About Health & Medicine

How to take a temperature

Shake the thermometer — make sure the mercury line is below 37°C. Armpit temperatures Place the thermometer in the armpit and close the arm, holding the elbow against the body. Wait for about 3-4 minutes before taking a reading. Oral temperatures In older children, place the thermometer well under one side of the tongue. Have the child hold it in place with his lips, not his teeth, and tell him to breathe through his nose. Make sure that he has not had a hot or cold drink within the last 5 minutes. Wait for about 3-4 minutes before taking a reading. Rectal temperatures We do not recommend this, unless it is performed by your nurse or doctor.

Cause

Fever is not an illness in itself but is the sign of an illness. There are many causes of fever in childhood. Most fevers, and the illnesses that cause them, are of relatively short duration. A fever may occasionally last much longer, and may be the sign of an underlying chronic or long-term illness or disease.

Infections are by far the commonest cause of fever in children. Most of these are caused by viruses, which are responsible for colds, upper respiratory infections, some ear infections, and the common infectious diseases of childhood such as chicken pox. These infections are self-limited (that is, they resolve after a period of time) and usually no specific treatment is necessary.

Some infections are caused by bacteria, and do need treatment with antibiotics. These include certain ear and throat infections, urine infections, pneumonia, and blood infections.

Other causes of fever are relatively uncommon, and include allergic reactions to drugs, chronic joint inflammation, some tumours, and gastrointestinal diseases.

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This test is used to diagnose urinary tract infections. The specimen must be fresh and sent without delay to the laboratory. If urine is left at room temperature for more than an hour, there can be difficulty in interpreting the final results of the test because of multiplication of germs in the sample.

Procedure

Wipe your child’s genital area with warm water, paying special attention in girls to wash the area between the labia. In girls hold the labia apart and ask the child to pass urine. Let the first few drops fall into the toilet or potty and then collect the rest in a sterile specimen jar provided by your doctor or nurse. The procedure is somewhat easier in boys, but make sure that the child does not touch the tip of his penis after you have wiped the area clean before collecting the specimen.

The specimen is sent to the laboratory and a sample is checked under the microscope immediately. A few drops of urine are also placed on a special culture medium, and incubated for 72 hours. After 24 hours any germs present will reproduce and be detected. This can help to identify the cause of your child’s urinary tract infection. The laboratory technician will also be able to check which antibiotics the germ is sensitive to and this will guide the choice of antibiotic the doctor uses to treat the infection.

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When I left my department-manager job and took over the whole store, everything changed. I felt different. Happy and sad at the same time. I was proud and excited, but sad that there was no going back. I would never be quite like I was before. I know that adjustment affected our sex. I was sort of afraid to have sex for some reason after the promotion. I don’t know if it was superstition or not, but it was like I was insecure, didn’t want to rock the boat, jinx myself. I got so busy trying to prove to everybody that I deserved the promotion that I never thought about deserving my wife or what she deserved.

HUSBAND

As I indicated earlier, mid-life crises are life crises that are finally getting our attention. There are as many books on transitions in life as there are transitions. Attention to sexual intimacy at times of change, no matter what “stage” we feel we are leaving or entering, preserves and enhances our intimate relationship and helps us through any transition.

I have listed some of the most recent sources of research on transitional life changes and adult development in the notes for this chapter. One of the most carefully researched approaches to adult development is by Dr. Gerald Levinson. He mixes sound research with interesting insights about the fact that development is not just something children do.

I noticed that at every major professional meeting on sexuality, professionals talk about overall life development more than about genitals. They do so because sex and development are one and the same. I have designed my own informal “adult sexual development cycle” that was used by the couples to discuss their own feelings about their sexual “place” at various times in their own lives. These are not steps or stages. Each phase is more like an overlapping spiral within which we move back and forth. Adults, like children, never “enter” a stage. They encounter life challenges and cope using their available resources at that time. So, as you look at each adult sexual cycle derived from my interviews, view them as reciprocal and interwoven, as stimuli for more learning, not places or stages.

SEXUAL PASSAGES: CYCLES OF THE DEVELOPMENT OF INTIMACY

Early Childhood

Integration of physical and emotional sexual sensations, combining touch with feelings

School Age

Overcoming sanctions against sexual self-worth and enhancing sexual self-esteem

Preadolescence

Developing sensitivity to*and for other gender and accepting sensitivity to same gender

Adolescence

Integrating love needs with sex needs

Young Adulthood

Expressing vulnerability and transcending needs to withhold

Adulthood

Learning value of stability and coping with pressures for variety

Mature Adulthood

Enjoying inclusivity, sharing in balance with autonomy and individuality

Aging Adulthood

Remaining creative in balance with accepting and tolerace

The sexual histories and the multiple therapy visits of the couples, as well as the thousands of other interviews of persons coming for sexual help, revealed a pattern of recurring sexual cycles that related to the development of each spouse’s love map. Here are the eight cycles briefly outlined. The future of therapy for sexual problems rests in this family and developmental approach more than the discovery of new techniques, postures, and genital reflex controls.

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For example, some surgeons recommend very major surgery for locally extensive cancer of the cervix (neck of the womb). This operation is sometimes recommended for cancer of the cervix that has grown into nearby pelvic organs: removal of the entire womb, upper vagina, fallopian tubes, both ovaries, all pelvic lymph nodes, the bladder and the lower bowel. The woman is left with bags on openings in the abdominal wall for both urine and faeces. People who agree to such surgery only because it gives them a chance of being cured altogether, should be checked very, very carefully for blood-borne secondary deposits beforehand. The check on the lungs I described above would not be sufficient if surgery like this was planned. Because the lungs are a common site for secondary cancer of the cervix they should be checked with a CT scan before such a drastic operation.

On the other hand, some of the less drastic operations aimed at cure also have a secondary aim. Surgical removal can be the best way of preventing or relieving symptoms from the primary growth. Thus, even people who are not cured may stand to gain something important from these operations—prevention or relief of unpleasant symptoms. Find out whether this is true for the operation that has been recommended for you. If you are sure that the operation is worth having even if if doesn’t cure you, it doesn’t matter so much if small secondary deposits are not found before the operation. Finding them after the operation like this would certainly be disappointing, but just think how much worse it would be for a patient who had had the operation for cervix cancer described above—it would be a complete tragedy.

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Although occasionally cysts rupture, they usually signal their presence by causing pressure on some organ or a lump in the abdomen becomes noticeable.

Diagnosis may not be easy. X-rays or scans of the liver using radioactive marker chemicals are not specific; what they confirm is the presence of a lump.

Several other tests using injections of serum into the skin have been in use for many years but they are not always accurate.

Some researchers have come up with a novel treatment in experimental animals, where the inner fluid of the cyst is removed and replaced with serum from an infected animal. Presumably the antibodies contained in the serum destroy the parasite. This has not been transferred to the treatment of humans.

Recently the use of drugs previously used to kill worms in animals has been successfully tried in man. Mebendazole and its derivatives have a low level of toxicity and show promising results.

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Cats are clean animals — but they can be a danger to pregnant women.

They pose the risk of the condition called toxoplasmosis.

In most cases, this is a mild human infection but, if a woman gets it for the first time during pregnancy, severe damage can occur to the foetus.

Toxoplasma gondii is a minute one-celled animal which appears to be a natural parasite of the cat, but for which other animals, some birds and even reptiles may act as intermediate hosts.

Oocysts or eggs may be passed with the faeces and be a source of infection.

Contact with the cat’s litter-tray or gardening without gloves in soil where the faeces may be buried can infect humans.

Eating improperly cooked meat, which may contain the oocysts, is another source of infection, if not the main one. Blood tests show that most of us eventually come into contact with the parasite, which appears to be widespread in most countries, although infections are often mild and undiagnosed.

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This is the most basic form of stress relief practised by both professional and non-professional alike. Here, the patient is encouraged to talk about his problems and anxieties to an individual who will be sympathetic and supportive. One does not have to be a psychiatrist to qualify as an audience of course. A tolerant friend may suffice, and for centuries the clergy filled this role, and many of them still do. However, the impersonality of the professional, his skilled prompting and therapeutic intent, give him a great advantage. A disadvantage is his costliness, but that reinforces the impersonality and also makes the process more purposeful for the patient. It gives the patient, to put it bluntly, a financial motive for recovery.

Sensitive physicians practise this form of supportive psychotherapy intuitively. The patient is made to fed that he it worthwhile, and that the doctor wants more than anything in the world to help him. As a result of his warm, friendly, positive attitude, the physician enables the patient to feel secure, accepted, protected, less anxious, and encouraged towards health. The aim is not to remake the personality but to help an individual over a rough spot in his life. Advice may be given about rest, exercise, diet, use of drugs, hobbies etc. Sympathetic counselling about dealing with practical issues is given. With reassurance and support, the doctor reinforces the patient’s defences against anxiety, emphasizes his capacity to get well, encourages self-esteem, and permits the patient to have a corrective emotional experience with someone who treats him differently from all other persons in his life.

This type of therapy is, of course, quite different from the analytic type practised by psychiatrists. The latter is aimed at uncovering unconscious material and allowing it to be aired, in the hope that a permanent change in personality can be effected. Analysis, which is in the realm of psychiatric treatment may, in severe cases, be required. It is interesting, however, to note that rashes of the type seen in neurodermatitis are a result of unresolved conflict. Whereas people with psychiatric diseases have virtually given up the struggle to resolve their conflicts, and therefore the incidence of stress-related skin diseases amongst such individuals is very small.

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Low G.I. eating means making a move back to the high carbohydrate foods which are staples in many parts of the world. The emphasis is on whole foods like whole grains—barley, oats, dried peas and beans, in combination with certain types of rice, breads, pasta, vegetables and fruits. You’ll find the recipes listed under each of our three main eating occasions—breakfasts, light meals (like soups, salads and pastas), and main meals with additional sections on desserts and snacks. While some of the recipes are specifically modified to lower the G.I. others are included to present new ways of preparing low G.I. foods.

The recipes have been developed to help you reduce the overall G.L factor of your diet improving its nutritional quality while you do it. They are designed to be incorporated into your usual diet, helping you to get your carbohydrate intake up to 50 to 60 per cent of your kilojoule intake and keeping your fat intake down to the recommended level of 30 per cent of kilojoules per day. Protein should stay constant at 10 to 15 per cent of energy. Most of the recipes are high in fibre, both soluble and insoluble.

Each recipe has been analysed for its nutritional value which is given per serve where the recipe is divided into a specified number of serves. The following information will help put this nutritional profile into context for you.

Kilojoules. The metric equivalent of Calories. This is the measure of how much energy the food provides. Those who bum lots of energy through exercise need a higher kilojoule intake than those who live more sedentary lives. A moderately active woman aged 18 to 54 years would consume about 8000 kilojoules a day; a man about 10 000 kilo-joules.

Fat. Our fat requirement is probably as small as 10 grams a day to provide essential fatty acids needed for health. The range of acceptable fat intake depends on your total kilojoule intake. People trying to lose weight could aim for around 30 to 40 grams of fat a day. Most others could do with 50 to 60 grams. Children and adolescents need more than adults because they are growing and should not have their fat intake overt/ restricted.

Carbohydrate. The total amount of carbohydrate (which includes starches and sugars) is listed with each recipe. Our aim is to help you increase your carbohydrate intake as your fat intake drops. It is not necessary to calculate how many grams of carbohydrate you eat on a daily basis, however the athlete or person with diabetes may find this information useful. This is so they can eat enough! On average, women should take in 250 grams of carbohydrate each day while men need about 350 grams. Athletes can consume anywhere from 350 to 700 grams of carbohydrate a day.

Fibre. It is recommended that we consume at least 30 grams of dietary fibre every day. A slice of wholemeal bread provides 2 grams of fibre, an average apple 4 grams. The average Australian consumes only 18 grams of fibre a day.

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Physiological adjustment. It has been recognised since the 1980s that overfeeding does not always result in the weight gain predicted by the physics energy balance equation. This is because in humans, the body defends itself against an imbalance between EI and EE by adjusting, within limits, the one to the other. Adjustment refers to the metabolic, physiological and behavioural changes that occur when the equilibrium, or ’settling point’ is altered by a positive or negative energy imbalance. The adjustments tend to oppose the energy imbalance to minimise the effect on body weight changes. This helps to explain why, with such huge variations in energy intake and energy expenditure over a year, there are normally only minor fluctuations in body weight in most people. It also helps to explain the plateaus and rebounds during a fat loss program.

The popular belief (based on the physics model presented above) is that fat or weight loss can be calculated in a linear fashion from the calorie deficit. However, reducing the amount of food eaten over a set period by a total of 3500kcals, will not result in an automatic loss of 0.45kg of fat, which would be predicted as the storage equivalent of 3500kcal. Adjustment in energy expenditure through a decrease in metabolic rate in particular, would mean that the reduction in body stores is much less than expected. The opposite also holds true for a positive energy balance. When more is eaten than is used up as energy, metabolic rate increases as body mass increases and again, the fat gain will be less than predicted.

It is this physiological adjustment which has been typically under-estimated in discussions of weight control, although a range of research has now identified it as a key factor in the long term failure of many programs. Adjustment is a biological protective mechanism which prevents excessive long term gains and losses in body energy stores. It is more effective in some people than others (perhaps partly genetically determined). It may also be more strenuously invoked if the energy deficit and weight loss are large.

The short term adjustments are mainly through appetite control, although changes in the thermic effects of food (TEF) are directly related to meal size. Lethargy can be a marked feature of low energy intakes. In the longer term as fat mass and FFM decrease so do RMR and fat burning (higher RQ). Often the changes are greater than expected and this is called adaptation. For example, the fall in RMR may be much greater than expected for the loss of FFM. The adaptive changes are a sign of active mechanisms in the body opposing major shifts in body weight.

Myth-information. Arguments about the benefits of butter or margarine are largely irrelevant when considering their use in fat loss. Both have equivalent fat energy value (i.e. 9 kcal/g).

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Pain is a message which tells us that a part of the body has been damaged or injured in some way. The message is transmitted by a network of nerves from the site of the damage or injury to the brain — where it is perceived as pain.

Pain is the dominant symptom for many women with endometriosis. Until recently the management of pain was largely ignored by the medical profession, and even now there is little written about which pain management techniques are the most beneficial for the relief of the pain associated with endometriosis.

It is thought that much of the pain of endometriosis, especially that experienced during menstruation, occurs when the implants bleed on to the tissues surrounding them, causing inflammation and the release of chemicals known as prostaglandins which in turn causes pain.

The endometrial implants and cysts may also cause pain as they grow and swell during the second half of the menstrual cycle, particularly if they are embedded in the ovary.

Adhesions can cause pain because they pull and stretch the organs in the pelvic cavity into abnormal positions.

The rupture of an endometrioma may also cause pain because the spillage of its contents severely irritates the surrounding tissues, causing inflammation and the release of prostaglandins.

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