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Category: General health

REPRODUCTION: CAESAREAN SECTION

After the ovum has been implanted in the lining of the uterus, this does not merely stretch to make room for the growing child. It also grows, becoming a heavy muscular organ. At the fourth or fifth month it has grown as high as the umbilicus, and at full term reaches to the top of the abdomen. When labor starts, the powerful and decidedly unpleasant contractions demonstrate the presence of plenty of musculature. I said that the uterus grew large but did not stretch. That is so until labor begins and then this versatile muscle adjusts itself most remarkably. While the upper part remains heavy and strong, the lower part does begin to stretch until finally there is an opening large enough to let the baby’s head through. And then when the baby leaves, the great muscle contracts down until, having pushed the placenta or afterbirth out, it is small enough to nestle well down in the pelvis. Truly an ingeniously adaptable musculature.
Shakespeare tells us that Brutus gave Caesar the most un-kindest cut of all; one of my fellow-surgeons way back in those days did just the opposite, for it is said that Caesar was born by way of a cut through his mother’s abdominal wall and into her uterus. Such deliveries have become common now and, until the last quarter century or so, had not changed greatly since the old Roman days. It must have been rare for a woman to survive this operation before the days of anesthesia and asepsis. Even with those aids, one took an added risk in doing a Caesarean. There was considerable blood loss and danger of peritonitis if the woman had been subjected to previous examinations. Today surgeons proudly do an operation which does not open the abdominal cavity at all. I am able to give you a good description of this operation from a source one hundred and twenty-five years old. Dr. William Potts Dewees wrote a famous System of Midwifery and in it was a letter from one Dr. Horner, regarding the Caesarean section.  I quote:
Dr. Physick proposes that in the Caesarean operation a horizontal section be made of the parietes of the abdomen just above the pubes. That the peritoneum be stripped from the upper fundus of the bladder by dissecting through the connecting cellular substance which will bring the operation to that portion of the cervix uteri where the peritoneum goes to the bladder.
As some of these words may be unfamiliar to you, I will elucidate. The operation consists in cutting across the lowest part of the abdominal wall. The lining of the abdominal cavity reaches as low as that. As it is loosely attached to the bladder it may be dissected free and pushed up. Hence without opening the cavity the surgeon may reach the lower part of the uterus. This is cut open, the baby and afterbirth extracted, and all the layers sewn back in place. When Dr. Physick suggested this, there was no anesthesia or asepsis. Patients just could not stand such long careful dissections. About a quarter century later the use of ether for anesthesia was begun, and before the end of the century asepsis was developed. It was a good many years more, however, before this operation so well described by Dr. Physick was adopted. This was presumably due to the modern contempt for historical perspective. The late Dr. Samuel C. Harvey, professor of surgery at Yale, told me that it was a rare student who felt there was anything worth knowing that was over ten years old. Probably some proud surgeon invented this operation a century after Dr. Physick had described it.  It might well have been used many years before.
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MULTI-INFARCT DEMENTIA: ASSESSMENT AND PREVENTION

Despite the picture given above it can still be difficult distinguishing between multi-infarct and Alzheimer’s dementia. The initial assessment always includes a detailed medical and personal history. In multi-infarct dementia there is often a strong family history of heart attacks and strokes, especially on the male side. The younger the age that these events occurred the more relevant they become. There may be a history of smoking and of high blood pressure (hypertension) as well as chest pains (angina) and/or leg pains (claudication). Heart attacks (myocardial infarction) and strokes (cerebrovascular accidents) may have already occurred. A step-wise decrease in mental faculties associated with other evidence of a stroke help make the diagnosis. Doctors look for the evidence of other blood vessels having furred-up (the ones in the brain don’t do it alone). A score is built up of likely linked events named after the man who invented it – the Hachinski score. The higher the score the more likely the mental impairment is due to multi-infarct dementia.
From the previous discussion it can be seen that there are risk factors for multi-infarct dementia in particular and strokes in general. Smoking, high blood pressure, excess fats in the blood (hyperlipidaemia and hypercholesterolaemia), obesity and a strong family history are relative risk factors. That means that within reason one can do something about them. One can’t chose one’s parents and grandparents but if they died from heart attacks or strokes when young then one should go to the doctor and have a full screen performed. High blood pressure can be lowered and smoking can be stopped, blood fats controlled and weight lost.
Once the damage has been done over many years it is often difficult to remedy. Following one stroke others still occur because the underlying problem (furred blood vessels) is still there. Some conditions such as sugar diabetes (diabetes mellitus) have an increased risk of stroke occurrence. In some people it may be possible to prevent further strokes occurring. Firstly, as many risk factors as possible are treated. In some people the furred-up blood vessels can literally undergo a re-bore to stop further blood clots forming on the furred-up surface. The blood can be made less sticky by the use of various drugs. Low dose aspirin is commonly used now to try and prevent mini-strokes (transient ischemic attacks). More rarely blood clotting is stopped by the use of the drug warfarin. There is some evidence that red wine may have a protective effect by increasing the amount of fat removed from the artery lining, the amount of red wine per day is disputed.
It must be hoped that as we become healthier in terms of diet, exercise and preventative medicine, then multiple strokes and multi-infarct dementia will become much less common.
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WHAT IS THE EYE PROBLEM CALLED MYOPIA?

It is estimated by the United States National Eye Institute that every fourth adult around the world is affected to some degree by myopia, the medical name for nearsightedness. Myopia is a condition in which parallel rays of light are focused in front of the retina, the consequence of an error in refraction or of elongation of the globe of the eye, causing nearsightedness.
To explain more fully: In normal vision, light rays entering the eye are bent by the cornea, bent and inverted by  the  lens,  and  come  to  focus on  the  retina,  the sensitive
membrane  at  the   back  of  the  eye  that  receives  images  and transmits  them  through  the  optic  nerve  to  the  brain,  where the image is turned right side up. In nearsighted eyes, images fall short, coming to focus in front of the retina.
Myopia is expressed medically in terms of diopters. If a patient has one diopter (-1.00 D) of nearsightedness, this means the farthest focus of the eyes is one meter (about three feet) from his or her eyes. If the patient has two diopters (-2.00 D) of nearsightedness, his or her farthest point of vision is half a meter from the eyes; with three diopters (-3.00 D) of such myopia, the far point is a third of a meter; with four diopters (-4.00 D), the far point is one-fourth of a meter. In other words, the person having nearsightedness of-4.00 D or one-fourth of a meter as his or her far vision can see clearly only to a distance of approximately nine inches. Between -1.00 D and -4.00 D is in the average or “usual” range of myopia.
Myopia consists essentially of two types; (1) usual myopia, in which the eyeball is longer than normal and with a cornea that is too refractive for which the patient may be wearing concave lenses in order to see at a distance, (2) the pathologic higher degree of myopia in which the patient may have approximately -7.00 diopters of “high myopia.” Then unusual changes begin to become apparent to the examining ophthalmologist, due to excessive stretching and elongation of the eyeball.
Using an instrument called the ophthalmoscope, the eye doctor sees the interior of your eye by using a beam of light directed inside. He observes along the spot where the beam falls and checks for a white crescent (conus) around the optic nerve. When stretching of the eyeball from high myopia becomes too great for the retina and choroid to withstand, the choroid becomes thinned and a large, whitish, yellow area of tissue degeneration is seen. The stretching produces cracks and even areas of wasting in the macula. At times a small red or black spot resulting from hemorrhage in the fovea may be observed. This is bad  because  it  abolishes  central  vision  and  is  referred  to  as a “Fuch’s dot.” Thus, while nearsightedness is a mechanical condition of the eyes, it can bring on an abnormal physiological change resulting in disease.
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YOUR CHILD’S HEALTH/ TEMPER TANTRUMS: TREATMENT

The theory of management of temper tantrums in young children is straightforward and, when put into practice, always works; it is putting it into practice that is difficult. The principles of management are no different from the management of most other developmental problem behaviours in childhood — reinforce wanted behaviours and ignore unwanted behaviours.

However, most parents, for reasons that are perfectly natural and understandable, have difficulty in applying these principles in a consistent way. The reasons for this are many. Often there is disagreement between the parents as to the best way to manage problematic behaviours. It is usually the father who takes a softer line, generally because he does not perceive the problem to be as severe as the mother. In most families it is the mother who is the primary care-giver, so that the father tends to assume less responsibility for day to day care. He sees that the child seems better behaved for him, having fewer tantrums. When the mother suggests a behaviour modification plan, often the father thinks that she is overreacting. It is vitally important that a management plan for children with frequent temper tantrums, or any other behaviour problems for that matter, be agreed on (and adhered to) by both parents, otherwise it is bound to fail.

Temper tantrums are best ignored. As soon as the child begins to have a tantrum, you should immediately leave the room, or turn your back. It is important that the child be paid no attention whatsoever. That is more easily said than done, of course, yet that is the mainstay of successful management. The details of behaviour modification, which is used in the management of most behaviour problems in childhood, are described elsewhere.

The frequency and duration of temper tantrums are inversely related to how much attention the parents give to the child during the tantrums. If you can accept that they are a normal part of the child’s functioning at a particular developmental phase, and not turn them into a power struggle (which, by the way, the child will always win, one way or the other) then they will simply disappear over time. Unfortunately, many parents, despite their best intentions, get drawn in, virtually guaranteeing that tantrums and often other associated problem behaviours will continue and intensify.

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HEART ATTACK – MYOCARDIAL INFARCT

The drug trinitrin is widely used to treat angina and it may even help in the diagnosis.

These tablets are placed in the mouth and sucked or chewed but not swallowed. The drug is absorbed through the mucous membrane of the mouth directly into the blood stream and works immediately. Should a clot form on an atheromatous plaque in one of the coronary arteries, it will block the artery. This is a coronary occlusion.

If the heart muscle supplied by that artery is deprived totally of its blood supply, death of the muscle will occur — a myocardial infarct.

Ischaema is the term given to impaired blood supply of any tissue. Myocardial ischaema may be temporary, as in angina, or prolonged, as in coronary occlusion.

The pain from an occlusion is of the same type as angina but is not produced by exertion and is unrelieved by rest. The pain may persist for hours and only be relieved by giving strong pain-relieving drugs like morphine and its derivatives.

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PREGNANCY RISKS – INTRODUCTION

Pregnant women and their doctors often read about the hazards to the foetus of taking any drug during pregnancy.

The anti-morning sickness tablet, marketed in Australia as Debendox, came under notice because of a court case in America. It must be stressed that this drug had been used widely in Australia for more than 20 years and there is no evidence that it increases the risk of foetal abnormalities.

Just because a woman who has taken a drug during early pregnancy has a child with an abnormality does not prove cause and effect.

Congenital abnormalities occur in one in 40 births and, so, are common.

Because of the costs involved in defending this drug in the courts, the makers have withdrawn it from the market.

Of even more importance is: what should epileptic women do when they become pregnant? Most are taking at least one, sometimes two, drugs to control their epilepsy.

Some recent reports have indicated that there is an increased incidence of foetal abnormalities in the children of these women, particularly the risk of hare lip or cleft palate.

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BABY AND CHILDHOOD URINARY TRACT DISORDERS: VAGINAL REGION INFECTIONS

In girls occasionally an irritation occurs in the vaginal region. Called vulvovaginitis, it may affect the vulva at the vaginal opening. There are many causes, ranging from a lack of hygiene, to infections from germs, to threadworms (which may have journeyed from the back passage and become lost in the vagina), to hormonal deficiencies. It sometimes indicates early diabetes.

There may be no symptoms at all. Or there may be a discharge from the vagina, or itch or irritation. The discharge may be whitish, or clear or stringy and slimey. Sometimes it is pussy if there is an infection present. A bloodstained discharge may indicate a foreign object has been pushed into the vaginal canal— this is not uncommon with youngsters.

Treatment

Any symptoms in this region should receive medical attention. With a few simple tests, the doctor can often diagnose the cause and order the correct treatment. Frequently, adequate cleanliness and hygiene will prevent these problems from taking place.

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BABY AND CHILDHOOD ILLNESSES: AUTISM

Childhood autism was first recognized in 1943 by Dr. L. Kanner, and since then has become a fairly well recognised problem. Only in the past few years has an increasing amount of interest been taken in the problem which affects about 5 children in every 10 000 under the age of 15 years.

It is believed that many of these children have brain damage, and more than half are severely mentally retarded. Autistic children have difficulty in relating and communicating with others, and their imaginative capacity is severely retarded. As a result the child tends to perform the same activities over and over, and will often repeat the same set of words frequently. Some children show reasonable levels of intelligence, and originally Dr. Kanner claimed that many were potentially of superior intelligence. Many seemed to have parents following professional occupations, even though they were cold rigid personalities. But this has since been cast into doubt by subsequent research.

Treatment

‘There is no medical treatment, but appropriate management and education can diminish behaviour problems and help bring out any latent abilities,’ the British Medical Journal stated recently in a leading article. The child’s future is closely linked with his ability to develop language, social awareness and useful skills.

‘Most autistic children need care all their lives,’ the Journal says, ‘but a few become independent, though eccentric adults. Very few develop a high level of skill in some special field, such as music, mathematics or art.’

There are now national societies which take a special interest in autistic children, and parents often gain much assistance in this manner. The Autistic Children’s Association of New South Wales is located at 545 Pacific Highway, Artarmon, Sydney, 2064.

DIRT EATING (PICA)

Some children seem to enjoy eating abnormal material that is not food. The range can be remarkable. It may include dirt, clay, snails, peeling paint, starch, and even ice! Some infants love playing with their bowel actions and may even eat this! A weird list of items have been recorded in the books of medical history. A craving for certain foods is more common, and it may include almost anything, from vegetables, to biscuits, sweets or fruits, to an abnormal extent. A few years ago an individual had a compulsive desire to eat ice, and devoured 9000 g a day, according to the Journal of the American Medical Association. Others have been known to eat newspapers and the pages from glossy magazines. One individual sustained a bowel blockage from the amount of newsprint in her intestinal system. If your child shows a propensity for eating odd objects please seek medical help. The child may be referred for assessment by a child psychiatrist.

Treatment

The case will be fully investigated. However, a large number are found to have an iron-deficiency anaemia. The simple use of preparations containing iron may completely reverse the strange compulsion, and the patient readily gets back to normal eating habits again.

‘Pica is quickly cured by therapy with iron, but this valuable information has been generally ignored,’ JAMA magazine recently reported. Do not scold your child—rather seek medical attention. The cure may be far more simple than you ever imagined.

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POISONING

Poisoning occurs when substances harmful to the normal functioning of the body are swallowed, inhaled, absorbed into the skin or injected. Signs that poisoning has occurred include abdominal pain, nausea, vomiting, drowsiness, burning pains from the mouth to the stomach, difficulty in breathing, congestion in the chest, headaches, ringing in the ears, blurred vision and sudden collapse. If possible the type of substance which has been ingested should be determined before giving first aid. Vomiting should not be induced if corrosive or petroleum based substances have been swallowed, nor in cases where the source of poisoning is unknown.

Food poisoning or gastroenteritis is usually caused by bacteria which inflame the lining of the stomach and intestines. The bacteria salmonella and staphylococcus are among the most common culprits and their growth is encouraged by reheating or half cooking food. It is important to practise good personal hygiene, especially washing hands, when handling food and to keep utensils and food preparation areas clean. Frozen food should be defrosted properly before cooking and not refrozen after it has thawed out. Previously reheated food should be cooked at a high temperature. Hot, cooked food should not be left in a cooling oven or other warm place. Bacterial growth develops. Food poisoning also occurs with contaminated seafood.

Symptoms of food poisoning are vomiting, diarrhoea and abdominal cramping, sometimes accompanied by sweating and fever. Diarrhoea and vomiting can lead to fluid loss, so dehydration may follow.

To treat food poisoning, fluid should be replaced by drinking small amounts of water, flat lemonade or diluted fruit juice frequently. Often the stomach will not tolerate solid foods. Taking garlic capsules can help fight infection. Peppermint tea is helpful in cases of nausea.

Poisoning can also occur as a result of absorption of various toxic metals in the environment. Lead, cadmium, mercury and aluminium are widely used by industry and our environment is now permanently polluted by them. These metals cannot be biodegraded into the environment. Lead poisoning can be caused when sanding off old lead based paint during renovations. The bioflavonoid, quercitrin, contained in the juice of citrus fruits, is a good chelating agent for lead, and gradually removes it from the body.

Cadmium is found in tobacco and cigarette paper and in superphosphate fertilisers. Usually found in conjunction with zinc, the ratio of cadmium to zinc is much higher in refined flour and white bread than in the same wholewheat products. Eating wholewheat products and not smoking reduce exposure to cadmium. Vitamin C, glutathione and the trace element selenium all help to alleviate cadmium toxicity.

Mercury is another highly poisonous metal. Apart from pollution of the environment, the consumption of seafoods and fish is a major source of mercury. Mercury is concentrated in algae in the ocean and becomes progressively more concentrated as it progresses up the food chain. Selenium is a natural defence against mercury. It is found in wheat which is grown in selenium rich soils.

During the 1970s evidence emerged that aluminium could be harmful to humans when people in Scotland using home dialysis for kidney failure suffered a type of dementia which was traced to the town water supply which was being used in the dialysis and which had been clarified with alum. There has been some evidence to link aluminium with Alzheimer’s disease, but this is still controversial. The consumption of aluminium is increased when food is prepared in aluminium utensils.

Some herbs can cause poisoning when taken in large amounts. It is therefore important to consult a qualified herbal practitioner when taking herbal remedies.

Water contamination by algal blooms, becoming more common with the pollution of our freshwater lakes and rivers, is another source of poisoning. Microcystis, a type of blue-green algae, produces hepatotoxins which cause bleeding and breakdown of the liver, sometimes inducing tumours. In 1981 several people in Armidale, New South Wales, showed signs of liver problems after drinking water from a reservoir contaminated by microcystis blooms.

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DYSLEXIA IN CHILDREN

Dyslexia, also known as “developmental dyslexia” or “specific developmental dyslexia,” is a type of learning disability that affects a child’s ability to learn to read. It is more common in boys than in girls. It’s not known exactly what causes the problem. Dyslexia often runs in families, but no specific genetic defect has been found to account for it. Some children with dyslexia may have had an accident that caused an undetected brain injury, but others have no such history. It is known, however, that dyslexia is not a form of mental retardation. And dyslexia is not related to low intelligence, physical handicaps, cultural disadvantages, low social or economic status, or brain damage.

A child with dyslexia often has no difficulties until entering school. Then the child finds that he or she cannot do things that other children can do easily. This experience can be embarrassing and painful. The child often finds it impossible to explain the problem and may become so frustrated that he or she either disrupts classes or becomes overly quiet and withdrawn. Other children may brand the dyslexic child as “stupid”; teachers and parents may consider the child lazy or unmotivated. The dyslexic child may, in fact, be very intelligent and may be trying extremely hard to learn to read. Pressure from teachers and parents to “work harder” can be confusing and frustrating and can lead to anger and rebellion. Some children with dyslexia find other activities that they can do well, such as sports or music. This may help them to adjust and feel more comfortable.

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