Breath-holding is one of the most frightening of all childhood behaviours. It is most disconcerting for parents to see a child suddenly stop breathing, often ending up limp and unconscious. It is often difficult to reassure parents that no harm comes to these youngsters. Breath-holding occurs in about 5% of children, generally between the ages of 6 months and 5 years, though it is in the young toddler age group that it is the most common.
Cause
The immediate cause of the breath-holding episode is anger or frustration on the part of the child, usually in response to not getting his own way, or else to pain or fear. It is not known why some children respond in this way and others do not.
Clinical features
There are two described sorts of breath-holding events, called blue (cyanotic) and white (pallid).
In the blue episodes, which are more common, the baby or child is upset and distressed, and after a period of increasingly intense crying, suddenly stops breathing. He becomes blue, limp, and sometimes may move arms and legs as if having a convulsion. After a brief period of time, usually half a minute or less, although it seems an eternity to the parents, he will resume breathing, and often crying, with no apparent ill effects.
The white or pallid episodes are usually a response to intense fear or pain. The crying is minimal or silent, and the baby or child stops breathing suddenly and without warning. He becomes pale, rigid, often arching his back, and the episode may end with movements of the limbs as if he is having a convulsion.
*185\90\8*
IMPRINT,” YOUR OWN PRIVATE “FETISH”
The term “fetish” has specific clinical meanings, but for the purpose of this interview, it was defined as an object that can lead to sexual arousal. Think of your own sexual turn-ons. Does soft, hard, cool, warm, rough, rigid, or some other characteristic seem to hold erotic stimulation for you? Mild, even strong preferences for certain clothing, colors, shoes, and fashions are natural. When these things become necessary adjuncts, even substitutes, then the love map develops roadblocks for mature love.
Dr. John Money, in his book Love and Love Sickness, describes “paraphilias,” sexual responsiveness to unusual or socially unacceptable stimuli. More frequent in men than women, paraphilia literally means “aside from love.” One husband reported, “I just love hair. Long, full hair. Just the hair can turn me on.” He came to the clinic because his wife felt that he was a “pervert” (she actually said he was a “pervert”) because he had “this hair thing.” Through counseling, the couple learned together to move “this hair thing” from necessity adjunct in their sexual interaction to a strong preference, with the wife able to enjoy with her husband different hairstyles during some of their sexual interactions.
“I would have never believed it. I even put on wigs. It’s fun, but it’s not all the time,” reported his wife.
“It really gets me that she will share in this thing. I get turned on with her and she gets turned on that I am turned on, just so long as the whole thing does not replace my feelings for her,” reported the husband.
Think of objects that have some erotic value to you. Try to think of three such objects, even if it at first seems impossible. The spouses were able to come up with such objects after some prodding. Place these at some point along the “arousal line” below and have your partner do the same. Discuss these objects, your feelings about them, and how and why you think these objects came to have erotic value. This is a helpful step to the sexual disclosure necessary for super sex.
(slight turn-on real turn-on necessary for turn-on)
Here is one example from one of the men: “I would put a soft and silky nightie, like a robe, at the slight turn-on level. Real strong perfume, I mean like the dime-store type, is a real turn-on. I guess that’s because I had a babysitter who wore that stuff when I was getting sexual. Necessary for a turn-on would be, let’s see, that’s more difficult. Oh yes, I would say smooth legs. I hate stubble.”
His wife reported the following: “I get slightly turned on to the most gentle hint of aftershave. Now, tight colored underwear is a real turn-on. I hate boxer shorts. They remind me of my father. Necessary turn-on? Well, I can’t make love with anyone, anyone at all, unless they have nicely manicured fingernails. I remember my uncle always had dirty or broken nails, and that still turns my love button to past off.”
As these spouses reported another sex imprint, their fetish imprint, you can see the impact of early childhood experiences in both examples. Stubble, dirty fingernails, and boxer shorts are on the love maps, whether these people wanted them there or not.
*85\97\8*
Over the years we built the image of who we thought we should be. We lived our lives with an uneasy feeling that we were not who we appeared to be. If we were not who we appeared to be, then who were we? We didn’t know. We were never able to answer the question.
The anxiety and/or the attacks blasted into our lives. They pushed past our control and steamrolled our defences. The image we had of ourselves crumbled with the weight of its own illusion. The disintegration of ourselves continued and our seemingly solid foundations of our self and our life were torn down.
Suddenly we were thrown back onto ourselves and we had nothing left as an identity. Our sense of inadequacy, our lack of confidence and lack of self-esteem became predominant. We felt helpless and isolated. Our need to be in control was the only defence we had left. We tightened our grip on it because we felt that total annihilation of ourselves was only an attack away.
We became separated from our real selves through a lifetime of suppression and, when we needed it most, we felt that we had nothing to give us strength or support. Our sense of helplessness and isolation increased dramatically. These feelings of helplessness and isolation are a measure of the degree to which we are separate from our self. It is the ultimate separation anxiety.
All of us search for external answers to our difficulties, but we don’t realise we are looking in the wrong direction. Although we may find temporary measures to sustain us, we don’t recognise or feel the enormous potential of our self which is waiting to assist us.
*99\94\8*
This is not to say that having an operation cannot possibly result in some patients dying of cancer a bit sooner than they would have otherwise. For example, it is known that anaesthetics and stress depress the function of the immune system. Experiments on animals with extensive cancer have shown that those that have a ‘look and see’ operation do die, on average, a little earlier than animals which do not. Notice that I said animals having a ‘look and see’ operation, not animals having an operation at which something is done to the cancer.
Try to keep these facts in perspective. If your cancer is apparently localised, surgery probably offers you the best, and maybe the only, chance of cure. If it is extensive, surgery could be the best way of controlling or preventing very unpleasant symptoms. If you stand to gain a lot from surgery, the possible temporary effects of the stress and anaesthetic on your immune system would not be enough to outweigh the probable benefit. On the other hand, they could be if your planned operation has only a small chance of achieving some minor and temporary benefit.
*224/40/1*
I don’t know about you, but I enjoy the summer — the long hot days, the outside activities, the sport and recreation enjoyed by most Australians.
I feel there are a few things we should know about the heat to avoid danger. The very young and the very old do not tolerate extremes of either heat or cold. In both, temperature regulation does not have the efficiency it should.
The body is like a motor. As it works, it produces heat. This heat must be got rid of or else our temperature will keep increasing. Most heat is lost by sweat evaporating from the skin, but this becomes ineffective when the atmospheric temperature is too high.
But very high temperatures can be experienced in parked cars when the windows are left closed and the car is exposed to direct heat, even on days of moderate temperature.
Babies and small children left in cars while mother is shopping can be placed in danger and the heat stroke that results could be fatal.
*412/71/1*
The new low-dose Pill has a lessened risk of side effects — but it also has a reduced margin of error.
This means that, if one Pill is missed in the cycle, there is a small but definite risk that ovulation may occur resulting in pregnancy.
If a woman on the Pill develops vomiting or diarrhoea, there is a risk that the Pill will not be absorbed and so she may risk pregnancy. We are now aware that taking certain other drugs at the same time as the Pill may make it less efficient.
Most of the anti-convulsants do this and so epileptic women taking medication to control their disorder need to be careful if they also wish to take the Pill. Some antibiotics have also been shown to interfere with the potency of the Pill.
The reverse effect may also be seen in that the Pill interferes with the action of other drugs.
It now appears that it has an effect on the levels of vitamins in the body, the levels of the fat soluble vitamins, A and D, may be increased while the water soluble, Â and C, may be decreased.
*158/71/1*
Make-up, like cosmetics generally, has a long and fascinating history. There is evidence from Palaeolithic cave paintings of the use of red and yellow ochre for colouring the skin. Queen Mentuhotep, in 3000 B.C., owned a small cosmetic chest containing preparations to beautify the eyes and maintain the condition of the hair, as well as deodorant perfumes for the armpits and groin. Ovid, the romantic Roman poet (43 B.C-17 A.D.), lectured the women of Roman on the need to use cosmetics as an essential practice to retain lovers. He also described how the wrinkles of old age may be concealed. In Queen Elizabeth’s day, milk baths were the fashion. Turkish ladies of that time were advised to have their skin flamed by a torch held by a eunuch of the harem. Clearly, women for many centuries have been prepared to go to the utmost lengths to improve the appearance of their skin and forestall the inevitable ogre of age. Today, many men also show an interest in skin care and the use of cosmetics.
The basic make-up used is the foundation cream. This both protects the skin to some extent from the drying effects of the elements and serves as a base for powder or blusher. As mentioned before, this foundation cream is basically a cold cream, which is tinted.
Pace powders are a combination of talc the predominant ingredient, 8 tea rates, kaolin, perfume and colouring substances. Talc is a complicated salt of magnesium, whose main characteristic is that it is very easy spreading, Stearates, which are also metallic salts, enable the powder to stick to the skin. Kaolin is a variety of aluminium salt which acts as an absorbent for perspiration. Compressed powders are the result of combining face powder with binding agents such as gum arable. Similarly, binding can be attained by the use of a moist sponge applicator to collect and spread the requisite amount of powder on the skin.
Mascara is a make-up used for darkening eyelashes. The use of eye-liner pencil, mascara and eyeshadow to highlight the eyes is a popular practice. These products contain various dyes, anti-bacterial agents, resin and bases. Allergies to these are not uncommon, particularly since the skin about the eyes is very thin and sensitive.
The colouring of lips for decoration is an age-old custom. Lipstick as we know it today is very different from earlier products. Most contain oil-wax mixtures, lanolin, staining dye, perfume and colour pigments. Each of these substances may cause an allergic reaction in some users.
Nail polish is essentially a lacquer containing cellulose, nitrate, solvents, resins and colouring agents. The resins which are responsible for the sheen and stickiness are the agents most usually responsible for allergic reactions. The thin skin of the eyelids is particularly prone to contact dermatitis, being highly sensitive to various cosmetics, especially hair preparations and nail polish.
Fragrances are incorporated in nearly every type of cosmetic and may also, of course, be used alone. Perfume is created from a chemical formulation of fragrant volatile oils, preservatives and alcohol. The oils are obtained from a variety of sources including spices, flowers and fruits. Toilet water (l’eau de toilette) is made by using large amounts of alcohol in the perfume formula. The scent is similar to that of perfume but does not last as long and is not as strong. Cologne is similar to toilet water and the terms are often used synonymously, although generally cologne is limited to citrus and floral bases. Both are applied more liberally than perfume, the fragrances are lighter, and the higher alcohol content means the lotions have a cooling, refreshing effect on the skin.
*8\44\4*
Most heart disease in the Western world, and increasingly elsewhere, is caused by atherosclerosis of the arteries, sometimes referred to as ‘hardening of the arteries’. Most people develop atherosclerosis gradually during their lifetime. If it develops sufficiently slowly it may not cause any problems, even into great old age, but if its development is accelerated by one or more of many processes the condition may cause trouble much earlier in life.
Atherosclerosis results in reduced blood flow through the affected arteries. In the heart this can mean that the heart muscle gets insufficient oxygen to provide the power for pumping blood, and it changes in such a way that pain is experienced (central chest pain or angina pectoris). Elsewhere in the body, atherosclerosis has a similar blood flow reducing effect: in the legs it can cause muscle pains on exercise (intermittent claudication); in the brain it can cause a variety of problems from ‘funny turns’ to strokes.
An even more serious consequence of atherosclerosis occurs when a blood clot forms over the surface of a patch of atherosclerosis on an artery. This process of thombosis can result in a complete blockage of the artery with consequences ranging from sudden death to a small heart attack from which the patient recovers quickly. The process of thrombosis can occur elsewhere in the arterial system with a range of consequences determined by the extent of the thrombosis. The probability of developing thrombosis is determined by the ‘tendency’ of the blood to dot versus the natural ability of the blood to break down clots (fibrinolysis). These two counteracting “tendencies’ are influenced by a number of factors, including some dietary factors (most notably the effect of fatty fish or fish oils in the diet).
People who have gradually developed atherosclerosis of the arteries to the heart (the coronary arteries) may gradually develop reduced heart function. For a while the heart may be able to compensate for the problem, so there may be no symptoms, but eventually it may begin to fail. Shortness of breath may begin to occur, initially on exercise, and there may sometimes be some swelling of the ankles. Modern medicine has many effective drug treatments for heart failure so this consequence of atherosclerosis does not have quite the same serious implications as it did in the past.
*138\33\4*
WHR is a ratio of abdominal subcutaneous and visceral fat to hip subcutaneous fat. The measure is ‘anchored’ to a measure around the hips because it had been thought that this was less variable to change. Recently though, Canadian researchers at Laval University in Quebec have suggested that waist measures alone may be sufficient. WHRs (or other ratio measures used, such as waist-to-thigh ratio) generally have a cut-off point determined by epidemiological studies with large populations. Figures of 0.9 for men and 0.8 for women are often used as the cut-off points for WHR beyond which increased disease risk is indicated, but in some studies the figures of 1.0 and 0.9 respectively are used.
Some research has shown that with fat loss in some people, there is a loss from the hips as well as the waist and therefore WHR can remain relatively constant. For this reason it is probably best used as an absolute measure of risk in the first instance of measurement, rather than a relative measure of change, and is best used in combination with other measures such as BMI.
Attempts are currently being made to incorporate WHR and BMI into a single formula, but so far these have not added to the individual predictive value of either single measure. Waist measurements suggested by the Laval group as indicative of disease risk are above 100cm for men and 90cm for women—irrespective of height. Researchers at Glasgow University8 have compared waist measurements with BMI and have come up with the following conclusions for health promotion:
• men with a waist size of > 102cm and women with a waist size of >92cm should be encouraged to lose weight
• men with a waist of between 94-102cm and women with a waist of 80-88cm should be encouraged not to put on any more weight
• men with a waist size of <92cm and women with a waist size of <80cm do not need weight management.
WHR has a relatively high validity in the measurement of abdominal fat distribution, particularly in men and post-meno-pausal women, however validity may be affected by changes in hip size that occur with changes in body fatness. Reliability and sensitivity of waist measures alone is quite high, particularly in the hands of an experienced measurer.
Correct sites for measurement of waist and hips can vary and although there are currently attempts to standardise these, there is still controversy about the correct locations. There is general agreement that hips should be measured at the widest part of the buttocks as determined from side-on. Protocols for waist measurement include measures at umbilicus (the navel), which has the particular advantage of being easy to find, but the disadvantage of being almost at hip level in some obese women. Another waist site is mid-way between the lowest rib and the top of the iliac crest (hip bone), which has the advantage of bony landmarks but does not always capture the large abdominal mass in very obese people. In lean people the waist is the narrowest part between the chest and the hips but in obese people it can be the widest, therefore this is not recommended as a definition. Each has its disadvantages, but provided the measure is used constantly, the actual site becomes less relevant.
WHR and waist circumference measures have the advantages of being quick, non-intrusive and useful for large scale population surveys. WHR has disadvantages in making comparisons between varying groups of people such as is often seen in different cultural groups. Asian women, for example, have small hips and WHR measures are much less valid as an indicator of health risk. Negroid women on the other hand have large hips and buttocks and their health risk may be misinterpreted from WHR measures. Overall WHR, or waist alone, may provide a quick and simple indication of health risk. Waist alone can then be used to examine the success of a fat loss program in those groups where abdominal fat is stored readily.
*63\186\4*
Congenital heart disease occurs in six to eight babies for every 1000 born. Nobody is certain why it happens. In some cases, the mother may have suffered from a bout of rubella in the early days of pregnancy. But with widespread use of vaccination this is becoming much less common.
So-called chromosomal abnormalities may take place. This means there has been damage to the fine filaments in the cells, occurring soon after conception. Once more, the reason why this happens is usually elusive. If a parent or other member of the family has this disorder, there may be an increased risk for future babies. Certain drugs taken during pregnancy may cause some cases. X-rays of the mother during pregnancy may in some cases be responsible. But in most, there is no known obvious cause.
Severe cases may result in the baby perishing during the first year of life. However, in recent years enormous progress has been made in medical research, and many cases can be surgically corrected to allow the child to develop into normal adulthood.
There are many and varied symptoms, but as a general guide the following should alert a parent to seek medical advice promptly. It could indicate some kind of heart disorder.
The infant or child may show a poor weight gain, and there are commonly feeding problems. There may be attacks of fainting, or even blackouts. In young infants this may show up as sighing bouts, when the infant becomes pale.
The infant may have difficulty in swallowing and may have a tendency to regurgitate curdled milk. Or may have difficulty in breathing comfortably. Sometimes the mother finds that the little fellow is more comfortable if he bends backwards. Often the child may decline activity and normal exercises which are being enjoyed by his or her friends. The child may simply want to squat down and watch the others at play.
Some cases are accompanied by a bluish skin colour- called cyanosis. This may occur from a very early age. A check of the mother’s case history may indicate that during pregnancy she suffered from rubella or had various other abnormalities.
Treatment
Any suspicious symptom needs prompt medical attention. The paediatrician has the facilities and knowledge for investigating all kinds of heart abnormalities. In the first instance this medical specialist will be seen because the parents feel their baby is not well or not normal. It is then up to the paediatrician to initiate the investigations and tests that will give the correct diagnosis.
Many different kinds of heart abnormalities exist, and because they are intricate and detailed we cannot here go into a minute study of them. But they involve various, single or multiple defects. There may be narrowing of the entrance to the different vessels; valves may be deficient and defective. One side of the heart may be connected directly with the other side via holes which should not be present. Similarly, the large heart vessels may interconnect in the wrong places. These will all lead to symptoms, and an increasing strain on the heart and on the child’s health in general.
Left unchecked, many of these will cause a deterioration of health either rapidly or during a period of some years. The outlook, when untreated, is usually poor.
However, with correct therapy, which often involves surgery, the outlook has been revolutionized in the past few years and in many cases the future prospect is excellent.
*87\87\2*
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