BLOOD IN STOOLS

Cause

The commonest cause in children for the appearance of blood in the stools (or bowel movements) is a small anal tear. This can happen if your child is constipated

A rarer cause is inflammatory bowel disease, in particular ulcerative colitis.

When to see your doctor

• if there is a large amount of blood in the stool;

• if the stool is black (this indicates that blood is mixed in with the stool and occurs with internal bleeding);

• if in addition your child has diarrhoea;

• if your child complains of abdominal pain;

• if your child has a fever or is generally unwell in addition to any of the symptoms above.

COELIAC DISEASE

A child who was celiac disease is unable to digest gluten, which is protein found in wheat and rye. Many foods contain gluten, and these must be avoided in such children. This cause of celiac disease is uncertain, although it does tend to run in families. The characteristic signs are poor appetite, chronic diarrhea and a bloated abdomen.

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Mastitis

Occasionally, if breast engorgement continues for some time, the breasts will become inflamed and a secondary infection may set in. This can be distressing and quite painful if not treated promptly. If you have mastitis, your breasts will be swollen and tender and you may also feel generally unwell or feverish. The affected area may look red and be sore to touch. The treatment for mastitis is usually paracetamol for pain relief, in addition to a short course of antibiotics. It is important to continue breastfeeding, and it may be easier for you to position your baby so that feeding positions for different feeds, in order to allow drainage of all milk ducts. Check for lumps after each feed and if you find any either massage them, or express the milk from the ducts in this area.

Babies who refuse the breast

There are many causes for a baby suddenly refusing the breast. A baby may simply be distracted by his surroundings, he may have a blocked nose or be unwell, or there may be a change in the mother’s milk supply for any number of reasons. Often the cause cannot be identified. Never try to force your baby to the breast if he is refusing feeds and do not lose confidence in your ability to breastfeed; breast breast, discuss possible tactics to overcome the problem with your maternal and child health nurse, your doctor or a breastfeeding counsellor.

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I felt anger. When my uncle died, when he died so quickly, so suddenly, and he was so close to me, I just got angry. I couldn’t cry. It’s sick, but I wanted to screw, screw all night long. I feel so guilty that the night he died I just wanted sex.

WIFE

Grief is a natural response to the end of a bond that lasted long enough to leave one of its members intensely alone. It is a natural physical and emotional reaction to bereavement. It always involves protest of the loss followed by some form of surrender and, we hope, adjustment and resumption of personal and social growth and development. All of us have felt it, but little is written of the impact of grief on sexuality.

Any strong emotion results in alteration of body chemistry. The master organ, the brain, alters the entire neurohormonal system whenever we experience strong emotion, and grief is one of the strongest emotions possible. The couples reported that grief had a distinct and traceable impact on their intimacy patterns. Here were the most frequent patterns of the sexual impact of grief:

LUST REACTION: Although it may seem incompatible with grief, lust can result from loss. As if symbolically attempting to recreate, to produce, to generate at a time of absence, emptiness, and loneliness, some of the spouses reported a strong need for sexual release at the time of a death or other loss. The buildup of stress chemicals may play a role in this reaction, as does the excitation of sudden change and challenge to the life system. Sex may be one of the ways some persons attempt to discharge their grief and the toxicity of built-up tension and stress.

If there is a supporting partner available who understands this temporary state, this form of heightened sexual activity can be therapeutic. If the partner feels used or is critical of the bereave partner, breakdowns in communication and sexual distance can occur.

One of the seldom discussed dimensions of losing a spouse s the “lust response” that comes with psychophysiological shock ù the absence of any acceptable outlet for its expression. Bereaved spouses are as much as twice as likely to become ill themselves in the aftermath of their loss, and a part of such illness may come not only from life-style changes and other emotional consequences, but from sexual frustration and related guilt.

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Mutualized touching and holding Balance of sexual needs Intimacy in all areas of marriage

Marital health: is your relationship “bond” or “attachment”?

Attachment

Immature, dependent Spontaneous

One partner does most of the touching and holding

One partner experiences more sexual needs

Intimacy only in sexual area

Bond

Mature, interdependent

Intentional

Mutulized touching and holding

Balance of sexual needs

Intimacy in all areas of marriage

Here’s an example of a bonding relationship, of a couple integrating sex and love:

We worked on it. It didn’t just come. At first I never thought we would necessarily end up together. I mean, we hit it off, but it wasn’t near as intense as some of my other relationships, particularly not what it was with my first longtime boyfriend. But it changed over time. We just seemed to move closer, talked it out. He had to be coached into hand-holding, but he loves it now, too. We really are together. I couldn’t tell you who starts each sexual encounter. It just happens. We don’t take each other for granted, but we are relaxed about us.

WIFE

1 know what she means, but then, I always seem to know what she means and she knows what I mean, and that is what I mean by how our relationship is.

HUSBAND

Here is an example of an “attachment” relationship:

I support her in her career and she essentially takes care of me. I know just how to please her, to take care of her in everything, including sex. I need her and she needs me. It’s more like she is the provider and I take care of the house. I can tell when she needs sex and she is never disappointed. I can tell you that she would never be able to have her life this way without me. I am really perfect for her. … I meet her every need. Her wish is my command. It’s just how our relationship works.

HUSBAND

He is my life, my support, my everything. He is just what I need sexually, too.

WIFE

In the second example, it is clear that an automatic, strongly patterned, dependent relationship exists, with sex tending to be onesided and separate from marital life, almost one item on a list of chores, divided out from total intimacy. The husband’s description does not refer to his own sexual needs, or any of his own needs for the matter. The wife accepts this role, attached both to her husband and to the pattern of their marriage. Attachment works and can keep spouses together, but not together for a super sex marriage, the bond of a growing and adapting love system.

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Medicine is not always high drama.

It’s the little discomforts which take the patient to the doctor. And it’s the minor complaints which fill a doctor’s working hours.

Ingrown toenails fall into this category.

They usually affect the big toe and may be on either side of the nail.

The cause is thought to be due to improperly cutting the nail or wearing tight shoes.

The edge of the nail at the side digs into the tissue. The toe becomes painful and infected. There is often a heaped-up area of proud flesh or granulation tissue overlying the nail and preventing healing.

In treatment the doctor will cut back the wedge of nail cutting into the skin. This will relieve the pain and produce temporary relief.

The granulation tissue is best treated by touching it with silver nitrate. The raw area shrivels up and is replaced by healthy skin.

Local antiseptics or antibiotics, or even antibiotics given by mouth, may be necessary if the infection is spreading.

It is importrant to trim the nails correctly. This is best done, not in a convex way with the centre higher than the edges, but the reverse — in a concave fashion.

But this condition is prone to recur. If so, it is best treated by operation.

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He must reassure his patients, and he must tell them so that they understand what is wrong with them, and what he intends to do.

Patients are people, and people have different hopes, aspirations, ideals and concepts about disease and illness.

In the past, few people were educated. The doctor belonged to an elite group, and his word was accepted without question.

If he said: “Take this medicine,” the patient took it. If he said: “I will operate,” the operation, was done, and the patient rarely asked why or even what was being removed.

Now we have universal education. We can all read, and magazines and newspapers are full of medical news. People have come to accept health and medical treatment as their right.

The media have access to the medical journals as soon as they come off the presses, and reports of new treatments appear to the public before the journal reaches the doctor himself.

Doctors are not inarticulate. They have to explain to their teachers at the bedside what is wrong with a patient and what is the correct treatment.

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This is a completely different way of using ionising radiation to get pictures of internal organs. Instead of sending X-rays through the body from an X-ray machine outside it, these pictures are produced by rays coming from tiny amounts of radioactive substances inside the body. Although this probably sounds less safe than X-rays, the amount of radiation involved is often less than with X-rays of the same part of the body.

Say, for example, we want to get a picture of the liver. One of the liver’s normal jobs is to keep the blood pure by removing certain substances from it. When such a substance is injected into the blood, it is concentrated in the liver within a short time. If that substance has been made radioactive, it sends out rays through the body which can be detected with something similar to an X-ray plate. The picture produced in this way shows us the shape, size ancU<5cation of the liver and which parts are working normally. Any part of the liver which has been so badly damaged that it can’t do its normal job will show up as a ‘hole’, where there is little or none of the radioactive substance.

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The first way to look for evidence of lymphatic spread is simply to carefully examine the patient, checking for swelling of the tissues and enlarged nodes. Because the lymph network nearly always follows the same pattern, your doctor will know which particular group of lymph nodes to check most thoroughly. For example, if the primary cancer is in the arm, or breast, the first lymph nodes to be affected would be those in the armpit. From there the cancer can go into the lymph nodes in the part of the neck just above the collarbone on the same side. There are lymph nodes just under the skin in the neck, arm pits, crease of the elbow, groins and back of the knee. If any of these are enlarged, they can easily be felt.

Unfortunately, there are many lymph nodes that are not so conveniently located. Chains of lymph nodes run up from the groins, just in front of the spine through the abdomen and chest. There are also groups of lymph nodes near most of the internal organs. Channels from these lead into the main chain I have described. They eventually form one large channel which empties its contents into the blood vessel just behind the inner end of the collarbone on the left. Cancer in a node at this spot can come from almost anywhere in the abdominal cavity or chest. Lymph nodes do not show up on normal X-rays. The only exception is some in the chest which, when enlarged, can be seen against the black air in the lungs. However, there are several ways of getting ‘pictures’ of the other internal glands. CT scanning is one method. This works best in chubbier people in whom the lymph nodes tend to be surrounded by fat. Because fat lets through more X-rays than the lymph nodes, it provides a contrast which allows us to ’see’ the nodes more easily than in a thin person. In thin people the nodes lie next to muscles and blood vessels, both of which let through about the same amount of X-rays as the nodes themselves, making them very hard to ’see’.

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