Because it is impossible to determine clinically whether the infection is due to bacteria or a virus, all ear infections are treated with a course of antibiotics. This may be a 5-day course, though sometimes the doctor will prescribe medications for 10 days to ensure that the infection has cleared up. Various antibiotics can be effective, depending on the age of the child. Most children improve after a few days, but you should always make sure that the child finishes the whole course of treatment.

Apart from antibiotics, other medications are often prescribed. Decongestants are somewhat controversial, for despite their common use in ear infections, they have not been demonstrated to be of benefit. Paracetamol in appropriate doses is usually beneficial for the fever as well as the pain, and nasal drops or spray may help relieve congestion and make the child more comfortable, as may blowing the nose.

In some children who have recurrent ear infections or a chronic infection (known as ‘glue ear’), ventilating tubes (grommets) are inserted into the eardrum to keep fluid from building up behind the drum, thus making sure that hearing is preserved. This is a very common procedure in childhood, and usually the child can be a ‘day patient’ — he does not have to stay overnight in hospital but has the procedure are in the ears, it is advisable not to go swimming unless special ear plugs are used to prevent water entering the middle ear. The ENT specialist will explain these precautions to you. Grommets usually fall out after 6 to 12 months, although sometimes special tubes are inserted which will stay in longer. In some children, grommets are reinserted several times.

When to see your doctor

The doctor should see the child at the first sign that the child may have an ear infection. Often he or she will want to review the child after the completion of treatment, to make sure that the infection has cleared up and that there is no evidence of glue ear. The doctor should also be seen immediately if there is any discharge from the ear, as this may indicate a perforated eardrum.

Prevention

There is no way we can prevent ear infections. If your child has recurrent ear infections, or you suspect that his hearing may be reduced, then it is very important that the child be closely monitored to ensure that he does not have a significant and persistent hearing loss.

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Cause

The exact cause of diabetes is not known. It does have a tendency to run in families.

Clinical features

You may be unaware that you have diabetes until it is diagnosed on a urine dipstick during one of your routine antenatal visits. The build up of glucose (sugar) in the mother’s system passes through the placenta to the baby. This in turn makes the baby grow very big and fat, but does not make him mature any faster. This may cause difficulties around the time of birth, because the baby may be too big to fit through the mother’s pelvic outlet. In addition, he will most likely be immature and require a special care nursery until his condition is stable. Immediately after birth the baby’s glucose level may drop dramatically (hypoglycaemia), and this needs to be monitored carefully. Such babies are jittery and may even have convulsions. Occasionally, if the risk of normal labour is thought to be too great to both mother and baby, a Caesarian section will be advised.

Treatment

Careful monitoring of the mother’s glucose levels throughout pregnancy is important for good control. This may be achieved by using a home glucose monitor. Avoiding sweet foods such as cakes, lollies and chocolates is mandatory. If stable levels cannot be achieved through dietary control, insulin may be used. Sugar levels usually return to normal soon after the delivery and there should not be any problems with breastfeeding.

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ANSWER: Probably the worst word in the sexual vocabulary is “climax.” It has become at the same time a goal, a purpose, and an end of sexual activity. A super marital sex rule is that the journey should be as important as or more important than the destination. Learning to focus on what is happening instead of where it is leading you will help. The physiological reflex or orgasm, like any human response, always involves an ebbing and flowing of sensation, of getting close, then not so close, then close again. What you report is perfectly natural. That’s the way all body processes operate, and sex is no different. Learning to enjoy the fading will also help, because there is no need to follow a “one way only” sexual system. If you want to experience an earlier orgasmic reflex as part of, but not the goal of, the sexual interaction, there are a few things to remember. First, learn about your sensitive areas, the Ñ and G areas. Learn what type, speed, intensity of stimulation you like and teach it to your partner. Some people report a “withdrawal from the edge” response when they get close to pelvic contraction. Practicing alone to go over that edge can help, but most important, psychasms can help take you over. Remember your capacity for both types of response and pressure will reduce. Pushing yourself when at the edge only causes more withdrawal. Letting the edge draw you over, letting the psychasm carry you over, can also be learned.

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While it is true that normal tissues are generally able to repair radiation damage better than tumours, there is a limit to their ability to do this. You know this from experience with other types of injuries. Let us take a simple example. A skin scratch can heal without leaving any mark. A small cut may heal without any help, leaving a small scar. A larger cut may only heal with the help of stitches. If a big chunk of skin and underlying tissues is actually removed, the defect may never heal over without grafting. The eventual appearance and function of an injured tissue depends on how severe the injury was.

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It is more common in those who have the typical hysterical personality. These are immature and inadequate and seem to have no ideas or emotions of their own but to take on the attitudes of the group in which they find themselves.

They like to be the centre of attention to make up for their inferiority feelings. This posturing may not be conscious. Children often seem to live out their fantasies, and those adults with hysterical personalities seem to behave in the same way. They are self-centred and bend and twist the truth to keep themselves in the limelight.

Hysterical symptoms are always assumed in order to gain, but this gain may not be obvious on casual examination.

The symptoms may be physical or emotional or both. The more knowledge the person has of real illness, the more closely may the symptoms mimic it. Paralysis, weakness and loss of feeling are common. Difficulty in swallowing, loss of the voice, blindness, deafness and loss of memory all occur.

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It has been estimated that about 40 per cent of patients consulting a doctor have no physical or mental disorder and that a further 40 per cent have an illness but will recover, whether treated or not.

So about 80 per cent of patients attending a doctor really need no treatment. In the long run it perhaps doesn’t even matter whether a diagnosis is made.

These people are probably going to do as well with alternative treatment as they are with orthodox Western medical treatment, so perhaps there is a living for the orthodox doctor as well as the alternative practitioner.

But what about the other 20 per cent of patients who do have a serious illness which, if properly recognised and treated, may be relieved or cured? Even fatal illnesses can often be relieved for a time.

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Rona Silverton, a New York-based psychotherapist with analytic training, is documenting women’s emotional reactions to endometriosis and what they can do to help themselves combat the problem. She sees in victims a common trait: self-blame and a sense of helplessness. Dr. Silverton notes: “If you don’t have the reality of endometriosis confirmed, or if it’s taking a long time to have it diagnosed, it stirs up other fantasies of what might be wrong.

“Some women fear they have a cancerous condition; others believe their pain is imaginary and don’t seek further help. Some even think they’re being punished for something they’ve done in the past. One woman—a professional now in her thirties diagnosed with endometriosis—confessed to mc that she had had an abortion when she was younger. She believed her condition was related to her once having aborted a child. Logically, she knew hers was a physiological problem, but inwardly—for her—endometriosis was indisputably related to that abortion.”

Personalizing the disease is only one of many reactions. One can almost understand how a sufferer could eventually declare a moral judgment on an illness, especially when she starts out being told the pain is imaginary. Since endometriosis does not present itself tike a broken leg—that is, in an absolute and obvious manner—it allows for a wider margin of self-doubt if the doctor asserts that there is nothing wrong.

While coping with pain the doesn’t understand, a woman’s sense of doubt can be compounded by the tear of what can happen next.

There’s a flood of feeling, especially about recovering and having children. Dr. Silverton reflected, “But there is hope, I feel. Once the disease is legitimized by virtue of correct diagnosis, and the reason she is in pain becomes cleat, then [a woman] can take steps to relieve it. Counseling helps women sort out the physical symptoms and reduce some of the guilt involved.

To restore self-esteem, any woman with endometriosis must be educated about the disease, not only in terms of hard medical information but also with a conviction to heed her own inner perceptions, A woman may know she has endometriosis even though her doctor insists she does not! When this occurs, stories such as the following are common.

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The word eczema comes from the Greek ekzeo, to boil over. In an acute case of eczema, the skin becomes red and swollen, with surface oozing and/or blistering which results in crusting and scaling. The chronic cases end up with thickened skin, evidence of scratch marks, and increased pigmentation. In infancy the most common form, but by no means the only form of eczema, is atopic eczema. The term ‘atopic’ indicates an inherited tendency to develop one or more of a related group of common conditions, such as asthma, hay fever, urticaria or eczema. It is estimated that 10 per cent of the population are atopics, and that hay fever is the most common manifestation. Eczema affects about 3 per cent of infants, and these have a one-in-four chance of developing asthma or hay fever some time later.

Atopic eczema usually appears in the infant between the age of three months and two years. The initial site of inflammation is commonly the face and scalp, with subsequent spreading to the limbs. Individuals with this condition manifest certain abnormalities, particularly of the skin, which are thought to be the reason for them developing atopic eczema.

These abnormalities include impaired oil gland function, which results in a dry and hence itchy skin. This is why so many of these infants also suffer from a ‘fish-scale’ condition, known as ichthyosis. Accompanying this is also impaired sweat gland function, which results in a poor response to temperature or climatic changes, and an increased tendency to overheat. This combination also results in a more itchy skin. They also have what is termed a lowered itch-threshold, which means that they feel itchy in response to stimuli which would not cause itching in the normal individual. In other words, their skin is hypersensitive to itch stimuli.

A further abnormality in children who suffer from atopic eczema is that they have an increased level of a certain protein in the blood known as IgE. This is the reason they exhibit positive reactions to most skin tests. Consequently, these skin tests are of little value in assessing the relevance of food stuffs in the causation of eczema. Furthermore, they exhibit defective T lymphocyte function, which results in an impaired cell-mediated immunity. With this, there is an abnormal blood vessel response to touch. Instead of the red line one normally sees on the skin after light stroking, these children develop a white flare due to capillary constriction rather than dilation.

Various factors may trigger an attack of eczema. These include external irritants, climatic changes or psychological factors. The type of eczema that develops varies from individual to individual. Rather than the classical flexural eczema in the creases of the skin, some people develop coin-like spots, mainly over the limbs, known as discoid eczema. Alternately, the eczema may simply affect the fingers or toes, with small water-filled blisters forming underneath the skin, known as dyshidrotic eczema. Some cases, however, only show white, rounded patches, mainly over the shoulders or on the cheeks, and this is known as pityriasis alba. Others may simply exhibit rather dry, irritable skin, without any redness or oozing, known as asteatotic eczema.

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