Health News and Information

The treatment of this problem is focused on identifying any underlying contributing factors in the child or family and then addressing them appropriately. This is often difficult and time consuming. For many children with mild or infrequent episodes, it is often best to adopt a wait and see attitude, meanwhile offering support to the child.

When to see your doctor

It is usually a good idea to see the doctor when this habit first becomes apparent, to rule out any scalp condition such as ringworm or other cause of inflammation which can be treated. The doctor may also be able to throw some light on other psychological factors which may be contributing to the problem. Occasionally the child may need to be referred to a specialist, either a dermatologist (skin specialist) or a paediatrician.

It is not known why some children pull their hair out, and there is nothing specific that can be done in terms of prevention. When it does occur, attention to possible sources of stress in the child may improve or cure the condition.

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What is your reputation with yourself? What you think of yourself determines in large measure what you will think of others.

“I sort of feel okay about me. Not good, not bad. Just okay,” said one husband.

“Well, then,” answered the wife. “What does that make me? Why did I marry just okay? I think I deserve A-plus.”

My interviews of sex offenders and persons debilitated by paraphilias, when sex is separated from love, indicate that one common thread unites all of these persons: They all have extremely low self-esteem. Sex becomes more important than people. They seem to treat others sexually as they feel about themselves. They become driven by a sexual compulsion for “it” rather than him or her. How you feel about yourself will predict to a great extent how you feel about your marriage and how your partner will feel about himself or herself.

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As we begin to practise awareness, we become aware of our own behaviour and our subtle motivations. Slowly and subtly these insights into our self break through. What was initially destruction can become construction.

When the insights first come they are fleeting glimpses of how we could be. They disappear and reappear as we begin to assimilate them and begin to build on them. We begin to see that responsibility for our peace and happiness is ours, and ours alone. We cannot shift the responsibility of ourselves to other people or to other factors.

Sometimes we are able to assimilate the insights easily, at other times it calls for hard work. Sometimes the insights can herald changes so basic they are accompanied by fear.

As we become aware of these insights we begin to see we are letting go of more than the disorder. Life begins to take on a different meaning. Our ideals and values change. Things which were once important to us no longer seem so, yet it appears there is nothing else to take their place.

This can be very threatening and disturbing, despite our desperate longings to be ourselves. The pre-disorder identity has gone; its place was taken by the ‘disordered’ identity. This in turn is breaking down, leaving us no sense of identity, no sense of self, to take its place. The feeling of total annihilation can seem closer than ever before.

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Even when all possible care has been taken, something unexpected may still be found during an operation. This happens especially with emergency operations, when there is not enough time to completely evaluate the situation before operating. However, it can happen with any operation. This means that you need another safeguard. You need to know what might still be found that would make the proposed operation inadvisable or impossible. Ask directly. You need to know how your surgeon would want to deal with each possible situation. Again, ask directly. You have the right to set limits on what you will permit. For example, you may not be prepared to have your breast removed (mastectomy) or to have your bowel ending in an opening on the abdominal wall (colostomy) or to have both ovaries or both testicles removed. Before making a final decision, try to find out what would be likely to happen if you refuse a certain procedure. In other words, try to make a really informed decision when setting your limits. Horrified as you may be at the idea of a colostomy or mastectomy, it is possible that the consequences of not having these procedures could be worse.

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Coconut oil and many suntan lotions do a poor job of filtering out these dangerous rays but there are available many lotions and creams which effectively screen most of the UV rays.

These may be used in different strengths, depending on whether you want complete protection or want some rays to pass through and allow you to build up a tan. Ask your chemist — he has a list prepared by the National Health and Medical Research Council and the Anti-Cancer Council.

The sun can burn the skin and this causes the same trouble as any other burn. A first degree burn is where there is reddening without blister formation. This can be painful and incapacitating. Toxic products can form in the damaged skin, be absorbed and lead to malaise, fever and the inability to work.

The delicate skins of children and older people are more likely to suffer damage. Plenty of fluids, rest and the application of cold compresses will help to relieve this sunburn.

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Displacement of the pelvic organs and the laxity of the vaginal walls may cause a woman to lose interest in sex, or pressure during intercourse may cause pain.

Repeated labors, particularly difficult ones, are believed to stretch and weaken all those structures which support the uterus. Tears through the lower vagina and perineum (the area between vagina and rectum) can weaken the pelvic floor and later lead to prolapse.

This is why most doctors who deliver babies often carry out an episiotomy by making a cut in this area to enlarge the opening as the baby is born, rather than allow a large head to tear it in an uncontrolled manner.

After menopause, the tissues may be weakened by the lack of circulating oestrogen, the female hormone. When the uterus falls down, it causes a feeling of pressure and discomfort, which may be worse when the woman strains by coughing or carrying heavy loads.

If the cervix protrudes, it may become inflamed and ulcerated by rubbing against the underclothes.

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Hypo-allergenic creams. Some years ago it became evident that cosmetic products were producing allergic reactions in some users. Several manufacturers then began to produce cosmetic lines from which known sensitizing agents were excluded. These cosmetics were called ‘hypo-allergenic’. Since then the manufacturers of major brands of cosmetics have realized it is in their interest to omit ingredients likely to cause a significant number of allergic reactions among consumers. Thus at present there is little distinction among established cosmetic products concerning their potential to sensitize. Reactions to cosmetics, while relatively rare, occur with so called hypo-allergenic cosmetics as well as with those not so labelled. To date there is no known method of producing a true non-allergenic cosmetic.

Vitamin E cream. Vitamin E is currently in vogue for the treatment of various normal and abnormal skin conditions. Like the vitamins A, D, and K, it is fat soluble. Only about 400 units per day ore required, and these are easily obtained by eating eggs, margarine or vegetable oils. Various claims have been made for vitamin E, in particular that it is capable of the removal of wrinkles and stretch marks, the rapid healing of burns and wounds, the removal of underarm smells, that it can improve sexual potency, and, furthermore, that it can diminish the incidence of heart disease and diabetes. It is used both in capsule and in cream form. However, there is no evidence whatsoever that vitamin E is absorbed through the skin. Therefore, any effect it may have is due to its cream base, which once again is simply a variant of the good old cold cream. Furthermore, the effect, if any, of vitamin E on the skin is completely unknown, since there have been no controlled trials by which to evaluate its pharmaceutical or cosmetic effect. Consequently, its use continues to be based on recommendation rather than knowledge.

Recently, vitamin E has been investigated by the Consumer Union of the United States, and the New York State’s Consumer Frauds and Protection Bureau, and the A.M.A. Committee of Cutaneous Health and Cosmetics. The conclusion was that ‘there is absolutely no evidence that vitamin E applied to the skin is in any way beneficial to that organ’. Furthermore, none of the various American manufacturers that were contacted by the Union could supply any controlled studies on the efficacy of vitamin E with skin disorders. At this stage, it is probably best to consider it as a vitamin searching for a disease to cure.

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The G.I. factor is important in heart disease too. It has a role in the diets of people who already have heart disease, but perhaps of greater significance in the long term, it has a practical role in the prevention of heart disease.

Preventing heart disease: primary prevention. More and more people now get regular checks of their blood pressure, and tests to check for diabetes. Increasingly blood fat tests are done to check this risk factor too. All health professionals give lifestyle advice on stopping smoking, the benefits of exercise and the nature of a good diet. When specific risk factors are discovered, diet and lifestyle advice is given, but sometimes may not be followed for long. It is especially difficult to follow advice if the effect of not following it is likely not to matter for ten or more years, and if the changes needed are not attractive. The changes must be wanted by the individual who will be helped by encouragement from friends and relatives, and the changes must ideally be positive changes—’I want to do this’ not ‘They’ve told me to do this’. Any new dimension in heart disease prevention must be seen as a great positive change rather than as negative.

Treating heart disease and secondary prevention. When heart disease is detected two types of treatment are given. Firstly the effects of the disease are treated (e.g. medical treatment with drugs and surgical treatment to bypass blocked arteries) and, secondly, the risk factors are treated to slow down the further progression of the disease. Treatment of risk factors after the disease has already developed is ’secondary prevention’. In people who have not yet developed the disease, treatment of risk factors is ‘primary prevention’. Obviously it would be better to give primary preventive treatment in all cases.

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Abdominal fat distribution is reflected in an extended abdomen or ‘pot belly’. This consists of expanded subcutaneous fat cells as well as increased visceral fat. Its extent could, therefore, presumably be measured through a measure of sagittal diameter, i.e. the width of the waist from back to front. This has recently been investigated and a device developed for determining the measure by Dr Henry Kahn from the University of Georgia. The device, called a sagittal diameter scale, measures the thickness of the abdomen at the umbilicus in either the lying or standing position.

The higher the SAD measure, the greater the risk of disease, and although norms have yet to be established for this measure, indications from the Georgia laboratory suggest that a SAD measure of greater than 25cm indicates an elevated health risk.

The abdominal diameter index, also developed by the Kahn team, is an attempt to compensate for the lack of perfect predictability of the SAD measure of visceral fatness.10 Because the sagittal measure includes not just visceral fat but bone, muscle and subcutaneous fat, the Georgia team have attempted to adjust for the non-visceral tissues that are incorporated in the SAD measure by dividing waist thickness by the girth of the mid-thigh. This also adjusts for overall body size as thigh thickness can be a good indication of total body size. ADI then becomes almost twice as powerful for the prediction of cardiovascular risk as the SAD alone.

Again there are, as yet, no well established norms for ADI. Early indications are that ADI measurements of over 0.5 (i.e. the cross-sectional thickness of the waist is over half the circumference of the mid-thigh) are highly predictive of risk for coronary heart disease.

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If the gland is underactive, a condition called hypothyroidism Occurs. In infants and children this is extremely important, for it may have an adverse effect on mental development and a condition called cretinism can take place. Symptoms may come on silently and be unnoticed for many weeks after birth. If left untreated, serious and severe mental defects are possible. (On the other hand, if too much hormone is produced, hyperthyroidism may occur, and this has another set of symptoms.)

The doctor or even a careful and watchful parent may not detect symptoms early, for they are often vague and ill defined. They include mental sluggishness, a pale grey cool skin, often constipation, a large tongue, and flabby muscles; the latter may cause the abdomen to protrude and there may be a swelling over the navel (called an umbilical hernia). The child’s cry or voice may be hoarse.

The baby may develop at a slower rate than normal, the eyes may seem to be widely spaced, and mental development is noticeably slow. Mental reaction is below normal. As the infant becomes older, the symptoms become more apparent, the skin tends to be dry and coarse, the hair dry, brittle and coarse.

Treatment

Today, in most Australian cities, new-born babies are ’screened’ for thyroid deficiency, and in time this will become universal in hospitals before mother and baby leave. At present, hypothyroidism affects about one baby in 4000.

Treatment is invariably successful. The thyroid hormone (usually in the form of the artificially produced product thyroxine) is given. This must be supervised carefully and perhaps continued for a long time. But it will avoid the serious consequences of untreated thyroid deficiency.

Babies who have missed the screening system, and who develop any of the symptoms described, should have prompt medical investigation by the doctor. The earlier treatment is commenced, the more successful will be the results and the less likely is the risk that the baby will develop serious mental handicaps.

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