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WHERE TO GET HELP: PRIMARY HEALTH CARE SERVICES

The general practitioner (GP) is usually the focal point of these community-based services. GPs are moving away from the old-style single-handed practice to more group work, often involving a number of doctors based in a health centre. These centers then become the base for the other primary health care workers and a focal point in the community. GPs are self-employed but come under the authority of the local Family Health Services Agency (FHSA). Government reforms of the NHS have encouraged certain GPs to become fund-holders. This implies a larger degree of financial autonomy and is only granted if the GPs concerned wish to apply, if their financial and patient base is big enough, and if they can demonstrate an understanding and competence of financial and management matters. It does mean that within certain restrictions the GP practice can operate more independently in a variety of ways (with the idea of benefiting the customers, i.e. patients). Running one’s own budget can improve services (the government’s intention). People have been worried however that patients seen as expensive would be deemed undesirable to fund-holding practices and either asked to find new GPs or get a less expensive service provision. There appears to be very little evidence of this but in cases of concern the patient or carer can contact the local FHSA to discuss the matter further in confidence (if discussing the issue with the GP fails to resolve the issue).
Until recently general practice was not seen as a very attractive career prospect unless working in a prosperous country area. This has now changed with new regulations requiring GPs to be specially trained. This usually takes the form of a 3 year vocational scheme, undertaken a year after qualifying and involving training in numerous specialties (children, the elderly, psychiatry etc.) A year is then spent in general practice under supervision. Many areas run organized schemes, while some doctors make their own. Increasingly many young doctors are being trained and then choose to remain in inner city areas improving the standard of health care to the population (often poor and with a high percentage of old people).
The government changes have also meant that GPs are being asked to meet certain targets (e.g. a certain number of children immunized) before full payment is given. This is meant to improve the overall standard of care. In addition, the government has insisted on the offer of an over-75 yearly screening programme. This means that every person over 75 must at least be offered a visit to check certain things: weight, blood pressure, hearing, eyesight, etc. Many GPs feel this is not a good use of their time as the pick-up rate is considered to be low. Many delegate this duty to the practice nurse and many practices do not follow up on the initial refusers.
The situation is complex and certainly not many new problems are uncovered if the government guidelines are strictly adhered to. GPs, however, are now in a position to widen the scope of the health check and include other services which may be of benefit, e.g. assessing levels of disability, depression, the possibility of abuse, etc. Good GP practices tend to offer good services, and as it is now easier to shop around and change GP, elderly customers should try and be more critical of the services on offer.
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HEALTHY EYES: STUDIES ON RK (RADIAL KERATOTOMY)

In September 1983, Spencer P. Thornton, M.D., director of research for the Eye Foundation of Tennessee located in Nashville, reported that a high success rate had been obtained in a series of patients undergoing radial keratotomy for myopia. “An overall average of 73 percent of our patients having between 2 diopters and 18.5 D of myopia attained 20/40 or better uncorrected vision,” he stated to the Biennial Canadian Contact and Intraocular Lens Conference in Toronto. Jean Robertson, a registered nurse and certified ophthalmic technician, assisted him in the collection of data.
The series consisted of two hundred consecutive patients who underwent operations after November 1979. The lowest degree of myopia was -2.00 D, while the highest amount was -18.5 D. The longest follow-up period was 3.5 years. All patients in the series were followed for at least one year. Approximately 71 percent of the patients had preoperative uncorrected vision of 20/400 or worse.
“Among those patients who had less than 6 D of myopia preoperatively, approximately 80 percent had improvements in vision to 20/40 or better without correction,” Dr. Thornton said. Postoperative acuity of 20/15 to 20/25 was achieved in 43 percent of the patients, and 75 percent of the total patient population was within + 1.00 D or -1.00 D of emmetropia.
In patients with myopia of -3.00 D or less, 86 percent had postoperative vision of 20/40 or better. Seventy-six percent of patients whose myopia ranged from -3.00 D to -5.00 D attained 20/40 vision or better postoperatively. In those with -5.00 D to -8.00 D of myopia, 68 percent attained 20/40 or better. Half of those patients with nearsightedness above -8.00 D attained 20/40 vision or better.
Only 2 percent of all patients had over-corrections of myopia that were more than +2.00 D of hyperopia (farsightedness) after one year. “There were no surgery-related complications that resulted in a loss of best-corrected visual acuity of more than one line in any case.” Dr.  Thornton said.  He noted that some patients have lost enough improvement in visual acuity to warrant a second operation. However, no patient has lost all improvement. Second operations were performed either to add more incisions or to deepen existing ones, he added.
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CHILD’S HEALTH/SPECIFIC PROBLEMS BEHAVIOURS: BREATH-HOLDING

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*

SUPER LOVE FOR SUPER SEX/LOVE-MAP LANDMARKS: DESCRIBE YOUR OWN “SEX

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*

HEAT PROBLEMS – INTRODUCTION

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 PILL – LOW-DOSE PILL

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*

BABY AND CHILDHOOD HEART DISORDERS: CONGENITAL HEART DISEASE

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*

BABY AND CHILDHOOD INFECTIOUS DISEASES: IMMUNIZATION AFTER CHILDHOOD

‘Are schoolgirls still given rubella vaccines?’ Jane asked.

‘They certainly are. It’s offered to any girl between the age of 12 and 14 years, usually soon after they enter secondary school. Again, a single injection is given, and this appears to give adequate immunity. Medical practitioners may also immunize girls and women in the childbearing years. However, it is advised that it shouldn’t be given to pregnant women or to any woman who may become pregnant within two months of immunization. But it’s available again to women in maternity hospitals immediately after they have been confined if they haven’t already been immunized.’

‘How about smallpox vaccine? Is that a dead topic, or still alive?’

‘It is now believed that smallpox, once a terrible killer, may have been virtually eliminated from the face of the globe. Many countries have relaxed their laws requiring vaccination. But a few are still holding on, and it is now only recommended for persons travelling to countries that specifically insist on vaccination.’

‘What about booster shots and all that? The story seems to be a never-ending one,’ Jane said.

‘It is certainly advisable to maintain immunity to those diseases which could continue to pose a threat,’ I answered. ‘For that reason, health commissions suggest that diphtheria and tetanus immunization be repeated at certain intervals—certainly tetanus should be reinforced every five to ten years, and definitely if a potentially infective wound is sustained. It’s better to be sure than sorry.’

‘Are there any others I should know about?’

‘Not really. Of course, if Sarah plans to visit various overseas lands when she grows up, protection against such diseases as malaria, typhoid, cholera and perhaps hepatitis are worth thinking about. We get reports of about 260 cases of malaria each year in Australia from overseas travellers—it is still a major killer disease in other lands.

‘However, let us now concentrate on the potential troublemakers that are knocking at Sarah’s front door,’ I said, pulling out my ball point pen and prescription pad. ‘Supplies for Sarah’s immunization still have to be obtained, for I prefer to use a fresh batch for every patient.’

*38\87\2*

PRIMAL THERAPY

Primal therapy was developed by Dr Arthur Janov, an American psychiatrist, in the 1970s, who noted that many patients uttered intense cries when they faced deep-seated and formerly repressed pain, typically associated with unfulfilled needs for parental love. These cries he named the ‘primal scream’.

Influenced by the Swiss psychotherapist, Alice Miller, who believed that children in many societies were ill-treated by parents and educators and consequently developed a false self, Janov developed a therapy which aims at dismantling neurotic defence mechanisms which the false self uses to protect the individual from the experience of pain. He believed that the ‘false’ or ‘unreal’ self begins to develop from around the age of six, and emotional and intellectual defence patterns have become fairly fixed by the teens. It is the job of the therapist, in a series of intensive sessions, to lead the patient into the ‘primal zone’, where the painful feelings of the suffering child within the adult can be brought into consciousness and integrated.

Since this therapy is so intense and often traumatic, it is important that a properly trained therapist be consulted.

*37\69\2*

CHILDREN’S HEALTH: EARRING PROBLEMS

Pierced ears frequently cause problems involving the earlobes. These problems not only are annoying but are occasionally serious. Three common earring problems are infection, eczema, and injury. Problems may occur if the ear piercer does not give proper instructions for care of the ears, or if the instructions are not properly followed.

Infection of the earlobes immediately after the operation may be caused by lack of proper sterile technique during the piercing. Infection occurring weeks later is usually from failure to leave “training” (post) earrings in place or to care for the pierced earlobes adequately.

Infections that occur after the first month are the result of improperly inserting the earrings. One common error is inserting earrings with posts that are too short for the earlobes. Another common error is pushing the guards in too far along the posts. Both of these mistakes cause pressure on the earlobes and injury to the skin; infection quickly sets in. Pulling down the lobe to insert the post can also cause infections. Pulling the lobe curves the straight channel the piercer has made and results in scratching the inside of the channel with the end of the post; the scratches then become infected. Sometimes infection is caused simply by inserting unclean earrings.

Eczema is a skin irritation. Eczema may develop on the earlobe if a person is sensitive or allergic to the metals used in inexpensive earrings. The skin of the ear-lobe becomes red, scaly, itchy, and sometimes infected.

The most common injury occurs when wearing hoop earrings during athletics and dancing. If a hoop is accidentally pulled or gets caught on something, the hoop can tear the earlobe neatly in half.

Signs and symptoms

Signs of eczema are redness, irritation, itching, and scaliness of the skin of the earlobe. Signs of infection are swelling, redness, lumps in the earlobes, tenderness, discharge, and rawness around the pierced openings.

Home care

At the first sign of any earlobe problem, remove the earrings. Then leave them out until the condition is corrected. Infection often is impossible to cure with earrings in place. If the infection is severe, the opening may heal closed and require re-piercing.

After removing the earrings, apply antibiotic ointment to the front and back of the lobes. Soak the earlobes in warm water.

If the irritation is severe, if the irritation does not clear up with treatment, or if there are signs of infection, see your doctor.

Precautions

• Ask the ear piercer for detailed instructions for care of newly pierced ears.

• Inquire whether the piercer will treat problems if they should occur.

• Leave training earrings in for one month after piercing. Turn them daily, and splash the fronts and backs with alcohol.

Medical treatment

Oral antibiotics may be required to cure infection. If the earlobe is badly cut or torn, plastic surgery may be necessary. The doctor may prescribe a steroid ointment if there is eczema but no infection.

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