The Health Blog

Australia’s climate is not kind to anybody’s skin. Babies and young children in particular are prone to dry skin.

Cause

Many babies have dry, peeling skin immediately after birth; this is normal and will soon improve. Too much bathing, and using a lot of soap can cause dry skin, or aggravate skin that is already dry. This is because it removes the skin’s natural oils, and the skin can no longer retain moisture.

Clinical features

Dry skin is often itchy and flaky. Areas most commonly affected are the elbows, knees and face. If the skin is excessively dry, cracks (or fissures) may appear which can be painful and even bleed or become infected.

Treatment

Avoid using all soaps in young children. Older children should be encouraged to use a non-irritant soap. Bath time should be shortened, and water should be warm but not hot. Avoid using any scents, bubble bath or bath salts. Special bath oils or

Baby oil can be added to the bath water. You can buy these across the counter at the chemist. Be careful, because they make the bath slippery. Sorbolene with 10% glycerine is an excellent cream which can also be purchased over the counter, and is inexpensive. It is very effective in the prevention and treatment of dry skin, and is non-allergenic.

When to see your doctor

• if your child has persistent dry skin;

• if your child has patches of dry skin which are red and itchy.

Prevention

The use of a lubricating cream after your child’s bath is often helpful in preventing drying of the skin. Do not overdo bath time — do not let your child sit around in the bath for more than 10-15 minutes.

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First Aid Kit (This can be kept in a separate bag.) Adhesive tape

Alcohol wipes or 70% alcohol in bottle Bandages, sterile (crepe, various sizes) Band-aids (various shapes) Cotton wool balls Disinfectant

Dressings (non-stick, e.g. Melolin) Eye pads, sterile Gauze, sterile

Needle (can be used for removing small splinters)

Scissors

Sling

Steristrips (used for closing small cuts)

Thermometer

Tweezers

Medicine Kit

Antihistamine (if prescribed) (for severe allergic reactions) Antiseptic solution (iodine) Calamine lotion

Ipecac. . Use only on the advice of your doctor or the Poisons Information Centre.)

Measuring cup (for giving medicines) Paracetamol

(You may also wish to keep back-up supplies of insect repellent, nappy rash cream, sunscreen, vaseline and zinc cream in your Medicine Kit, as well as having supplies of these handy for day-to-day use.)

Note that medicines requiring refrigeration should be kept on the top shelf of the fridge at the back, not in the medicine cabinet.

Always check the expiry date on medicines and creams or ointments and replace them when necessary. Take all old medications to the chemist for safe disposal.

Never leave medications within reach of children. It only takes a second for a child to grab and swallow something dangerous.

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HYPERAROUSAL: I get all sweaty. My heart beats, any hands are wet, but I feel kind of cold. I get over-ready, overanxious. I’m so turned on that I can’t even feel anything really. I just seem carried away, like I have to do it now or I’ll explode. My wife keeps saying “Slowdown, slow down, take it easy,” but I just want to take it fast. I really can’t control it.

HUSBAND

I have an “on” switch, I swear. I even start kind of a nervous laugh and get dizzy. I don’t know what’s happening, but it’s like running as fast as I can down a steep hill and not being able to stop. It’s frightening, really.

WIFE

Three hundred forty-nine men and 284 women classified themselves as experiencing this hyperarousal state in what they felt was “most” of their sexual experiences. Remember, we all experience this state sometimes in our sexual lives, and we can all experience more than one sexual problem at a time. In fact, hyperarousal and seminal seepage or early Skene’s glands emissions in the absence of contractions commonly occur together.

Hot times in our lives typically result in this “out of control” orientation, and it extends to our sex life. When we are running hot, when we are hostile, impatient, and competitive, we are in a state of maladaptive hyperarousal. Sex can be so intense, so fast-paced, that we almost miss it entirely. Our sexual intensity, our sexual speed seems to break the intimacy barrier instead of the sound barrier, but little real intimacy results as we go right past it.

This category of problem contains erective difficulties. The failure of the penis or clitoris to erect or a lessening of intensity of erective experience is simply a natural reflex to the accompanying emotional state of anxiety, of running hot. It makes little sense to treat the symptom instead of the cause or to blame the penis or clitoris for failing to erect while we are sending direct neurohormonal orders for them not to do so.

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First, place yourself on each axis in the direction that you feel best represents your feelings about your marriage. Next, place your partner on that same axis. Your marriage will then have four scores to discuss on the Sexual-System Exam, your score for self and partner and your partner’s two scores. Remember, as with super marital sex, it’s the doing, not the scoring, that counts!

It will sometimes seem that a certain score must be a better score, but systems theory, the theory behind the super sex marriage, teaches that too much of even an apparently good thing is not necessarily the healthiest status for a growing adapting system. An athlete can be very fit—scoring high on all measures of muscle, speed, and endurance—yet not be very healthy—adaptable, happy, loving, and learning. Try to break free of your assumptions of good or bad and think in terms of balance, in terms of positioning your marriage for change, growth, and responsiveness to the needs and maturation of the marital partners.

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Pruritus ani is the term we use to describe the condition of an itch or discomfort around the anus.

This is a common problem, which is often made worse by the treatment the sufferer uses himself or what is prescribed for him.

The cause is due to a combination of factors. Nervous tension is not only a cause but also a result.

A wet, unclean skin in this area may be the main factor.

Excessive sweating, frequent loose bowel actions, leakage of mucus and, particularly, inadequate cleaning all predispose to the problem.

It is difficult to clean the area by the use of conventional dry toilet paper.

Cleaning around the anus is more effective with a soft wet cloth. The European habit of the use of a bidet to wash the area is also effective.

Rubbing with dry toilet paper may irritate the skin and eventually make it itch, which we can make worse by scratching.

Most of the local preparations may further sensitise and irritate the area, so the problem continues.

Many cases can be cured simply by stopping the patient using the cream or ointment he has been using for months or years.

Topical applications of cortisone to relieve the inflammation, or anti-fungal drugs to clear thrush infection should only be used for a limited time.

The clean healthy skin of a baby’s bottom soon becomes red and angry if left in contact with a dirty nappy. So too may the adult bottom, which is no longer smooth but wrinkled around the anus and thus provides pockets where small amounts of faeces may remain to irritate the skin.

More good can be done to cure this unpleasant and common problem if we paid better attention to simple cleaning measures than using elaborate and potent drugs.

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Cortisone is a hormone normally produced in the body by the adrenal glands which lie above the kidneys.

It is essential for life and has many functions, one of which is to suppress inflammation.

Inflammation is the normal process where the body defends itself against either injury or infection, but sometimes this inflammation gets out of control, or is provoked in the body by antibodies produced, as it were, by the body developing an allergy to its own tissues.

Cortisone can suppress this inflammation and control, if not cure, the disease.

Cortisone derivatives are widely used as creams and ointments in treating skin diseases.

Most skin diseases provoke inflammation in the skin and cortisone applied topically reduces this and often clears the rash.

Because cortisone can suppress the inflammation needed to control infection it may be used when there is infection on the skin, or for that matter when taken by mouth it may suppress the body’s ability to deal with the infection.

Prolonged local use may damage the skin, leading it to lose its elastic tissue and become thin as in old age and with prominent blood vessels.

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While the diagnosis may be suspected from the symptoms, it can be confirmed by taking a biopsy from the bowel. This involves removing a small piece of the bowel wall and examining it under the microscope. Once the gluten has been eliminated from the diet, a repeat biopsy should show the appearance of the bowel has returned to normal.

Elimination of gluten from the diet will usually produce improvement within a few days but it may take up to a year for the child to fully regain normal health.

Parents of children or adults with this disorder need the advice of a dietitian to plan proper meals which are fully nourishing. There is a Coeliac Society which can give advice in planning meals and playing a supportive role to sufferers and their families.

It needs to be stressed that parents whose children have similar symptoms to those I have listed as occurring in coeliac disease should not assume that this may be the cause and place their children on a gluten-free diet without proper diagnosis being made.

If this is done without proper advice, the diet chosen may be inadequate in all the necessary factors and result in further malnutrition.

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I’ll explain here what the lymph system is, because it is important in understanding cancer. When you get a sore throat you may get swollen, painful lumps in your neck. These are lymph nodes (also called lymph glands). Normally they are smaller than a pea and quite soft. There is a network of these nodes throughout your body, and they are all connected to each other by very fine channels (or vessels). Eventually, all these channels join into one which empties its contents into the bloodstream at a point just behind the inner end of your left collarbone.

The job of the lymph system is to drain all excess fluid from your tissues and to filter out any unwanted material. So, with your sore throat, the germs go through the lymph channels to the nearest lymph nodes in your neck. There they are filtered out and white blood cells get to work on them and destroy them. In the process the node gets bigger, harder and painful.

In the same way, lymph nodes will filter out and trap cancer cells which come to them through the lymph channels. The nodes actually form part of your immune system and so have cells in them which ‘recognise’ the cancer cells as dangerous. If only a few cells come through, they can be completely destroyed. If there are too many for the node to handle, they survive, and grow to form a hard, but usually painless, lump. This is a type of secondary growth and it, in turn, can release cancer cells to travel either through more lymph channels or the blood to other parts of the body.

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As a simple definition, osteoporosis is a condition in which bone becomes so fragile and brittle that it breaks comparatively easily. Bone is a living, changing thing, containing two main types of cells called, confusingly, ‘osteoclasts’ and ‘osteoblasts’. All through our lives, the osteoclasts wear away microscopic craters in the bone, and then the osteoblasts fill these craters with newly formed bone, exactly matching the space dissolved away by the osteoclasts. That way, bone is constantly renewed — a sort of repair-and-maintenance system. Oestrogen is thought to reduce the rate at which osteoclasts dissolve bone, and to increase the rate at which osteoblasts build it up. Once oestrogen levels fall, the osteoclasts dissolve the tiny craters at a faster rate than before, while the osteoblasts don’t replace the bone so efficiently. Eventually, the bone becomes less dense and strong, and more liable to fracture.

Bone is built up during childhood and teenage years, and reaches a peak content (called ‘peak bone mass’) in the early twenties. For the next 15 years or so, the bones thicken and strengthen, but then from about the age of 35 onwards, bone mass starts to fall gradually. In a man it continues in -this gradual fall for the rest of his life, and a man of 90 can expect to have lost about 25 per cent of his total quantity of bone. In women, however, bone density drops dramatically in the years immediately after the menopause — about 3-5 per cent every year in the vertebrae of women who have had a natural menopause, and as high as 7-9 per cent in the vertebrae of women who have had an early oophorectomy. (The hip joint loses bone density at a slightly lower rate.) To lose bone at about 3 per cent a year may not seem much, but if you get a calculator, start with 100 (to represent the amount of bone you have at the menopause), then subtract 3 per cent from that figure, then 3 per cent again from the next figure, you will find that after doing this seven times you get a figure of 80. In other words, after losing 3 per cent of your bone every year for seven years, you are left with just 80 per cent of what you had at the start of the menopause – and you are probably still only in your fifties. Many women lose bone mass at a faster rate than 3 per cent, and sometimes for as long as 15 or 20 years; it is not unusual for them to end up having lost one-third or even half of their bone mass by about the age of 70. No wonder fractures occur!

Bones are not solid things, like an iron bar, as this would make them very heavy. Each bone contains an outer shell of ‘cortical’ bone, which is strong, compact and dense, and an inner area of ‘trabecular’ bone, which is brittle and fragile. The bones that are most vulnerable to fracture in osteoporosis are those that have a higher proportion of trabecular bone, such as the hip joints and the vertebrae of the spine.

Trabecular bone is made up of tiny vertical pillars, joined together with horizontal cross-ties, giving it strength with the minimum of weight. In osteoporosis, as the osteoclasts wear away bone faster than the osteoblasts can build it up again, these pillars and cross-ties lose their connections with each other, and the bone therefore loses its strength. Eventually, it becomes so fragile that it can fracture while you are doing such everyday things as lifting a casserole out of the oven, opening a stuck window, putting shopping bags into the boot of the car, doing up the back zip of a dress, or even coughing, laughing or sneezing.

The main component of bone is calcium, which is held in a soft substance called collagen; as collagen levels fall, so do die levels of the calcium held within it. Oestrogen helps the body to absorb calcium effectively, making it available to the osteoblasts, and as oestrogen levels fall after the menopause, so calcium is stored less effectively. Much of it is just excreted in the urine instead of being used to build bone.

As oestrogen is needed to get the ‘bone building’ balance right, and as it also helps the body to absorb calcium and preserve collagen, you can see why oestrogen therapy is so effective in preventing osteoporosis. It can’t rebuild damaged bone, but it can help prevent further bone loss. It has been said of HRT that it ‘stops osteoporosis in its tracks’, because oestrogen therapy at any stage after the menopause halts bone loss.

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The health care costs of abdominal, vaginal and laparoscopically assisted hysterectomies are comparable. However the reduced recovery time of the latter approach promises considerable benefits to women, their families and employers.

An economic evaluation that compared the costs of abdominal hysterectomy and endometrial resection in England for the four months up to and including surgery, found total costs for the former were nearly twice that of the latter. The authors suggested, however, this was not the end of the story:

Given the fact that a subgroup of women requires re-treatment due to resection failure and that this study considers a relatively short period of follow-up, the long-term costs and benefits of endometrial resection need to be evaluated before widespread diffusion is justified.

The all-up cost of an abdominal hysterectomy in Australia in 1993 was about $5000, and for a vaginal hysterectomy it was considerably less at $3550. The cost of a laparoscopically assisted hysterectomy was about $5700, of which almost $1200 was for disposable instruments. Women who do not have private health insurance and whose hysterectomy is carried out in a public hospital ca*n expect to pay nothing. Women with private health insurance can expect to pay $500 or more, regardless of whether they attend a public or private hospital. Their payment will depend on their level of insurance and the fees charged by their surgeon and anaesthetist. Uninsured patients having a hysterectomy in a private hospital face payments of $2500 to $3000.

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