Antidepressants Blog

It is very important that both parents and children understand very clearly how best to manage asthma. If the child has frequent attacks, or if symptoms prevent him from playing sport, sleeping at night, or feeling healthy, then it may be that the child is being undertreated. Your doctor should be made aware of this, so that treatment can be changed as necessary.

It is a good idea to keep in regular touch with the child’s doctor to make sure that symptoms are monitored closely and that treatment is optimal. Ensure that you and your child understand how to take the asthma medication — how much, how often, and the correct way to use the inhaler. If not sure, ask the doctor. The use of inhalers, in particular, needs to be explained carefully, and demonstrated several times.

Children with asthma are not always good at judging the severity of their symptoms. Often they say they feel fine even though their asthma is poorly controlled. Children over the age of 6-7 years may benefit from having a peak flow meter at home to monitor the asthma and the response to treatment. Check with your doctor to see if your child needs one.

It is important that you let the school know about your child’s asthma. Sport and exercise should be encouraged, not limited and avoided. Children may benefit from taking some inhalant medication just before exercise to prevent a wheeze or a cough from occurring during sport.

Asthma medicines are generally very safe, especially those that are inhaled. Children generally get into trouble because they do not take enough asthma medication, rather than because they take too much. If you feel that your child is experiencing side effects from medications (for example, sometimes medicine taken by mouth may make a younger child overactive), you should report this to your doctor so that changes can be considered. It is very important not to stop the medicine without letting your doctor know.

There should be an asthma management plan for every child with asthma. Parents and children should know what triggers asthma symptoms, what medications they take and how they work. They should also know what to do if the symptoms get worse, and what to do in an emergency if there is not the expected response to the drugs that are usually taken. If you or your child are uncertain about any aspect of asthma as it relates to you, then consult your doctor immediately. Do not wait until it is convenient, or until after the next acute attack. Do not put it off — asthma is often unpredictable — go and obtain the information now.

*251\90\8*

If you are in a chair, people rule you out as a sexual possibility. I think the doctors did, too. My wife and I actually thought that our sex life was over. It’s better than ever. Really. It sounds impossible, but it is better because it is not genital, can’t be just genital.

HUSBAND

The issue of spinal damage and sexuality has finally received more research attention. Anderson and Cole, in their book Sexual Options for Paraplegics and Quadriplegics, provide a list of guidelines for the physically handicapped that apply to all diseases. The list provides an excellent summary of the points that I have been making in this chapter.

1. A stiff penis does not make a solid relationship, nor does a wet vagina.

2. Urinary incontinence does not mean genital incompetence.

3. Absence of sensation does not mean absence of feelings.

4. Inability to move does not mean inability to please.

5. The presence of deformities does not mean the absence of desire (interest or arousal in my response system).

6. Inability to perform does not mean inability to enjoy.

7. Loss of genitals does not mean loss of sexuality.

There are so many different forms of spinal-injury impacts that I cannot discuss each specific type, but the rules above apply to each.

There are, of course, other diseases that I cannot discuss in this book. I have included the information I collected from the marital couples group and other patients with whom I have worked. One husband’s statement has stayed with me as the best summary of the relationship between disease and sexuality. He is a mentally impaired man who has been married two years. He was engaged for sixteen years because, by his report, “Nobody thought we should or could get married. They thought it was a joke.” He describes his love with his wife as follows:

“I know that people get divorced. I know I’m not as smart as most people. I’m not as smart as people who get divorced. But I can say I am smart enough to know something they don’t know. I can say it. I can say that since I’m not so smart as they, maybe I am not as busy with all those other thoughts. Maybe I can love more because I don’t think more, I’m not distracted from love. I’m not always thinking, but I’m always loving. Loving is easier than thinking because you have someone else to help you. Maybe people think too much and love too little.”

*287\97\8*

Seldom were early research subjects asked much about what happened “after.” I found this to be a very special time, as the couples learned to free themselves from the “separation phenomenon,” the tendency either to just cuddle and sleep or to start thinking about the kids, the car, the dog, or the cat. As pointed out earlier, leaving one another quickly, getting our minds on other things, might have helped in prehistoric times. Lingering too long in a sexual experience would make a couple a double-course dinner for a predatory animal. We now have the luxury of pausing awhile, for quite a while if we choose. Once we are aware of the role of contemplation, of sending and receiving signals to our spouse even in silence following physical intimacy, we add an entirely new dimension to our sexual interaction; we find super sex.

“We would look into each other’s eyes. It was strange. I could almost hear him, receive something from his, but we didn’t talk at all. It was like the sex set us up for a whole type of being together that we could never have at other times.” This report from one of the wives illustrates the “contemplative” phase.

“X-rated films always end each scene with ejaculation. You never see them together much after that. It’s a whole different thing to sort of stay with her. I don’t mean to get ready again or anything, I mean to almost relive the sex, even your marriage just by being quiet together.” This husband at five-year follow-up had discovered the importance of “being” instead of “doing” in his sexual experiences with his wife.

*114\97\8*

Let us take an example of the involuntary abuse of our body.

Suppose your water supply contains a poison which has no taste in low concentration (eg. fluoride). Your body has a limited capacity to metabolise, neutralise and excrete such a toxic poison. In the first few years it copes very well. But the intake of the poison gradually exceeds the capacity of the body to expel it. So the poison accumulates somewhere in your body, in your bones and joints for example. When the concentration of this poison exceeds a certain limit, perhaps after 10-20 years of drinking such water, you may develop symptoms of arthritis. The actual delay as well as symptoms may vary, depending on your lifestyle, diet etc..

Now imagine, that your diet contains an unknown number of mysterious ingredients.

Your body tries to cope. It never lets you down, if it is at all possible. It tries to metabolise and excrete everything , but unfortunately you take some more toxins in with your next meal. Unable to free itself from all unwanted substances, the body temporarily deposits some of these substances in various forms and in various organs around your body in the hope, that conditions for their disposal may arise later.

However, you do not know and do not care about creating such conditions. Temporary deposits become permanent and continue to grow. If the deposits are not toxic enough to actually kill you immediately, depending on a number of conditions :

you can become overweight and/or

your body enters a state of “healing crisis” – simply

speaking you develop a disease and/or

your body begins to age quickly – the rate of damage is accelerated

Note, that the conclusion we reached by examining the natural functions of our body is that the development of diseases in the body is a direct consequence of diet, the fact that Medical science started admitting only recently.

We also found how we can tell that we are eating the wrong diet. Our body from time to time enters into an uncomfortable state of “healing crisis” (commonly known as “disease”) trying to communicate to our conscious mind that it cannot cope any more and we should change our ways.

We have also determined how to tell if we are eating too much. We simply become overweight.

Note, that in each case analysed above there was a significant delay between our actions and their consequences to our health.

*13\96\8*

In Australia most lawyers would advise their clients against bringing a civil action unless the evidence was quite obviously against the doctor.

The information a doctor gains from his patients is confidential and he may not breach that trust by revealing that information to any third party.

If he does the patient may invoke the law and seek damages. However, in a court of law, the doctor’s duty is to the law and not to his patient.

He may be directed to reveal that information and he cannot claim privilege.

If he does so, preferring not to reveal the information he has, then he is not above the law and the judge may hold the doctor in contempt of court. If so, a fine or imprisonment may be imposed.

The law and medicine are both ancient, learned and proud professions, and practitioners of both hold the rights of their clients are important.

In most cases where there may be a clash of interests, good sense and conciliation will solve most difficulties.

When it fails to do so, the clash is highlighted to the detriment of both professions.

Doctors think like doctors and lawyers think like lawyers, but then don’t all of us consider our own job and our own way of carrying it out, important?

The law is for guidance of wise men. I would like to think that no one profession has a greater claim to wisdom than the other.

*481/71/1*

The endings of both types of nerves release chemicals which act on receptors in the target organs and tissues.

The parasympathetic nerves release a chemical called acetylcholine and the receptors are called cholinergic. The sympathetic nerves release the chemical noradrenaline and their receptors are called adrenergic.These latter are divided into alpha and beta receptors, named from the first two letters of the Greek alphabet.

The drugs we are talking about block the action of noradrenaline on the beta receptors and so interfere with the function of these tissues and organs when the sympathetic nervous system is stimulated.

The first use of the beta blocking drugs was in treating angina, the chest pain produced by exertion when the coronary arteries supplying the heart muscle with blood have become narrowed.

These drugs act to reduce the work done by the heart and can prevent the disabling, severe chest pain.

Their action does not improve the efficiency of the heart but the reduction in pain can help the sufferers to lead more comfortable and productive lives.

However, caution is needed, for those with associated heart failure may find their condition worsened.

*225/71/1*

“My doctor thinks I’m almost recovered from endometriosis.” a thirty-year-old woman from Indiana wrote to me. “and I wonder. I’ve been trying to get pregnant for a year and a half, but have had no luck so far. My gynecologist told me mat he suspects my tubes may be blocked from the endometriosis. He wants to X ray them. Isn’t this dangerous? I want a baby, but I’m afraid of all this radiation.”

Diana’s query is one that we commonly hear from women who are recommended for special work-ups when infertility is involved. X rays should be used advisedly and infrequently, but they can be instrumental in deciding the degree of tubal damage.

Abdominal X rays will pick up only large tumors or hard masses, because these will form a shadow on the exposed film. Since endometriosis is soft tissue, it will not show up on these standard X rays. However, a hysterosalpingogram, or X ray of the uterus, used along with an injection of dye, has aided doctors in making an accurate diagnosis. The amount of radiation from a hysterosalpingogram is very low.

If Diana decides to go ahead with this X ray, she will find it pain-free. The procedure is simple. The test is performed while a woman is resting on an examining table. The doctor inserts a speculum into the vagina and the cervix is steadied with a special clamp. A small hollow tube, or cannula, is placed inside the cervical canal and will serve as the conduit for the injected dye. When the dye enters the uterine cavity, it is seen on a fluoroscope screen, and the doctor simultaneously takes an X ray. (If you refer to the illustration below, you can see that the dye has pushed into the uterine cavity, which appears to be normal. The right fallopian tube is open, indicated by dye spilling from the tube. The left tube is closed and damaged as a result of endometriosis; the dye has collected there and does not spill out into the pelvic cavity.)

Normally, the uterine cavity is small and triangular. If it is enlarged or if there is certain “intravasation”—that is, the dye fails into small pockets in the wall of the uterus—these signs might indicate a condition called endometriosis interna, or adenomyosis. Confined to the inside wall of the uterus and weakening it, adenomyosis can coexist with endometrial implants outside the uterus, or it may exist alone. Adenomyosis creates heavier menstrual flow and is responsible, in part, for continuous pain.

Sometimes, endometrial implants stick on the outside of the fallopian tubes, causing them to narrow. This X ray will outline the tubes to reveal whether or not they are open, since the dye will be pushed through the hair-thin fallopian tubes. A healthy tube shows up with the dye already expelled and spilling toward the ovary and bowel. The circumstances are different when the tube is damaged. The dye won’t escape, but will be trapped within one of its fimbriae, the ringerlike ends of fallopian tubes. Chances of pregnancy are nearly impossible with such a damaged tube.

Recall for a moment Sampsons theory. It proposed that the fallopian tubes were conduits for endometrial fragments during retrograde menstruation. The fallopian tube may be first to come in contact with the endometrial fragments outside the uterine cavity. Surprisingly, however, endometriosis is rarely found in the tubes. When there are endometrial implants on the tubes, they can be recognized by their characteristic dark blue color. In advanced cases, implants may penetrate deep into the wall of the tube, forming dense adhesions with the surrounding organs.

Tubal problems are often the cause of infertility, although it is not always endometriosis causing the problem, as it is in Diana’s case.

*50\43\4*

This was the first disease to have its actual bacterial cause identified. The Norwegian, Dr G. Hansen, discovered the bacteria, known as Mycobacterium leprae, in Oslo in 1873. He tried unsuccessfully to infect human volunteers. Even today, it is extremely difficult to transmit this disease, and to date it has only been cultivated artificially in the foot pads of certain mice and in the South American armadillo.

To many people the mere mention of leprosy conjures up a picture of severely diseased and unclean people. Contrary to popular opinion, however, leprosy is not highly infectious. Most infections occur in childhood, but because of the long incubation period, from 2-10 years, it does not become apparent until adulthood. Furthermore, infections virtually only occur in endemic areas: that is to say, in countries or in races in which the resistance to this particular germ is, for some genetic reason, diminished. These countries include many parts of the Middle East, Asia, Africa. South America, Pacific areas, some Southern European countries around the Mediterranean, and Australia. The infection is transmitted by germs from the nose and throat, being inhaled or entering through a skin abrasion. The world incidence of this disease is between 12 and 20 million. In the United States there are 3000 known cases and about 10000 estimated cases. Similar discrepancies in numbers would also occur in other countries such as the United Kingdom or Australia. The reason for these discrepancies is that people with this disease do not want to come forward and be treated. This is because the disease and the term ‘leper’ have such unfortunate and incorrect connotations- People believe themselves to be outcasts and do not come forward for effective treatment. Australia, in fact, has the highest endemic rate of leprosy in the world because it is so prevalent amongst the Aboriginal people, particularly in the Northern Territory. The incidence in Australia has increased markedly over the past ten years due mainly to the increasing number of immigrants from India and South-East Asia.

From prehistoric times up until quite recent years, leprosy has been regarded more as a sin than as a disease. During the Dark and Middle Ages it was treated by priests, not doctors. Not only were a variety of common skin diseases incorrectly labelled as leprosy, but calling a person ‘a leper’, for doing anything undesirable, was a handy method of stigmatizing that person and making sure he or she become an outcast. Unfortunately, even today, people suffering from this disease are still discriminated against socially, legally, and medically, and are thus stigmatized by the community at large. Gradual education of the community and the substitution of the term Hansens disease for that of leprosy should, in time, change the public’s attitude towards the disease.

There are two major forms of Hansens disease. One, the tuberculoid form, appears in patients with relatively good resistance or immunity to the bacteria. Usually it occurs in localized areas, where it may be seen as a raised rash which has lost its sensibility to touch. There may also be loss of sensation in the area supplied by a specific nerve, and accompanying muscle weakness.

The other form, the lepromatous form, occurs in those with a poor resistance or immunity to the bacteria. It may first appear as a stuffiness of the nose, with or without a discharge, Then various rashes may appear which, in this form, are not insensitive to the touch. Later on lumps and bumps may appear, and there is often accompanying patchy hair loss. Later still the person’s features, particularly of the face, may become quite misshapen. This is due to damage of the underlying bone. The eyes may also be affected by various specific inflammations. Involvement of the nerves may lead to loss of sensation from the skin, and subsequent paralysis of muscles. Many organs in fact may be affected, but the patient docs not usually feel ill, nor does the disease often cause death. The onset of the condition is usually gradual, but when there is loss of sensation occurring in the hands or feet, repeated injury will result in considerable damage, thickening of the skin and subsequent deformity. It is this type of damage, due to anaesthesia, that may eventually result in fingers or toes disintegrating (this has been incorrectly called ‘fingers dropping off). It is also this thickening of the skin, along with the deformity caused by underlying bone damage, that can result in the disfigurements which have lead people to shun those suffering from the disease.

*78\44\4*