Treatment
No cure for psoriasis is yet available, but much can be done to improve the condition. If your child has a rash, it is advisable to see your doctor in any case, especially if there is a strong family history of psoriasis. Your doctor can advise you on the methods of treatment available, and may suggest referral to a paediatric skin specialist. The treatment will depend on the age of the child, and the severity of the disease.
A number of different ointments and creams, including cortisone creams and coal tar preparations, can be prescribed for psoriasis, and ultraviolet light (sunlight) may be beneficial.
When to see your doctor
See your doctor if your child has the symptoms described above.
Prevention
There is no way to prevent an initial attack of psoriasis.
Complications
Although complications are rare in children, adults with psoriasis sometimes suffer from an associated form of arthritis.
*326\90\8*
Newborn babies are particularly vulnerable to extremes of temperature. Their temperature mechanisms are not yet fully developed, so strict attention needs to be paid to their warmth and clothing. Keep the temperature of their room pleasant, but not hot (around 18-20°C). For winter outings cover your baby’s head with a woollen hat, hands with mittens and feet with warm socks or booties. When indoors remove this extra clothing to prevent overheating. In summer, do not overdress your baby, and choose loose fitting, light clothes. Cotton underclothes are the most comfortable for all weather, and should be changed every day.
*79\90\8*
Couples in the clinic program are asked to spend one weekend alone, away from the spouse, taking time to think about the relationship, their spouse, and their feelings about self in the context of the relationship. They are asked to be alone during the weekend or whatever two days are picked, and not to take friends along. If possible, they are asked to go to a place that the couple has visited together. This revisit seems to help in the contemplation and meditation about the meaning of the relationship.
A wife reported, “I hadn’t done that for a long time, really been alone. Even in college, I was always with someone. I felt like something was missing. It wasn’t like absence made the heart grow fonder, but that I seemed to see the relationship in a different way. It’s really something to be alone, not to call home, not to be a couple after being a couple for years.”
“I got kind of sad,” reported her husband. “On business trips, I am always with someone or busy or tired. I always call home.
This time, I went to the same fast-food store that we went to together in Toronto and I seemed to sense her absence strongly.”
Sometimes, marital therapists suggest formal or legal separation as a means of learning. I have never found this strategy effective and have seen partners learn only how to be even more distant from one another. The sexual sig I am suggesting here is not for separation, but for closeness, a chance to step back, just as one moves back to look into the partner’s eyes before an intimate kiss. This separation is not a test, but an opportunity to learn the impact of the partner when the partner is not physically close.
You might like to try “marital telepathy” during this single sig. Even though you don’t call, try sending messages. Set aside a mutually agreed-upon time of day and sit down for a few minutes. Try to send and receive, to sense and be sensed. Russell Targ and Keith Harary collected scientific research on such “sending,” and concluded, “Scientific evidence does strongly suggest that the ability to function psychically is a genuine human capacity which, for many people, seems to improve with practice.”
“I can tell you now,” said one husband, “I am convinced we are getting better at this sending thing. I lay there in bed and could almost hear her talking to me. When I got home, I asked if she sent a message, the names of our three children. Tell him what you said.”
“This is like the Twilight Zone, but, yes. I thought I would try it like you said. We picked the time and I sent the name of the three kids. He got them in the same order I sent them, which was not by age. It’s probably just coincidence, isn’t it? I mean, of course we would both think of the kids.”
Why would coincidence make it any less important?
Someone once said that a kiss is nature’s way of getting two people so close together they can’t see each other’s flaws. This sexual sig is an opportunity to be apart so that you may become even more aware of the bond that holds your marriage together.
*189\97\8*
You don’t just say “Hey great, IVe been hoping you would ask me out.” It takes the challenge away, and without the challenge of the chase, there is no energy behind the whole thing. You still have to chase them until they catch you.
MEDICAL STUDENT
Acknowledging that a bonding invitation has been sent to you is one of the riskiest steps in the bonding process. How can you trust your senses, even your own ears? Does he really mean it? Why would she be interested in me? Maybe he’s just being funny? Maybe she’s teasing? I’ll look like a fool if I take this seriously, but I hate to miss the chance just in case this is serious. All of these thoughts can occur almost simultaneously when a bonding invitation is perceived.
One of the thousands husbands recounted the following story. “She asked me up for a drink after the show. I have always had trouble with this ‘up for a drink’ thing. I sort of used to go into my ‘get ready for sex’ mode, but sometimes it just means up for a drink. It’s hard to tell. She told me to have a seat. That’s not an easy thing. Do you take a chair or the couch? She said, ‘Make yourself comfortable. I’m going to get real comfortable myself.’
‘ ‘Now I really went into sex mode two. How do you get yourself comfortable sitting for the first time in someone’s apartment? I took off my tie, unbuttoned my shirt, kicked off my shoes, and moved to the couch. I even rolled up my sleeves. I was getting aroused.
“She returned to the room and I felt like a jerk. ‘What do you think you’re doing, moving in?’ she said. She had changed to jeans and paint shirt. ‘I’m finishing sanding my old table. Get yourself a drink and let yourself out, will you? I don’t want to drag dust through the carpet.’
“I made up some cover lie. I think I said something like, ‘Oh, I just can’t stand that tight collar and jacket. I think I’ve gained a little weight and it’s all too tight.’ I even went into greater detail trying to save face. What a night.”
Just as proception requires vulnerability and directness, reception requires a lowering of defenses, taking major risks. It requires sufficiently resilient self-esteem to endure the knocks we all receive in the bonding process. We have to be arrogant enough to assume that someone wants us and humble enough to remember that many people would choose to have nothing to do with us. Is the other person sure? Am I sure?
Do you remember taking the risk? Do you remember allowing yourself to feel that someone you wanted really wanted you?
*49\97\8*
Shingles or herpes zoster is due to the same virus which causes chicken pox, or varicella. It is
believed that the virus does not disappear after an attack of chicken pox but remains in the body, lying dormant in the nerve cells of the posterior horn of the spinal cord or in the posterior ganglia, collections of nerve tissue at the side of the spinal cord.
The cells, in the back part of the cord, are concerned with sensation. The anterior horn cells, at the front of the cord, are related to motor function. Some years later the virus multiplies, becomes active and produces the condition of shingles.
Shingles therefore develops only in those who have previously had chicken pox. When somebody has shingles, then susceptible people like his or her grand-children sometimes may develop chicken pox if they are in contact. The reverse does not appear to happen, but herpes zoster may be more common when chicken pox is prevalent in the community.
Shingles may occur at any age, even in children. However, the younger the person the less likely are complications. The frail and the elderly may suffer greatly from this condition and then it is more likely to be followed by persistent inflammation of the nerves and severe pain or neuralgia.
*558/71/1*
If the pancreas is removed so that no insulin at all is produced, the resultant diabetes can be controlled by about 40 units of insulin daily. By contrast, many true diabetics require up to 100 units daily, so diabetes is more than lack of insulin; there is some degree of insulin resistance.
Broadly, we can classify diabetics into those who are insulin dependent and those who are non-insulin dependent.
It is thought that this may be an auto-immune disorder where the body becomes allergic to its own tissues and manufactures antibodies which act on those tissues, causing inflammation.
The non-insulin dependent type usually develops slowly. It is often spoken of as maturity onset diabetes as it is more common in the elderly, although it may develop in some young people. It is particularly associated with obesity.
*301/71/1*
Congenital dislocation of the hip is a,disorder once thought to occur about once in every\1000 births.
But awareness of the condition has led to earlier diagnosis that it is believed to be as common as 1 per cent, that is, 10 in every 1000.
While the cause is not known for certain, there are several predisposing factors.
It is more common in girls than boys, in those with a breech presentation rather than babies lying with the head down at birth and in those who have a family history of the disorder.
It is important to diagnose this condition in the first few days after birth. If this is done, putting the child in a special splint for about three months will result in cure. With early diagnosis and splinting, the hip develops normally.
When diagnosis is delayed, splinting may need to be prolonged and eventually an operation may be required.
Doctors who deliver babies are well aware of this condition and check the child at birth, when a few days old and again before discharge from hospital. Nurses in the hospital are also aware of the problem.
As a follow-up and to detect any babies who slip through this net, the Infant Welfare Sister will also check the baby for congenital dislocation of the hip, or CDH.
The very few, if any, who do miss out on diagnosis may not be detected until the child starts walking. Unfortunately, when this happens, treatment may be prolonged and more complicated.
*51/71/1*
Pyridoxine (vitamin B6), a letter in the Lancet (1:636) suggests, may be like Thalidomide in its ability to cause human birth defects. The letter reports the birth of a child with nearly total absence of the right lower leg, the type of defect seen so often in babies whose mothers, during pregnancy, had taken Thalidomide.
By itself, this report would not be sufficient to incriminate pyridoxine as the cause of birth defects (it could have been a coincidence), but viewed in the context of pyridoxine’s other known side effects, it looks highly suspicious. Given repeatedly in large enough doses, both Thalidomide and pyridoxine, it has been found, cause almost the same type of nerve damage in the limbs, with numbness and tingling in the “stocking and glove” areas, progressing to weakness and instability in walking.
This suggests that pyridoxine and Thalidomide share a common toxic effect on human tissue, and that this is also capable of producing birth defects. Although there is no proof of this, it would be prudent to avoid the current fad of taking supplemental pyridoxine.
The woman whose baby was deformed, incidentally, had been taking one 50 mg tablet of pyridoxine every day.
*215\143\2*
Signs and symptoms
To pinpoint its cause, recurrent abdominal pain must be associated with other symptoms such as vomiting, diarrhea, constipation, blood or mucus in the stools, fever, and failure to gain weight, painful urination, ingesting inedible substances (pica), or anaemia. Also important is the pattern of the pain – where it is, when it occurs, how long it lasts.
In general, recurrent abdominal pain that is accompanied by no other symptoms or has no set pattern is probably not serious.
Home care
If constipation is the cause of the pain, correct it by changing your child’s diet or using a glycerin suppository. If milk seems to be the cause, eliminate milk and milk products from the diet for one or two weeks; then add milk to the diet again and observe the effects. If emotional stress is responsible, try to eliminate the stress. Most important, note and record the pattern of recurrent abdominal pain and any other symptoms that occur before consulting your doctor.
• Recurrent abdominal pain due to emotional stress is real and requires treatment just as much as pain due to an identifiable physical condition.
• Do not try to relieve stomach pain by giving laxatives or placing ice on the stomach.
Medical treatment
Your doctor will take a careful history of your child’s recent health and perform a complete physical examination. Frequently the doctor will order urine, stool, and blood tests. If the cause of the pain still is not clear, X rays of the stomach, large and small bowels, and the urinary tract may be required. If X rays provide no clues to the problem your child may be hospitalized for extensive blood tests and an internal abdominal examination.
*202/84/5*
• Find other things to do with your hands that will help you cope with tension. Knitting, ‘worry beads’, playing with a bunch of keys, or whatever, all work.
• Get your family and friends to sponsor you to stop smoking.
• Have a bet with someone as to how long they think you will give up for.
• In the early days of giving up, change your routine so that old trigger-points and situations don’t get at you while your urge to smoke is great.
• Keep busy. Sitting around thinking about smoking and how much you miss it will soon have you longing to go back to it.
• Be prepared for the mood swings as your body gets used to doing without the 100-400 puffs a day it has been accustomed to.
• Don’t kid yourself about how strong-willed you are-keep away from people and situations where you could be put to the test. One small slip and you will have undone all your previous efforts. One day in the distant future you might be able to enjoy the odd cigarette or cigar after a meal but in the early days this is too much to hope for. Complete abstinence is the only way.
• Give yourself a treat every day. Make sure that not all of them are in the form of foods, or you will soon get fat.
Obviously it is best never to start smoking in the first place. Here are some tips on ‘primary’ prevention:
• Breastfeed your children exclusively for at least six months and offer the breast after that whenever they need comforting. Psychiatrists and analysts have found that many smokers are ‘frozen’ at the oral stage of life during which a baby’s main pleasure comes from his or her mouth. If breastfeeding (or bottle-feeding even) goes badly and the baby is left to cry, its oral needs unfulfilled, it is thought that later in life he or she will turn to other forms of oral gratification. Undoubtedly, smoking is the most common of these, though earlier on in life dummy- and thumb-sucking are also widespread. Most normally developed adults don’t seek oral pleasure in this way and don’t respond to stress and anxiety by putting something in their mouths. Some, of course, do and these can be found at any slimming clinic or club.
• Perhaps the best preventive measure adults can take for their children is to ensure that they themselves don’t smoke. This will greatly reduce the likelihood that the children around them will want to smoke.
• Next, it’s worth trying to bring up our children to be able to resist peer pressures to take up the habit. Most young children say they don’t ever want to smoke yet obviously a percentage will be smoking by the age of 15. We should teach children that to take up smoking only because of pressure from their peers is to show that they cannot hold their own against their peers by doing only what they really want to do. They should be encouraged to think of smoking not as tough or glamorous but as an attempt to appear tough or glamorous by those who lack confidence. Such thinking has been shown in tests in California to protect children against drugs and alcohol too.
Another successful ruse is to use older young people to deliver the anti-smoking message in their own style. Play-acting helps in group work and can be fun too. Parents can also get across the message that:
1. You don’t have to be conned by smoking advertising.
2. They wish they had never taken it up because they can’t afford it.
3. They are glad they gave it up and how much better they feel.
4. It is possible to resist smoking just to go along with the crowd.
5. Smoking doesn’t make you ‘cool’.
6. By resisting smoking you will also be able to resist drugs and alcohol.
A study of 526 Californian students, who were encouraged in this way, found that those who were trained to be able to resist the pressures to start the habit began smoking at less than half the rate of those who did not have the training.
*222/72/5*