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EAR INFECTIONS: BLOW THE NOSE PROPERLYOften the middle ear is infected because a child has not learned how to blow the nose properly. The worst technique is to hold both nostrils tightly when blowing, since this forces the infected material from back of the nose into the middle ear. The proper technique requires that only one nostril be held and that blowing be gentle. Preferably, the handkerchief or disposable tissue should be held quite loosely over the opening of the nostrils.Middle-ear infection may lead to some degree of deafness and, rarely, to permanent loss of hearing. Following an infection the child should be taken to a specialist – an otorhinolaryngologist – who will test the loss of hearing and do everything possible to stop the progress of infection and restore action to the damaged tissues of the ear.Mastoiditis used to be frequent after infection of the ear, but now the total number of cases of mastoiditis has been greatly reduced by the antibiotic drugs. Pain and tenderness in the region behind the ear are the first symptoms of inflammation of the mastoid. The skin may be swollen so that the external ear seems to be pushed away from the head. Early treatment of infected ears will usually prevent this complication. Surgical treatment of mastoiditis involves an operation in which the infected area is opened and the infected material cleaned out. Unless controlled, a secondary inflammation of the coverings of the brain-meningitis – is possible.*25/318/5*

OBSESSIVE COMPULSIVE DISORDER: DIFFERENCES BETWEEN BDD AND OCDPeople with BDD also tend to have poorer insight than those with OCD. In a study Dr. Jane Eisen and I did, we compared insight into the underlying belief in 85 people with BDD and 64 with OCD. A typical belief in BDD is looking ugly or deformed; OCD beliefs vary but often consist of a belief that something bad will happen if a ritual isn’t performed (e.g., the house will burn down if the stove isn’t checked 30 times). On average, insight in BDD was poor, whereas in OCD it was good to fair. Specifically, we found that people with BDD are more convinced that their belief is true and are more likely to think that other people agree with them. They’re also less willing to be convinced by someone else that their belief isn’t true, and they try less often to convince themselves that it isn’t true. They’re also less likely to think that their belief has a psychiatric cause (for example, due to a disorder such as BDD or OCD) and more likely to think it’s actually true.The poor insight of people with BDD is one of the reasons that cognitive approaches (cognitive restructuring and behavioral experiments; see Chapter 14) are usually emphasized when treating BDD with cognitive behavioral therapy. Cognitive approaches target the unrealistic thinking and poor insight that’s usually present in BDD. Many expert therapists think that behavioral approaches (exposure and response prevention) when used alone (that is, without cognitive approaches) tend to be less effective for BDD than for OCD. Cognitive approaches are therefore usually combined with behaviourial approaches when treating BDD.While BDD and OCD both appear to respond preferentially to SRIs, they may respond somewhat differently to other medications. In Chapter 13 I described a study in which I added a typical neuroleptic (pimozide) or placebo to an SRI (fluoxetine). This study found that pimozide wasn’t more effective than placebo. This differs from findings in OCD, for which pimozide and other typical neuroleptics are often effective when added to an SRI. While the BDD study findings need to be confirmed, this is another way in which BDD’s treatment response may differ from OCD’s.*364\204\8*

PREVENTING ASTHMA: SOME NECESSARY PRECAUTIONS – DIETProper and regular diet is very important. The diet should be light, nutritious, well balanced, and one which does not contain items that do not suit the children. Spices should be avoided. Sometimes cold drinks, chuttnies and pickles cause coughing; these should be avoided. Children prone to asthma attack should avoid heavy meals, specially at night, as it causes discomfort in breathing or may even precipitate breathlessness. Ideally, dinner should be at least 2 hours before the bed time. Instead of taking heavy meals at longer intervals, a child should be encouraged to eat small meals more frequently. Fried food should be avoided and the child encouraged to eat more vegetables, fruits, and drink soups. There should be adequate variety in the diet, but everything should be taken in moderation.Asthmatic children, as far as possible, should avoid eating food outside the home, specially food that is heavy with fat and fried. However, in a party, these children may have a bight meal with one or two comparatively fat-free dishes.Children who develop asthma do not gain weight and sometimes even lose weight.Their diet, therefore, has to be closely supervised. As a rule children require more calories per kilogram of body weight than adults because:1. the basal metabolic rate in children is higher,2. there is greater physical activity, and3. more calories are needed for growth.Asthmatic children have even higher metabolic rate because of hurried breathing.School-going children often hurry through their breakfast because they wake up late, and then hurry through their lunch because they want to play. Towards the end of the day, they tend to take a heavy dinner which is not advisable. A full stomach when going to bed is more likely to trigger an attack.If most of the common triggers are controlled, even if not eliminated altogether, such children can lead relatively healthy and full life, without too many attacks.*91\260\8*

Diabetics have to blame their ailment not only on a failure of the islets of Langerhans – located in the pancreas – to produce sufficient insulin, but also on a functional disorder in the anterior lobe of the pituitary as a contributory factor. No matter how much bile the liver produces, the process of breaking down fat will suffer if the pituitary fails to manufacture the necessary hormones. A change in the blood pressure, too much or too little elimination of water, even the start of labour pains, are all connected with the function of the posterior lobe of the pituitary and its secretion of hormones.

Until recently, science had not succeeded in fully understanding the complex hormone structure of this interesting little gland. And this is the reason why it has not yet been possible to produce its hormones synthetically. It is always a risk to prescribe medicine that has a direct effect on the pituitary, except in small homoeo­pathic doses. Such medicines can have a very detrimental effect on the patient if he is sensitive to drugs.
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The pituitary gland governs the activity of the thyroid, the supra­renal gland and the sex glands. It is known as the master gland, having the leading position among the endocrine glands. Its direct link with the central nervous system in the area of very important centres at the base of the brain, the hypothalamus, has been the subject of much research, since it appears that the pituitary gland influences all the vital processes either directly or indirectly. It also appears that, together with the thymus gland, the pituitary determines growth. Since the entire development of the sex glands and sex organs is controlled by the pituitary, a hermaphrodite condition may be attributed to impaired development or disturbed functioning of this gland. A pregnancy could never run its normal course without the cooperation of the pituitary.
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No specific treatment is commonly used for normally healthy children who have a bout of shingles. Treatment is symptomatic, and you may choose to give your child paracetamol if he complains of mild pain. Do not apply creams or lotions to the rash. If you cannot stop your child from picking at the blisters, apply antiseptic.

When to see your doctor

• if the rash is on the child’s face;

• if your child complains that the rash is either itchy or painful;

• if you are unsure that the rash is shingles;

• if your child suffers from a chronic illness, or if he is taking immunosuppressive medication;

• if the rash does not clear up in 10-14 days;

• if the rash looks infected, or your child has a fever or is otherwise unwell.

Complications

Occasionally shingles can affect the eye. The cornea is mainly affected, and the eye becomes red and sore, with the shingles appearing as tiny ulcers. If you suspect this in your child, you should see your doctor immediately.

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Make sure that whenever you are breastfeeding, both you and your baby are comfortable. In the first week or two it may hurt you to sit down if you have had stitches, and using a rubber ring or pillow can help a little. Some women prefer to breastfeed while lying on their side, facing their baby. This can be more comfortable, especially if you are very tired. Proper attachment of the baby’s mouth to the breast is essential for successful breastfeeding and can prevent problems such as sore nipples. Good techniques can be learnt, so do not be afraid to ask for help. It is important that the baby’s head is in line with his back, and that his whole body is facing towards you. Bring the baby to your breast, supporting it as you offer it to him, and make sure that he sucks on most of the areola, not just the nipple. The baby should be placed at the right height in relation to your breast so that he does not drag on your nipple. A pillow or cushion can help you to hold the baby comfortably. Place the telephone by your side if possible, or better still take it off the hook during feeds so that you won’t be disturbed unnecessarily.

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I often tell couples to select a weekend soon, a time when you can go away together and not receive any phone calls. You may not take your watches. This is a trip only for one another and based on the marriage, not the clock. You can ask for wake-up calls and check clocks anywhere, but on this trip, no watch-watching. You must make sure that all of your concerns about home are taken care of. Start planning now, because this trip is difficult. This will be your R&R trip, a trip to recommit to the marriage and celebrate its re-creation. Couples generally appeared eager but confused.

“Do you mean just a weekend away?” asked the husband. “We do that often.”

No, this is not just a weekend away. This is a re-honeymoon trip, a special marital trip of intimacy. A celebration. Each partner should buy a gift for the other that costs a total of less than five dollars and will last forever. You will exchange this special symbolic marital gift with a personal note during the trip. I would like each of you to write out special new vows to one another that you will exchange. The selection of the gift is important and difficult. The price limit will cause you to think about this.

This couple selected Toronto for their trip. They had been there several times, usually with friends. They selected a play to attend and a deluxe hotel. Your own trip could be down the street, just so long as you are alone together away from everyone and everything. When you check in, make love before doing anything else. Sexual intimacy should not be the last thing, but the first thing. Remember your daily walks, remember the posture of the future, and remember to set aside time for your own private ceremony of recommitment.

One wife described the ceremony she shared with her husband.

“We lit a candle, but the damn smoke alarm went off. We decided to turn off all the lights and open the drapes so the city lights would light our room. We got in the posture of the future, naked, but we didn’t touch genitals. We looked at each other. I don’t know how long, we didn’t have a watch. Time just didn’t matter. We shared our vows and we cried. Really cried. We sat closer and held each other. Later we exchanged gifts and little notes.”

Her husband added, “She gave me a picture she had framed. Just a snapshot of us at the beach when we first met. Do you know what I gave her? You would never guess. I gave her two things. First, I gave her a cheap little painting of a light tower. She couldn’t stop laughing. [Remember the sex word game? This was the creative wife who had a new name for the penis and testicles, the light tower on the rocks.] Then you know what? I gave her a little painting I did myself with a plastic frame. Five dollars doesn’t go too far. I painted a picture of our house. Just our house with a big sun behind it. We laughed and cried. We knew we were making memories.”

The wife added, “We just sort of nodded our heads when we shared our vows. The words didn’t seem to matter.” The communication of this couple was on a level beyond words, in a language unique to their marriage, to their love.

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