Medsarticles. Medical Weblog

Preschoolers experience the same sleep problems as toddlers. Bad habits and behaviours learned during the toddler period have often become entrenched by this time. During school age most children will have outgrown the problems seen at younger ages, but this is the peak age for nightmares, school terrors and sleepwalking. Some children also have trouble getting off to sleep, or wake very early in the morning. This is often related to stresses in their day to day life, and many children ruminate endlessly about the day’s events or worry about what the next day will bring.

In general, the problems referred to above are those that persist for prolonged periods of time when the child is well and there are no specific family disruptions. It is very important for parents to understand that all children will exhibit altered sleep patterns when they are sick or there are changes to family routine. Even trivial illnesses, such as colds, that do not seem to affect young children much during the day, may affect them at night. They may need more cuddling and become more dependent on parents, and may wake during the night even if they have already established regular sleep patterns.

Similarly, it is quite normal for children to regress at times of stress or family disruption. Children who have to spend time in hospital or have been separated from the parents for some other reason will behave like a younger child for a period of time. One of the commonest reasons children regress, including reverting to more immature sleep patterns, is the arrival of a younger sibling.

*157\90\8*

Constipation can also be caused by cancer directly, through partial or complete blockage of the bowel. Constipation due to blockage is often accompanied by pain and sometimes by passage of blood and/or small amounts of slimy fluid through the back passage. If the blockage is right down near the rectum you may feel as though you want to open your bowels all the time. This is because a growth inside the rectum or pressing on it can feel just like a motion always waiting there. I think it is easier to cope with this unpleasant symptom if you understand what is causing it. Of course, if you have hard motions in the rectum which you cannot pass without help, you can get exactly the same symptoms—a feeling as though you want to go all the time, but when you do, you pass only small amounts of slimy fluid. These symptoms are sometimes mistaken for diarrhoea, which can be disastrous— obviously treating it as diarrhoea can make it much worse! This mistake should never be made because it is very easy for a doctor or nurse to tell one from the other simply by checking inside your rectum with a gloved finger.

*194/40/1*

Pinch the patient’s nose between finger and thumb, take a deep breath and apply your lips firmly on the lips of the patient.

If this procedure or blood or vomit around the mouth makes you sick, place a clean handkerchief over the mouth and breathe through that.

If the mouth is injured or if it is difficult to breathe through the mouth, “mouth-to-nose” resuscitation will produce equally good results.

Breathe into the mouth and watch to see if the chest is rising. This will show that your breath is getting into the patient’s lungs. Then sit up and watch the chest collapse. This will show that the air is coming out. Take another deep breath and repeat the exercise.

For a child, breathe at the rate of about 20 per minute, and for adults about 10-15 per minute. As a rule a few quick breaths for a start, then settle into a routine.

If artificial respiration has to be maintained for some time, you may become tired. If there is someone with you, taking turns will make it easier. Keep it up until the patient starts breathing on his own.

If your patient starts breathing, even shallowly, time your breathing to coincide with his.

*637/71/1*

Mention gout and people are apt to snigger, yet this common disease is no laughing matter.

My introduction to gout was in the comics of my youth, where the Indian Army colonel with the flushed face had his foot wrapped in a turban and his mood was always irascible.

This comic attitude, unfortunately, still persists, so that the sufferer gets little sympathy. But he himself is also likely to regard it too lightly.

Gout, or podagra, is an ancient disease, being well known even before the time of Hippocrates, the “father of medicine” who lived nearly 500 years before Christ. The list of famous men who have had this disorder reads like an historical Who’s Who.

Gout is mainly a male disease — 20 times as many men get it for every woman sufferer. The first attack usually comes in the forties but it is not unusual in men in their twenties — and it can even occur in children.

The trouble is an inborn error in metabolism — the tendency to gout is inherited.

*382/71/1*

The operation which women most fear is removal of the breast.

This is only done for cancer and the fear of that disease is added to the feeling of disfigurement and loss of femininity.

Hysterectomy, or removal of the womb, on the other hand is usually done for non-cancerous conditions. Yet this operation is often misunderstood by women and as a result leads to many problems which are mainly preventable.

The uterus or womb is an organ, shaped like a pear and about the size of a golf ball. It lies low in the pelvis and can’t be felt through the abdomen unless it is enlarged. The neck of the womb, or cervix, projects into the top of the vagina.

From either side of the uterus come the Fallopian tubes and the outer open ends of these lie over the ovaries. The womb is held in place by ligaments.

The inside of the womb is hollow and lined by tissue called the endometrium.

During a woman’s reproductive life, this tissue is acted on by the hormones, oestrogen and proger-sterone, which are produced by the ovaries.

*130/71/1*

While recognising that nervous tension can produce or aggravate physical symptoms, neither you nor your practitioner should jump to the conclusion that this is happening, without first checking other possibilities. If your practitioner dismisses a symptom as being due to nervous tension and you don’t feel this conclusion is right, I suggest you ask for a second opinion.

On the other hand, if you and your practitioner come to the conclusion that a symptom is caused or aggravated by nervous tension, this is not something to be ashamed or embarrassed about. You are under enormous strain and it would be surprising if your nerves did not play up in some way. Symptoms caused or aggravated by nervous tension are no less important, real or uncomfortable than any others. You are a whole person, not just a physical body. All parts of you are important and interconnected. Be kind to yourself — don’t judge yourself harshly, but respect and take care of all of you!

Once you accept that nervous tension is playing a part in producing a symptom, it might then improve or even clear up altogether. If not, there are basically three ways of tackling the situation. You can choose any one, two or even all three.

*161/40/1*

The G.I. Factor ranks foods on the basis of their measured blood sugar response to a specific food. The rate at which glucose enters the bloodstream affects the insulin response to that food and ultimately affects the fuels available to the exercising muscles. There are times when low G.I. Foods provide an advantage and times when high G.I. Foods are better. For best performance, a serious athlete needs to learn about which foods have high and low G.I. factors and when to eat them.

High G.I. Factor foods like potatoes will produce a rapid increase in glucose and insulin levels, something which is not desirable just before a race when glycogen stores should already be fully charged. Low G.I. Foods, such as pasta, which are digested and absorbed much more slowly, are able to provide glucose to the working muscle towards the end of exercise when glycogen stores are running low. They can be likened to a continuous injection of glucose during the event. This can boost energy when fatigue begins to set in. After the event, high G.I. Foods are best because they stimulate more insulin, the hormone responsible for putting glycogen back into the muscles.

Manipulating the G.I. Of your diet can give you the winning edge!

*110\42\4*

The micro environment refers to those aspects of the environment that are closer to the individual. Again, these can be classed as either physical or socio-cultural. Because they are more personal, however, they are much more amenable to change and represent opportunities for those working at the clinical or individual level. Many potential micro-environmental changes, either within the home, workplace or social environment, are often considered within a behaviour therapy approach to obesity management.

The socio-cultural micro environment. Partner support has been shown to be particularly important to the success of fat loss programs in the home environment. It’s often presupposed that family nutrition practices are influenced mostly by the female in the household, although one study done with spouses of men in a male ‘waist loss’ program in Australia has shown that there is a greater influence on the household environment when the man of the house decides to make a change to reduce fatness. It also seems that females are more likely to provide support for their male partner to lose fat than vice versa.

There are regular eating and exercise patterns within families, workplaces and other social settings which may have counter-productive effects on fat loss programs. A recent survey of eating patterns, for example, showed that dietary patterns close to that regarded as healthy (such as eating breakfast and eating low-fat and high-fibre foods with limited alcohol consumption) are most common on Monday mornings. After that, the dietary pattern declines to Sunday nights with the worst consumption patterns occurring from Friday to Sunday, Work and social pressures over the course of the week no doubt help cause this effect, which also occurs in a yearly cycle from early in the New Year until the end of the year. The implications of this are that fat loss programs designed to lead to lifestyle changes are less likely to be effective if introduced at those times (i.e. late in the week or year) when the social environment is least supportive.

With children, the influence of the family is most significant. Recent research by Dr Len Epstein, a psychologist working in childhood obesity in the US, has shown that reducing inactivity by rewarding children for not watching TV or carrying out other sedentary activities such as video games is a more effective fat loss technique than directly rewarding their involvement in exercise or sport. More importantly, many children who are encouraged to reduce inactivity actually end up liking exercise, and even vigorous exercise, more than those who are put into a regimented exercise program.

Peer and close support group attitudes are also a significant part of the socio-cultural micro environment. For men in particular it’s thought that only exercise that is vigorous and exhaustive has value for improving health and reducing body fatness. Exercise such as that required to walk to the shop, walk up stairs, mow the lawn, or carry out chores is seen purely as a nuisance, or inconvenience. A major initiative here is to change the mental orientation to regarding all forms of activity as an ‘opportunity’ rather than an ‘inconvenience’. By refraining the issue in the minds of the subject, the significance of the external environment is, at least, partly nullified. Currently, this is not aided by social attitudes which regard someone as being successful once they possess all the leisure saving devices possible: while these remain a sign of economic affluence, they are undoubtedly facilitators of physical inactivity.

*174\186\4*

Summary of main points.

• Bioenergetics is the study of energetic events occurring in living organisms; it covers energy (food) intake and energy expenditure.

• Fat is the most energy dense nutrient, containing more than twice the energy of carbohydrate or protein. Energy expenditure is made up of resting metabolic rate, the thermic effect of food and the energy cost of physical activity.

• Bigger people have a higher metabolic rate mainly because of a greater resting metabolic rate from a higher fat-free mass.

• Even very small females require an energy intake of around 1200kcal per day to maintain energy balance.

The living cells of the human body are in a constant state of molecular activity, where they are used, degraded and synthesised to maintain life. These actions require energy which is defined as ‘the capacity to perform work. This definition does not, however, describe the many biological functions that either require or liberate energy in the body.

Understanding what energy is and how the body acquires, converts, stores, and utilises it is the key to understanding how humans can perform activities. It also provides the basis for understanding how fat is used as an energy source, or substrate, and how this may be optimised for best maintenance of body fat levels. The study of energetic events occurring in living organisms, which commenced in the 18th century, is called bioenergetics.

*35\186\4*

There are all kinds of worms. Some you find when digging in the garden. They’re usually long, juicy-looking, slimey things but they are useful (so my gardening friends remind me) for aerating the ground and helping plants grow. Then there are cut-worms which always seemed to chop off my new seedlings at ground level (that’s why I gave up gardening). My older brother, an inveterate and fanatical fisherman in his spare time, often searches the beach for worms when holidaying. He says they make good bait.

But I’m getting carried away… I wish to talk about human worms, or rather worms that inhabit the human system. They are commonly called threadworms, or Enterobius vermicularis if you like scientific names you can hardly get your tongue around. They are called threadworms because they look just like that. A bit of white cotton cut up into little lengths. Only they are very active and can turn and twist and crawl around in a most active way.

Worm infestations are common in children. Often the worms, in large numbers, come from the anal canal and crawl around the external part of the back passage. In fact, if examined at night with a torch, many of these creepy crawling things may be seen in a child with a heavy infestation. Personally, they give me the creeps.

In turn, this produces irritation and itching of the back passage. Often the child scratches, and the area may become sore or even infected if the skin is broken and germs start multiplying. Worms are commonly blamed for irritation, nail biting, nervousness and restlessness, especially during the night. Often vague gastric and nerve symptoms are related to infestations, rightfully or wrongfully. And the worms in their merry-making may become lost; cases have been reported in girls where the worms have reached the vagina and set up irritations there. They are also blamed for some cases of ongoing bed-wetting in children. But often there are few or no symptoms.

Commonly all of the children in a family may be infected. The eggs are highly infectious, and transmitted by scratching fingers from the anal region, they may reach toys, school books, writing implements and other objects that are of common interest. Once the eggs have reached the fingers, it is only a matter of time before they reach the mouth, then the bowel. Here they readily and rapidly hatch out, to set up further infestation. Inattention to adequate hygiene is a major factor in their spread. Inadequate hand washing after handling another person’s property, or before handling food or putting the hands to the mouth, is an important factor.

Treatment

Often it is simple to make the diagnosis, and often parents themselves will see the worms in their children. A simple examination of the stools will often reveal their presence; sometimes the doctor will have an examination carried out to discover either the worms or their eggs. These may be collected from fresh stools, or from around the anal margin. A simple test to detect their presence is done by sticking a piece of cellophane adhesive against the patient’s skin, removing it and replacing it on a glass slide which is then examined under the microscope. The doctor or pathologist may do this.

General hygiene is important. All members of the household should be treated at the same time—or the whole class if the disorder is widespread and has come to the general attention of the teachers.

The hand-washing routine after attending the toilet every time, and before handling or eating food, is essential. Soap and hot water should be used. The fingernails should be scrubbed often with a nail brush and soap. Nails should be kept short at all times, and regularly retrimmed. Regular washing of underclothing and bedclothes is important in getting rid of eggs.

Medication is usually very effective. However, although a single dose is often adequate to kill the organism in the bowel, reinfection is common. Ideally, the whole family is treated at the same time, and proper medical supervision is suggested. Pyrantel embonate (commercially known as Combantrin) and viprynium embonate (Vanquin) have been widely and successfully used for several years. Mebendazole (Vermox) in one single dose is also extremely effective.

Roundworms

Infestation by roundworms (Ascaris lumbricordes) is rare in this country. It is common in tropical countries, and may cause abdominal distention, colic, diarrhoea and emaciation. It is diagnosed when the worm or its eggs are located in stools. The egg may be passed in the faeces into the soil, where larvae develop, and are retransmitted to humans via soil-contaminated fingers or feet. Medical treatment is satisfactory.

Tapeworms

Tapeworms (caused by Taenia saginata from beef or Taenia solium from pork) come through eating inadequately cooked infected meat. General abdominal symptoms, diarrhoea and fever may occur. The parasite sucks blood from the bowel lining. Diagnosis is made when parts of the body are detected in faeces. Medical treatment effects a cure.

Giardiasis

A parasitic bowel infestation, giardiasis has been around for many years, but only for a short time, to any appreciable extent, in Australia. It produces loose bowel actions that do not stop within a few days, as do most bowel upsets. Motions are loose, watery, frothy, offensive. Most doctors consider a diarrhoea that has been persisting for a week or more to be most likely caused by this parasite. It is treated with metronidazole, and proper medical supervision is advisable. Treatment is invariably effective, but recurrences may occur. Most cases have been imported into Australia from European and Eastern lands, and it is now firmly entrenched in this country, especially in the eastern states.

*56\87\2*