not take aspirin or liquid paraffin. Always mention that you take warfarin to any doctor or dentist treating you. Take tablets strictly as directed without fail and have your blood tests. Take the tablets at the same time each day. Do not take a double dose. Advise your doctor of any illness. Avoid pregnancy.
Anxiety
What is anxiety?
Anxiety is an uncomfortable inner feeling of fear or imminent disaster. Most of us experience some temporary degree of anxiety in our lives, sometimes with just cause and at other times without. It can be a common normal human reaction to stress, and being anxious over appropriate things may help to make us more responsible, caring people. Some people, however, are constantly anxious to the extent that it is abnormal and interferes with their lives. Severe cases of anxiety can lead to panic attacks or hyperventilation. Special advice Be less of a perfectionist: do not be a slave to the clock; do not bottle things up; stop feeling guilty; approve of yourself and others; express yourself and your anger. Resolve all personal conflicts. Make friends and be happy. Keep a positive outlook on life, and be moderate and less intense in your activities. Seek a balance of activities, such as recreation, meditation, reading, rest, exercise and family/social activities. Relaxation Learn to relax your mind and body: seek out special relaxation programs such as yoga and meditation. Make a commitment to yourself to spend some time every day practising relaxation. About 20 minutes twice a day is ideal, but you might want to start with only 10 minutes. Sit in a quiet place with your eyes closed, but remain alert and awake if you can. Focus your mind on the different muscle groups in your body, starting at the forehead and slowly going down to the toes. Relax the muscles as much as you can. Pay attention to your breathing: listen to the sound of your breath for the next few minutes. Breathe in and out slowly and deeply. Next, begin to repeat the word relax silently in your mind at your own pace. When other thoughts distract, calmly return to the word relax. Just let go: this is a quiet time for yourself, in which the stresses in body and mind are balanced or reduced. Medication Doctors tend to recommend tranquillisers only as a last resort or to help you cope with a very stressful temporary period when your anxiety is severe and you cannot cope without extra help. Tranquillisers can be very effective if used sensibly and for short periods.
Recommended reading
Dale Carnegie, How to Stop Worrying and Start Living, rev. edn, Cornstalk, Sydney, 1999. Ian Gawler, Peace of Mind, Hill of Content, Melbourne, 2000. Jon Kabat-Zinn, Full Catastrophe Living, Delacorte, New York, 1990. Ainslie Meares, Life Without Stress, Penguin Books, Melbourne, 1991. Bob Montgomery & Lynette Evans, You and Stress, Penguin Books, Melbourne, 1995. Norman Vincent Peale, The Power of Positive Living, Vermilion, London, 1996. C Norman Shealy, 90 Days to Stress-free Living, Element, 1999.
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Aphthous ulcers
What are aphthous ulcers?
These are very painful ulcers that arise in the lining of the mouth, usually in the gums between the lower lip and teeth. The small hole on the surface exposes the sensitive tissue beneath. These mouth ulcers are not herpes infections or cancerous. of ulcers are quite common in some people. Any ulcer that lasts beyond 3 weeks is unusual. If the doctor is concerned about an ulcer, a blood test or biopsy may be taken.
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7 The elderly
Arthritis in the elderly
Arthritis means inflamed joints, and there are many types of arthritis. The commonest type is osteoarthritis, which is a problem of wear and tear due to excessive use over the years and to old injuries in the affected joints. Most cases of arthritis are mild, and people cope with it. Arthritis does not necessarily get worse as you get older; sometimes it can get less painful (arthritis in the lumbar spine is a good example of this). which should be taken with food. Inform your doctor if you have had a peptic ulcer or get indigestion. There are new drugs which are kinder to your stomach. Glucosamine has proved effective for osteoarthritis of the knee. Special equipment It is possible to increase your independence at home. There is a wide range of inexpensive equipment and tools that can help with cooking, cleaning and other household chores. These can be discussed with your physiotherapist or occupational therapist. Surgery Modern surgery can give excellent results with relief of severe pain for most joints. The new techniques and artificial joints are improving all the time, and so there is no need to suffer with severe pain.
bone
Asthma
What is asthma?
Asthma is a common chest condition in which there is temporary narrowing of the breathing tubes in the lungs (airways) because they are hyperreactive (oversensitive). In asthma these tubes have inflammation and swelling of their linings, increased mucus inside, tightening of the muscles in their walls and therefore less flow of air in and out. number have it again as adults. Others continue with it. About 1 in 10 adults has asthma.
Prevention of attacks is the best treatment, and all people with asthma and their families need to know how to manage their asthma well.
muscle wall mucus constricted muscle (b) swollen lining
Know your asthma Read all about it and be informed. Try to identify trigger factors and avoid them. Become expert at using your medicine and inhalers. A big problem is incorrect inhaler technique (up to 80% of patients). Know and recognise the danger signs and act promptly. Have regular checks with your doctor. Have physiotherapy: learn breathing exercises. Work out a clear management plan and an action plan with your doctor for when trouble strikes. Learn the value of your lung function with spirometry. Always carry your reliever inhaler and know how many doses are left. Stay at your best If you need medications, these should be as simple, safe and effective as possible. This is why inhaled medications are most often used for asthma. There are basically three types of inhaled medication that your doctor might advise you to use: the preventor (such as Pulmicort, Flixotide, Tilade or Intal) the reliever (such as Bricanyl, Oxis, Ventolin or Atrovent), which is called a bronchodilator combined preventor and reliever (such as Seretide or Symbicort)
Key points
Get to know how severe your asthma is. Avoid trigger factors such as tobacco smoke. Keep at your best with suitable medicines. Get urgent help when danger signs appear. Have a written action plan for asthma. Use your inhalers correctly and use a spacer if necessary (check your method with your doctor or asthma educator). A peak flow meter may help you assess severity. Have regular reviews with your doctor when well.
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holding the puffer upside down holding the puffer too far away pressing the puffer too early and not inhaling the spray deeply pressing the puffer too late and not getting enough spray doing it all too quickly: not breathing in slowly and holding your breath squeezing the puffer more than once not breathing in deeply not holding your breath for 10 seconds
Extra points
1. The usual dose of a puffer (reliever) is 1 or 2 puffs every 34 hours for an attack. 2. If you do not get adequate relief from your normal dose, you should contact your doctor. 3. It is quite safe to increase the dose, such as to 612 puffs. 4. If you are using your inhaler very often, it usually means your other asthma medication is not effective or is not being used properly. Discuss this with your doctor.
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before bronchodilator
What are the early warning signs of severe asthma or an asthma attack?
symptoms persisting or getting worse despite adequate medication increased coughing and chest tightness poor response to 5 inhalations of relievers benefit from reliever inhalations not lasting 2 hours increasing medication requirements sleep being disturbed by coughing, wheezing or breathlessness chest tightness on waking in the morning low peak expiratory flow readings Contact your doctor if these problems are present.
Action plan
If any of these are present, immediately: Call an ambulance and say severe asthma attack (best option). or Call your doctor. or If you are having trouble finding medical help, get someone to drive you to the nearest hospital. Keep using your bronchodilator inhaler continuously if you are distressed. Get an action plan such as the National Asthma Campaign Asthma first aid 4 4 plan from your doctor.
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Atopic eczema
What is atopic eczema?
Eczema refers to a red, scaly, itchy, sometimes weeping skin condition. Atopy refers to an allergic condition that tends to run in families and includes problems such as asthma, hay fever, atopic eczema and skin sensitivities. However, anyone can become allergic. Atopic eczema is common and affects about 5% of the population. It is not contagious. No particular cause has been found. drying preparations such as calamine lotion extremes of temperature, especially cold weather with low humidity and heat stress and emotional upsets teething certain foods (which parents may identify) Note: The relationship of diet to eczema is controversial and uncertain. It may be worthwhile avoiding certain suspect foods for a 34 week trialthese include cows milk, fish, eggs, wheat, oranges and peanuts.
Medical help
Your doctor, who should be consulted if you are concerned, may prescribe antihistamine medicine for the allergy and sedation, special moisturising creams and lotions, antibiotics for infection (if present) and milder dilute corticosteroid creams, which can be very effective.
Typical sites of infantile eczema John Murtagh, Patient Education, Fourth Edition, McGraw-Hill Australia 13
Atrial fibrillation
What is atrial fibrillation?
Atrial fibrillation (AF) is a specific irregular rhythm of the heartbeat. Fibrillation means an uncoordinated quivering movement of muscle fibres. Heart function involves the contraction of two chambers, the smaller atrium which connects to the larger ventricle. The hearts electrical conduction system runs from the atrium to the ventricle with the firing beginning in the atrium. In atrial fibrillation the atrium beats too fast and the ventricle cannot keep pace and beats at a slower and more irregular rate than the atrium. The heart still pumps out blood, usually faster but not as efficient as normal.
atrial fibrillation
Seek medical help if you notice: a change in heart rate, rhythm or strength shortness of breath swollen feet chest pain pain in the calf on walking unusual symptoms such as unexplained weakness weight loss
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Autism
What is autism?
Autism, described first by Kanner in 1943, is a developmental disorder commencing in the first 3 years of life. It affects at least 8 children in 10 000; boys are 4 times more likely than girls to be affected. The main features are: inability of the child to form normal social relationships, even with his or her own parents delayed and disordered language development (about one-half of all autistic children never learn to speak effectively) obsessive and ritualistic behaviours such as hand flapping, spinning, twiddling pieces of stick or string and hoarding unusual objects restricted range of interests lack of imagination and difficulty in development of play anxiety over changes in routine It is now recognised that there are a variety of types of autism, hence the modern term autistic spectrum disorder. Aspergers syndrome is one of the important types.
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How is it diagnosed?
There are no specific blood or imaging tests. The diagnosis is made after assessment and testing by skilled paediatricians, psychiatrists or psychologists.
Further information
Victorian Government Disability Online information: www.disability.vic.gov.au/dsonline Dr Tony Attwood has written articles, presentations and books on Aspergers syndrome: www.tonyattwood.com.au/ Victorian Aspergers Syndrome Support Network: http://home.vicnet.net.au/~asperger/
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10 Musculoskeletal disorders
Backache
What causes backache?
Backache usually is caused by minor strains in the muscles or ligaments, but more serious lower back pain usually is the result of an injury to one of the many joints in the base of your spine. The joints include the facet joints and discs, which when disturbed can push against painful tissue or nerve roots just behind them. The injury usually happens while bending your spine forwards (flexing it), especially while lifting something heavy. Never bend forward with your legs straight to perform any task. Once you have experienced back trouble, it has a tendency to recur, and so be careful to protect your back. Scrubbing floors and gardening Your hands should be as far forward of you as necessary to keep your back straight. Do not flex your back by having your hands working too close to your knees. Bending Take care when bending, for example tying shoelaces or putting on stockings. Put your foot on a stool, chair or box that is near enough to your body and high enough so that you do not have to bend down to your foot. Pain relief The recommended analgesic is paracetamol or a drug you can buy across the counter. It is best to avoid strong narcotic drugs. Ask your doctor.
Right
Wrong
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rash
rapid breathing
change in conscious state drowsiness, confusion or delirium rapid heart rate rapid, difficult or noisy breathing convulsion red rash, especially if it looks like flecks of blood
As a general rule the illness seems like the flu at first and we must emphasise that it can be difficult to diagnose in the early stages. Doctors prefer to see people early rather than later, when the patient will be very sick. In infants the signs of meningitis may not be so obvious but neck stiffness, vomiting and headache are more noticeable in children over 3 years of age. These symptoms may be masked and confuse the diagnosis if the child is on antibiotics. The diagnosis is made by lumbar puncture (usually), blood tests or brain scans.
Bed-wetting (enuresis)
What is nocturnal enuresis (bed-wetting)?
It refers to bed-wetting at night in children (or adults) at a time when control of urine could be reasonably expected.
What is normal?
Bed-wetting at night is common in children up to the age of 5. About 50% of 3-year-olds wet their beds, as do 20% of 4-year-olds and 10% of 5-year-olds. It is considered a problem if regular bed-wetting occurs in children 6 years and older, although many boys do not become dry until 8 years. Bed-wetting after a long period of good toilet training with dryness is called secondary enuresis.
Key points
Bed-wetting: is not the childs fault rarely has an emotional cause gets better naturally nearly always clears up before adolescence requires a gentle, non-interfering approach responds well to an alarm from 7 years
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Bells palsy
What is Bells palsy?
It is a condition where the muscles on one side of the face become paralysed because of a problem in the nerve (called the facial nerve) that controls those muscles. make a good recovery. The slow and steady recovery takes about 6 months. Operations to help correct the problem are used occasionally for those rare cases where recovery is not complete.
Care of the eye If your eye cannot close fully, it is important to protect it from injury such as dust and grit by wearing goggles and putting a patch over the eye at night. The eye should not be allowed to dry, and artificial tears are usually prescribed. Report any unusual pain in your eye immediately. Massage and exercises Massaging and exercising the facial muscles may help recovery. Using oil or cream, massage the muscles of the forehead, cheek, eyes and lips. Exercise these muscles in front of a mirror by screwing up the eyes tightly to close them, smiling widely, baring the teeth and winking.
Bells palsy
Heat treatment If you have pain in the face, apply heat 3 times a day to the painful area. Wring out a face washer after soaking it in hot water and apply for 10 minutes. Make sure your eye is closed or covered. General care Continue your normal activities, but choose a good lifestyle by getting plenty of rest and sleep, avoiding smoking and excess alcohol. Look after your teeth: brush and floss your teeth more often. Keep a positive outlook on life. Remember that your somewhat embarrassing problem should soon settle.
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Bereavement
When a loved one dies, the bereaved person invariably goes through a predictable human process of grieving. The extent of the reaction will depend on circumstances such as the suddenness and unexpectedness of the death. It will depend also on the age of the deceased and the bereaved, and other factors such as personal, family, national or religious customs and habits. However, no matter what the circumstances, the bereaved will suffer a reaction and the emotions described here are regarded as normal responses. ings and intense grief are commoner when the death is unexpected. It is important that you do not feel too badly about any apparent neglect on your partthe if only I had feeling. The feeling of intense grief usually lasts about 6 weeks and the second stage of grief for about 6 months, but it can resurface every now and then over the next few years. During the last 4 months or so of this stage you will feel sad and helpless, then pass into a state of apathy and depression (the third stage).
Self-help
First, you must realise that it is normal to pass through these stages of grieving, and so you cannot fight it. A bereaved person should always try to acknowledge his or her loss and not shut it out. Talking about the deceased to relatives and friends and sorting out the persons possessions will help enormously in coming to terms with your loss, even though it may be painful at first. At the beginning it is good, if possible, to see the dead person, touch them if you want to, attend the funeral and give expression to your emotions. If you have doubts about the exact cause of death, make sure that you discuss it with your doctor as soon as possible. If you have prolonged intense grief feelings, make sure that you get professional help. Avoid visiting spiritualists: they seem to aggravate the problem. You may find considerable support from others who have suffered a similar loss and from various self-help organisations. Most people find that it is helpful to have a break away from the home, especially staying with sympathetic friends or relatives in a different area or in another state. The first anniversary of a death or the first Christmas spent alone can be a very difficult time, and so it is good to make arrangements to have company at that time.
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What is dyslexia?
Dyslexia is an SLD with reading. A dyslexic child has below average reading skills yet has no physical problems and has a normal IQ. Other SLDs may be present, particularly with spelling, writing and clear speaking. Dyslexia is a term derived from the Greek for difficulty with words. It was originally called word blindness.
Characteristics include:
a reluctance to read aloud a monotonous voice when reading following the text with the finger when reading difficulty repeating long words
The above features, of course, are seen in all or most learners, but if they persist in a bright child dyslexia should be considered. The most important factor in management is to recognise the problem, and the earlier the better.
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Bipolar disorder
What is bipolar disorder?
Bipolar disorder is a disorder of mental function in which the persons mood can swing between two (bi) poles ranging from the elated hyperactivity of mania on the one hand to the flatness of depression on the other. It was previously called manic-depressive illness. talkative; fast speech easily distracted decreasing work performance enthusiastically starts (rarely finishes) new projects increased sexual drive and activity
Stage 2: Mania
high as a kite reckless behaviour (e.g. spending sprees, running up debts, sexual promiscuity) wild, garrulous speech grandiose ideas and plans impaired judgement/lack of insight hasty decisions (e.g. job resignation, marriage) paranoia racing thoughts; flights of ideas They may be out of touch with reality such as having delusions (false beliefs) or hallucinations. Behaviour may include singing, dancing or laughing for no reason. The depression pole There are typical depressive symptoms but with a tendency to be more severe with bipolar disorder. The onset is gradual and sufferers become increasingly withdrawn and lose interest in things that they normally enjoy. There is a slowing down of many basic functions such as energy, appetite, sex drive, speech and movement. Sleep is affected. Problems multiply with pessimism, guilt feelings and reduced self-esteem and confidence. Some feel unable to face the world and that life is not worth living and may stay shut in their room. Thoughts about death and suicide are common and indicate the need for urgent attention.
increasing activity and restlessness; high reduced sleep; early waking leaping out of bed early and vigorously
Bee stings
First aid 1. Scrape the sting off sideways with a fingernail or knife blade. Do not squeeze it with the fingertips. 2. Apply ice to the sting site. 3. Rest and elevate the limb that has been stung.
Snake bites
First aid 1. Keep the patient quite still. 2. Do not wash or cut the wound. 3. Immediately bandage the bite site very firmly, but not too tightly. A crepe bandage is ideal; it should extend above the bite for about 15 cm. 4. Place the limb that has been bitten in a splint: use a firm stick or slab of wood. 5. Get the patient to the nearest doctor or major hospital without delay. If possible, take the dead snake along too.
Tick bites
Ticks may lodge anywhere in the body of humans and their bite can be fatal, especially in children. First aid Do not attempt to pull the tick out by grasping the body. Take the patient to someone who is expert at removing them. If this is not possible, pour vinegar onto the tick, wait 30 seconds, then loop a strong thread around the ticks head close to the skin and pull it sharply sideways.
Spider bites
The Sydney funnel-web and the red-back spiders are the most dangerous. Unlike bites from snakes, spider bites are painful. First aid The first aid for the Sydney funnel-web is exactly the same as for snake bites. For red-back spider bites, apply an icepack but do not bandage. Then seek medical help.
Note
The box jellyfish (sea wasp) in tropical waters is very dangerous. Liberal amounts of vinegar should be applied as soon as possible.
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Blepharitis
What is blepharitis?
Blepharitis is chronic inflammation of the margins of the eyelids. It can involve the eyelids, eyelashes, conjunctiva (whites of the eye) and the meibomian glands (those which lubricate the eye).
ulcers on eyelids
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Body odour
Body odour is an unpleasant smell that is a social embarrassment for many people. soap is pine soap. It is preferable to scrub morning and night under the shower, since the sweat glands and bacteria are active day and night. If the soap is not working, use an antibacterial surgical scrub (which your pharmacist can supply). Choose suitable clothes Choose natural fabrics such as cotton and wool that absorb perspiration better than synthetics. They also allow better evaporation of the sweat from the fabric. Keep your clothes fresh Regular washing of clothes is important. Using the same underwear for up to seven days is a certain way to cause bad smells, so change each day, especially in the summer months. A daily change of your shirt or blouse is also advisable and regular laundering or dry-cleaning of stale coats, trousers and skirts is essential. Underarm antiperspirant deodorants Ask your pharmacist for the most suitable antiperspirant deodorant. Do not use a deodorant only. Dietary advice It is important to watch what you eat, as some foods contribute to body odour. Avoid or reduce the intake of garlic, fish, curry, onions and asparagus. Reduce your intake of caffeine (coffee, tea and cola drinks), which stimulates sweat activity. Care of smelly feet If your feet are sweaty and smelly, make sure that you change your socks (should be cotton or woollen) regularly. Use shoe liners such as Odor Eaters or charcoal inner soles. Also use a special solution such as Driclor or Hidrosol or the new preparation Neat Feat. Shaving hair under the arms
Shaving the hair from the armpits is certainly essential in women with a body odour problem. Surgery If you perspire heavily from the armpits, the sweat glands can be surgically removed by a simple procedure called axillary wedge resection. Ask your doctor to arrange this if necessary. Desperate measures If all else fails, you can try the old skunked dog trick by taking a bath in dilute tomato juice. Pour 2 cups of tomato juice in your bath water and sit in it for 15 minutes before scrubbing with a deodorant soap. This is reported to be very effective.
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Knock knees
Knock knees are also normal in children and most have these between the ages of 3 years and 8 years. Running can be awkward, but improves with age. The rule for normal 3-year-olds is: 50% have 35 cm between the ankles (DBA) 25% have more than 5 cm These invariably straighten nicely after 8 years.
Rules in summary
It is normal for: Bow legs 03 years Knock knees 38 years Legs straight by adolescence
DBK
DBA
(i)
(ii)
(iii)
Bow legs
Knock knees
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Bronchiolitis
What is bronchiolitis?
Bronchiolitis is a chest infection in which there is inflammation of the bronchioles, which are the smallest branches of the respiratory tree of the lungs. This results in narrowing and blockage of the small air passages with mucus, leading to a negative effect on the transfer of oxygen from the lungs to the bloodstream. Bronchiolitis can be confused with bronchial asthma or the effects of an inhaled foreign object. underlying tendency to asthma. Some infants with recurrent bronchiolitis may eventually develop asthma. However, most infants with recurrent wheeze will not develop asthma.
Key points
Bronchiolitis is a viral infection in the first year of life. It usually gets better in 710 days. Antibiotics will not cure it. Extra fluids are usually needed. It usually is a once only condition. Some children get recurrences over 2 years.
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bronchitis
bronchial tree
Medical help
Prevention of more infections is important. This may be achieved by giving high doses of vitamin C, anti-influenza injections and antibiotics. Your doctor may prescribe small doses of antibiotics throughout the winter months or may advise you to take a full dose at the first sign of a flare-up. The reason for this is that bacterial infection soon complicates the viral infection. See your doctor as soon as possible if you notice your sputum changing to a yellow or green colour. If you have wheezing and breathlessness, an aerosol inhaler will be prescribed if tests show that your breathing capacity is reduced. Your doctor can help you with techniques to stop smoking. STOP NOWbefore it is too late. Physiotherapy can help if you have difficulty coughing up sputum.
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Bunions
What is a bunion?
A bunion is an inflamed bursa (small bag of fluid) overlying a V-shaped bony prominence on the outside edge of the joint at the base of the big (first) toe. called a bursa. If it becomes red and inflamed it is termed bursitis. The bursa may become infected especially in people with diabetes and this is a serious problem. The overlying skin can also break down to form an ulcer. The affected joint is also more likely to develop osteoarthritis (wear and tear arthritis) sooner than usual. Hallux valgus can cause foot pain and stiffness due to the altered mechanics of the foot. Corns and calluses are prone to develop at various points of the foot apart from the bunion.
big toe
Bunions are a very common condition but most people are not troubled by them. They are 3 times more common in women which possibly reflects the footwear problem. They tend to run in families.
A podiatrist will be able to provide expert help including the treatment of associated skin problems. Medication is usually unnecessary unless the bursa becomes infected. Surgery: Operations are reserved for severe cases not responding to careful foot care and the results are excellent. However, it is preferable to treat bunions conservatively and sensibly in order to avoid surgery.
trochanteric bursitis
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Calluses
What is a callus?
It is simply a thickening of skin caused by some form of repeated pressure and friction. It is usually not painful but can be uncomfortable. It is common on the sole of the foot over the base of the toes. A callus can be found on any part of the body, especially the hands or the knees. When a callus is pared, normal skin is found underneath.
Warts
What is a plantar wart?
A plantar wart is a wart that has grown on the sole of the foot and then gets pressed into it by pressure. It feels like a stone in the shoe and can be quite painful. It is caused by a viral infection and is more common in children and young people, who may pick the virus up from public showers. When it is pared, small bleeding points are exposed. Plantar warts are more difficult to treat than corns and calluses.
Callus
Wart
Corns
What is a corn?
A corn is a small tender raised lump that is round and has a hard centre. Corns usually form over the toes over the joints, between the toes and on the outside of the little toe. Sometimes they can be very painful. Paring reveals a white circular mass of old skin.
Corn
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Intoeing in children
Intoeing is common in children but invariably improves with age. Corrective shoes or inserts do not hasten improvement. There are 3 different types of causes: 1. hooked feet: in infants 2. tibial torsion: in toddlers 3. inset hips: kindergarten or pre-school children
Metatarsus varus
Tibial torsion
Tibial torsion is where the main bone (the tibia) of the leg rotates inwards from below the knee. It results when the normal development of rotation is prevented by the childs sleeping posture. Most legs with tibial torsion get better without treatment. If the legs are not symmetrical (the same on both sides) or the torsion persists for longer than 12 months, the child should be seen by a specialist.
The w position of femoral torsion (inset hips)
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Cancer
What is cancer?
Cancer is an abnormal disorganised growth of cells in the tissues of a person. The cells multiply out of control and drain vital nutrition from the normal cells. A foetus growing in a mothers womb is a rapid growth of cells, but unlike cancer it is beautifully organised. Cancer is often referred to as a growth. There are two types of growth: benign and malignant. The benign type is more organised and not generally dangerous as opposed to malignant growth (cancer), which can spread from its original site to other areas of the body. Do these symptoms or signs always mean cancer? No, not always, but it is dangerous to ignore them because the earlier the treatment (if cancer is the cause) the greater the chance of recovery. Unusual bleeding should always be treated very seriously. If you have any of these listed symptoms or any trouble that persists longer than a month, see your doctorto be on the safe side. It probably will not be cancerbut whatever it is should be cured! Is pain an early sign of cancer? No, not usually. Pain is usually a very late symptom of cancer, when it has grown into the nerves. People often think that persistent pain such as headache and back pain means cancer, but this is rarely the case. However, pain should not be ignored.
Cannabis (marijuana)
What is cannabis?
Cannabis is a drug that comes from a plant called Cannabis sativa or the Indian hemp plant. It contains a chemical called tetrahydrocannabinol, which makes people get high. It is commonly called marijuana, grass, pot, dope, hash or hashish. Other slang terms are Acapulco Gold, ganga, herb, J, jay, hay, joint, reefer, weed, locoweed, smoke, tea, stick, Mary Jane and Panama Red. Marijuana comes from the leaves, while hashish is the concentrated form of the resinous substances from the head of the female plant and can be very strong (it comes as a resin or oil). become bored, inert, apathetic and careless. A serious effect of smoking pot is the inability to concentrate and to learn and the loss of memory. Other serious problems are: deterioration of academic or job performance respiratory disease, especially bronchitis (more potent than nicotine for lung disease) often a prelude to taking hard drugs becoming psychotic (resembling schizophrenia) impaired ability to drive a car and operate machinery
The effects of smoking marijuana appear in up to 20 minutes and usually last 25 hours, followed by drowsiness. With larger doses, feelings of confusion, restlessness, excitement, anxiety or panic usually develop.
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median nerve
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Chickenpox
What is chickenpox?
Chickenpox (varicella) is a mild disease, but is highly contagious and in adults it may result in severe illness. It is caused by a virus that can also cause shingles (herpes zoster). Recovery occurs naturally, because a virus cannot be killed by drugs. Chickenpox affects mainly children under the age of 10. Scarring Most people worry about this, but usually the spots do not scar unless they become infected.
Vaccination
A vaccine against chickenpox is now available, and is usually given after 12 months of age in children. Ask your doctor for information.
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In the pool
Five centimetres of water in a pool can drown a toddler. A pool not in use should be made safe from wandering childrenat least covered and preferably fenced offand children should swim only with adult supervision. Keep pool chemicals, especially acid, locked away.
In the bathroom
Poisons and burns are also the main bathroom hazards, but children do drown in baths. Run cold water before hot into childrens baths and always test the water temperature before the child gets in. Never leave children unattended in a bath. Tablets and medicines may be fatal for children: store tablets and medicines in a childproof place and destroy all leftovers. Toilet cleaners and deodorants also should be locked away.
In general
Floor-to-ceiling glass doors and windows should have two stickers on them (one at your eye level, the other at toddler eye level) to prevent people walking through. False plugs should be inserted into all power points that are not in use, especially those within toddlers reach. Bar radiators and children do not mix. Any type of fire should have a guard around it.
In the playroom
Any object smaller than a 20-cent piece may choke a child: there should be no beads around or small removable parts on toys. Keep jars containing small items such as buttons out of reach. Do not pin dummies to clothing; tie them on instead.
Remember
Prevention is so much better than cure. When you are upset about something it is easy to forget about your child for a moment, so be doubly careful when you are having an off day. Prepare your house now, and good habits will save lives and prevent tragedy later. Buy a bottle of syrup of ipecac and write your doctors telephone number beside your telephone for rapid action should your child swallow something dangerous. Know the local Poisons Information Centre telephone number. Your friends and relatives homes may not be as safe as yours.
In the bedroom
Remove the plastic cover from a new mattress, remove the bib before the baby goes to sleep, and never leave a baby unattended on the bed or table. Check childrens clothes for fireproof materials and choose the safest garments. Select close-fitting clothes; ski pyjamas are safer than nighties; tracksuits are safer than dressing gowns.
In the yard
Insecticides, weed-killers, fuels, paints, paint strippers and all garden products should be labelled and stored away from children. They should never be stored in old drink
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Chlamydia urethritis
What is chlamydia?
Chlamydia is a type of bacteria and one of its varieties, Chlamydia trachomatis, is the most common sexually transmissible infection (STI) in the world. It is 3 times more common than gonorrhoea. Fallopian tubes. This is the commonest form of pelvic inflammatory disease, which can result in infertility.
How is it diagnosed?
Chlamydia is diagnosed by taking special swabs from the affected areas: from the urethra of the male penis and the cervix and urethra in females. A new and easier method for the patient is to perform special tests on the first voided specimen of urine.
Important points
Chlamydia is a common STI. It sometimes causes symptoms in men. There may be no symptoms in women. It can cause infertility in women (and less commonly in men). It is readily treated by antibiotics. Treatment may be by a single dose only but may need repeat courses. All sexual partners need to be treated. Do not have sex until the infection is cleared (both partners). It is the affected persons responsibility to inform their partner(s) that they have chlamydia. Condoms provide some protection.
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8 Prevention
Cholesterol: how to lower cholesterol
Why bother?
Heart disease is the number one killer in Australia. It is mainly caused by clogging up of the arteries by a fatty substance known as atheroma, which comes from having too much fat in the blood. This serious process is called atherosclerosisthe condition that can lead to heart attack or stroke. There are two types of fat that cause damage if their levels are too highcholesterol and triglyceride. A special blood test taken after fasting for at least 12 hours can tell if one or both of these fats are too high. diet, by eating saturated fats especially from animal foods. (Therefore it is a rare problem in vegetarians.) Most people can lower the level through changing their diet. Occasionally the level is so high in some people that, in addition to the diet, special medicine is necessary to reduce it to the right level. The prescribed drugs are very effective. Note: Although cholesterol is present in animal food, it has been shown that it is necessary to reduce the amount of all the saturated fats (plant and animal) in our diet and to lose excess weight in order to get our cholesterol down. Foods rich in starch (such as bread, rice and pasta) and foods rich in starch and fibre, known as complex carbohydrates, also help.
Triglyceride
If your triglyceride level is too high, fixing the problem is usually quite straightforward because it is mainly due to being overweight. It is caused by having too many calories in the diet, especially from sugar and other carbohydrates and high-calorie drinks (e.g. soft drinks and alcohol, in particular beer). The aim is to get your weight down to an ideal level.
Golden rules
Keep to your ideal weight. Take a high-fibre diet. Eat fish at least twice a week. Beware of fast foods. Avoid deep-fried foods. Take regular exercise. Always trim fat off meat. Avoid biscuits between meals. Drink more water. Do not smoke. Limit alcohol intake.
Cholesterol
High cholesterol is a bigger problem, and if your level is too high it is important to reduce it. Cholesterol is a white fatty substance made mainly in the liver by animals, including humans. We get high levels mainly through our
The low cholesterol diet
Foods to avoid Eggs Milk Organ meats Seafood Meat Poultry Bakery food Fast food Nuts Fruit and vegetables Miscellaneous whole eggs, egg yolks whole milk and its productsbutter, cream, cheese, ice-cream, yoghurt, condensed milk brains, liver, pat, liverwurst, kidney, sweetbread prawns, squid (calamari), fish roe, caviar, fish fingers, canned fish in oil (e.g. sardines) fatty meatsbacon, ham, sausages, salami, canned meats, pressed meats, meat pastes, hamburger mince duck, goose, skin of chicken and turkey, pressed chicken pies, pasties, pastries, cakes, doughnuts, biscuits fried chicken, chips, fish, dim sims, spring rolls, etc., hot-dogs, pizzas, fried rice cashews, macadamia nuts, coconut, roasted nuts, brazil nuts, peanuts, peanut butter (can have in very small amounts) gravies, potato crisps, caramel, chocolate (including carob), butterscotch, health food bars, fudge, coffee whitener and other cream substitutes, toasted breakfast cereals (especially with coconut) saturated fatslard, dripping, suet, copha, cooking (hard) margarine, coconut and palm oils, mayonnaise frying, roasting in fat
Suitable foods egg whites low-fat milk, skim milk and its productscottage and ricotta cheese, buttermilk, non-fat yoghurt fresh fish, scallops, oysters, canned fish in water, lobster and crab (small amounts) rabbit, veal (without fat), lean cuts of beef, lamb and pork (in moderation) chicken, turkey (lean and without skin), preferably free-range bread, crumpets (especially wholemeal), crispbreads, water-biscuits, homemade items (pies, etc.) if proper ingredients used pecan nuts, hazelnuts, walnuts, almonds, seeds (in moderation) all types (very important) rice, pasta, cereals, jelly, herbs, spices, canned spaghetti, Vegemite, tea, coffee, honey, jam, alcohol (small amounts)
polyunsaturated fatsmargarines, salad dressings; vegetable oilsolive, walnut, corn, soya bean, sunflower, safflower, cottonseed (all in moderation) using vegetable oils (as above), baking, boiling, grilling, stewing
Cooking methods
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The only treatment proven to slow down the relentless progression of COPD is smoking cessation.
Medical help Visit your doctor regularly for check-ups and if you get a chest infection. Oxygen may be needed if your problem is severe home oxygen units are available. Visit your doctor without delay if you get a cold or bronchitis, or start coughing up sputum. If you have a chest infection antibiotics will help clear it up. Bronchodilators If your chest is tight or wheezy, inhalation of a bronchodilator should help. Many patients respond well enough to get sufficient short-term relief. New agents delivered by inhalation may give improved results. Corticosteroids Some patients may benefit from a course of inhaled or oral corticosteroids and doctors may undertake a trial of this therapy. Prevention for all patients influenza injection every year in autumn pneumococcal vaccination every 4 years if you still smoke QUIT
Reprinted with permission of Australian Doctor
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the skin and comes on at rest. It is generally worse in bed at night, is constant and hard to relieve. Other symptoms Other symptoms or signs include loss of normal hair on the legs, shiny skin, nail changes, coldness of the feet and discolouration of the foot (such as red, white or blue).
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Circumcision
Who gets circumcised?
Circumcision is performed on baby boys for a number of reasons, but mainly because it is demanded or requested by their parents, often for religious or cultural reasons. It is a routine ritual in some religions or cultures, but in other societies parents tend to be uncertain about the decision to circumcise and may worry a lot about it. Some parents want the operation so that the child can be just like his father. In older boys and some adults, circumcision may be necessary for medical reasons, but this is quite uncommon. Some people argue that it protects against the spread of HIV and other sexually transmitted diseases. point out that there is no hurry to operate because it is best performed when the baby is not wearing nappies.
Key points
Routine circumcision is not recommended. It is best avoided on newborn babies. It should be considered when there is: very tight foreskin recurring infection of the foreskin difficulty in passing urine foreskin that cannot be pulled back easily.
Tight foreskin
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Coeliac disease
What is coeliac disease?
It is a hereditary disorder of the small intestine caused by a sensitivity to gluten in food. Normally the lining of the small intestine has a fluffy velvety texture but with coeliac disease it becomes smooth and flat. This reduces its ability to absorb nutrients including sugars, proteins, vital minerals and vitamins from food. The intestine simply cannot tolerate gluten in food. The exact reason is unknown. The condition is also called gluten enteropathy and non-tropical sprue. In adults Common symptoms include: tiredness and lack of energy (may be anaemia) weight loss diarrhoea bulky, offensive faeces faeces difficult to flush down toilet flatulence and abdominal swelling anorexia and nausea
How is it diagnosed?
Special blood tests can give a strong clue to the diagnosis. However, the key test is a biopsy of the lining of the small intestine, which is done under sedation. This shows the flat lining of the intestine.
What is gluten?
Gluten is a type of protein present in most grains, especially in wheat and rye and also in barley and oats. It is present in most of our breakfast cereals.
Other considerations
There is no restriction to general activities. It is useful to contact a coeliac disease support organisation such as the Coeliac Society in your state.
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Common cold
What is the common cold?
The common cold is an infection of the upper respiratory passages, especially the nose and throat. It is caused by any of several types of viruses. It is quite different from influenza (the flu), which is caused by more intense viruses.
Main complications
How is it caught?
If you have a cold, you must have breathed in the virus, which is carried in the air after being coughed or sneezed out by another person with a cold.
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Conjunctivitis
What is conjunctivitis?
It is an inflammation of the conjunctiva, which is a thin, clear tissue that lines the eyelids and the eyeball, except the cornea. It is very common, but not a serious problem except in newborn infants. Viral infection a painful red eye slight discharge only Viral conjunctivitis, which is also associated with upper respiratory infections, is the conjunctivitis that usually occurs in epidemics (known as pink eye). It usually lasts 23 weeks and can be very contagious, so care needs to be taken not to infect others. Allergic conjunctivitis itchiness and redness of the whites of the eyes a gritty feeling in the eyes no discharge A feeling of irritation and watering may be found with all these types.
Eye bathing with salt water Antibiotics will not work if there is discharge still in your eyes, and so it is vital to wash away this debris with a weak, salty solution. It is preferable to have this warm. The solution can be made by dissolving 1 teaspoon of salt in half a litre (500 mL) of boiled water. Use this solution before instilling eye drops. Another method is to add a pinch of salt to an eyebath of lukewarm water. Apply the eyebath closely to the rim of the eye, look upwards and blink the eye, which will then be irrigated by the solution. Sometimes bathing the eye with saline or a weak solution of povidone-iodine (Betadine) diluted 1 in 10 with saline or water will clear the eye infection.
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Constipation
What is constipation?
Constipation is: hard, often very small stools infrequent bowel movements or a feeling of unsatisfied emptying of the bowel
large bowel
Apart from slack habits, there are other important causes such as bowel cancer, drugs, thyroid disease, depression, anorexia nervosa and lead poisoning. Any medicine that you are taking should be suspected of causing constipation.
Diet Take plenty of fluids, especially water and fruit juices. Eat foods that provide bulk and roughage, for example vegetables and salads, cereals (especially bran), fresh and dried fruits, and wholemeal bread. Some examples of food with good bulk (from least to most) are potatoes, bananas, cauliflower, peas, cabbage, lettuce, apples, carrots and bran. Fruit has good fibre, especially in the skin, and some have natural laxatives (e.g. prunes, figs, rhubarb, apricots). Habit
Answer natures call to empty your bowels as soon as possible. Develop the after-breakfast habit. Allow time for a good relaxed breakfast and then sit on the toilet (up to 10 minutes if necessary) while reading! Eat meals slowly in a relaxed manner at regular times. Laxatives Avoid laxatives, codeine compounds (tablets or mixture) and neglecting the call of nature. Many laxatives can actually aggravate the problem in the long run and should be avoided. If absolutely necessary, your doctor may recommend one of the hydrophilic bulk-forming agents such as isphagula and psyllium.
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Contact dermatitis
What is contact dermatitis?
It is a skin inflammation caused by an allergic or irritating reaction to certain substances coming into contact with the skin. The reaction can be acute (sudden), within minutes to hours, or chronic, which comes on slowly (such as the reaction to the nickel in a watchband).
Allergens plants (e.g. rhus, grevillea, primula, poison ivy, mango skin, parsnips) chemicals in some perfumes and cosmetics some metals in jewellery, especially nickel (e.g. nickel buttons or studs); chromate (in cement and leather) rubber and latex some topical medications (e.g. antibiotics, anaesthetics, antihistamines) resins and glue dyes coral
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Normal reactions
You will naturally feel terrible and react with disbelief and a whole range of emotions and physical feelings that are quite unfamiliar to you. These reactions include fear, helplessness, sadness, anger, shame, guilt, frustration and a terrible let down. The why me? feeling is very real. The feelings usually last for only a few minutes at any one time. All this is a normal response to a crisis, and then you go through a recovery cycle.
Recovery
You may not think so at the moment, but you will soon learn to cope; nature heals in time. The human body has a remarkable ability to cope both physically and mentally with extreme stress. It is therefore important for your own sake and that of your loved ones who rely on you that you cope and keep on an even keel until time heals your misfortune. There is light at the end of the tunnel.
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These risk factors increase the likelihood of development of hardening of the arteries (or atherosclerosis); the benefit of reducing them is obvious. The factors are interrelated; for example, excessive intake of alcohol will lead to hypertension. Hypertension The higher the blood pressure, the greater the risk. Regular checks, say yearly for people over 40 years, are advisable. Doctors recommend that you have the diastolic level (lower level) of blood pressure kept at 90 mmHg or below. Smoking Cigarette smoking has been clearly shown to increase the risk of heart disease. The death rate from coronary heart disease is about 70% higher for smokers than for nonsmokers and for very heavy smokers the risk is almost 200% higher. The more one smokes, the greater the risk. It has also been proved that the incidence of heart disease falls in those who have given up smoking. High cholesterol It has been proved that high blood cholesterol is related to heart attacks. High cholesterol is caused by a diet high in
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Cramp
What is cramp?
Cramp is a painful spasm in the muscle, usually the calf muscles of the leg. It can also occur in the foot. The affected muscle feels hard and tense, and it is almost impossible to control it.
Exercise 2: This usually follows exercise 1 before retiring. Rest in a chair with your feet and legs horizontal and with support under your Achilles tendon. Keep this position for 10 minutes. 189
Croup
What is croup?
Croup is a common viral infection of the upper airway at the level of the throat, namely the voice box (larynx) and windpipe (trachea). It is a special problem in children, who normally have narrow air passages, and usually occurs from 6 months to 3 years of age but can occur up to 6 years or so. The younger the child, the more susceptible he or she is to croup. It tends to occur in the winter months. Treatment tips Give the child paracetamol for fever. Antibiotics will not help, because croup is caused by a viral infection; however, they are used for any bacterial infection that develops with the croup. Stay by the childs bedside until the child settles. Have the child propped up in bed or lying on a few pillows for support. Watching television can help the child relax. Wrapping the child in a blanket and walking around outside may help the symptoms to settle. Medication The modern method is to give the child steroids (cortisone) by mouth or by spray for the more troublesome attacks.
Key points
Croup is worse at night. Keep the child calm. Moist air is helpful. Croup can be dangerous. Get help if you are concerned.
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Crying baby
All noise at one end and no sense of responsibility at the other is an old saying about infants. However, crying is an important expression to develop a proper interaction between the baby and parent or carer. Teething Babies usually cut their first teeth between the ages of 6 months and 2 years. The gum is often swollen and sore at the spots where the tooth erupts. This discomfort can make the baby cry, but it does not usually last for longer than a week. Infant colic This is one of the commonest causes of unexplained gusty crying in an infant. It is a distressing but harmless problem that some babies develop from as early as 12 weeks of age and lasts until 1216 weeks. It typically develops in the late afternoon and early evening and lasts for about 3 hours in a day and continues for at least 3weeks. Loneliness Some babies may cry because they feel lonely and are looking for comfort and attention. If the baby stops crying when picked up, the cause may well be this lonely feeling. Infections Infections are not all that common in infants but will be diagnosed by your doctor. Examples of such infections are a respiratory tract virus, urinary tract infection, gastroenteritis and middle ear infection. A middle ear infection, which can cause much distress, may be indicated by a fever, running nose and the baby pulling at his or her ear.
You should keep these problems in mind when you check your crying baby. However, much of the crying has no specific causes.
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5 Womens health
Cystitis in women
What is cystitis?
Cystitis is inflammation of the bladder, which is a very common problem; it is suffered by many women at some stage in their lives. The most vulnerable times are starting sexual activity (hence the term honeymoon cystitis), during pregnancy and after menopause.
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Dandruff
What is dandruff?
Dandruff is the excessive production of small flakes of dead skin on the scalp. It is a normal process, because the cells of the outer layer of scalp skin (the epidermis) die and are replaced constantly, like all other cells in the body. The dead cells then move to the outer edge of the skin and flake off after about 1 month. skin inflammation called seborrhoeic dermatitis is considered to be a most important cause of dandruff.
In some people the dandruff is severe and persistent and itchy. Two causes of this are dermatitis of hair-bearing skin (seborrhoeic dermatitis) and psoriasis. There is usually evidence of these skin disorders on other parts of the body.
hair follicles
Mild cases Suitable shampoos are zinc pyrithione (e.g. Head and Shoulders, Dan-Gard), selenium sulphide (e.g. Selsun) and mixed preparations (e.g. Ionil). The shampoo is massaged into the scalp, left for 5 minutes, then rinsed thoroughly. Use it 23 times a week. Stubborn scaling and itching This often is due to seborrhoeic dermatitis and psoriasis. Coal tar shampoos are effective for psoriasis. Examples are: Ionil T or Ionil T Plus shampoo, followed by Ionil rinse conditioner Sebitar shampoo, followed by SebiRinse conditioner Nizoral shampoo is ideal for seborrhoeic dermatitis. The best way to use it is to start with a milder shampoo, rinse off, then use Nizoral, leave it for 45 minutes and then rinse off. Use it twice a week. If itching is a problem, a cortisone scalp lotion such as Diprosone or Betnovate scalp application can be used.
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Dementia
What is dementia?
Dementia is a disorder in which a previously normal brain does not function normally and the affected person becomes confused, forgetful and out of touch with the real world. It is rare in people under 65 years of age and appears more likely to develop with increasing age. It tends to progress slowly after it develops. The cause is not always known, but dementia can follow brain damage from physical abuse such as boxing, excessive alcohol and other drugs, and hardening of the arteries to the brain. There is a genetic tendency to early dementia in some families.
The problem occasionally results in marked emotional and physical instability. It is sad and difficult for relatives to watch their loved ones develop aggressive and antisocial behaviour, such as poor table manners, poor personal cleanliness, rudeness and a lack of interest in others. Sometimes severe problems such as violent behaviour, sexual promiscuity and incontinence will eventuate.
Support groups
It is important to contact an Alzheimers support group in your state or locality. One such special support and advisory group is called ADARDS (the Alzheimers Disease and Related Disorders Society).
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Depression
What is depression?
Most people feel unhappy or depressed every now and again, but there is a difference between this feeling and the mental illness of depression. Depression is a very real illness that affects the entire mind and body. It seriously dampens the five basic activities of humans: their energy for activity, sex drive, sleep, appetite and ability to cope with life. They cannot seem to lift themselves out of their misery or fight it themselves. Superficial advice like snap out of it is unhelpful, because the person has no control over it. loss of interest in things such as sex inability to enjoy normally enjoyable things tension and anxiety irritableness, anger or fearfulness feelings of guilt or worthlessness or being unwanted difficulty in concentrating and making decisions headache, constipation or indigestion
The symptoms may vary during the day, but are usually worse on waking in the morning. If they are severe, the depressed person may not feel like living at all.
Important points
Depression is an illness. It is commoner than is realised. It just happens; no one is to blame. It affects the basic functions of energy, sex, appetite and sleep. It can be lethal if untreated. It can destroy relationships. The missing chemical needs to be replaced. It responds well to treatment. Never give upbetter times are ahead.
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If you do experience some of these milder effects, it is usually a sign that the medication is working. You soon adapt to most of these side effects, which can settle after 23 weeks. Contact your doctor about any problemsthis is very important.
Important points
Take the tablets as instructed. Side effects tend to improve. Improvement takes about 23 weeks. Plan to take them for about 6 months. Do not drink and drive. Keep the tablets away from children. Contact your doctor about any concerns.
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Diabetes
What is diabetes?
Diabetes mellitus is a disorder in which there is too much sugar in the blood. It is caused by a lack of an important hormone called insulin, which is made by a gland behind the stomach called the pancreas. Diabetes comes from a Greek word meaning to pass or flow through and mellitus means sweet. Insulin controls the balance of sugar (glucose) in the body.
Diabetes
This is achieved by: eating good food regularly (not skimping) spacing the meals throughout the day (three main meals and three snacks) cutting down fat to a minimum avoiding sugar and refined carbohydrates (e.g. jam, honey, chocolates, sweets, pastries, cakes, soft drinks) eating a balance of more natural complex carbohydrates (starchy foods) such as wholemeal bread, potatoes and cereals eating a good variety of fruit and vegetables cutting out alcohol or drinking only a little learning about glycaemic index (GI) foods and preferably eating low-GI foods
Is exercise important?
Yesit really benefits your health. Exercise is any physical activity that keeps you fit. Good examples are brisk walking (e.g. 2 km per day), jogging, tennis, skiing and aerobics. Aim for at least 30 minutes 3 times a week, but daily is ideal. Go slowly when you start.
Good advice
Exercise is important. Do not get overweight. A proper diet is the key to success. A low-fat, low-sugar diet is needed. Do not smoke. Minimise alcohol. Take special care of your feet. Self-discipline will help make your life normal. 193
Key points
1. Check your blood glucose regularly, and record the result and the date and time of the test. 2. Be careful to follow the instructions accurately. 3. Ideal blood glucose levels are between 4 and 8 mmol/L. 4. If you are ill or under stress, your blood glucose level is likely to go up. You should check it more often than usual, and see your doctor if it does go up. Dont forget to record the date, time and result of your blood tests.
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Objectives
Achieve an ideal weight through diet and exercise (most important). Maintain a diet low in fat and sugar and high in fibre and complex carbohydrates. Aim to eat a complex carbohydrate at each meal. Keep the fasting blood sugar below 6 mmol/L.
Common mistakes
poor mixing technique when mixing insulin wrong doses (because of poor eyesight) poor injection techniqueinto the skin or muscle rather than the soft, fatty layer not taking insulin when you feel ill
Storing insulin
Keep insulin stores (unopened bottles) in the refrigerator, not the freezer. Opened bottles can be stored in a cool, dark place; refrigeration is not necessary. Keep insulin out of heat and sunlight. Keep an eye on expiry dates on the bottles.
Golden rules
Take your insulin every day, even if you feel ill. Do not change your dose unless instructed.
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Incontinence of urine
These exercises are designed to help women with incontinence of urine. Incontinence means wetting yourself when you do certain things such as coughing, running, sneezing or laughing, or when your bladder gets full and you pass urine before you reach the toilet. Please note Do not bear down as if trying to pass a bowel motion (or as a woman would do during childbirth). This strengthens the wrong muscles and may make the incontinence worse. It may take a week or more to begin to identify the muscles that need to be exercised to regain the strength and tone of the pelvic muscles.
Stage 2
Now that the correct muscles have been identified, these are the pelvic exercises to do every day. They should not be done while passing urine. (a) While sitting or standing with thighs slightly apart, contract the muscles around the back passage (rectum) then the front muscles around the vagina. Hold this contraction while counting to 5 slowly. Now relax these muscles. Repeat this 4 times. Try to be aware of the squeezing and lifting sensation in the pelvis that frequently occurs when these exercises are done correctly. (b) While sitting or standing, tighten the muscles around the front and back passage together. Hold this contraction for just 1 second and relax. Repeat this exercise 5 times in quick succession. Please note
uterus
thigh
pelvic muscles
Stage 1
To identify the correct muscles to exercise, do the following exercises during the first week: (a) To identify the muscles around your back passage or rectum, sit or stand comfortably and imagine that you are trying to control diarrhoea by consciously tightening the ring of muscles around the back passage. Hold this squeeze for 4 seconds each time. (b) Go to the toilet and commence passing urine. Now try to stop the flow of urine in midstream. Once this is done, recommence voiding until the bladder has emptied. The muscles used to slow or stop the flow of urine are the front pelvic muscles, which help support the bladder. (c) Some women find they can identify the correct pelvic muscles by inserting a finger into their vagina, then squeezing the finger by contracting the pelvic muscles. If the finger cannot be felt to be squeezed, probably the wrong muscles are being exercised or the muscles are still very weak. Do not give up, but proceed with the stage 2 exercises. 70
These slow and quick exercises are important to strengthen the pelvic muscles properly. In stage 2, it is not appropriate to do the stage 1 exercise of stopping the flow of urine each time urine is passed at the toilet. This is only a preliminary exercise. These exercises ideally can be done every hour, but certainly not less than 4 times every day. With practice, the exercises should be quite easy to master, and they can be carried out at any timewhile waiting for a bus, standing at the sink or watching television. There is no need to interrupt the daily routine. Once every week or two, it is important to return to stage 1 for a quick check that the correct muscles are being used. Other measures Maintain ideal weight (being overweight hinders the exercises). If exercises dont work a trial of a drug may be worthwhile. Surgery may help stress incontinence.
Note
Check with your doctor if you are having persistent problems.
8. Encourage breastfeeding
Breastfeeding gives the best nutritional start to life.
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Diverticular disease
What is diverticular disease?
Diverticular disease (also called diverticulosis) is the presence of small blind sacs called diverticula in the wall of your large bowel (colon). It is related to a lack of fibre in your diet. About 1 person in 3 over the age of 60 years throughout the Western world has this problem. It is not really a disease, but a condition in which small pouch-like swellings hang from the bowel wall. Infection in such a pouch is called diverticulitis. Constipation leading to straining to move and open your bowels is a predisposing factor.
Complications are infection and bleeding, which are uncommon. If infection (diverticulitis) develops, you will experience abdominal pain, nausea and fever. These symptoms or any bleeding require prompt attention by your doctor.
1. cereals, such as bran, shredded wheat, muesli or porridge 2. wholemeal and multigrain breads 3. fresh or stewed fruits and vegetables Bran can be added to your cereal or stewed fruit starting with 1 tablespoon and gradually increasing to 3 tablespoons a day. Fibre can make you feel uncomfortable for the first few weeks, but the bowel soon settles to your improved diet.
Note
Any unusual symptom, such as bleeding, constipation, diarrhoea and other changes in your normal habit, may be a sign of bowel cancer. If they occur, report to your doctor.
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66
Earache in children
What causes earache in children?
The commonest cause of earache is acute infection of the middle ear (otitis media), which usually follows a nose or throat infection such as the common cold. Another common cause, especially in older children, is infection of the outer ear (otitis externa) caused by fungi or bacteria that infect ears blocked with wax, water and sweat. This often occurs after swimming, and so is more prevalent in summer. An important cause to consider is a foreign body in the ear (e.g. an insect or the child poking something down the ear). This could even cause a ruptured eardrum.
There may also be: poor hearing a discharge from the ear
outer ear
Glue ears
It is advisable to have your child checked after a middle ear infection to see that the ear has returned to normal. Sometimes a glue ear (secretory otitis media) follows acute otitis media. This is the build-up of a sticky glue-like fluid that gets trapped behind the drum when the fluid cannot drain out of the Eustachian tube.
Otitis media
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swollen inflamed skin of outer ear canal eardrum soggy debris and wax
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Eating disorders
The main eating disorders are anorexia nervosa, bulimia nervosa and binge eating. At least 6 in 100 Western women have an eating disorder, with 1 in 100 having anorexia nervosa, at least 1 in 100 bulimia nervosa and about 4 in 100 binge-eating disorder. repeated attempts to lose weight irregular periods depressed mood with guilt after a binge a sense of lack of control during an eating episode excessive exercise
Anorexia nervosa
Anorexia nervosa is a condition of obsessive desire for thinness through dieting, leading to extreme weight loss. There is a refusal to eat adequately and to have a normal body weight. The cause is unknown but a deep-seated emotional problem based on past experiences may be a significant factor. Typical features of anorexia nervosa femalesadolescents and young adults a refusal to eat poor body image intense fear of becoming fat loss of body fat loss of at least 15% of body weight no or very scant periods dry and scaly skin tendency to exercise obsessively high mortality rate
Risks complications of frequent vomiting, e.g. dental decay, salt and fluid loss
Binge-eating disorders
This is the eating of larger amounts of food than would a normal person in a given period. Some people may binge once a day while others many times a day. It is similar to bulimia except that self-induced vomiting and the use of laxatives to reduce weight does not occur. Typical features of binge-eating disorders secretive and impulsive eating eating foods easy to swallow, high in calories and usually forbidden at other times most patients are obese eating episodes occur in the absence of hunger fear of loss of control binges triggered by feelings of sadness, anger, anxiety or paranoia binges average 2 days a week for 6 months
Who gets it? It is a disorder of adolescent girls with an incidence of 1 in every 200 16-year-old school girls. It can affect young men. There are two common age groups when it comes on: 1314 and 1718. About 40% of people with anorexia will later develop bulimia.
Bulimia nervosa
Known as binge-purge syndrome, bulimia is recurrent episodes of binge eating in secret, followed by self-induced vomiting, fasting or the use of laxatives and fluid tablets (diuretics). The cause is unknown but is probably due to a deep-seated emotional problem. Typical features of bulimia nervosa a disorder of young females begins later than anorexia nervosausually 1725 years binges of high calorie, easily digested food fluctuations in body weight
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Encopresis
What is encopresis?
Encopresis is the involuntary passage of stool into the underwear (or a place other than the toilet) on a regular basis in a child over 4 years of age. Sometimes the child regularly starts soiling his or her underclothes, after having previously been well toilet trained. Children do not usually have complete bowel control until at least 212 years of age. About 12 children in 100 have the problem and it is 3 times commoner in boys than in girls. underwear. The child is unaware of this and control has been lost because the usual anal reflex does not respond. Parents often think their child has diarrhoea when the problem is really constipation. The doctor can diagnose it by examining the rectum.
The laxative is then continued each day. A lubricant or softener such as a paraffin oil preparation may be added. Encourage your child to follow the structured toilet routine (5 minutes, 3 times a day). The above program may be repeated or laxative therapy continued until the problem settles. It usually requires supervision for at least 12 months. Sometimes referral to a special clinic may be necessary. Other pointers for parents Get children 5 years and older to clean up themselves. Ask for the teachers co-operation. Do not return to napkins. Do not allow siblings to tease the child. Provide incentives (e.g. time out with parents).
Remember
hard, constipated faeces
rectum
Praise effort and success. Do not blame, shame or punish for accidents. Do not overreact. Check and correct any stresses. Seek the co-operation of all contacts. Provide a high-fibre diet with plenty of fluids. Establish good toilet habits.
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Endometriosis
What is endometriosis?
The tissue lining your uterus (womb) is called the endometrium. Each menstrual cycle part of it grows and becomes engorged with blood and then is shed as a period. Endometriosis is a condition in which fragments of the endometrium grow in other places such as the wall of the uterus, the ovaries, the ligaments inside the pelvis, the Fallopian tubes and on other pelvic organs. Each cycle, the blood from these fragments cannot escape because it is embedded in tissue in the pelvis. Small blood blisters develop and irritate the tissues. There are many theories about the cause of endometriosis, but we do not fully understand how it comes about.
How is it diagnosed?
It is indicated by the symptoms, but the only accurate method of diagnosis is by directly seeing the condition with a small tube called a laparoscope passed through a small cut into the abdomen. The spots of endometriosis are seen as small red or black lumps.
Surgical treatment The ovaries and womb are usually left intact but the endometrial tissue is destroyed by heat or laser and scar tissue is removed. The aim is to reduce symptoms and improve fertility.
normal
Medical treatment Hormone treatment with one of the contraceptive pills, progestogens or danazol, aims to suppress the menstrual cycle, causing the endometrial cells to shrink and, hopefully, disappear. Hormones are usually taken for 612 months.
Endometriosis
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Epilepsy
What is epilepsy?
Epilepsy is a disorder that comes in various forms and shows up as a fault somewhere in the complex electrical circuits of the brain and nervous system. This minor fault results in the brain being unable to work properly for a brief periodthe various symptoms depend on what part of the brain is affected.
nerve cells in brain
electrical short-circuit
One has to be very careful about driving. However, most people with epilepsy can drive. The usual rule is that they can drive if they have not had a convulsion for a period of from 1 to 2 years.
People with epilepsy can hold down most jobs, but if liable to blackouts they should not work close to heavy machinery, in dangerous surroundings, at heights (such as climbing ladders) or near deep water. Careers are not available in some services, such as the police, military, aviation (pilot, traffic controller) or public transport (e.g. bus driver).
The convulsion
In this type of seizure, patients suddenly become unconscious and fall to the ground. Their bodies go stiff, and then may twitch or jerk briefly. The tongue may be bitten and the bladder usually empties. They then may be drowsy or sleep for half an hour or so. Such a convulsion usually causes no problems. Dos and Donts for the onlooker Dont: move the person (unless necessary for safety) force anything into the persons mouth try to stop the fit Do: roll the person on to his or her side with the head turned to one side and chin up call for medical help if the convulsion lasts longer than 10 minutes or starts again Note: The convulsion in itself will not cause death or brain damage.
Establishing breastfeeding
There are three important things that you should know about breastfeeding: 1. positioning the baby on the breast 2. the let down 3. supply and demand Occasionally some women experience engorged breasts or insufficient milk supply until breastfeeding is fully established.
clusters of alveoli
Positioning
Your posture Make yourself comfortable. Sit upright, but let your shoulders relax. Support yourself with cushions or a footstool, if necessary. Your baby Unwrap the babys arms. Turn the babys body towards yours. Have the babys mouth at the same level as your nipple. Support the babys body well. Hold the baby close to you.
Montgomery's glands
Latching on Support your baby across the back of the shoulder. Tickle the babys lips with your nipple until the mouth opens wide. Quickly move the baby on to the breast when the mouth is wide open. (Do not try to bring your breast to the baby.) Make sure the baby has a large mouthful of breast and not just the nipple. Aim your nipple at the top lip, so that the lower lip will be well below your nipple. The babys tongue should be over the lower gum. (This is hard to see yourself.) If you feel the baby is not well positioned, slip your little finger into the corner of the mouth to break the suction, take the baby off and try again. You are both learning this, so take a few slow breaths and take your time. If you need to support your breast, use your four fingers under the breast, well away from the areola.
notice a tingling or a pins-and-needles sensation or a fullness when this occurs. Others notice leaking from the other breast or nothing at all. You may notice that the baby changes from sucking quickly at the breast to a slower suckswallow-suck-swallow pattern. The milk higher up in the breast (the hindmilk) is rich in fat and calories. It is important that you have a let down, so that the baby does not get only foremilk. If you are anxious, in pain, or embarrassed, your let down may be slow. Eliminate these factors before feeding if you can. Once breastfeeding is well established, you will be able to breastfeed anywhere, but in the early days you need a supportive environment.
Let down
When your baby is feeding, the nerves in the nipple start a reflex action that allows the milk-producing alveoli to be squeezed, which pushes milk along the ducts towards the nipple. This is called the let down reflex. Some women
(a)
(c)
Lie on your back with your hips and knees bent and make cycling movements with your legs. Elderly patients and anyone with lower back pain should be careful when doing this exercise. This exercise can be performed on a bicycle, preferably an exercise bicycle.
(a)
(c) (b)
(d)
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It is a good idea to learn how to keep the lumbar spine in a fixed position by using the abdominal muscles and those around the spine. Lie face-up with one hand under your neck and your knees bent. Draw in your stomach firmly, and press your lumbar region against the floor by slightly raising your buttocks. Holdcount to 6relax; repeat 10 times. Note: Swimming is the ideal exercise for your back. air and roll them from side to side. Hold for 5 seconds on each side. Repeat 5 times. 5b A better variation is to bend up the leg on your painful side and stretch it across your body while you turn your head to the opposite side. Use your hand to reinforce the stretch on your bent leg.
Lie flat on your back, bend one leg up, grasping it with your hand just below the knee, and bend your head forward so that your forehead approaches your knee. Hold for 5 seconds. Repeat on the other side.
1 3
4 5a
5b
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(a)
(b)
injured shoulder
(a)
(b)
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There appear to be two main causes: 1. chronic strain of the ligaments binding the vertebrae together due to poor posture 2. stiff or jammed joints where the ribs join the spine usually due to injury, including lifting and falls
(a)
(b)
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cataract in lens
Retinal disorders Disorders of the retina (the photosensitive area of the eye) can lead to varying degrees of blindness. Diabetes and other diseases can cause retinal problems. Sometimes the retina can become detached and seriously affect your eyesight. Retinal detachment can be treated successfully if detected early.
Tips
Light bulbs are better than fluorescent lights. Have regular checks for blood pressure and diabetes. Have an eye examination every 23 years. Eye problems tend to run in families.
The doctor will usually check your vision and examine your eyes. The foreign body will be located (however, sometimes it comes out before this but still feels as though it is in the eye). Since the eye is very sensitive to pain, the doctor will usually put some local anaesthetic drops into the eye to make removal comfortable. The foreign body will be removed either with a cottonwool bud or, if it is stuck in the cornea, with a needle.
Febrile convulsions
What are febrile convulsions?
Febrile convulsions are fits or seizures that occur in young children when they have a high fever (a fever greater than 38C). A convulsion (fit) is a sudden event when the child is not quite with it, starts to jerk or twitch and may have difficulty in breathing. Most children are absolutely normal later on. One problem is that about 25 to 50% will go on to have another seizure.
What is a rigor?
A rigor or a chill is an episode of uncontrolled shivering which lasts for 1020 minutes. It may be associated with shaking and teeth chattering. A rigor is sometimes mistaken for a febrile convulsion.
Key points
Febrile convulsions may occur again. They usually occur from 6 months to 3 years of age. They cause no long-term problems. They do not cause death, brain damage or epilepsy. They stop by 6 years of age.
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12 months onwards
You can now introduce cows milk and more solid foods especially meats, vegetables and fruit.
Cautionary advice
Choking Be carefulavoid nuts, whole peas, popcorn, raw and uncooked pieces of hard fruits and vegetables (e.g. apples and carrots). Always supervise your baby when eating, especially up to 12 months. Cows milk Cows milk should not become a main drink until 12 months of age. Babies on a cows milk diet who eat little are prone to develop iron deficiency anaemia (seen often from 12 to 36 months). If cows milk is used before 9 months it should be brought to the boil and cooled before use. Milk intolerance develops in some babies. Allergies Be alert for allergic reactions usually seen with cows milk, egg, soy beans, peanuts and fish. Symptoms include flushing, blotchy skin, swelling of the face, pallor and wheezing soon after eating. Diarrhoea and abdominal colic also indicates intolerance. Consult your doctor if you are concerned. Honey Avoid honey for babies under 12 months as it may contain bacteria.
69 months
Lumpy foods can be introduced at 69 months, as by this time babies learn to chew. From 6 months you can introduce well-cooked meats which contain iron (beef, lamb and chicken) and fish but be sure to remove bones and gristle. The texture should be mashed or finely chopped. Other foods: milk-based foods (e.g. custard, yoghurt) egg yolk (delay egg white until 912 months) lentils (e.g. baked beans) Solids can be offered before a drink to develop a yearning for solids. Note: Dont cook with salt or add sugar to fruit.
Reference
http://www.chw.edu.au (fact sheets)
912 months
By 9 months more solids should be eaten each mealtime and the milk should be gradually decreased34 breastfeeds or 600 to 800 mL of formula is sufficient. 30 John Murtagh, Patient Education, Fourth Edition, McGraw-Hill Australia
Fever
What is fever?
Fever is present when the temperature of the body (measured inside the mouth) rises above 37.2C in the morning and above 37.8C later in the day. The normal body temperature is up to 37C. Most fevers are due to an infection in the body and are an important part of the bodys defence against infection. Fever is usually caused by a virus but sometimes by bacteria. The temperature returns to normal when the infection settles. excessive drowsiness signs or symptoms that worry you Children Dress the child in light clothing. Do not overheat with too many clothes, rugs or blankets. Keep the child cool, but avoid draughts. Give the child small drinks of light fluids, especially water, often. Do not worry if the child will not eat. Give paracetamol syrup every 4 hours until the temperature settles. Sponging with lukewarm water for up to 30 minutes will help especially if paracetamol is taken. Give the child plenty of tender loving care, with reassurance that they will soon feel well. Note: Cooling measures such as completely undressing the child and using fans are not necessary. Seek immediate medical help for the following: severe headache or neck pain (with stiffness) light hurting the eyes repeated vomiting a convulsion or the child acting odd undue drowsiness or difficulty waking up refusal to drink the child looking sicker no improvement in 48 hours earache or other pain
Fever in children
Fever is common in children, in whom the temperature may rise quickly to 38.5C or higher. It does not mean the child has a serious illness. It is normal for children, especially infants and toddlers, to have at least 5 or 6 episodes of fever a year. Note: teething does not cause fever. When is fever harmful? Fever itself is not harmful until it reaches a level of 41.5C. This level is very uncommon in children. Extremely high temperatures are often due to human error, for example: shutting a child in a car on a hot day overwrapping a febrile child One complication is a febrile convulsion in a child between 6 months and 5 years of age. The most common complication is dehydration so drinking lots of fluids is important.
Management of fever
Adults Do not overheat with too many clothes or blankets. Drink a lot of light fluids, especially water. Take aspirin or paracetamol tablets for relief. Fan or sponge the patient if the fever is severe. Seek medical attention for the following: severe headache or neck stiffness twitching, shaking or convulsions
Key points
Fevers fight infection. Fevers are common in children. Give them paracetamol mixture every 4 hours. Keep them cool. Keep up fluids.
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Fibromyalgia
What is fibromyalgia?
Fibromyalgia is a chronic pain disorder affecting the soft tissues of the body (muscles, muscle coverings and ligaments) over a widespread area from the neck to the knees. In the past it has been called fibrositis and soft tissue rheumatism. A feature of this rather puzzling condition is that it is chronic, meaning that it lasts for at least 3 months and usually on and off for years. Note: The degree of pain varies from person to person and for an individual can vary from day to day.
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Flat feet
Flat feet in children
Flat feet due to low arches are common and usually quite normal in children. In fact, all newborn children have flat feet. They are also common in pre-school children and present in about 10% of teenagers. It is normal for parents to be very concerned but there is usually nothing to worry about. Children have low arches because they are loosejointed and flexible so that the arch moulds to a flattened position when standing.
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6 Mens health
Foreskin hygiene
The normal foreskin in infants and children does not need special care and should not be forcibly retracted for cleaning from birth to 5 years of age. As a rule the foreskin will retract when it is ready and it should only be retracted by its owner.
(a)
(b)
(c)
(d)
(e)
(f)
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Gallstones
What are gallstones?
Gallstones are small, hard stones that develop in the gall bladder in a similar way to which pearls grow inside oyster shells. They usually vary in size from that of a grape seed to the size of a marble.
liver
gallstones blocking ducts cause biliary pain gall bladder bile gallstones
Self-help Diet is very important. Avoid overeating and eating fatty foods, or any foods that may bring on attacks of biliary pain. A sensible low-fat diet usually keeps the problem under control.
Medical help Strong pain-killers are needed to relieve the attacks. Sometimes the stones can be dissolved by a special chemical or shattered with special shock waves, but most troublesome gallstones need to be removed by surgery. This usually involves removing the gall bladder and its stones and, if necessary, removing stones from the bile duct. The usual modern-day operation is percutaneous cholecystectomy using a laparoscope. It is a type of key-hole operation in which the gall bladder and stones are removed through the scope. Patients are usually able to leave hospital after 12 days.
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Gastritis
What is gastritis?
Gastritis is inflammation of the mucus membrane lining the wall of the stomach. It is caused by various germs especially viruses, irritating chemicals including various drugs, foods that disagree or overeating. It may have an acute (sudden) onset and be short-lived, or be chronic with a slow onset and persistence.
duodenum
It is generally a mild illness and quick recovery follows. One complication is an erosion (ulceration) of the stomach wall that may result in vomiting blood. This rather alarming development requires urgent attention. If vomiting is profuse you have to be careful about getting dehydrated.
inflammation of gastritis
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Gastroenteritis in children
What is gastroenteritis?
It is an infection of the bowel that causes diarrhoea and sometimes vomiting. It is very common in young children and is mainly caused by viruses. lemonade (not low-calorie) 1 part to 6 parts water sucrose (table sugar) 1 teaspoon to 120 mL water glucose 1 teaspoon to 120 mL water cordials (not low-calorie) 1 part to 16 parts water fruit juice 1 part to 4 parts water Note: Children can suck suitable iceblocks. One preparation is Hydralyte, which is available at your pharmacy. Warning: Do not use straight lemonade or mix up Gastrolyte with lemonade or fluids other than water. Days 2 and 3 Reintroduce your babys usual milk or formula diluted to half strength (i.e. mix equal quantities of milk or formula and water). Do not worry that your child is not eating food. Solids can be commenced after 24 hours. Start with bread, plain biscuits, jelly, stewed apple, rice, porridge or non-fat potato chips. Avoid fatty foods, fried foods, raw vegetables and fruit, and wholegrain bread. Day 4 Increase milk to normal strength and gradually reintroduce the usual diet. Breastfeeding If your baby is not vomiting, continue breastfeeding but offer extra fluids (preferably Gastrolyte) between feeds. If vomiting is a problem, express breast milk for the time being while you follow the oral fluid program.
How is it caught?
The viruses can be easily picked up from other people who may have immunity but pass on the infection. Bacteria, usually on contaminated food and often spread by flies, can also cause the problem.
Exclusion
Gastroenteritis is very infective so children should be excluded from others until 24 hours from the last bout of diarrhoea or vomiting.
Consult your doctor if: diarrhoea is profuse, e.g. 810 watery stools vomiting persists any of the danger signs are present severe abdominal pain develops diarrhoea persists or recurs with introduction of milk
Glandular fever
What is glandular fever?
Glandular fever (properly known as EpsteinBarr mononucleosis) is a viral infection that causes an illness similar to influenza. It is sometimes called the kissing disease because it was observed to be passed from one person to another through the mouth. It is also transmitted by coughing and sharing food. The virus spreads through the bloodstream and the lymphatic system, causing the spleen, liver and lymph glands to swell as well as causing a fever (hence the term glandular fever).
How is it diagnosed?
The best way to diagnose the illness is for a blood test to be done. The blood shows abnormal cells (called monocytes) under the microscope, hence the name mononucleosis.
enlarged liver
enlarged spleen
Dos: take paracetamol (in modest doses) to relieve discomfort or pain but not if the liver is affected rest (the best treatment), preferably at home and indoors drink plenty of fluids such as water and fruit juices gargle soluble aspirin or 30% glucose to soothe the throat Donts: drink alcohol or eat fatty foods push yourself to perform tasks attempt to return to your normal daily routine until advised to do so by your doctor (about 4 weeks after the illness starts) participate in contact sports until at least 4 weeks after complete recovery Finally, it is common to feel depressed during the illness and in the recovery phase because you may feel tired and lethargic. Report any such problems to your doctor.
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Glaucoma
What is glaucoma?
Glaucoma is a common eye disorder caused by increased fluid pressure within the eyeball. This high pressure can damage the delicate blood vessels and nerve fibres in the eye. The pressure in this watery fluid builds up because the drainage system gets blocked. Glaucoma, which runs in families, is the second commonest cause of blindness in Australia.
How is it diagnosed?
retina
It is detected by routine examination of the eye and by a special instrument being placed on the surface of the eye to measure the pressure of the fluid in the eyeball. It is a simple and painless test that is usually done as a routine screening test by doctors, especially eye specialists.
frequent changes of glasses that are unhelpful blurred or fogged vision loss of side vision recurrent pain inability to adjust eyes to a darkened room coloured halos around lights
Have regular eye examinations (e.g. everyone over 35 should have routine tests and in particular those over 60 should have glaucoma tests every 23 years). If you have a close relative with glaucoma, you should have yearly inspections.
Remember
Glaucoma is common. It causes blindness. It can be treated successfully. It may be symptomless at first. Always have unusual eye problems checked.
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Gonorrhoea
What is gonorrhoea?
Gonorrhoea (also known as the clap) is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It commonly affects the urethra, especially in men, and other genital areas but may also develop in the anus or throat, depending on the sexual activity. In both sexes Gonorrhoea of the anus and throat may have no symptoms or soreness. There may be a discharge (a feeling of dampness) around the anus. Gonorrhoea is diagnosed by taking special swabs from the infected areas or testing the first passed specimen of urine.
penis
discharge of gonorrhoea
Important points
Gonorrhoea may cause no symptoms, especially in women. It can cause infertility in women (and less commonly in men). It is readily treated by antibiotics. All sexual partners need to be informed and treated. Sexual intercourse should be avoided until the infection is cleared. Condoms provide protection.
Gonorrhoea in men
In women In women gonorrhoea often causes no symptoms but can produce vaginal discharge or pain on passing urine. If it produces pelvic inflammatory disease (PID) it can cause: pain and tenderness deep in the pelvis lower abdominal pain and tenderness fever, an unwell feeling and painful periods pain on intercourse
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Gout
What is gout?
Gout is a type of arthritis that is caused by uric acid crystals getting caught in the spaces between the joints of the feet, the hands and some larger joints. The tissue around the joints becomes inflamed, and this inflammation triggers the sensitive nerve endings at the joint, causing extreme pain. Uric acid is a waste product from the body, especially from proteins called purines. It is passed out in the urine by the kidneys, which sometimes cannot cope with the load of uric acid, and this causes a build-up in the body. However, it does appear to be hereditary and is far more common in men, especially between the ages of 30 and 60. It is one of the oldest disorders known to humans, and some well-known victims include Alexander the Great, Kublai Khan, Michelangelo, Martin Luther, Isaac Newton, Henry VIII, John Wesley, Francis Bacon and Benjamin Franklin.
restrict intake of food high in purines, especially organ meats (liver, brain, kidneys, sweetbread), shellfish and tinned fish (sardines, anchovies, herrings) reduce your intake of alcohol eat a normal, well-balanced diet drink plenty of water maintain a normal weight, but avoid crash diets wear comfortable shoes get regular exercise
Dont:
take your worries to bed exercise too strenuously overexpose yourself to cold drink excessive amounts of alcohol (keep to a modest level only, e.g. 2 standard drinks a day)
Dry skin
Dry skin is a common problem, especially in people with atopic dermatitis (eczema). It is rough, scaly skin that is dry to touch and less elastic than normal skin. Some people describe it as feeling like sandpaper. It is especially common in cold, dry climates. Soaps Avoid using the traditional alkali soaps and harsh soaps. Use soap substitutes such as Dove, Neutrogena or Cetaphil lotion. Less expensive soaps such as oatmeal soap, which are readily obtained from health shops, can also be used. After showering After you shower, do not rub hard with a towel but pat dry and then rub a bath oil or mild baby oil into the skin. Clothing Avoid wearing wool next to the skin. Do not wear heavy woollen clothing. Wear cotton clothing. Skin softeners and lubricants Apart from various mineral oils and Vaseline Intensive Care, preparations that soften, lubricate and soothe the skin include QV skin lotion, Alpha Keri lotion and Nutra-D cream. Moisturisers Although skin softeners act as moisturisers, the urea-based moisturisers can help make the skin more soft and supple. Examples are Nutraplus, Calmurid, Redmin sorbolene, Vitamin E and glycerine lotion, and Aquacare HP. Another suitable moisturising agent is QV cream. Diet Eat a well-balanced diet. Drink ample water during the day.
Key points
Dry skin lacks surface moisture. Avoid excessive bathing and showering. Take shorter and cooler showers. Apply skin softener or moisturiser after showering. Use soap substitutes. Avoid wool and heavy clothing next to skin. Avoid overheating and dryness in rooms. Follow a good diet. Drink plenty of water.
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Haemochromatosis
What is haemochromatosis?
It is a condition where too much iron accumulates in the tissues of the body. Iron is an important element especially for the quality of our blood but excess is harmful. The normal levels of iron in the body are about 3 grams in women and 4 grams in men. In haemochromatosis, the level rises to over 20 grams.
pituitary gland
liver
pancreas
Haemorrhoids
What are haemorrhoids (piles)?
They are knobbly varicose veins of the rectal or anal area, which can prolapse outside the anus and hang as small grape-like lumps. It is important to get into the habit of answering the call of nature. The problem tends to run in families. Other associations are heavy manual work, sitting for long periods (such as bus driving) and pregnancy.
normal vein
internal haemorrhoid
anus
prolapsed haemorrhoid
external haemorrhoid
Haemorrhoids
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Diffuse alopecia
Telogen effluvium This complex term stands for diffuse shedding of hair. It can be triggered by a variety of stressful conditions after which it takes about 24 months for the hair loss to occur. In this disorder up to 50% loss is common so perceptible thinning will be noticed. Patients usually complain of large clumps of hairs with white bulbs coming out with gentle tugging on combing or shampooingthis can exceed 150 hairs a day compared with the normal average of 50100 hairs. The classic precipitating event is childbirth when the hair thins about 3 months later. Others include any severe stress, high fever, weight loss especially crash dieting, trauma from surgery or an accident, malnutrition, ceasing the pill and certain illnesses. People can be reassured that spontaneous recovery is usually expected in about 6 months. If stress factors are corrected and recovery is poor, topical minoxidil for a minimum of 4 months can be used. Chronic telogen effluvium This condition occurs usually in menopausal and postmenopausal women. There may be an episode of dramatic hair shedding that recovers but recurs weeks to months later and lasts up to several days. Fortunately it does not result in obvious baldingit is self-limiting and does not need treatment. Drug-induced alopecia Drugs are a very important cause of alopecia. Those that cause telogen effluvium include cytotoxics (cancer chemotherapy), anticoagulants (warfarin, heparin), antithyroid drugs, antiepileptics and various hormones.
Alopecia areata
This is a disorder of the hair follicle that causes complete hair loss in patches leaving a smooth, clean, normal scalp or other hairy area. A smaller localised patch will usually recover spontaneously within 12 months, though some 68
Halitosis
What is halitosis?
Halitosis is unpleasant smelling or bad breath. It is common in healthy people, especially in the morning when they first awaken from sleep. cancer general infections with fever (e.g. glandular fever) diabetes liver disease kidney disease drugs, including smoking
Other possible causes anxiety and stress habitual mouth breathing, which dries saliva in the mouth sulphur compounds from the back of the tongue
How is it managed?
Dental and mouth care The most important thing is to clean the teeth and mouth regularly, especially with a toothbrush and dental floss. To get rid of plaque and tiny food particles it is important to: Brush the teeth regularly during the day, immediately after each meal if possible. Rinse the mouth out with water after meals. Use dental floss each day to clean the teeth. Gargle with an antiseptic mouthwash (e.g. Listerine, Cepacol). Gently brush the back of the tongue with a soft toothbrush. Nutrition Ensure you have at least 3 healthy meals a day. Regular eating helps. Avoid foods such as onions, garlic, peppers and spicy salami. Avoid strong cheeses. Avoid excessive alcohol (maximum 4 standard drinks a day for men, 2 for women). Chewing fresh parsley, especially after eating onions and garlic, is helpful. Lifestyle Avoid fasting for long periods during the day. Avoid smoking. Avoid excessive coffee (maximum 3 cups a day). Special tip A proven method is to gargle an oil and water mixture. Make up a mixture with equal volumes of aqueous Cepacol and olive oil. Gargle a well-shaken mixture and expel, 4 times a day.
Gases from the stomach Another cause is gases and smells coming from the stomach due to the breakdown of some foods. Certain people seem to be prone to this problem. It is worse when fasting. Foods that tend to cause problems are onions, garlic, peppers, alcohol, spicy salami and similar meats. Medical causes Medical disorders that cause halitosis include: tonsillitis chronic nose and sinus infections lung disorders (e.g. TB and bronchiectasis)
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Hangover
What is a hangover?
A hangover is the extreme drained and uncomfortable feeling the morning after a bout of excessive drinking of alcohol. It is a type of acute drug toxicity. The main symptoms are headache, nausea and fatigue. hangover there is no evidence that it is harmful. It is best to mix water with alcoholic drinks, for example, mineral water to follow or precede alcohol. A hair of the dog that bit you eases the hangover: That is, try to alleviate a hangover by having a drink or two the following morning. This may help you feel better due to taking fluid and reversing the withdrawal symptoms but it is a dangerous practice if used regularly. It can be a forerunner of alcohol dependence. Drinking coffee sobers you up: This may be partly true but coffee also has a diuretic effect and leads to loss of fluid.
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Hay fever
What is hay fever?
Hay fever (also known as allergic rhinitis) is an allergic reaction of the nose, throat and eyes to irritating particles in the air. It is similar to asthma, except that the oversensitive (allergic) reaction occurs in the upper respiratory tract instead of the lungs. There are two types of allergic rhinitis: seasonal rhinitis, which occurs only during certain seasons, usually spring perennial rhinitis, which is present throughout the year fatigue, alcohol, chilly damp weather and air-conditioning can aggravate it also.
Is it inherited?
It does tend to be hereditary. Children whose parents are allergic have an increased chance of getting hay fever. It is a common disorder, and people can grow into it and out of it at any age.
allergens
mast cell
histamine eyes
nose
throat
Avoid the allergen, if you know what it is. (Consider pets, feather pillows and eiderdowns.) Sources of the house dust mite are bedding, upholstered furniture, fluffy toys and carpets. Seek advice about keeping your bedroom or home dust-free, especially if you have perennial rhinitis. Pets, especially cats, should be kept outside. Avoid chemical irritants such as aspirin, smoke, cosmetics, paints and sprays. Medical help Your doctor has many treatments available, ranging from antihistamine pills to desensitisation (after skin testing reveals your allergens). The newer antihistamine pills do not cause as much drowsiness as did the older ones. Sprays for the nose and drops for the eyes, available by prescription, are very effective.
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Head injury
What happens?
The patient has sustained a head injury that appears to be mild. He or she has been observed and is showing no serious signs of damage, so can go home and expect that rapid recovery will follow. However, very rarely, complications may follow at any time over the next few days.
skull
What is concussion?
Concussion is the typical head injury that involves a temporary disturbance of function of the brain. The effect can vary from mild giddiness or headache to loss of consciousness. There may or may not be a brief period of unconsciousness. The other symptoms, according to the severity of the blow to the head, can include being stunned or dazed, senselessness, headache (may be the only symptom), amnesia (loss of memory), dizziness, blurred vision, vomiting, irritability, unsteady walking and mental lapses. The usual outcome is excellent with recovery in an hour or so, but occasionally some may take a few days to return to normal. Note: There is no such thing as delayed concussion. There can be a post-concussion syndrome with persistent headache and dizziness. It requires investigation.
repeated vomiting fits or spasms of the limbs or face blurred or double vision In children Children should be allowed to go to sleep, but should be woken every 4 hours to see if they are rousable and conscious.
Other points
Diet Any food and drink can be taken in moderation after the first 4 hours, but avoid alcohol. Pain-killers Paracetamol can be taken in the usual doses for headache. Avoid taking aspirin. Drugs Avoid sedatives; take no medication unless instructed.
Icepacks and cold compresses Icepacks and/or cold compresses can be used over swollen or painful areas of the head. Rest Stay resting in bed for 2 days with the head and shoulders slightly elevated. When you start getting up, return to bed if you feel giddy or get a headache. Rest quietly at home and do not return to work or your normal activities until after 7 days.
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What is presbycusis?
Presbycusis (pronounced prez-bee-ku-siss) is also known as old age deafness and is the commonest type of hearing impairment in older people. It is caused by wear and tear in the very delicate workings of the inner ear. It does not cause total deafness but difficulties in understanding speech, especially with background noise.
People with presbycusis frequently confuse words such as fit and sit, math and mass, fun and sun. They often say Dont shoutIm not deaf.
Causes of neurosensory deafness (usually not reversible) nerve damage exposure to loud noise, including sudden explosions certain drugs
91
Remember
Hearing problems are common in children. Children are normally born with hearing. However, some are born with deafness. The earlier deafness is detected the better. The first 12 months are critical for diagnosis and treatment. The commonest cause of hearing difficulties is ear infection leading to glue ear. Deafness can cause learning problems at school, poor speech and behaviour problems. Any speech or language delay requires investigation. Hearing tests are easy to do at any age. Hearing aids are required by 12 months to be effective.
33
Heart failure
What is heart failure?
Heart or cardiac failure occurs when the heart, which is a muscular pump, fails to pump enough blood around the body. The heart becomes inefficient either because the muscle is weakened or because there is a mechanical fault in the valves controlling the flow of blood.
tiredness nausea breathlessness lungs heart liver swelling of liver and abdomen
swelling of ankles
Self-help Reduce your physical activity: rest if your symptoms are severe but take exercise such as walking if your symptoms are mild or absent. Cut down your salt intake: have a salt-free diet. Limit your fluid intake to less than 112 litres a day. Reduce your weight if you are overweight. Avoid smoking. Take no alcohol or small quantities only. Medication The most commonly used medicines are vasodilators (ACE inhibitors)the key drugsto open up the blood vessels, and fluid tablets (diuretics). This helps take the load off the heart. A drug called digoxin may be used to improve the strength of the heart. Your doctor will advise you about other drugs.
valves
vein
artery to arteries
215
Heartburn
What is heartburn?
Heartburn is not a disease but a symptom of burning discomfort in your chest, usually associated with an acid taste in the mouth. It is also referred to as indigestion or dyspepsia and is associated with drinking and eating.
Dos: eat in a slow and relaxed manner eat sitting down and relaxed avoid foods that burn eat small or moderate meal squat rather than bend keep your bowels regular avoid stress: relax! relax for half an hour after a meal reduce your alcohol intake
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Hepatitis A
What is hepatitis A?
Hepatitis A, also known as infectious hepatitis and yellow jaundice, is a viral infection of the liver. Hepatitis means inflammation of the liver. Unlike most other types of hepatitis, hepatitis A invades the liver after it enters the body from the bowel by taking in infected food or water.
How is it spread?
The virus is present in the bowel and is spread from person to person through close contact such as infected hands, towels and food, especially from contaminated water and shellfish. That is, it gets from the faeces of the infected person to the mouth of another. It may take 1550 days after picking up the virus before the disease becomes evident, with 28 days being the average time. The patient is most infectious 2 weeks before and 1 week after the onset of jaundice. Hepatitis A is more likely to be contracted overseas in a Third World country with poor hygiene.
enlarged liver
Your doctor may advise that each member of your family be given an injection of immunoglobulin, which protects against hepatitis for 3 months. The injection should be given within a week of exposure. Immunisation People can now be immunised against hepatitis A by a course of 2 injections.
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Hepatitis B
What is hepatitis B?
Hepatitis B is a virus that infects the liver causing it to become inflamed. It is very infectious, more so than the AIDS virus.
shared razor blades, toothbrushes biting, kissing
What is a carrier?
A carrier is a person who has not been able to get rid of the virus from his or her body. Carriers are a risk to other people and have a responsibility to tell dentists, doctors and other people about this. The doctor will advise on how to cope.
sex
Transmission of hepatitis B
How is it spread?
The virus is carried in all body fluids: blood, saliva, semen and vaginal secretions, breast milk, tears and perspiration. It is usually picked up by absorption of infected blood through cuts and sores in the skin, by sexual intercourse or by sharing infected items such as razor blades, toothbrushes, needles and syringes. Procedures such as ear piercing and tattooing can also spread it. The commonest ways are through intravenous drug use and sexual intercourse with carriers.
Good hygiene Do not share personal items (e.g. razors, toothbrushes). Use a condom for sex. Be careful not to get anothers blood on cuts or wounds. Do not share needles.
Vaccination This involves a course of 3 injections. It can be combined with hepatitis A vaccine.
Remember
A blood test can tell whether you have immunity or are a carrier. Talk to your doctor about the prevention of hepatitis B. Be responsible and inform your contacts.
Is there a cure?
There is no easy cure, but it can be prevented. Prevention is done by good hygiene and vaccination.
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Hepatitis C
What is hepatitis C?
Hepatitis C is a virus that infects the liver. It has only been discovered in recent years and is the commonest virus causing hepatitis. About 9 in 1000 Australians carry the virus in their blood.
Symptoms Main methods of transmission
tiredness
tattooing
How is it spread?
Hepatitis C is spread by blood, especially by sharing needles from intravenous drug use (most cases), or from tattooing and body piercing. Before 1990 it was possible to get hepatitis C from blood transfusions, but since then blood from donors has been tested for hepatitis C. There appears to be a very small risk of spread during homosexual or heterosexual intercourse. It also does not spread easily through normal family or household contact so families and friends can be reassured. However, sharing razor blades and toothbrushes can spread the virus. Carriers have a responsibility to inform doctors, dentists and other close contacts about their problem. tattooed people prisoners (high level of drug injections)
Is there a cure?
Some patients who are identified by DNA testing can be cured and there are new drugs to treat hepatitis C. Prevention is really the best cure. There is no vaccine currently available.
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Does it spread?
Herpes simplex is contagious. It is present in saliva of affected persons and can be spread in a family by the sharing of drinking and eating utensils and toothbrushes or by kissing. It is most important not to kiss an infant if you have an active cold sore.
Herpes simplex
120
Is it contagious?
Yes, but only mildly. Rarely, children might acquire chickenpox after contact with someone who has herpes zoster, but it would be very unusual to catch herpes zoster from another person.
It is not true that it is a dangerous disease or that the patient will go insane. Another myth is that a person will die if the rash spreads from both sides and meets in the middle: this is nonsense. For the majority, herpes zoster is a mild disease and an excellent recovery can be expected.
Herpes zoster
121
Does it recur?
After the first infection, the herpes virus remains deep in the nerves that supply the affected area of the skin. Half of those who have the first episode have recurrent attacks; the others have no recurrences. Fortunately attacks gradually become milder, less frequent and usually stop eventually. Recurrences after many months or years can be precipitated by menstruation, sexual intercourse, masturbation, skin irritation or emotional stress.
How is it caught?
It can be caught by direct contact through vaginal, anal or oral sex. Rarely is it transferred to the genitals from other areas of the body by the fingers, and it has never been proved that it can be transferred from places or objects such as toilet seats, towels, spas or swimming pools. Contact is from person to person.
shaft
= herpes ulcer
Females Blisters develop around the opening of, and just inside, the vagina and sometimes on the cervix and anus. Passing urine might be difficult, and there can be a vaginal discharge.
= herpes ulcer
vagina
anus
In both sexes, it can affect the buttocks and thighs. A serious but uncommon complication, especially in females, is the inability to pass urine.
119
Hirsutism
What is it?
Hirsutism is the presence of excessive body or facial hair. For women, the areas most affected are the beard area (upper lip, chin, front of the ears), the chest, the abdomen and the front of the thighs. The condition varies from being mild and hardly noticeable to being obvious. it. Uncommonly, it is caused by cysts or tumours of the ovaries or adrenal glands.
What is normal?
Many women feel they are very hairy, but if this occurs in the normal female hair-growth areas (such as the armpits, forearms, pubic area and around the nipples) there is no cause for concern. A tendency to be hairy may run in families or be prevalent in some races, such as those from the Mediterranean region. Even if the hair growth seems to be in a male pattern, there is usually no serious underlying cause and the problem can be treated. About 10% of Australian women are affected.
69
Hiatus hernia
What is a hiatus hernia?
A hiatus hernia occurs when the upper part of the stomach, which is joined to the oesophagus (gullet), moves up into the chest through the hole (called a hiatus) in the diaphragm. It is common and occurs in about 10% of people. is called reflux oesophagitis, and it may cause bleeding (perhaps anaemia) or a stricture. A serious complication is twisting (called volvulus) of the herniated stomach in the chest. The warning signs in the months beforehand are epigastric fullness and pain whilst eating. These patients cannot cope with large meals. Cancer in a hiatus hernia is very rare, but there is a slight increased risk of it developing in the inflamed area.
Self-help Keep to your ideal weight. Avoid stooping. Avoid smoking. Reduce alcohol and coffee. Avoid tight corsets. Adjust your bed. Take antacids. Have small meals. Avoid spicy food. Avoid hot drinks. Avoid having supper. Avoid gassy drinks.
hiatus hernia
stomach
Losing weight nearly always cures it. Eating several small meals each day instead of 2 or 3 large ones helps. You must have a light evening meal without alcohol and avoid supper so that your stomach is empty on retiring. It takes about 12 hours for the stomach to empty. Smoking certainly aggravates it, as do coffee and alcohol, especially spirits. If symptoms occur at night, you are advised to use extra pillows to prop up your head and shoulders. If this fails, you should raise the head of your bed about 10 cm (4 inches) to prevent acid reflux at night. Medical help If over-the-counter antacids and other measures do not help, your doctor may prescribe a special mixture or tablets to reduce reflux. If your problem persists, an operation (which has good results) may be necessary.
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Soft furnishings Keep soft furnishings to a bare minimum in the bedroom. Avoid heavy curtains and wash the curtains regularly. Window blinds such as vertical blinds are preferable. Soft toys Avoid soft toys in the sleeping area. If you cant, have only a few and wash them regularly. Putting them in the deep freeze overnight (in a freezer bag) once a fortnight will kill the mites. Living area Avoid upholstered furniture if possible. It is preferable to use wipeable furniture such as leather, vinyl and wood.
Other tips
When dusting, use damp dusting in preference to a feather duster. Avoid dust collectors such as wall hangings and beanbags. Any stored clothing, especially jumpers and coats, should be aired in the sun before being worn. Special insecticides (acaricides) are often used to destroy mites in carpets but they are expensive, of doubtful value and, on balance, not recommended.
Best tips
Use top-grade dust mite covers for bedding. Wash bed linen in hot water at or above 55C. Avoid carpet and soft furnishings (if allergy is severe).
Preventive steps
General points Direct sunlight kills the mites, so let lots of sunlight into the house. 218
Hypertension
What is hypertension?
Hypertension means high blood pressure and is present when your blood pressure is greater than normal levels for the population. There are two types of blood pressure (BP) that we measure: systolic and diastolic. The systolic BP is the pressure at the moment the heart pumps the blood into circulation and the diastolic BP is the pressure when the heart relaxes and takes in blood. Both levels of pressure are very important. BP is measured in millimetres of mercury (mm Hg). We have hypertension if our pressure is greater than either the systolic pressure (140) or the diastolic pressure (90) which are the standard uppermost limits of normal. Very high BP is one more than 180 systolic or 110 diastolic. keeping the BP within normal limits, we reduce the risks of strokes and heart trouble, including coronary attacks and kidney failure.
Medication If natural measures do not bring down your BP, tablets will be necessary. The tablets act by softening the strong pumping action of the heart or relaxing the tight arteries or reducing the body chemicals that control your BP. The tablets must be taken regularly as directed and never stopped unless advised by your doctor.
Immunisation of children
The importance of immunisation
The use of vaccines during childhood has dramatically reduced the number of deaths from the basic infectious diseases. Immunisation is vital preventive medicine, and parents have a responsibility to make sure their children are immunised. Whenever we have an infection, our bodies automatically defend themselves by producing substances called antibodies that neutralise the infection. These antibodies remain in the body to fight further contact with germs, and this protection is called immunity. A vaccine works by stimulating the production of antibodies to give us this immunity. Rubella Rubella or German measles is not a serious disease except if contracted during the first 3 months of pregnancy, when it can cause serious problems in the baby. Immunisation is available for all children at 12 months and then during early adolescence for schoolgirls. Being immune to rubella takes a great load off the mind of any expectant mother. Haemophilus influenza type B (HiB) This is a serious bacterial infection that caused many deaths from meningitis and epiglottitis. The vaccine was introduced in 1992, and infections are now rarely seen. Meningococcus
Vaccination at 12 months is given to immunise against the C strain of the potentially deadly meningococcal infection. Varicella (chickenpox) The vaccine is recommended as a single dose at 18 months but can be given from 12 to 13 months. It should be considered at 10 to 13 years if there is no history of varicella. Pneumococcus Pneumococcus causes respiratory infections such as pneumonia. Vaccination is recommended for children as a three dose series; extra doses are required for those at risk.
{ {
DTP(a), hepatitis B, haemophilus, polio(b), pneumococcus DTP, hepatitis B, haemophilus, polio, pneumococcus DTP, polio, hepatitis B (or at 12 months), pneumococcus measles, mumps, rubella, haemophilus, hepatitis B (or at 6 months), meningococcal C varicella DTP, polio, measles, mumps, rubella consider hepatitis B and varicella Boostrix(c), polio
18 months Before school entry (4 years) 1013 years Before leaving school (1519 years)
(a) diphtheria, tetanus and pertussis (whooping cough), known as triple antigen (b) sabin vaccine (c) Boostrixadult diphtheria, tetanus, pertussis
Impetigo
Impetigo, more commonly called school sores, is a very contagious (catching) skin infection. It can occur anywhere on the skin but usually affects the face, particularly around the mouth and nose. Impetigo is most common in infants and children, particularly those just starting school, but can affect adults. Impetigo can occur in other areas on the body, especially around the buttocks, legs and arms. The blisters and crust of impetigo are not painful but they may itch. A skin swab and culture will confirm the responsible germ.
35
Infant colic
What is infant colic?
It is the occurrence in a well baby of regular, unexplained periods of inconsolable crying and fretfulness, usually in the late afternoon and evening, especially between 2 weeks and 16 weeks of age. No cause for the abdominal pain can be found, and it lasts for a period of at least 3 weeks. It is very common and occurs in about one-third of infants.
36
Infertile couple
What is infertility?
Infertility is the inability to conceive after a period of 12 months of normal unprotected sexual intercourse; that is, not getting pregnant after a year of trying. A more preferable term is subfertility, which is the situation where a couple has problems achieving conception. Sterility is the extreme case when conception can never occur. timed, and determine whether there is a sexual difficulty such as partial or occasional impotence or premature ejaculation. If a correctable condition comes to light, the couple will be given advice and told to try again for several months. If there is still a problem, the main tests that will be done are the sperm test in the male and the ovulation tests in the female. The sperm test The male is required to provide a complete ejaculate of semen, preferably by masturbation, after at least 3 days abstinence from sex. This fluid is placed in a clean bottle, kept warm and examined under the microscope within 1 hour. Normal values are more than 2 mL with a sperm concentration of more than 20 million per millilitre and more than 50% normal forms and motility. Ovulation tests Ovulation can be worked out from the history of the nature of the periods, the cervical mucus and body temperature. Measurement of hormone levels in the blood on day 21 of the menstrual cycle will indicate whether ovulation is occurring. Other special tests If these tests are normal, there are many others (including special X-rays of the tubes and uterus of the female) that can be performed. However, your doctor will refer you to a specialist for management.
220
Influenza
What is it?
Influenza, usually called flu, is a respiratory infection caused by a virus, which is a tiny germ that cannot be seen even under an ordinary microscope. There are several kinds of influenza virus, and they seem to keep changing just when we seem to be immune to them. However, they all produce a similar illness. respiratory infection that usually makes the victim sick enough to go to bed. Flu tends to go to the chest and makes the whole body ache; the common cold usually only affects the upper respiratory passages, causing a runny nose, sneezing and a sore throat.
Influenza
How is it caught?
Influenza usually comes in epidemics, when it spreads from one person to another in the spray from coughs and sneezes (called droplet infection). The virus enters the nose or throat and may spread to the lungs. It is extremely infectious.
122
Ingrowing toenails
An ingrowing toenail occurs when the nail of the big toe curves under at the sides of the nail so that it grows into the skin.
cut nail towards centre
corners of nail project beyond skin stretch skin folds with thumbs daily
wrong
221
meats: beef (especially), veal, pork, liver, poultry fish and shellfish (e.g. oysters, sardines, tuna) seeds (e.g. sesame, pumpkin) eggs
Fruits
dried fruits (e.g. prunes, figs, raisins, currants, peaches) juices (e.g. prune, blackberry) most fresh fruit
Vegetables
greens (e.g. spinach, silver beet, lettuce) dried peas and beans (e.g. kidney beans) pumpkin, sweet potatoes
Grains
iron-fortified breads and dry cereals oatmeal cereal For better iron absorption, add foods rich in vitamin C (e.g. citrus fruits, cantaloupe, brussel sprouts, broccoli, cauliflower).
Irritable bowel
What is it?
An irritable bowel (also known as irritable colon or irritable digestive system) is one that does not work smoothly and causes abdominal problems such as colicky pain and disturbed bowel actions. The bowel is a muscular tube that propels the food along in waves (called peristalsis). This muscular action may become overactive and cause spasms or tight contractions rather like a cramp in the leg muscles.
nausea
flatulence
223
Kidney stones
What are kidney stones?
Kidney stones are small hard stones that form in the kidney and sometimes move into the ureter. They vary in size from a grain of sand to a golf ball and in number from one to several. They are also referred to as renal calculi or urinary calculi.
kidney
bladder
Drink at least 2 litres of water every day. Reduce uric-acid-containing foods, especially beer, red meat, red wine and organ meats (brain, kidney, liver, sweetbread). Reduce oxalate-containing foods, especially chocolate, rhubarb, vitamin C tablets, tea, coffee and other cola drinks. Avoid processed meats, organ meats, yeast spreads and high salt foods. Restrict salt intake. Reduce your animal protein consumption: restrict yourself to one major meat meal a day. Have a high-fibre dietplenty of vegetables and fruit.
224
A cracking sensation (called crepitus) or clicking or clunking on bending the knee is often heard. Occasionally the knee may give way. Knee swelling is relatively uncommon. Movie-goers knee This condition is sometimes called movie-goers knee because sufferers prefer to use an aisle seat to stretch the leg out straight into the aisle. These people get a diffuse ache when they sit for long periods with the knee bent.
(a)
(b)
Quadriceps exercise: tighten muscle by straightening the knee to position (a) from the relaxed position (b)
Your doctor or therapist will advise on the most appropriate exercises. For straightforward cases of anterior knee pain simple quadriceps exercises can be very effective. Quadriceps exercise (see figure) Tighten the muscles in front of your thighs for about 5 seconds (as though about to lift the leg at the hip and bend the foot back but keeping the knee straight). Hold your hand over the lower quads to ensure that they are felt to tighten. This tightening and relaxing exercise should be performed at least 6 times every 2 hours or so until it becomes a habit. It can be done sitting, standing or lying.
Reproduced with permission of Australian Doctor
147
Laryngitis
What is laryngitis?
Laryngitis is a relatively minor infection or inflammation of the larynx (voice box) which is situated at the top of the trachea (windpipe). The problem usually seems a lot worse than it really is because of the marked effect on ones voice.
oesophagus
123
Leg ulcers
What are leg ulcers?
Leg ulcers are abnormal holes that occur in breaks in the skin in the lower leg. Ulcers can occur in any person, but the elderly who have poor circulation are most likely to develop ulcers. They usually occur in the area known as the gaiter area of the leg. Twice as many women as men are affected. of the heart reduces swelling and quickens healing. Avoid standing for long periods, but undertake moderate walking exercise. Avoid smoking and have a nutritious diet. Be extremely careful not to injure the leg, as the skin of the legs is fragile. Do not scratch, watch out for sharp stakes in the garden and be careful of hot-water bottles. Keep ulcers covered and sterile (ulcers require moisture to heal). Medical help The ulcer will require regular dressings to keep it clean and free from infection. Special substances may be added to clean out the debris in the ulcer. A nurse may be able to call regularly to dress the ulcer. It is usually better to keep the dressing on for a few days. You will be provided with a knee-high elastic bandage or a thick elastic stocking to wear during the day. It may be necessary to apply a skin graft to promote the healing.
Remember
Keep your leg elevated as often as possible. Keep the leg compressed with a firm bandage, tights or support stockings. Avoid further knocks and other injury.
Combing The eggs can be removed after treatment by combing with a fine-tooth metal comb while the hair is wet. Eyelashes and eyebrows If the nits are present, apply yellow soft paraffin in a thick layer twice a day for 8 days.
How is it diagnosed?
The finding of lice or nits on the head is the only way to diagnose infestation. The nits are seen as small, whitish flecks securely attached to the base of the hairs, especially behind the ears, on the back of the head and near the forehead. Unlike dandruff, they cannot be brushed off. 124
How is it diagnosed?
Diagnosis is made by finding eggs or lice tightly applied to the hair shaft. The lice may be seen to move like crabs, but usually are seen as rust-coloured specks in the pubic hair.
Note: shaving the pubic hair may help but it is not essential. How often? Repeat the treatment in 1 week. Sometimes a third treatment is necessary. Clothing and bedding Bedclothes and underwear should be washed normally in hot water after treatment and hung in the sun to dry. Contacts Sexual contacts and the family must be treated. Young children can be infested from heavily infested parents.
How is it spread?
Crablice are transmitted by close personal contact, especially during sexual intercourse. They may rarely be transmitted to young children by contact with heavily infested parents.
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1 Marriage
Making your marriage work
When a couple marry, a bond of love is invariably present; this bond will at times be put to the test, because marriage is no bed of roses. For most couples this bond will grow, mature and become a wonderful source of joy despite the rough times. However, others may not cope well with the problems of living together. To split up is a terrible loss in every respect, especially for any children of the marriage. Many troubled couples have achieved great happiness by following some basic rules of sharing. 3. Continue courtship after marriage. Spouses should continue to court and desire each other. Going out regularly for romantic evenings and giving unexpected gifts (such as flowers) are ways to help this love relationship. Engage in some high-energy fun activities such as massaging and dancing. 4. Make love, not war. A good sexual relationship can take years to develop, so work at making it better. Explore the techniques of lovemaking without feeling shy or inhibited. This can be helped by books such as The Joy of Sex and videos on lovemaking. Good grooming and a clean body are important. 5. Cherish your mate. Be proud of each other, not competitive or ambitious at the others expense. Talk kindly about your spouse to othersdo not put him or her down. 6. Prepare yourself for parenthood. Plan your family wisely and learn about child bearing and rearing. Learn about family planning methods and avoid the anxieties of an unplanned pregnancy. The best environment for a child is a happy marriage. 7. Seek proper help when necessary. If difficulties arise and are causing problems, seek help. Your general practitioner will be able to help. Stress-related problems and depression in particular can be lethal in a marriage they must be nipped in the bud. 8. Do unto your mate as you would have your mate do unto you. This gets back to the unconscious childhood needs. Be aware of each others feelings and be sensitive to each others needs. Any marriage based on this rule has an excellent chance of success.
The two big secrets of marital success are caring and responsibility.
Early stage
Later stage
83
Measles
What is measles?
Measles is a highly contagious disease caused by a virus; it can have more serious after-effects than many people realise. The complications can be dangerous, and so the illness should be taken seriously.
How is it spread?
The disease is very infectious and is spread to other people usually by kissing, coughing and sneezing. Once inside the body the virus has an incubation period of about 1014 days, and the patient is infectious for about 5 days before and 5 days after the rash appears.
School exclusion
Children should be kept away from school until they have recovered or for at least 5 days from the appearance of the rash.
38
Melanoma
What is it?
A melanoma is the most dangerous type of skin cancer. It grows from special cells in the skin called melanocytes. A melanoma is usually brown or blackish in colour and looks like a freckle, mole or spot. They can begin in moles, but most begin in normal skin. an increase in size, or spread to surrounding skin thickening of the mole bleeding itching
In fact, any change in a mole may be a warning, and should be discussed with your doctor.
Can it be cured?
If melanomas are removed early, they can be completely cured. Over 95% of patients are cured with early removal.
melanocytes
melanoma
fatty tissue
normal skin
225
Mnires syndrome
What is Mnires syndrome?
It is a disorder of the balance system in the ear causing attacks of severe dizziness and other unpleasant symptoms. It was described by a French physician, Prosper Mnire, in the nineteenth century. noise head injury aspirin in high doses allergies (e.g. to alcohol, chocolate, dairy products) otosclerosis (a bone-conduction deafness)
In most cases only one ear is affected. Attacks come on suddenly and may even cause the person to fall over. The attacks usually last from 30 minutes to several hours. They may come on as often as twice a week (unusual) or twice a month to as few as one every year or so.
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Menopause
What is the menopause?
The menopause is the end of menstruation, which in most women occurs between the ages of 45 and 55, with an average age in Australia of 51 years. However, the term is used in a broader sense to describe the months or years before and after the last period, during which the periods become irregular and the body adjusts to reduced levels of female hormones. This may last 25 years or sometimes longer. osteoporosis of varying degrees. Certain drugs and medical conditions and smoking can aggravate it. If you are slightly built or have a family history of osteoporosis, speak to your doctor about this potential problem.
Remember
Menopause is a normal change representing the end of reproductive life. Be informed and unafraid. Report to your doctor if you have a return of unusual bleeding. Continuing medical checks for breast examination, Pap smears and general health assessment are important.
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Migraine
What is migraine?
Migraine or the sick headache is derived from the Greek word meaning pain involving half of the head. It is a common problem that affects about 1 person in 10. It is commoner in females and is worse between the ages of 20 and 50 years. It tends to run in families. Famous people with migraine include Julius Caesar, Elvis Presley, Charles Darwin, Karl Marx and Tchaikovsky. hormonal changes: just before menses or when taking the pill bright lights, glare and flickering lights (e.g. television) changes in the weather excessive noise strong perfume head trauma (e.g. jarring can cause footballers migraine)
When to seek immediate help unusually severe headache weakness on one side of the body loss of vision speech disorder 227
Miscarriage
After your miscarriage you will undoubtedly be confused and wondering why this sad event happened to you. The main thing is to remember that it was nothing that you did wrong, and so you should not feel any sense of blame or guilt.
What is a miscarriage?
A miscarriage, which is called a spontaneous abortion in medical terms, is the spontaneous ending of pregnancy before the baby (foetus) can survive outside the womb. Sometimes it is complete (when both foetus and afterbirth are expelled); other times it is incomplete (when only part of the pregnancy is expelled).
Molluscum contagiosum
What is molluscum contagiosum?
Molluscum contagiosum is a common and contagious viral infection that causes small, firm, wart-like lumps anywhere on the body. It usually occurs in school-age children. It also occurs in adults where it is commonly found on the genitals, inner thighs and abdomen and is usually sexually transmitted.
central depression
top view
side-on view
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Mumps
Mumps
Mumps is a viral infection of the salivary glands, especially the parotid gland, which lies in front of and below the ear. It was one of the common infectious diseases of childhood, but is not seen as often now because of the immunisation program. both testes are affected. Like any viral infectious disease, it can very rarely cause meningitis and encephalitis (inflammation of the brain).
School exclusion
Nine days from the onset of symptoms is recommended, or up to the obvious disappearance of the swollen glands.
How is it spread?
Mumps is spread by coughing or sneezing. The virus takes about 18 days to incubate after contact. Mumps is only a moderately infectious disease. It is infectious from 2 days before its onset up to the time the swellings disappear (usually after 6 days but can be up to 12 days). The patient should be isolated, especially from adults who have not had mumps.
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Nail disorders
What are the causes of nail disorders?
There are many disorders that can cause unsightly disfigurement of the toenails and fingernails but the most common are trauma and infection. Damage to the nail occurs from trauma (injury), and self-trauma due to people injuring their nails by excessive nail-biting, picking and over-cleaning. Infection is a common cause especially from fungal infections which mainly involve the toenails but can affect the fingernails. An infection usually with bacteria of the skin folds surrounding the nail is also common and can become a chronic problem if the acute infection is not cured.
loose nail fungus spreads towards base
cuticle
Fungal infection
nail. The yeast Candida albicans (thrush) infection may complicate it. It often aggravates nail lysis.
What is onychomycosis?
Onychomycosis is a fungal infection of the nail. It is a common problem of toenails which becomes more common as we grow older. Heat and humidity (the result of wearing shoes) are also factors. It is usually associated with tinea of the feet. If it is suspected your doctor will take scrapings of the nails for laboratory examination.
The effect is that the nail lifts at its end allowing access of air and debris from the outside. Dirt and grit, keratin (dead skin) and chemicals get in under the nail causing discolouration and further damage to the nail.
What is paronychia?
Paronychia is an infection of the skin folds surrounding the nail. Acute painful paronychia, which is usually caused by the bacteria Staphylococcus aureus, often leads to a blister of pus (often called a whitlow) alongside the nail. A very serious problem is the development of chronic paronychia with the loss of the cuticle at the base of the 228
Nappy rash
What is nappy rash?
Nappy rash (also called diaper dermatitis) is a red, irritating skin rash corresponding to the area covered by the nappy. It affects the genitals, buttocks, groin and thighs, but usually spares the creases not in contact with the nappy. 2. After changing, gently remove any urine or moisture with diluted Sorbolene cream or warm water. 3. Wash gently with warm water, pat dry (do not rub) and then apply any prescribed cream or ointment to help heal and protect the area. Lanoline or zinc cream applied lightly will do. Stoma adhesive powder is an excellent protective substance. 4. Expose the bare skin to fresh air whenever possible. Leave the nappy off several times a day, especially if the rash is severe. 5. Do not wash in soap or bath too oftenonce or twice a week is enough. 6. Avoid powder and plastic pants. 7. Use special soft nappy liners that help protect the sensitive skin.
Medication
For persistent nappy rash, your doctor will usually prescribe a mixture of mild cortisone cream and an antifungal cream to treat the thrush. A soft skin moisturiser such as Vaseline or a mixture of zinc oxide and castor oil should be used to keep the skin lubricated.
Key points
Keep the skin dry. Expose the skin to air and sunlight where possible. Use protective creams. Do not use soap or plastic covers. Do not bath the baby too much. Visit your doctor if the rash is not responding after 4 days.
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look up in a strained position for long periods (e.g. as when painting a ceiling) twist your head often towards the painful side (e.g. as when reversing a car) lift or tug with your neck bent forwards work, read or study with your neck bent for long periods become too dependent on collars sleep on too many pillows
Do:
keep your neck upright in a vertical position for reading, typing and so on keep a good posture: remember to keep the chin tucked in sleep on a low, firm pillow or a special conforming pillow sleep with your painful side on the pillow use heat and massagemassage your neck firmly 3 times a day using an analgesic ointment
Professional help
Your doctor may prescribe mild pain-killers such as aspirin or paracetamol or other medicine for a short period, especially if arthritis is developing. A course of exercises to mobilise stiff joints in the neck and strengthen the supporting muscles is probably the best treatment. To overcome a painful episode, therapy to the muscles and joints by gentle mobilisation from a trained therapist is highly recommended.
work, read, study and so on with the neck bent for long periods
Do...
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Inverted nipples
What is an inverted nipple?
It is a nipple that inverts or moves into the breast instead of pointing outwards when a baby tries to suck from it. When the areola is squeezed, the nipple retracts inwards.
Cracked nipples
Cracked nipples are usually caused by the baby clamping on the end of the nipple rather than applying the jaw behind the whole nipple. Not drying the nipples thoroughly after each feed and wearing soggy breast pads are other contributing factors. Untreated sore nipples may progress to painful cracks.
Interesting facts
Vision is present at birth and matures gradually to adult vision at about 12 months. Hearing is present at birth; if not, the first 12 months are critical to correct it.
Normal development in children
Milestone Lifts chin up Notices sudden constant sounds (e.g. vacuum cleaner) Social smile Smiles readily Vocalises when talked to Follows moving person with eyes Laughs Coos Recognises mother Responds to loud noise Squeals in delight Grasps and plays with rattle Turns to voice Lifts head Rolls over (prone to supine) Sits with support Rolls (supine to prone) Reaches and grasps Transfers objects from hand to hand Turns towards soft sound No head lag when pulled up to sit Feeds self biscuit/rusk Laughs, squeals and chuckles Sits without support Babbles Stands holding on Turns instantly to voices across room Crawls Plays peek-a-boo Says mama/dada (inappropriate) Anxious with strangers Waves goodbye Pulls up to stand Age 4 weeks 4 to 5 weeks 6 weeks 2 months 2 months 2 months 3 months 3 months 3 months 3 months 3 months 3 to 4 months 3 to 4 months 3 to 4 months 4 months 4 to 6 months 5 months 5 to 6 months 5 to 8 months 6 months 6 months 6 to 8 months 6 to 8 months 6 to 9 months 6 to 9 months 6 to 10 months 6 to 7 months 7 to 9 months 8 to 9 months 8 to 9 months 8 to 9 months 8 to 12 months 9 to 10 months
A good sign of healthy development is a child who is alert, is interested in objects, relates well to others and is explorative. If your child does not appear to reach these milestones at the listed age there may be no reason to be unduly concerned, as every individual is different and there is a large variation in reaching milestones. If you have any concerns speak to your doctor or infant welfare nurse.
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Nosebleed
What causes nosebleeds?
Nose bleeding (epistaxis) occurs from the tiny veins that are just under the thin surface of the middle or central part of the nose. The nasal lining has lots of blood vessels, which help to warm the air entering the nose. This tissue is rather fragile and easily damaged by infections, including colds, and by injury. A crust that usually forms over the surface is meant to help healing but comes off easily through picking the nose or sneezing. The blood vessels then bleed easily, but a blood clot forms after a few minutes to seal the bleeding vein.
icepack
Rules Do not blow your nose for about 12 hours afterwards, as it may dislodge the clot. Avoid picking your nose. If bleeding stops then recurs, pinch your nose for 10 minutes. Try to avoid swallowing the blood. If bleeding continues after 20 minutes or more, report to your doctor or nearest casualty department.
Medical help If the bleeding keeps coming back, your doctor can do many things to stop the bleeding such as: special gauze packing cauterising with a special chemical or diathermy applying an ointment with an antiseptic or a chemical that constricts blood vessels
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cone of paper
tions (such as friars balsam, Vicks VapoRub or other menthol substances) that can be dissolved in hot water. Add 1 teaspoon of the inhalant to 500 mL of boiled water (just off the boil) in an old container such as a widemouthed bottle or plastic container. Rather than using the old-fashioned method of a towel over the head, use a paper cone or a vacuum (Thermos) flask to direct the vapour to the nose and mouth. Inhale the vapour slowly and deeply through the nose, and then exhale slowly through the mouth. Do this for 510 minutes 3 times a day, including before going to bed (the most important time). When you finish the inhalation, blow your nose as described.
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Fattening foods
It is essential to cut down on high-calorie foods. These include: fats (e.g. oils, butter, margarine, peanut butter, some nuts) alcohol refined carbohydrates (e.g. sugar, cakes, soft drinks, sweets, biscuits, white bread) A good rule is to avoid white foodthose containing lots of refined sugar or flour. Instead go for complex carbohydratesgrains and vegetables.
Physical activity
A brisk walk for 2030 minutes each day is the most practical exercise. Other activities, such as tennis, swimming, golf and cycling, are a bonus.
Weight-losing tips
Have sensible goals: do not crash diet, but have a 36 month plan to achieve your ideal weight. Go for natural foods; avoid junk foods. Avoid alcohol, sugary soft drinks and high-calorie fruit juices. Strict dieting without exercise fails. If you are mildly overweight, eat one-third less than you usually do (only). Do not eat biscuits, cakes, buns, etc. between meals (preferably not at all). Use high-fibre foods to munch on. A small treat once a week may add variety. Avoid seconds and do not eat leftovers. Eat slowlyspin out your meal. Ask your doctor about medicines that claim to remove weight.
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What is CPAP?
CPAP, which stands for continuous positive airway pressure, is the most widely used treatment for OSA. The affected person wears a close-fitting mask over the nose during sleep while a small air compressor forces air under low pressure into the upper airways to keep them open.
back of throat
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Osteoarthritis
What is meant by arthritis or rheumatism?
Unfortunately, these common terms produce a considerable amount of fear and concern for many people. Rheumatism is a vague term used to describe aching in joints and muscles, and the word should be avoided. Arthritis means inflammation of the joints, but there are over 100 different types of arthritis. The most serious is rheumatoid arthritis, which is uncommon. The most common is osteoarthritis, which is usually not serious and causes only minor discomfort in some people.
What is osteoarthritis?
This is a condition that occurs during the bodys normal ageing process as a result of wear and tear of the joints. It is also called degenerative joint disease. The smooth gristle or cartilage that covers and protects the ends of the bones at the joints is gradually worn away. The joints become rough, and stiffness and inflammation can develop. X-rays are taken to confirm the diagnosis of osteoarthritis; all other tests done have normal results. X-rays show some degree of osteoarthritis in 1 or more of the joints of 9 out of 10 people over the age of 40.
cartilage
Walking aids Shoe inserts, good footwear and a walking stick can help painful knees, hips and feet. Medication Aspirin and paracetamol are effective pain-killers for mild osteoarthritis. Your doctor may prescribe antiarthritic medications, but a few may have to be tried to find the one that works best for you. The tablets should be taken with food. A natural substance, glucosamine, has proven effectiveness for osteoarthritis of the knee. Injections: New lubricants that are injected into the knee are available and suit many people. Special equipment It is possible to increase your independence at home. There is a wide range of inexpensive equipment and tools that can help with cooking, cleaning and other household chores. These can be discussed with people at an Independent Living Centre, with physiotherapists and occupational therapists. The Arthritis Foundation in each capital city is able to provide information about many aspects of arthritis. 149
normal joint
osteoarthritic joint
Osgood-Schlatter disorder
What is Osgood-Schlatter disorder?
It is a short-lived problem of the leg at the knee, in which a painful lump affecting the bone develops in early adolescence during a period of a growth spurt, associated in particular with considerable physical activity. The area of bone affected is the tibial tubercle which is a prominence just below the knee joint. It is a growing centre for this long bone of the lower leg. This common disorder was described independently by two surgeons in 1903, namely Robert Osgood of Boston, USA and Carl Schlatter of Zurich, Switzerland.
knee joint
over-enthusiastic action routines (e.g. running, jogging, jumping) being male and aged 1116 being overweight rapid bone growth
It is a temporary self-limiting condition that usually heals over 618 months with an average of 12 months. Sometimes recovery may be delayed, especially in those who continue sporting activity, until bone growth ceases. The end result is a prominent painless tubercle.
What is the best management? What are the signs and symptoms?
a swollen, warm and tender bump below the kneecap pain in this area during and after activity pain aggravated in sports involving kicking, and running and jumping, such as basketball, football and gymnastics pain reproduced by attempts to straighten the bent knee against force such as jumping or weight-lifting pain aggravated by kneeling down and going up and down stairs it usually affects one knee but about 1 in 3 patients will have both knees affected The diagnosis is usually obvious but can be confirmed by an X-ray which shows a gap in the tubercle. The best treatment is rest from sporting activity to prevent pain and allow healing. Apart from running, other activities such as cycling and football should be restricted. Any activity that induces pain should be avoided during the healing phase. For acute pain use icepacks and basic analgesics. A cushioned kneepad is helpful if kneeling hurts. Warm compresses or heat packs can provide relief after the acute phase settles. Supervised quadriceps exercises involving stretching can promote healing. Avoid cortisone injections and immobilisation in plaster casts. Rarely a small operation is necessary to remove an irritating piece of bone that has not healed.
Reproduced with permission of Australian Doctor
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Osteoporosis
What is it?
Osteoporosis is a condition leading to thinning of bones so that they become weak and brittle.
osteoporosis
thinner bone
normal
thicker bone
Drug treatment
The best treatment is probably preventive hormone replacement therapy with the onset of the menopause. There are now many drugs available to treat established osteoporosis.
Key points
Osteoporosis is a common condition. It starts from a young age but develops faster in middle and older age. The main aim is to prevent it from occurring.
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affected (in approximate order) are the hip bone (pelvis), the thigh bone (femur), the shin bone (tibia), the skull, the spinal bones (vertebrae), the humerus and the collar bone (clavicle).
pelvis
vertebrae
The weakened bones are more likely to break and rarely a tumour can develop in the affected bone. Deafness can occur from pressure on a nerve from the enlarged skull. The increased blood flow through the bones can cause heart failure or high blood pressure.
tibia
Painful breasts
What causes breast pain?
Breast pain (known as mastalgia) has several causes. The main type of breast pain is cyclical mastalgia, which is a general breast discomfort that occurs in the second half of the menstrual cycle. The pain, which comes on with ovulation, is mainly premenstrual. It obviously is caused by a hormonal effect and is not harmful. Other causes are: pregnancy infection (after childbirth) tumours certain drugs weight gain bra problems
Note: Early breast cancer is usually painless, but all lumps need careful investigation.
Is it common?
It is a very common problem, with about 2 out of 3 women complaining of breast pain at some stage of their lives. It is most common in the 30s and early 40s.
Drug treatment
Adjustment of oral contraception or hormone replacement therapy (if it applies to you) may help mastalgia. However, there are several other hormones that can be prescribed.
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Parkinsons disease
What is Parkinsons disease?
Also known as shaking palsy or paralysis agitans, Parkinsons disease is due to an imbalance of chemicals in the nerve cells in the brain that regulate movement. Because these cells do not fire smoothly, various body movements are affected. There is no pain, numbness or pins and needles. Later on falls may be a problem.
An important part of managing at home is to keep as active as possible with the help of a caring family, friends and other people. Your mobility can be assisted, for example, with walking sticks, bath rail supports, special banisters where you normally walk and chairs with high seats and arms. It is important to have regular exercise and to stick to your everyday routine as actively as possible. Your doctor should see you regularly to assess your progress. Ask about special programs to teach people how to improve their balance and coordination. Medication No drug will cure the problem, but there are modern drugs that can do much to relieve symptoms, particularly stiffness and poor mobility. Drugs that lead to higher levels of dopamine in the brain can be prescribed and it is better to prescribe them early rather than wait until the symptoms are more severe. The drugs can have side effects such as feeling sick in the stomach (nausea) and a dry mouth, and so your doctor will have to juggle them according to the progress you are making.
shuffled walk
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Peanut allergy
What is a food allergy?
Allergies are oversensitive reactions by the bodys immune system to certain foods, due to the release of a chemical called histamine. A food allergy, which usually starts in infancy and childhood, is commonly caused by milk and other dairy products, eggs and peanuts. Other foods include oranges, soya beans, nuts, chocolate, fish and wheat.
How is it diagnosed?
It is diagnosed initially upon suspicion of an abnormal reaction to food containing peanuts. A food challenge test and skin prick test, and/or RAST test under medical supervision, help confirm the diagnosis. 42
have multiple sexual partners have steady partners who have sex with others do not use barrier methods of contraception (e.g. condoms) have operations needing the opening of the cervix (e.g. dilation and curettage, and placement of an IUD)
ache in the lower back mild lower abdominal pain Both acute and chronic painful intercourse menstrual problems (e.g. painful, heavy or irregular periods) unusual, perhaps smelly, vaginal discharge painful or frequent urination
vagina
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Peptic ulcer
What is a peptic ulcer?
A peptic ulcer is a raw area or small hole in the lining of the stomach or the duodenum (the first part of the small intestine). Most ulcers occur in the duodenum (duodenal ulcers); a smaller number develop in the stomach ( gastric ulcers). The diagnosis is confirmed by gastroscopy (placing a tube into the stomach) and the H. pylori test.
Note
Peptic ulcers are now very treatable with excellent modern drugs, and so any suffering should not be necessary. Report any sudden severe stomach pain or vomiting or passing of blood.
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Perianal haematoma
What is a perianal haematoma?
Haematoma means a collection of blood and peri means around so a perianal haematoma is a small collection of blood that develops just outside and around the opening of the anus. It is sometimes referred to as an external pile, a thrombotic pile, or an external haemorrhoid, but strictly speaking it is not a haemorrhoid, which is a collection of blood arising inside the anus. At first there is a very small collection of blood under the skin, but after a couple of hours it forms into a small firm clot.
anus
perianal haematoma
blood clot
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Pharyngitis
What is pharyngitis?
Pharyngitis is inflammation and infection of the pharynx, which is that part of the throat at the back of the tongue between the tonsils and the larynx.
inflamed, red, swollen pharynx
sore throat tickle or lump in throat difficulty swallowing fever (in more severe cases) red, swollen throat possible muscular aches and pains
tonsils
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Phobias
What is a phobia?
A phobia is an abnormal fear of or aversion to a specific object or a certain situation. It is a type of anxiety disorder which can precipitate a panic attack. People with phobias tend to avoid these situations or objects and become anxious when they anticipate having to meet them. For example, people may dread the sight or touch of a spider (arachnophobia) or have a morbid fear of heights (acrophobia). These types of fears do not usually prevent people leading a normal life; they avoid the subject of the fear. On the other hand, fear of confined spaces (claustrophobia) or open spaces (agoraphobia) are more serious problems to cope with.
herpetophobia homophobia hypnophobia iatrophobia musophobia mysophobia necrophobia neophobia noctiphobia nyctophobia ophidiphobia pyrophobia taphophobia sociophobia theophobia xenophobia zoophobia creepy crawling things homosexuals going to sleep doctors mice dirt, germs death anything new night darkness snakes fire being buried alive social situations God strangers animals
What is agoraphobia?
Fear of open spaces or public places is one of the most serious phobic disorders. Avoidance includes the many situations involving the issues of distance from home, crowding or confinement. Typical examples are travel or public transport, crowded shops or parklands. For some people, anywhere outside the house is a threat. They feel that they may lose control, faint or suffer embarrassment. Agoraphobia is commonly associated with depression and marital or family disharmony.
Typical specific phobias
Name of phobia acrophobia aichmophobia ailurophobia androphobia anthropophobia apiphobia aquaphobia astraphobia aviatophobia brontophobia bufonophobia cancerophobia cardiophobia cynophobia dentophobia genophobia gynophobia Fear of heights needles/sharp objects cats men people bees water lightning flying thunder toads cancer heart disease dogs dentists sex women
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How is it commenced?
This varies according to the type of pill prescribed, so follow the instructions that come with the pill packet. It is usual to start the 28-day pack on the 1st day of bleeding of your next period and the 21-day pack on the 5th day of your cycle or on a particular day (e.g. Saturday) after your next period starts.
Pityriasis rosea
What is pityriasis rosea?
It is a skin rash thought to be caused by a virus. It commonly occurs in young adults (especially aged 1530) but might occur at any age. It is not considered to be contagious.
ultraviolet light therapy 3 times a week is helpful. Bathe and shower as usual, but use a mild soap such as Dove or Neutrogena. If itching is a bother, use some soothing lotions or creams. These include calamine lotion, calamine lotion with 1% phenol, menthol 1% in aqueous cream or urea cream. If itching is severe, your doctor will prescribe special medication which may include cortisone tablets or cream.
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Plantar fasciitis
Plantar fasciitis is a common condition that causes pain under the heel of the foot. It is known also as policemans heel. The painful area is usually situated about 5 cm (2 inches) from the back of the heel on the sole of the foot.
Plaster instructions
You have had a plaster cast applied to a limb. To allow the plaster to work properly, it is important that you: Lie down for the next _____ hours. Elevate the limb for the next 48 hours (ideally above the level of your heart). Move the fingers or toes around. Return tomorrow or whenever advised for a plaster check. Appointment: __/__/__ at ______. Return for a second follow-up appointment in 710 days.
Elevation
Arm Have the hand raised so that it is higher than the opposite shoulder level (if possible). The arm can be supported on a pillow or in a sling. Leg Raise the foot of the bed and place the plaster cast on a pillow or cushion. The patient can lie down or sit up, as long as the leg is elevated.
Pain relief
Pain can usually be relieved by: elevating the affected limb taking a pain-killer such as paracetamol (not a very strong analgesic) keeping busy with interesting distractions Very severe pain indicates abnormal swelling so you need to be seen by a doctor immediately.
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Weight control The most important first line treatment is achieving weight loss for those who are overweight or obese. This can be difficult and may take a year or so. The help of an accredited practising dietician is advisable. The diet is based on low carbohydrate and energy control similar to that used for diabetes. Weight loss alone in obese women with PCOS can restore normal ovarian function. Exercise Regular exercise to control weight and keep fit is needed (e.g. 30 minutes of brisk walking each day).
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Polymyalgia rheumatica
What is polymyalgia rheumatica?
Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disorder of older people that affects the muscles of the shoulder and hip regions of the body. Poly means many and myalgia means painful muscle, so it stands for pain in many muscles. Most people experience aches and pains as they grow older and these usually cause little trouble and respond well to simple pain-relieving medication, but PMR is quite a different matter. Everyday problems: getting out of chairs combing hair putting on coat car driving for long periods Possible general problems: malaise (feeling unwell) fever anorexia weight loss depression There is no weakness, wasting of muscles or arthritis (inflammation of joints).
Postnatal depression
It is quite common for women to feel emotional and flat after childbirth; this is apparently due to hormonal changes and to the anticlimax after the long-awaited event. There are two separate important problems: 1. postnatal blues 2. postnatal (or postpartum) depression
Postnatal blues
The blues are a very common problem that arises in the first 2 weeks (usually from day 3 to day 5) after childbirth.
Postnatal depression
Some women develop a very severe depression within the first 612 months (usually in the first 6 months) after childbirth. They seem to get the blues and cannot snap out of it. The onset is usually in the first three days after childbirth.
10
Premenstrual syndrome
What is the premenstrual syndrome?
The premenstrual syndrome, which is commonly called premenstrual tension or PMT, is a set of symptoms, both physical and psychological, that some women experience before their periods. These symptoms usually go away when the period starts. The symptoms are caused by hormonal changes in the body before the period and vary from woman to woman. The build-up of fluid in the body at this time is an example of this.
Is it common?
Yes; possibly up to 90% of women experience some symptoms, which can vary from minor to severe. PMT tends to increase with age.
Psychological symptoms
Physical symptoms nausea headache dizziness hot flushes acne breast swelling and tenderness bloated abdomen
Keep a list of your main symptoms and note when they occur over a 23 month period. Use this information to help plan around your symptoms; for example, avoid too many social events and postpone demanding business appointments. Lifestyle changes Diet. Eat regularly and sensibly: eat small rather than large meals; avoid salt, caffeine and excess fluids. If necessary, reduce your weight to ideal level. Exercise. Regular exercise often helps (e.g. swimming, aerobics, tennis). Relaxation. Plan to do things that you find relaxing and enjoyable during this time. Stress aggravates PMT, so reduce it wherever possible. Proper dress. Sensible dressing to cope with breast tenderness and a bloated abdomen is useful (e.g. a firmfitting bra and loose-fitting clothes around the abdomen). Medicine. Some medicines may help those with more severe symptoms, so discuss these options with your doctor. Examples of proven treatment used for premenstrual tension include vitamin B6 (pyridoxine), chaste tree (vitex angus castus) and certain antidepressant agents. It is worth taking pyridoxine 100 mg daily for 6 months. If PMT persists discuss it with your doctor.
constipation
swelling of ankles
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Normal prostate
Enlarged prostate
84
urethra
enlarged prostate
Before surgery
bladder
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Pruritus ani
What is pruritus ani?
Pruritus ani simply means itch of the anus or itchy backside. It is a very common disorder of the skin surrounding the anus. In children threadworms may be suspected; however, it is usually seen in adult males with considerable inner drive, often at times of stress and in hot weather when sweating is excessive. 4. Bowel movements Keep bowels regular and smooth by eating plenty of highfibre foods such as bran, fresh carrots and apples. Some doctors claim that your bowel actions should be so smooth and complete that toilet paper should not be necessary. 5. Toilet Clean gently after bowel movements. Use soft paper tissue (avoid pastel tints), then clean with tufts of cottonwool with aqueous cream or bland soap and water. The best way is to use cottonwool wetted with warm water only. 6. Soaps and powder Do not use perfumed soaps and talcum powder, including baby powder. A neutral soap such as Dove or Neutrogena is preferable. 7. Clothing Wear loose clothing and underwear. In men, boxer shorts should be used in preference to jockey shorts. Cottons should be used. Let the air circulate in the area. At times a skirt but no underpants (in women) is desirable. Avoid panty hose if possible. 8. Topical creams Do not use ointments or creams unless your doctor has prescribed them. If a cream has to be used, simple creams may be the most soothing (e.g. toilet lanoline). Seek your doctors advice before using over-thecounter prescriptions. Your doctor may prescribe a special cream.
Rules of treatment
1. Scratching Stopits taboo! If you scratch at night, wear light cotton gloves to bed. 2. Bathing Avoid hot water. Excessive showering and scrubbing is also bad for this condition. Use a cream such as bland aqueous cream for cleaning rather than soap. 3. Drying Keep the area as dry and cool as possible. After washing, dry gently and thoroughly with a soft towel or soft tissue: do not rub. Warm air from a hairdryer is very useful.
Remember
Pruritus ani will certainly settle with this plan of management.
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Psoriasis
What is psoriasis?
It is a chronic skin disorder in which red or deep pink raised patches covered by white scales appear on the skin. It usually causes no discomfort but it can get slightly itchy, especially on the scalp or around the anus. The main problem is the unsightly appearance of the rash, but fortunately it is usually covered by clothing. You may have a single patch or several large ones. The cause of psoriasis is unknown and it shows a tendency to run in families. by cells produced beneath the surface. In psoriasis the normal rate of cell production is speeded up, and this does not allow the cells to manufacture a substance called keratin that gives skin its hard surface. The result is unsightly flaking of the skin.
Is it serious?
No; it does not usually affect general health. Some people (about 5% of those with psoriasis) can develop a painful arthritis in the joints.
Is psoriasis common?
Yes; it affects about 1 in 40 people. It appears most often between the ages of 10 and 30, and most cases are mild.
Note
Psoriasis is not an infection and is not contagious. No one has a cure for psoriasisbeware of quack cures. Avoid sunburn.
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Children are not spoiled by too much love, but rather by too little. The little brat is usually the child who is neglected in some way and is seeking attention. Children have antennaethey can sense feelings towards them. The child who is loved knows it and develops into a contented, mature adult. Love has to be unconditionalno strings attached. Children have to receive genuine love, for their own sakenot because they are pretty or talented or have great personalities. No matter who they are, or what they look like, or how they perform at school or sport, they all need encouragement and praise so that they have a healthy self-esteem. Love is not being possessive and clinging to children with smothering affection or showering gifts on them. Love is common sense.
Remember
Parents are heroes and role models for their children. Dont let your children down. Parents are the best teachers. At times parents need the wisdom of Solomon.
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Reflux in infants
What is gastro-oesophageal reflux?
Reflux is where the food in the stomach overflows back into the oesophagus (gullet). It often causes a baby to bring up or vomit milk after a feed. A mild degree of reflux is normal in babies, especially after they burp; this condition is called posseting. However, the reflux can be quite severe in some babies, who appear to vomit after their bottle or breastfeeding. Thickening of feeds Giving the baby thicker feeds usually helps those with more severe reflux. Parents can add a thickener to existing feeds or use a pre-thickened formula. The old-fashioned remedy of using cornflour blended with milk in bottles is still useful.
Bottle-fed babies (powdered milk formula)
Carobel: Gaviscon:
Cornflour:
Karicare:
Add slightly less than 1 full scoop per bottle. Mix slightly less than 12 teaspoon of Infant Gaviscon Powder with 120 mL of formula in the bottle. Mix 1 teaspoon with each 120 mL of formula. Check with your doctor or nurse for the proper method. This formulation is easy to use but is more expensive. Give according to the manufacturers instructions. Other commercial thickening formulas.
Breastfed babies
Carobel:
Gaviscon:
Add slightly less than 1 full scoop to 20 mL cool boiled water or 20 mL expressed breast milk and give just before the feed. Mix slightly less than 12 teaspoon of Infant Gaviscon Powder with 20 mL cool boiled water or expressed breast milk and give just after the feed.
Key points
Reflux: is common improves with age usually clears up by 9 months of age is helped by elevating the cot is helped by thickening the feeds is helped by frequent small feeds is helped by propping up the baby after feeds
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Retirement planning
Retirement can be a most enjoyable period of the life cycle, one of productivity and self-realisation. However, for many people it can bring considerable unforeseen sadness and stress. This is mainly brought about by inadequate planning and changes of relationships. Studies show that very few people plan for it until just before the time. because it encourages your family to visit you. Children often interpret a move to a small unit as dont come and stay with us, although this may not be the intention. Financial security You really need sound advice for a secure financial future, including investments. Try to work out your finances 5 years in advance and allow for inflation and home maintenance. If you own your home and car, you have a good basis. Health You need good health to enjoy your deserved retirement. Take care not to get into bad eating and exercise habits. Plan a sensible, healthy, balanced diet. Avoid smoking and excessive drinking. Regular and effective exercise is important. Appropriate exercises are walking for 2030 minutes each day, swimming, cycling and golf. Activities Retirement gives you the opportunity to devote more time to those interests and hobbies that you already enjoy. It will also give you the chance to pursue new ones. There are many agencies that will provide information on programs for the retired, adult education courses (especially in the arts and crafts) and community work. If your hobby can supplement your income, that is a bonus. Useful activities include sports such as bowls, golf and tennis, travel, nature walking, voluntary or part-time work. Many retired people get considerable pleasure out of carpentry and woodwork. Housing Keep your family home if you can. Carefully weigh up the pros and cons of movingit can bring much stress, worry and financial problems. As you get older it is most important to have transport, shopping and medical facilities nearby. Companionship Good friends and neighbours are excellent insurance policies for a happy retirement. Try to keep in contact with your valued friends. The relationship between husband and wife will be tested, as you have to spend much more time together. Sadly some couples cannot cope with this under my heels syndrome and marital breakdowns do occur. Make sure this does not happen to you.
Loneliness Loneliness is a terrible problem; it can lead to depression and a feeling of worthlessness. A common mistake is to sell the family home and move to another location, usually in a small unit. This separation from old friends, neighbours and family can cause much heartache. It often happens to country people who move to the city. You need your family around you, especially if your spouse dies. You should give consideration to keeping your family home,
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Rheumatoid arthritis
What is rheumatoid arthritis?
Rheumatoid arthritis is a disease of the joints, usually the smaller joints of the body. Many people believe wrongly that this is always a disabling, severe condition. In fact, it may be mild and can be well controlled using modern medicine. It is not infectious, but no one is able to say what triggers it. There is no cure for this condition, but all patients can be treated. foot joints are affected. The tendons may become so weak that they can snap. A special problem is the neck, which can become unstable so that manipulative procedures can be dangerous and cause paralysis.
normal joint
How is it diagnosed?
After being suspected by the doctor upon examination, rheumatoid arthritis can usually be diagnosed by tests, including X-rays of the hands and special blood tests.
Ringworm (tinea)
What is ringworm?
Ringworm which is also referred to as tinea is a fungus infection of the skin. It causes a superficial infection of the surface layer (keratin) of the skin resulting in scaly itchy patches. The classic ringworm, of course, is the wellknown red ring that is usually seen on the trunk of the body, but it can take on forms other than the ring. The fungi are referred to as dermatophytes and there are three main types that infect the skin of humans.
tinea of scalp
tinea of beard
at the surface of the scalp producing a black dot appearance. It is usually seen in children and can be difficult to clear up. It is caused by Microsporum canis typically acquired from dogs and cats. Tinea of the body (tinea corporis): This is the classic ringworm we are familiar with that appears on the trunk and limbs. It starts on the trunk as a small, round, red patch which is scaly and itchy. The patch gradually grows until it is about 25 mm (1 inch) across; as it gets bigger the central area heals, leaving a red ring on the skin at the edge. After a week or two, other patches may appear nearby and sometimes can spread quickly. Tinea of the groin (tinea cruris): Also known as Dhobie itch and jock itch, this is a common infection of the groin area of young men, usually athletes. Tinea of the feet (tinea pedis): This is the common tinea in the skin between the toes with smelly macerated scaling. It can extend onto the soles of the feet. Tinea of the nails (tinea unguium): This can affect both toenails and fingernails causing thickened, discoloured crumbly nails with crusting at the free edge. Tinea of the beard (tinea barbae): This may cause an itchy boggy swelling called a kerion. The diagnosis is made by taking skin, hair or nail scrapings and performing microscopic examination and culture.
tinea of groin
How is it transmitted?
The fungus is found almost everywhere and can be acquired from animals (zoophilic), from other humans (anthropophilic) and from the soil. In general, fungi transmitted from animals such as a pet cat or dog are more contagious and cause more severe inflammation of the skin. The guinea pig is a potent source of tinea of the face. Person-to-person contact is a common mode of transmission. The fungi from infected people can contaminate objects such as towels, shoes, dressing-rooms or shower stalls, thus contact with these surfaces facilitates spread. The risk is higher with: crowded living conditions day care centres or schools communal bathing areas close contact with animals
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What is rosacea?
Rosacea is an acne-like inflammation of the skin of the face, of unknown cause. It causes red flushing with small, red, raised bumps (papules) and, sometimes, pus-filled spots (pustules). It tends to come and go. It is referred to as the curse of the Celts. The name is derived from the Latin, meaning like roses.
Typical features involves the cheeks, nose, forehead and chin mainly occurs between 30 and 50 years of age more common in women the nose can enlarge, especially in men (rhinophyma) may be tender can affect the eyes It is aggravated by: stress saunas and hot baths excessive sun exposure hot drinks hot and spicy foods that induce flushing alcohol to excess exercise corticosteroid creams, especially fluorinated ones
Typical features involves the area around the lower nose and mouth and chin mainly affects young women It is aggravated by: topical corticosteroids, especially fluorinated ones pregnancy oral contraception creamy cosmetic products
Treatment The best treatment is a course of antibiotics such as tetracyclines taken by mouth for 6 or 8 weeks. Sometimes topical ointments may be prescribed for mild cases. There is no special diet. Cease (slowly) all creamy preparations including cleansers, moisturisers and make-up. 239
Treatment Avoid or reduce aggravating factors. Avoid oil-based make-up. Your doctor may prescribe an ointment or gel.
How is it spread?
The disease is moderately infectious and is spread by droplets from the nose and throat. Once inside the body, the virus has an incubation period of about 1421 days before it starts to cause symptoms (if at all).
School exclusion
The child is usually excluded until fully recovered or for at least 5 days from the onset of the rash.
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Scabies
What is scabies?
Scabies is a highly infectious skin infestation caused by a tiny mite called Sarcoptes scabiei. The mite, which is a type of arthropod, burrows just beneath the skin in order for the female to lay her eggs. She then dies. The eggs hatch into tiny mites, which spread out over the skin and live for about 30 days only. The mites cause an allergic rash. Typical distribution of
the scabies rash
Where? Apply to the entire body from the jawline down to the tip of the toes (even for genital scabies). Make sure you treat under the nails, in all the skin folds and the genitals. How? First have a warm shower or bath (not too hot). Use a clean washer and towel, and allow the skin to dry. Paint the lotion on all the skin thoroughly with a brush such as a shaving brush or paint brush. Do not rub your eyes or wash your hands. Put on clean clothes. Leave overnight for permethrin and for 24 hours for benzyl benzoate, then have a shower or bath. How often? One treatment is usually enough. It can be repeated in a week for a more severe infestation, but check with your doctor. Clothing and bedding Remove pillows and sheets, pyjamas and underwear after the second shower and wash them normally in hot water as a separate load. Hang the washing in the sun.
How is it diagnosed?
Scabies is diagnosed by its very itchy, lumpy rash. It is rare to find the tiny mites, but it may be possible to find them in the burrows, which look like small wavy lines. When dug out, they are examined under the microscope.
Note
The whole family must be treated at the same time, even if they do not have the itch (one application is sufficient). Use separate towels and brushes. Itching can continue long after successful treatment; resist repeated treatments, but check with your doctor who will prescribe an antipruritic. Spray pillows, mattresses, chairs, car seats, prams and other soft articles with insect spray. 129
Schizophrenia
What is schizophrenia?
It is a disorder of the mind that results in disorganisation of normal thinking and feeling. Schizophrenia, which literally means split mind, is often thought of as a split or double personality (the Dr Jekyll and Mr Hyde perception), but this is a false impression as there is no such thing. It is not an intellectual disability. Schizophrenia can come in various forms with different symptoms and outcomes. The common type is described here. If the schizophrenia is severe, the person will seem very disturbed and irrational.
The hallucinations are typically auditory, such as hearing strange voices in the head or in the air. Visual hallucinations (seeing things) and tactile hallucinations (feeling things) are uncommon.
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Sciatica
What is sciatica?
Sciatica is a type of neuralgia (nerve pain). The sciatic nerve is a huge nerve (about the size of an adults small finger) that controls the function of the leg, especially the foot. It passes from the spine into the buttock, then into the back of the thigh and leg.
pain of nerve root pressure bulging disc putting pressure on nerve root ligament
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Scoliosis
What is scoliosis?
Scoliosis (also called idiopathic adolescent scoliosis) is a lateral (sideways) curve of the spine. It usually develops during the growth spurt at 1113 years. The general rules are: less than 20observe 20 to 40brace over 40 to 45operate Patients with significant scoliosis will be referred to an orthopaedic surgeon for an opinion.
right rib hump
Positive forward bend test showing difference between right and left sides
In extreme cases the lungs and heart can be compressed, leading to breathing difficulties. The worst feature for the patient is social embarrassment.
Cobb angle
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Seborrhoea in infants
What is seborrhoea?
Seborrhoeic dermatitis is a common skin inflammation that occurs mainly in the hair-bearing areas of the body, especially the scalp and eyebrows. It can appear on the face, neck, armpits and groin. In particular, it can cause nappy rash. If it affects the scalp it is called cradle cap.
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Seborrhoeic keratoses
What are seborrhoeic keratoses?
Seborrhoeic keratoses are harmless, brown, slightly raised growths that give the appearance that they are sitting loosely on the skin. They are one of the most common skin blemishes. Some people refer to them as delayed birthmarks while others refer to them unkindly as barnacles of old age. The cause is unknown. They are more common with advancing age and in those with a family history of these lumps. Some can appear as though a dried sultana has been pressed onto the skin. Others can have a surface resembling a currant bun. They may be solitary or, more commonly, multiple. The lumps are asymptomatic, that is, they do not itch or cause pain.
They usually gradually get larger and darker and increase in number. Sometimes they are rejected by the body and fall off, leaving a pale area on the skin. However, most remain permanently.
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Self-examination of breasts
Why examine your breasts?
Regular breast self-examination (BSE) helps you become familiar with the usual feel of your breasts. You will detect any lumps in the breast at an early stage of their development. Although only 1 in 10 breast lumps is cancer, 1 in 15 women develops breast cancer at some time. Most breast cancers are found (as a lump) by the woman, not by the doctor. Early detection of a lumpif it is a breast cancermay mean a better chance of a cure. By performing regular BSE, you are safeguarding your health.
Position
The breast tissue must be spread as flat as possible. Lie on your back with one arm behind your head. The right breast is examined by the left hand and vice versa. Large-breasted women might need to modify this position. First lie on your side, then bring your shoulders flat onto the bed. Once you have examined as far as the nipple, lie flat on your back to examine the remainder of the breast.
Examination
Vertical strips Examine up and down the breast in vertical strips, beginning from the outer border. At the end of each strip, move the fingers about 2cm towards the breastbone and examine another vertical strip. The flat of your fingers Use the flat part of your fingers, including the fingertip pads, to feel the breast. Move your hand in slow, circular movements. Light and firm pressure At each spot feel first with light pressure (to detect any lump just below the surface), then with a firm pressure (to detect any lump near the ribs). When finished, reverse the position to examine the other breast.
If you find a lump, dimpling of the skin, or a discharge, make sure you see your doctor as soon as possible. Please do not be afraid or put it off. Most changes are not cancer. 77
muscle
humerus
Physical therapy, especially exercises under the supervision of a physiotherapist, assists recovery especially when the thawing stage commences. It is usually too painful to tolerate during the freezing and frozen stages.
Reproduced with permission of Australian Doctor
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particularly includes swimmers (freestyle and butterfly) and those playing sports requiring throwing and pitching such as baseballers, softballers and cricketers.
Unfortunately recovery is very slow in more severe cases and can take as long as 12 years to settle but tendonitis invariably gets better naturally. It is possible to continue normal activities of living. In severe cases which are complicated by calcification of the tendon, bursitis or tearing of the tendon, recovery may be very slow.
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Skin cancer
Skin cancer is usually found in fair-skinned people who are exposed to too much sun.
Who is at risk?
Older people are at risk, as the risk of skin cancer increases with increasing age. Fair-skinned people living in hot, sunny climates are most at risk. People with freckles, several dark moles and fair skin are especially at risk. It is most common in people of Celtic (Scottish, Irish and Welsh) background. It is not as common in people with very dark skin (of African, Indian and Asian origin). It is rare in Australian Aborigines. The darker the skin, the lower the risk of developing skin cancer. Those with fair, sensitive skin who burn easily and rarely tan are at greatest risk. Sunspots (solar keratoses) are dry, rough, persisting spots on the skin, which can change into skin cancer and need to be watched.
Squamous cell carcinoma is quite dangerous appears on hands, forearms, face and neck common on lower lip, ear and scalp in men with thin or no hair can spread to other parts if left untreated too long most common over 60 years of age more common in men with outdoor occupations Melanoma the rarest and most dangerous type usually starts in a mole only a few moles become melanoma can occur anywhere on the body most common between 30 and 50 years of age
How is it prevented?
Protect yourself from the sun: Try to avoid direct sunlight when the sun is strongest (from 10 am to 2 pm standard time, i.e. from 11 am to 3 pm daylight-saving time). Always wear a broad-brimmed hat, T-shirt and baggy shorts when in the sun. Be wary of reflected sun on cloudy days and wind that dries the skin. Use a SPF factor 15 or more sunscreen on exposed skin and renew it regularly. Make sure you protect yourself at high altitudes. Wear a shirt or dress with sleeves. Avoid sunburn. Protect children from sunburn. Their skin is more sensitive than adults skin to sunlight. Early detection The earlier you detect skin cancer, the simpler the treatment. The outlook for most skin cancers is excellent.
Remember
You are the best person to check your skinno one knows it as well as you.
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Sleep problems
How much sleep do we need?
Many people are not aware that the amount of sleep we need for normal health varies with our age. Also, adults are different in the amount of sleep they need; for some, 4 hours a night is ample; for others, 10 hours is not enough. The average sleep for a 50-year-old is 7 hours a day. Go to bed to sleep (not to read, eat or watch television). Only lie down to go to sleep when you feel sleepy. Try to settle down before going to bed. Do not try to sleep immediately after a heavy meal, after difficult work that required a lot of concentration, after strenuous exercise or after an emotional upset or argument. Try to recognise what helps you settle best. The following are useful to some people: glancing through a magazine, listening to the radio, having a warm (not too hot) bath or shower, or some other relaxation technique. You might find something else that works better for you. Often, having a warm milk drink as you retire to bed will help. Many people find that drinks containing caffeine (such as tea, coffee and cocoa) make it difficult to go to sleep. Alcohol can stop many people from settling to sleep and can cause others to have disturbed sleep. Decide the hours during which you want to sleep and try to sleep only within that period. Repeated naps during the day will make sleep at night difficult. In general, you will come to no harm if you do not sleep at all for one or two nights; you will catch up later. Find a settling-down routine that works best for you. Even if it seems only partly effective, the fact that you have a routine will eventually assist your sleep. Undertake a relaxation program such as meditation. Dont take your worries to bed.
What is insomnia?
Insomnia is a lack of adequate sleep, which may be difficulty getting off to sleep, difficulty staying asleep, or waking early. It is a temporary problem in most instances and is usually due to a passing personal problem; however, sometimes it just happens for no reason.
A special tip
Special sleep disorder units to help your problem are present in most major cities. Ask your doctor about them.
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Smear test
What is a smear test?
The smear test, also called a Pap test (Papanicolaou test), is a simple test that scrapes cells off the surface of your cervix for examination in a laboratory.
cervix spatula
vagina
but many have died of cancer of the cervix by not having a smear test.
Key points
The smear test is simple, quick and painless. It should be done every 2 years. It should be done throughout life from the start of sexual activity up to 70 years. The smear test allows your doctor to prevent cancer of the cervix. Cancer of the cervix is curable if detected early. The smear test is your safeguard.
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Smokingquitting
What are the facts on smoking?
Each year over 20 000 Australians die from diseases caused by smoking. Out of every 5 people who smoke 20 or more cigarettes a day, 2 die before the age of 65. Cancer: Smoking is the major cause of death from cancer, especially lung cancer (86% caused by smoking). Other lung disease: Smoking causes chronic bronchitis (smokers cough) and emphysema. Hardening of the arteries: Smoking can cause hardening of the arteries of the heart (angina and coronary attacks), brain (strokes) and legs. Women smokers have problems with pregnancy (including smaller babies), increased chance of infertility, an earlier menopause and an increased risk of osteoporosis.
Cancer of mouth and throat larynx (voice box) and trachea (windpipe) Other diseases brain lungs stroke bronchitis and emphysema coronary artery disease
ulcers
reduced fertility
What is in a cigarette?
The most harmful chemicals in cigarettes are tar, nicotine and carbon monoxide. Nicotine causes the addictive effect.
A final word!
Ask your general practitioner for help ASAP. Do not put it offask for help now. It is unnatural to keep smoking. Choose the good, healthy life.
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Snoring
What is snoring?
It is sonorous sound with breathing during sleep, caused by vibrations in the upper airways from the nose to the back of the throat. It is caused by partially obstructed breathing during sleep. For neck problems, keep the neck extended at night by wearing a soft collar. Consider a trial of an intranasal device such as the Breathing Wonder which is a hollow intranasal plastic insert. Your pharmacist can advise you about the range of such devices. Try to sleep on your side. If you tend to roll onto your back at night, a maverick method is to consider sewing ping pong balls or tennis balls on the back of the nightwear. Others wear a bra (with tennis balls) back to front. Special surgical procedures may solve the problem for some people with very severe snoring. Others may be helped with special machines that deliver continuous positive airway pressure (CPAP) through a face mask. Special anti-snoring pillows have not proved to be any better than regular pillows or raising the head of the bed. When all else fails, provide those affected in the household with ear plugs.
back of throat
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Snuffling infant
What is the cause of snuffling?
Snuffling is usually caused by a viral infection that infects the upper respiratory tract (airways), particularly the nose. This is called rhinitis, which is a common minor infection in adults but in children it causes considerable discomfort because the nasal passages are so small. The infection makes it difficult to breathe through the nose. The virus is usually one that causes the common cold. The so-called upper respiratory tract infection (URTI) is very common in infants from the age of 46 months upwards, although infection can occur earlier if children are exposed to the viruses. The average child can expect to get up to six episodes each year. A robust crying child is not as big a cause for concern as is a whimpering, pale, inactive child.
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Spondylosis
What is spondylosis?
Spondylosis is a condition of the spine in which it is hardened and stiffened by osteoarthritis. It is also referred to as degenerative disease of the spine. The two areas commonly affected are the neck (cervical spondylosis) and the lower back (lumbar spondylosis). in sciatica are common. There may be pain in the back of the legs after a long walk. This uncommon problem is caused by narrowing of the space inside the spine from overgrowth of the bones due to arthritis and may require an operation.
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Joint sprains
One of the commonest injuries in sport is a joint sprain: stress on the joint stretches its lining or ligaments (or both) beyond normal limits. Most often, damage occurs to the knee, ankle and wrist joints, making them swollen, tender and painful to move. Bruising is not always obvious. Again, first aid is based on RICE: Rest Rest helps prevent the injured area from moving, reducing pain and speeding healing. Use crutches to take the weight off injured joints in the leg. Cold will reduce swelling, pain and stiffness. Use a reusable compress or a packet of frozen peas or beans or wrap ice cubes in a damp tea-towel (or a thin bath towel); never apply ice directly to the skin. Use the icepack for about 20 minutes every 3 hours for the first 48 hours. Compress and support the injury with a firm (not tight) elastic wrap bandage. Elevate the leg on a stool or chair (leg, knee and ankle injuries) or put your arm in a sling (shoulder, arm and wrist injuries) until the swelling goes.
Compression Elevation
If the injury is severe, see a doctor immediately. After resting the muscle for a few days, stretching can begin. Warm the area first with an infra-red lamp or a hot-water bottle. Then stretch your leg or arm about 5 times to contract the muscle gently. Do this twice each day for 14 days. Do not return to sport until the pain and swelling have gone, the muscle is strong and you can move the limb freely without discomfort.
Ice
Note
Reusable soft-fabric cold compresses that can be stored in a freezer (at least 2 hours) and dual-purpose hot/cold packs are available and are ideal for the athlete to have always available.
Compression Elevation
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Sprained ankle
What is a sprained ankle?
A sprain occurs when there is damage to the ligaments that bind the bones of the ankle joint. The fibres of the ligament that has been overstretched tear and then bleed. The tear is usually minor, involving a small number of fibres, but sometimes the ligament can be completely torn. be a fracture or a complete tear. Sometimes the discomfort of a sprain settles quickly, but should it persist beyond 34 days a visit to your doctor is advisable. Your doctor may apply a special strapping. Self-help This includes following the RICE formula: Rest Rest as much as possible. If the sprain is severe, use crutches to take the weight off the ankle. Apply icepacks and/or soak the ankle in cold water to reduce swelling and pain. Use a special reusable compress (e.g. ACE wrap) or a packet of frozen peas or beans or wrap ice cubes in a damp tea-towel; never apply ice directly to the skin. Use the icepack for about 2030 minutes every 3 hours when awake for the first 48 hours. (Icepacks can be placed over a bandage.) Compress and support the ankle with a firm (not tight) elastic bandage. Elevate the leg on a stool or chair until the swelling goes.
Ice
ankle joint
Compression Elevation
Exercise program
Sprained ankle
Exercises started early will help prevent permanent stiffness. Exercise every hour up to the point of discomfort. Do each exercise at least 10 times. 1. Firmly flap your foot up and down at the ankle joint. 2. Rotate your foot inwards and outwards, keeping the foot at right angles to the leg. 3. Combine these exercises so that your foot moves slowly in a circle (clockwise, then anticlockwise). Pain-killers Take analgesics for pain, especially at night. Paracetamol with or without codeine is usually sufficient. Walking Walking with your ankle supported in comfortable walking shoes is recommended for short distances. Walk as normally as possible, but avoid standing still for long periods. Walking without shoes in sand is an excellent way of strengthening your ankle quickly (after the first 23 days).
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General points
The myth, a squint will usually correct itself, is untrue. True or alternating squints need referral and correction. The lazy eye will become blind if not working by 7 years of age. Early surgical correction of a true squint, preferably at 12 years, is best.
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Pay attention to your breathing: listen to the sound of your breath for the next few minutes. Breathe in and out slowly and deeply. Next, begin to repeat the word relax silently in your mind at your own pace. When other thoughts distract, calmly return to the word relax. Just let go: this is a quiet time for yourself, in which the stresses in body and mind are balanced or reduced. Try to practise when your stomach is empty: before breakfast and before the evening meal are ideal times. During the day, check yourself frequently for tension: take a few long, deep breaths and breathe away the tension. Practise positive thinking. If you catch yourself thinking negative thoughts about your illness, silently say over and over to yourself: Every day, in every way, my health is getting better and better. Note: Prayer is an excellent form of meditation and relaxation. Health through nutrition A sensible approach to your diet can make you feel marvellous. Increase the amount of complex carbohydrates and fibre (vegetables, fruit, whole-wheat products, brown rice, fish, cereals, etc.) in your diet. Drink plenty of water. Decrease salt, total fats (butter, cream, meat fats, cheese, peanut butter, etc.), refined carbohydrates (sugars, sweets, cordials, ice-cream, cakes, etc.) and caffeine (coffee, tea and cola drinks). Reading The Pritikin Promise will provide many healthy ideas and recipes. Exercise Devise a program suitable for you. Walking for 20 minutes each day or every second day is an excellent start. A good callisthenic or yoga program is ideal.
Talking it over Getting it off your chest is more important than you realise. Talk to someone you admire and trust. Going to a minister of religion or your doctor can be powerful, especially if you can feel forgiven and if any guilt is relieved. The traditional Christian sacrament of confession or reconciliation is noted to be very powerful in helping stressed guilty people. Relaxation Practising relaxation is vital for the uptight person. Meditation is excellent and classes are available, but you can practise yourself. Make a commitment to yourself to spend some time every day practising relaxation. About 20 minutes twice a day is ideal, but you might want to start with only 10 minutes. Sit in a quiet place with your eyes closed, but remain alert and awake if you can. Focus your mind on the different muscle groups in your body, starting at the forehead and slowly going down to the toes. Relax the muscles as much as you can.
Recommended reading
Dale Carnegie, How to Stop Worrying and Start Living, rev. edn, Cornstalk, Sydney, 1999. Craig Hassed, Know Thyself, Hill of Content, Melbourne, 2002. Ainslie Meares, Life Without Stress, Penguin Books, Melbourne, 1991. Bob Montgomery & Lynette Evans, You and Stress, Penguin Books, Melbourne, 1995. Norman Vincent Peale, The Power of Positive Living,Vermilion, London, 1996. 245
Stroke
What is a stroke?
A stroke, also called a brain attack, occurs when an area of the brain is damaged following interruption to its blood supply. This results in deterioration of the mental and physical functions controlled by that particular area.
area area of of brain brain affected affected nerves to nerves to skin and skin and muscles muscles
Surgery
If a person has partially clogged arteries to the brain (the carotids), it may be possible to clean them out rather like a brush cleaning out a chimney. This is a good option in some patients, especially in those who have had transient ischaemic attacks.
Stuttering
What is stuttering?
Stuttering is a common disorder of speech in which a person who clearly knows what he or she wants to say has difficulty expressing it fluently. The flow of speech can be affected by one or more of the following characteristics: difficulty starting to speak (maybe a silent period) speech interrupted with silent pauses repeated words or sounds (e.g. I I I I I think . . .) prolonged words or sounds (e.g. How are you feeeeeeling?)
There may also be associated body movements such as nodding of the head, shuffling of the feet or blinking of the eyes. Many children can have a temporary phase when the flow of speech is abnormal but most of these do not develop a stutter.
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Sunburn
Sunburn is inflammation or redness of the skin caused by overexposure to the ultraviolet rays of the sun or to sun lamps. It is more likely to occur in people with light coloured skin.
246
Tantrums
What are childhood tantrums?
Temper tantrums are a type of behavioural disorder in children (especially in toddlers) whose protest to frustration is a dramatic reaction of temper. The tantrum can vary in time from as short as 2030 seconds to as long as several hours. The behaviour can include: kicking or stamping the feet shouting and screaming throwing things rolling around on the floor banging the head crying (without being hurt) holding the breath (which can be frightening) Move away. Ignore what can be ignored: parents should pretend to ignore the behaviour and leave the child alone without comment. This can include moving on to a different room and busying yourself with something else, but do not lock the child in his or her room. Be flexible: decide if the demands are reasonable before saying yes or no and stick to your decision. Avoid what is avoidable: try to avoid the cause or causes of tantrums, such as visiting the supermarket. Distract what is distractable: redirect the childs interest to some other object or activity that would interest them. Use time-out: consider firm action by taking the child to a safe room or space and insist they be quiet (usually for 2 minutes) before they come out of time-out. Make some realistic and firm rules to follow. Keep the child busy with activities in circumstances conducive to boredom and disruption. Praise appropriate behaviour as soon as it occurs.
Sometimes there is no obvious reason. Tantrums may continue to occur if the child gets what they want, often when parents or other carers reward them to seek peace and avoid conflict. An example of this is when your child picks out a toy from the shelf of a shop and demands I want it. You say no and return it. The child gets upset, grabs the toy and shouts mine, mine. If you give in to avoid a scene and say you can have it just this time, the child gets the message that no can mean yes if they protest strongly enough. So if tantrums work, they are likely to recur.
nasolacrimal duct
What is the treatment for persistent cases? What are the symptoms in infants?
Excessive watering of the eye is the main sign. Mucus and yellow pus may appear in the tears. The discharge is worse on waking. This may clear up or progress to become For more severe blockage or when eye watering has not settled by 12 months of age, the ducts can be probed and dilated under light anaesthesia. After dilation the tear-duct system is irrigated by forcing saline through a syringe into a fine blunt needle. This invariably solves the problem. Very rarely, an artificial duct will need to be fashioned surgically.
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247
Teething
When does teething occur?
Baby teeth (milk or deciduous teeth) Babies usually cut their teeth from age 6 months until 23 years. New teeth continually erupt during this time. The first teeth to appear are the lower incisors (during the first year). These seldom give much trouble. The first and second molars (between ages 1 and 3) tend to cause problems. Usually the first set (20 teeth) is complete soon after the second birthday. Be prepared for variationssome babies have teeth (1 or 2) at birth, while others have none at 1 year. This has no significance. These teeth are lost between 6 and 12 years. The baby wants to chew on something (such as fingers). The baby is irritable and crying (on and off for no more than a few days). The baby has difficulty with sleeping. The problem usually settles quickly and it is important not to link coincidental illnesses such as fever, diarrhoea, vomiting, earache, convulsions, nappy rash and cough with teething.
Lower set of 10 baby teeth and times when they usually appear
Gentle massaging of the gum with the forefinger wrapped in a soft cloth or gauze pad is comforting. A gel such as Orosed can be massaged into the gums every 3 hours if the problem appears to be extremely troublesome. Place a face washer in the freezer and allow the baby to chew on the cool washer. Allow the baby to chew on a clean, cold, lightly moistened face washer. (A piece of apple can be placed inside the face washer.) Give the baby a teething ring (kept cold in the refrigerator) or a teething biscuit. Medication
Adult teeth
Permanent teeth may appear as soon as the baby teeth fall out. If they appear before this, the dentist may have to extract the baby teeth. Permanent molars appear later, about 12 years. A full set is 32 teeth.
Medicine is usually not necessary for teething. Paracetamol mixture should be used for any discomfort. For more severe problems, especially if they are affecting sleep, an antihistamine or a combined mixture of antihistamine and analgesic can be given at night. Your doctor can advise you about this. Other measures Cleaning the teeth at first with a face washer and then with a small soft toothbrush can commence when they appear, especially after the 8 incisors have erupted. Regular dental visits are advisable from about 3 years. Explain to children what they can expect about losing their first teeth.
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Is it a serious problem?
It is an annoying problem rather than a serious problem. Fortunately it responds well to treatment.
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Tennis elbow
What is tennis elbow?
Lateral epicondylitis (tennis elbow or backhand tennis elbow) is inflammation of an important forearm muscle tendon at the point of attachment to the outer side of the elbow bone. Tennis players are not the only sufferers. It is common in golfers, carpenters, bricklayers, violinists and housewives, especially those between 35 and 55 years of age.
humerus
Exercises Use a dumbbell or similar type of weight such as a bucket of water. Start with 0.5 kg (1 lb) and build up gradually to 5 kg. 1. Sit in a chair beside a table. 2. Rest your arm on the table so that the wrist is over the edge. 3. With your palm facing downwards, grasp the weight. 4. Slowly raise and lower the weight 12 times. Rest for 1 minute. 5. Repeat twice. Do the exercise every day until you can play tennis, work or use your forearm without pain.
lateral epicondyle
medial epicondyle
tennis elbow
The towel-wringing exercise This hurts at first, but usually cures the problem by 6 weeks. Roll up a handtowel and, with your arms straight, grasp the towel, then wring it slowly so that your wrist is fully bent forwards. Hold for 10 seconds, then reverse the wringing action to extend your wrist; hold for 10 seconds. Gradually, increase the time by 5 seconds until you can hold for 60 seconds. Do this twice a day, twice in each direction. Many people prefer to do this exercise using a large face washer while showering. Tennis Do not use a tightly strung, heavy racquet or heavy tennis balls. Keep your strokes smooth and try not to bend the elbow. Start the game quietly, taking time to warm up to it.
Armbands
Some tennis players use a non-stretch band or brace around the arm, about 7.5 cm (3 inches) below the elbow. You might not find it helpful, but it is worth trying. Bands are available from (some) pharmacists, tennis shops and orthopaedic appliance firms.
Tension headache
What is tension headache?
Tension headache, which is also referred to as tension-type headache or muscle contraction headache, is a tight constricting pain covering most of the head and is associated with stress or tension. It is the most common form of headache. Many sufferers do not realise that the headaches are associated with tension until it is pointed out to them. repressed hostility, anger or frustration a poor, scrappy diet, for example eating on the run (combined with stress)
Effect a dull ache or tightness in these areas, like a tight band around the head or a heavy weight on top
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Testicle, undescended
What is an undescended testicle?
It is a disorder of boys in which one or both of the testicles (the male sex glands) have not descended into their normal position in the scrotum. The testicles develop inside the abdomen in the foetus and start their descent through the abdominal wall so that it is usually complete by a month before birth. The testicles are attached to the body by long cords called spermatic cords. descent is uncommon. 12% of testicles are still undescended at 1 year.
Sometimes the testicles are present in the scrotum at birth but with the growth of the child the spermatic cord does not keep up with the general body growth. By about school age the testicles are undescended and sit high in the groin.
low
If left untreated, there is an increased chance of reduced fertility and sterility in some males. This is apart from the psychological effects of the altered male self-image. The main concern is the risk of cancer in the undescended testicle, which is up to 10 times greater than normal. The cancer eventually develops in young adults between 20 and 40 years of age.
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How to do TSE
Testicular self-examination is a simple procedure which is useful for young men to learn. Examination is best done using two hands, as illustrated. Explore each testicle individually. Using both hands, gently roll the testicle between the thumbs and fingers. If pain is experienced, too much pressure is being applied. The examination should be done about once a month, preferably after a warm bath or shower, when the scrotal skin is most relaxed.
TSE technique
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Thumb sucking
What does thumb sucking involve?
It involves placing the thumb or finger on the roof of the mouth behind the teeth (hard palate) and sucking with the mouth closed. It is basically a habit and should not be regarded as an abnormal disorder. It is one of the first pleasurable acts that the infant can manage.
What to do (for a child over 6 years) Carefully observe things that provoke thumb sucking. Find ways of avoiding these trigger factors. Provide extra attention. Organise pleasant distractions. Give praise and rewards for efforts to stop.
When to seek help if the problem persists after 6 years, especially if it is excessive and persistent if the child wishes to stop but cannot despite good efforts (even when offered rewards for good attempts to stop) In such situations special counselling may be required. Sometimes the help of the dentist to fit a special training device in the mouth may be required.
Remember
Thumb sucking is usually a passing habit that most children grow out of by school age. Special treatment is rarely necessary. Avoid giving attention to the problem, but give plenty of attention to the child.
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Tinea pedis
Tinea pedis, also called athletes foot, is a fungus infection of the skin of the feet. The fungus, called tinea, grows in the skin between and under the toes, especially the outer two little toes. Sometimes it spreads to the soles of the feet. It may also grow on the toenails, which become thickened and whitish-yellow. The same type of fungus may infect the skin of the groin, especially the scrotum in men. This condition is called jock itch. It is good to dry your feet with a hairdryer. After drying your feet, use an antifungal powder, especially between the toes. Remove flaky skin from beneath the toes each day with dry tissue paper or gauze. Wear light socks made of natural absorbent fibres, such as cotton and wool, to allow better circulation of air and to reduce sweating. Avoid synthetic socks. Change your shoes and socks daily. If possible, wear open sandals or shoes with porous soles and uppers. Go barefoot whenever possible. Use thongs in public showers such as at swimming pools.
Medication The old-fashioned remedies such as tea tree oil (melaleuca alternifolia), Castellanis paint, Whitfields ointment and tolnaftate are still useful for mild cases, but the best treatment is one of the new antifungal creams or solutions such as clotrimazole, miconazole or terbinafine. These should be gently applied after drying, 2 or 3 times a day as directed for 23 weeks. If the condition is severe and stubborn, your doctor may prescribe a course of tablets.
Is it serious?
Tinea pedis is a harmless condition.
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Tinnitus
What is tinnitus?
Tinnitus is hearing abnormal noise in the ear or head when there is no sound coming from the outside. The word tinnitus comes from the Latin tinnire, which means to ring. Although it usually refers to ringing in the ear, tinnitus may include buzzing, roaring, whistling, hissing or a combination of sounds.
semicircular canals
ear canal
to brain
A useful treatment, especially for those having trouble getting to sleep, is to have background music playing when retiring at night. Other sounds that are sometimes used include FM static produced by a radio set off the station and environmental sound-masking tapes. Tinnitus maskers Some people are helped by wearing a tinnitus masker, which is a device like a hearing aid worn behind the ear. It produces a type of hissing noise that tends to counterbalance the tinnitus noise. Hearing aids If a hearing loss accompanies the tinnitus, the use of a hearing aid can mask the tinnitus with amplified sound. This makes it easier to focus on outside sound. Distracting activities Some people can cope by diverting their attention away from their tinnitus by keeping themselves busy and undertaking interesting activities that focus their mind elsewhere. Examples include gardening, power walking, music, television, handicrafts, jigsaw puzzles, card playing and discussion groups. Counselling and support Most cities have a counselling service for tinnitus sufferers. Ask your doctor about the Australian Tinnitus Association.
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Training method
Choose a day when you are at home to begin telling them about the steps to follow, for example: Tell mummy or daddy. Go to the toilet or bathroom. Take off your pants. Sit on the toilet. Do a wee or a poo. Wipe yourself or ask someone to help. Flush the toilet. Wash and dry your hands.
Best times to sit them on the toilet first thing in the morning after meals when you sense their need to go before going out upon returning home
Special tips Give lots of encouragement and praise. Give your child lots to drink. Ask your child if they need to go. Sit the child on the toilet for about 5 minutes, but dont force them. Help your child to relax on the toilet. Teach your child to wash their hands. Handle accidents calmly and use the opportunity to teach the toileting steps. Get boys to sit on the toilet at first to urinate. Dad can show boys how to urinate while standing. Keep nappies on at night until they stay dry. If the training upsets them, wait for a month and try again.
Key points
Use a potty or toilet with a seat ring and a step. Explain the process in simple terms. They will learn to use the toilet when they are ready. Sit both boys and girls on the toilet to pass urine. Do not force them if they refuse to use it. Make a fuss of successpraise and reward them.
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Tongue soreness
What are the causes of tongue soreness?
The common causes of a sore tongue are: trauma from teeth, especially sharp teeth and bites hot food and drink aphthous ulcers geographic tongue A painful tongue, which is uncommon, usually has a burning pain on the tip of the tongue and is considered to be due to a nervous disorder. 3 times a day and try to leave on the tongue for a couple of minutes. Dont rinse out the mouth.
Black tongue
Black tongue, also called brown tongue, is a term sometimes used to describe a black or dark discolouration or stain on the top surface of the tongue. It is a harmless condition but its appearance and presence cause people with it considerable concern.
Geographic tongue
Geographic tongue is a non-serious inflammatory condition of unknown cause in which a changing pattern of smooth red patches with a raised margin that can be coloured white, yellow or grey, appears on the tongue. The pattern resembles a relief map with mountain ridges, hence the term geographic. The patches move around to other parts of the tongue with a major change occurring every 3 weeks. The process may then subside and go into remission which may be complete or partial. However, it may return at a later time. Anyone can get it.
Treatment
Lifestyle management This involves a good nutritious diet and drinking lots of fresh water. Eating raw fruit and vegetables that provide roughage on the tongue and in the mouth is advisable. Good examples are apples, celery and carrots. Try to drink up to 2 litres of water a day. You can prepare water with lemon juice and use a plastic bottle to squirt it into your mouth several times a day. Otherwise frequent sips of water help the problem. Good dental hygiene is important so regular check-ups are also advisable. If you smoke or chew tobacco try to quit this habit. If you are under excessive stress and burning the candle at both ends try to amend this with a more relaxing, healthy outdoor lifestyle. Adequate rest and recreation should be a major goal in your life. The pineapple treatment Cut a thin slice of fresh pineapple into 8 segments. Slowly suck a segment on the back of the tongue for 40 seconds and then slowly chew it. Repeat this until the entire slice is finished. This should take about 8 minutes. Do this twice a day for 710 days by which time the tongue usually returns to normal. Repeat this should the discoloured tongue return. If you have irritable bowel syndrome, talk to your doctor because the salicylic acid in pineapple may aggravate the condition. 249
Tonsillitis
What is the cause of tonsillitis?
Viruses or bacteria (germs) break through the tonsils defence and cause red, swollen, painful tonsils, often with pockets of yellow pus. Tonsillitis may be a feature of glandular fever.
uvula
tonsils
tongue
Tonsillitis in children
Most children experience attacks of tonsillitis during preschool and early school years, when the tonsils are normally large and defences against infection are not fully developed. For most children, proper treatment of acute attacks is all that is required. The attacks will become less frequent as the child matures; tonsillectomy is advised only in exceptional circumstances.
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Travel sickness
Who gets travel sickness?
Almost everyone is sick when sailing on rough seas. However, some peopleespecially childrensuffer sickness from the effect of motion on a boat, in a car or in a plane. The larger the boat, plane or car, the less is the likelihood of sickness; travel by train rarely causes sickness. Nearly all children grow out of the tendency to have travel sickness, but many adults remain bad sailors.
These are good for mild travel sickness. It is desirable to take oral medication for travel sickness 60 minutes before the trip. During a long trip this can be repeated 34 times a day to prevent the symptoms. Some medicines such as antihistamines make you drowsy, so take care: this sedative effect may be good for children or for those travelling long distances by plane.
Ginger
Some people find that ginger helps so it is worth drinking ginger beer or ginger ale before and during travel.
Skin patches
outer ear
Scopolamine adhesive patches are the most widely used medication for long-term travel, especially sea travel. One patch should be applied to dry unbroken hairless skin behind the ear 56 hours before travel. It should be left on for 3 days but removed immediately the trip is over. Wash the hands thoroughly after applying and removing the discbe careful not to touch your eyes with your fingers after doing this.
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Diarrhoea
There are several ways to relieve and treat travellers diarrhoea: 1. Avoid solid foods and drink small amounts of fluids often. (Remember: use only boiled water or safe commercial beverages.) 2. Rest. 3. Take antidiarrhoeal tablets as directed (for mild cases). 4. When the diarrhoea has settled, eat light foods such as rice, bread or biscuits.
Vaccinations
Important recommended vaccinations are shown in the table. Your doctor will advise you on which vaccinations you will need. Other diseases to consider are rabies and typhus.
Malaria
One sting from an infected mosquito can cause serious illness. Malaria is common in many African, South American and South-East Asian countries. To prevent malaria, protect yourself from mosquitoes and take antimalarial drugs prescribed by your doctor. Avoid rural areas after dusk. Use insect repellents that contain diethyltoluamide (such as Rid or Repellem). Wear protective light-coloured clothing with long sleeves and legs, and sleep in screened rooms or use mosquito nets. Avoid using cologne, perfume and aftershave. Antimalarial drugs should be taken before exposure and up to 4 weeks after exposure to give maximum protection. Malaria that resists drug treatment with chloroquine occurs in many countries. Your doctor will prescribe another drug as well as or instead of the usual chloroquine if you are at risk of exposure to this type of malaria.
A guide to vaccination for travellers for important diseases (in rural areas of high risk countries)
Vaccination Tetanus Diphtheria Polio Yellow fever Duration 10 years 10 years 10 years 10 years Comments Essential for travelling. Essential for travelling. Essential for travelling. Compulsory if visiting certain central African or South American countries. Not recommended by WHO; still required if epidemic. Recommended for all developing countries. Might be advisable if you are visiting rural developing countries: ask your doctor. Consider for visits to endemic areas if in close contact with locals. Consider in certain Asian countries for trips longer than 12 months or during an epidemic. Recommended for long stays in high risk areas.
Japanese encephalitis
14 years
Drugs cannot guarantee 100% protection. If you develop an unexplained fever, sore throat or severe rash, seek medical advice.
Rabies
1 year
Your destination
Different countries have different vaccination requirements. For advice about the country you intend to visit, contact your own doctor.
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253
Tubal ligation
What is tubal ligation?
Tubal ligation is a sterilisation operation in which the Fallopian tubes are cut off or blocked. This stops the sperm reaching the egg in the tube, which is the normal site of fertilisation.
uterus
clip method
Tubal ligation
The cut tubes can be rejoined by microsurgery, but there is no guarantee of regaining fertility. The successful pregnancy rates vary between 30 and 80%, depending on the technique used. The simple clip method gives a better chance of reversal. Tubal ligation, however, should be regarded as permanent and irreversible and not entered into lightly.
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Umbilical hernia
Umbilical hernias are very common in babies.
Key points
Umbilical hernias: are common in infants do not require treatment usually go away by 4 years of age can be corrected by a simple operation if necessary
Umbilical hernia
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These basic features lead to anxieties about the body, and so many adolescents focus on their skin, body shape, weight and hair. Concerns about acne, curly hair, round shoulders and obesity are very common. There are usually special concerns about boygirl relationships and maybe guilt or frustration about sexual matters. Many adolescents therefore have a lack of selfworth or a poor body image. They are very private people, and this must be respected. While there are concerns about their identity, parental conflict, school, their peers and the world around them, there is also an innate separation anxiety.
Healthy distraction
Most authorities say that the best thing to keep adolescents healthy and well adjusted is to be active and interested. Regular participation in sporting activities and other hobbies such as bushwalking, skiing and so on with parents or groups is an excellent way to help them cope with this important stage of their lives.
Remember
Adolescent problems are a passing phase. Some authorities say it ends at 18 or 19, while others claim the age of reason is reached at 23 or 24!
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period Day
ovulation
period
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 beginning of cycle most fertile days next period, beginning of new cycle
egg (ovum)
Fallopian tube lining of uterus breaks down blood leaves through vagina (b)
(a) Ovulation Ovulation occurs usually from day 11 to 17 (average day 14) Up to this time the hormones have been preparing the lining of the uterus to receive the embryo if the egg is fertilised This lining gets thick and full of blood (b) Menstruation If fertilisation (pregnancy) does not occur, the lining of the uterus is no longer required It is shed through the vagina This is called the menses
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Urticaria (hives)
What is urticaria?
Urticaria, also known as hives, is a common allergic disorder in which a red, itchy, lumpy skin rash appears out of the blue. These skin lumps, which are known as weals, can develop anywhere on the body, including the palms and soles. The weals, which have pale centres and red margins, can spread out and join up to form large irregular patches. They are usually about 15 cm across. These weals can rapidly change shape and come and go over a period of minutes or hours. Urticaria can be acute in onset (in which the cause is often known and the disorder settles within 6 weeks) or chronic (where it lasts longer). underlying chronic disease (e.g. lupus, lymphoma) pregnancy (last trimester)
Note
Tension and stress usually make urticaria worse.
What is angio-oedema?
This is a serious form of urticaria in which the face, especially the lips and skin around the eyes, suddenly swells. It can be serious if the throat swells. You should contact your doctor immediately if this develops.
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Vaginal thrush
Vaginal thrush, sometimes called monilia or a yeast infection, is a common condition caused by an overgrowth of the micro-organism Candida albicans. Factors that might cause vaginal thrush intercourse oral contraceptives an IUD (intrauterine device) tight-fitting jeans nylon underwear leaving on a wet bathing suit after swimming humid weather travel (due to prolonged sitting) obesity
How is it prevented?
Other symptoms cheesy-white discharge discomfort during intercourse pain when urinating unpleasant odour (possibly) Wash and thoroughly dry the genital area at least once a day. Do not wear panty hose, tight jeans or tight underwear or use tampons. (Candida thrives in warm, moist, dark areas.) Do not use vaginal douches, powders or deodorants. Follow a healthy lifestyle.
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Varicose veins
What are varicose veins?
They are twisted and swollen veins caused by faulty valves in the system of veins in the leg. The failure of the valves to close properly causes blood returning to the heart to pool in the veins.
deep vein
muscles that 'pump' blood up perforating veins with normal valves faulty valves
Normal veins
Varicose veins
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Vasectomy
What is vasectomy?
Vasectomy, which is the commonest method of sterilisation in men, is an operation in which the two vas tubes (the vas deferens) are cut and tied. This blocks the flow of sperm from the testicles into the penis, so that when the man ejaculates the semen does not contain sperm.
tube (vas deferens) cut and tied on both sides so that sperm are blocked from entering the semen
blocked sperm
testicle
What are the side effects of vasectomy? How is the operation done?
This simple operation, which can be performed under a local or a general anaesthetic, usually takes about 30 minutes. It is done through two small cuts in each side of the scrotum (bag) or through one cut in the middle. The vas tube, which lies just below the skin, is picked up and cut. About 1 cm of it is removed; the ends are tied off and then cauterised with a hot needle. Bruising and swelling are common problems but settle after about 2 days. Bleeding and infection occur sometimes, but they settle quickly with treatment. A small lump caused by a build-up of sperm can develop at the operation site: these sperm granulomas usually settle themselves.
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256
Rules
Perform 3 times daily (if possible). Take about 10 minutes each time. Usually do 5 or more times to each side. They are beneficial only if dizziness is reproduced. Take anti-sickness tablets if nausea is a problem.
It doesnt matter on which side you lie down first. Turn your head away from the side on which you lie down. It is important to reproduce dizziness with the exercises. If the exercises are done regularly, the symptoms should settle over a period of several days but this may vary from 34 days to weeks.
Method
1. Sit on the edge of bed; turn your head slightly to the left side (about 45). Lie down quickly on the right side
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Viral infection
What is a viral infection?
Viral infections are caused by viruses, which are microscopic germs and are quite different to the larger bacteria germs. They look like tiny crystals under the microscope. They are the commonest cause of infection, but are usually not serious. We eventually get over the infection simply by resting and looking after any troublesome symptoms.
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Fourth disease
rash mainly on forearms and thighs
vagina
vulva
labia of vulva
Vulvovaginitis in children
Vulvovaginitis can affect women of any age but it is particularly common in young pre-pubertal girls, especially between the ages of 2 and 8 years. The skin of the vulva and vagina is thin and poorly developed at this age and is susceptible to the action of bugs (germs) from the skin and the anus.
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Hamstring stretch
Quadriceps With one hand supporting the body, grasp the ankle with the other so that the foot is pulled up towards the buttock until you reach stretch point.
The exercises
The drawings illustrate stretches for the left leg. Stretch until the muscle just begins to feel tight (stretch point). It is important to hold the stretch position for 2030 seconds, relax for 10 seconds and repeat each exercise for each leg. The stretching program should last 1020 minutes. A practical program is to perform each exercise 2 or 3 times on each leg.
Hip stretching
Adductors Stand with your feet apart. Bend one knee while keeping the other straight. Bend until a stretch is felt in the groin and inner thigh (stretch point).
Quadriceps stretch
Flexors (iliopsoas) Lie on your side. Grab the ankle of the uppermost leg with your hand. Pull the ankle backwards and slightly to the side.
Thigh stretching
Hamstrings Place the heel of the right leg on a low table or chair. Keep the knee straight. Reach forwards with both hands until you reach stretch point. It is very important to warm down by repeating the gentle stretching exercises and jogging for several minutes after sporting activity.
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Warts
What are warts?
Warts are lumps on the skin produced by a virus. The virus invades the skin, usually through a small injury, and causes the skin cells to multiply rapidly. Wart viruses are spread by touch or by contact with the shed skin of a wart. of one of the proprietary wart paints should suffice, for example, salicyclic acid + lactic acid (both about 17% strength). Do not treat warts on your face and genitals with wart paint, because the skin on these areas is very sensitive. Anal and genital warts require special professional care.
Common types
The common wart is a small, hard, flesh-coloured lump with a cauliflower surface. It can grow anywhere on the body, but is most common on the hands. It is usually painless. The plantar wart (papilloma) is a wart that grows on the sole of the foot and tends to become pushed in as you walk. It is usually painful, rather like walking with a stone in your shoe. Anal warts and genital warts are usually spread sexually and tend to multiply very rapidly. They are caused by a different strain of wart virus.
Common warts
1. Soak the wart in warm, soapy water. 2. Rub back the surface of the top of the wart with a pumice stone. 3. Apply the prescribed paint or ointment, but only on the wart. It may be wise to protect the surrounding healthy skin with petroleum jelly (Vaseline).
Note:
Carry out this treatment every day. Carefully remove the loose dead skin between applications. Plantar warts The wart is first shaved back (pared) by your doctor with a sterile blade (this should not be done at home). Then use the same steps as for common warts. The use of the pumice stone is very important. Your doctor should check progress in 6 weeks. It is usually a very slow process. Other methods Some warts remain stubborn and other methods can be used by your doctor. These include freezing with liquid nitrogen, electrocautery and the application of very strong pastes. Most warts eventually respond to treatment, leaving the skin free of a scar.
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labia
Genital warts are very contagious, so sexual activity should be avoided until all the warts heal completely; then condoms should be used during sexual intercourse. It is important not to scratch the warts and to practise good hygiene by keeping the genital area well washed and dry. Sexual partners should be informed by you, checked by their doctor and perhaps referred to a specialist clinic.
anus
shaft
coronal sulcus
glans of penis
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Whiplash
What is whiplash?
Whiplash is the term applied to a sudden injury of the neck when the neck is whipped backwards forcibly in an accident. It usually occurs in motor vehicle accidents but can occur in contact sports such as football and other similar accidents. It is a term that doctors prefer not to use now, instead referring to it as an acceleration hyperextension injury. up to about 3 months. A better outcome is obtained with good treatment but recovery will not be speeded up by repeated X-rays or wearing a cervical collar.
Note: Ask your doctor about any drugs you are taking.
Apart from a sore neck there is a tendency to feel flat and depressed for about 23 weeks. Talk to your doctor about this feeling if it persists. Note: The symptoms are usually worse if there is pre-existing osteoarthritis of the spine. 3 out of 4 people involved in rear-end collisions do not experience neck symptoms.
Worms
Worm infestation is still reasonably common, especially in tropical or subtropical communities. There are various types of worms, including the common pinworm (also called threadworms or enterobiasis), roundworm (these can be very large), hookworm and whipworm. The treatment for each of these worms is almost identical. This leaflet will focus on pinworms. worms to other members of the family by contaminating food, sheets and towels.
Pinworms
Pinworms are tiny white worms about 1 cm (12 inch) long. They are more common in children, especially school children, although they can infect adults. The host of these worms is humans and they are spread from human to human. There is no evidence that they are picked up from family pets. Life cycle of pinworms Pinworms enter the gut as eggs in contaminated food or sometimes through bare skin in contact with contaminated soil. The eggs hatch in the intestine and about 2 weeks later the female worm lays eggs around the anus of the person. These eggs then hatch into the tiny worms. The eggs or worms cause irritation of the anus and the itching provokes scratching, often subconsciously at night. The child thus picks up some eggs on the fingers. Sucking the finger or eating food with unwashed hands will then cause re-infection. The child may pass on the
anal opening
Medical help
The affected person should take one of the commonly used drugs such as pyrantel, albendazole or mebendazole, usually as a single dose. It should be repeated after 23 weeks. If this treatment is not successful, all members of the family should be treated, even though they have not been diagnosed as having worms. An ointment may be prescribed to relieve anal irritation.
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