Impetigo is the name given to sores on the skin which have become infected. These are usually scabbed over and often drain pus. They can spread rapidly to other parts of the body and are also highly contagious.

Cause

The surface layers of the sore are infected with a germ (either Streptococcus or Staphylococcus aureus). Because the skin is broken it cannot serve as a barrier against these germs, and so they ‘feed’ on the wound.

Clinical features

In the early stages you may only notice red blebs or blisters anywhere on your child’s body, although they are especially common around the face, hands and legs. These spots may become pus-filled and scab over as they spread. The scabs are usually a yellow-green colour, and soon increase in number.

Investigations

If treatment is not progressing well, your doctor may suggest a swab (or brushing) of the affected area to identify both the germ, and the antibiotic which will be effective against it.

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Many health professionals are involved in the care of children. Virtually every child will periodically visit a general practitioner, who will assess and treat the common illnesses that are an inevitable part of childhood. Most children come into contact with other health professionals, although less frequently.

Listed below is a who’s who of professionals your child may need to see, together with a brief description of what each one does.

General Practitioner A doctor who looks after the whole range of illness in adults and children. All GPs will have had some training in child health as part of their undergraduate training. There is currently no requirement for any additional training in paediatrics, and many have not had any additional training in this area. Others will have had 3 months or more of additional training in paediatrics.

Paediatrician A doctor who has done a minimum of 6 years’ training in paediatrics and has passed postgraduate examinations in this field after qualifying as a doctor. General paediatricians are involved with the more general aspects of child health, on a consultant basis. This means that the child is referred for consultation by the GP or another health professional.

Many paediatricians specialise in a particular area of paediatrics:

anaesthetist – puts people to sleep for an operation

cardiologist – heart

developmental paediatrician – child development

endocrinologist – endocrine glands (e.g. thyroid)

gastroenterologist – gastrointestinal system, including the liver

haematologist – blood

immunologist – the body’s immune system

neonatologist – newborn babies

nephrologist – kidneys

neurologist – the brain and nervous system

oncologist – cancer

ophthalmologist – eyes

orthopaedic surgeon – bones and joints

otolaryngologist (ENT surgeon) – ear, nose and throat pulmonologist (respiratory paediatrician; – lungs rheumatologist – joints and limbs urologist – kidneys and urinary system.

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SEXUAL PROBLEMS – DECREASED AROUSAL

I can tell you now that I have lost my sex drive. I just don’t feel like it, want it. or really even want to talk about it.

There isn’t much time for that sort of thing anymore. My mind and feelings are on the kids right now.

The first report was a wife’s, the second from a husband. Five hundred eighty-eight men and 678 women in the sample reported some problem with the arousal axis of the sexual-response system. Some of these same persons at times experience hyperarousal as well, so life phase was an important predictor of sexual response. Most clinicians report that diminished sexual arousal (what they call sex drive) is the most frequent sexual difficulty. I found that there was no one dominant problem and that no one problem stood alone. At cold times, sexual arousal cools down as much as it may heat up at hot times.

A word of warning here. The hot and cold dimensions overlap. You can, as I have said, be “hothy cold” or “coldly hot.” You can be as vigorously depressed as you can be passively agitated. At such times, the apparently “cold” person may be showing the “hot sex problems,” including hyperarousal, while the apparently “hot” person may be displaying the “cold sex problems,” including diminished arousal. In operating your own sex clinic, and particularly at this step of understanding your marital relationship style and any areas you both wish to correct or enhance, you may want to read my book Superimmunity, in which I describe hot and cold life-styles and provide several tests related to these orientations.

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The crises we have had seem to have-strengthened us somehow. We get better at solving things as we go along.

HUSBAND

With every setback, our marriage is set back. We just can’t take much more.

MALADAPTIVE:

CRISES WEAKEN MARRIAGE, LOSS DRAWS SPOUSES APART

WIFE

ADAPTIVE:

MARRIAGE IS STRENGTHENED AT TIMES OF LOSS AND OTHER CRISES

012345678 9., 10

TENDING TOWARD    TENDING TOWARD

ADAPTABILITY    MALADAPTIVENESS

Think of the major crises your marriage has been forced to cope with. Loss of a parent, a sick or handicapped child, loss of job or other major setback. Did such events actually seem to help your marriage (adaptive)? Or did they tend to weaken it (maladaptive)?

You may find it difficult to understand how a marriage could be “too” adaptable, but the issue of room to grow explains this possibility. “Premature adaptability” excludes the newness, freshness, and challenge necessary for personal and relationship growth, much as speaking for a child can delay and sometimes permanently restrict language development for that child. All growth depends upon periods of stress within the system, times where everything seems out of whack, when adjustments must be made.

The couple in my example scored toward maladaptive. A recent work problem for the husband resulted in a severe marital argument, almost to the point of violence. “Damn it, what does she think? I have this terrible thing happen to me through no fault of my own, and she wants to go that night to visit her mother in the nursing home. Sure, I put my hand through the bedroom door, but it’s only a thin door,” said the frustrated husband.

The wife added, “He’s done that before, when his Uncle Ned died. We just can’t handle these kinds of things. I need help, too. My mother was all alone in that place, and all he can think about is his job. We might as well not be married. We deal with things alone.”

Their sexual problems also had drawn them even further apart. The wife reported that she was inorgasmic and had pain during intercourse. The husband had consulted sex manualsand diagnosed himself as a’ ‘premature ejaculator.” He looked to what was wrong with him, not what might be wrong with the marital system.

The wife said, “I’m like a rubber doll to him. Sex is rare because it hurts and just verifies each time how bad the problem is, how much pain there is in our marriage.”

The husband reported, “Instead of trying to help, she actually loves it that I come too soon. It sort of saves her the time and problem of having sex too long with me.”

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The condition where the fingers go cold, white or blue in response to exposure to cold is called Raynaud’s phenomenon first described by Maurice Raynaud, a medical professor in Paris, in 1862.

We now call Raynaud’s disease only those cases which appear to occur spontaneously and use the term Raynaud’s phenomenon for those where there is a definite underlying cause.

The disease is more common in young women but young men are also affected. The nerves which control the arteries of the fingers appear to be oversensitive. The arteries may go into spasm and prevent any blood flow under a variety of stimuli.

This may be exposure to cold such as going out in cold weather, putting the hands in cold water or just reaching into the refrigerator. Emotional factors may also play a part.

Raynaud’s phenomenon may occur in a number of potentially serious disorders such as systemic lupus erythematosis, polyarteritis nodosa and scleroderma. These are usually regarded as auto-immune diseases, where the body, as it were, develops allergies to its own tissues, producing antibodies which cause inflammation. The blood vessels are involved in this inflammation.

Buerger’s disease involves inflammation of both arteries and veins and is believed to occur only in smokers. Workers using vibrating tools may develop Raynaud’s phenomenon after many years.

Treatment consists in treating the underlying cause, if there is one. Some cases may respond to the use of drugs to dilate the arteries. Cutting the nerves which constrict the vessels may be of some use.

Most cases of Raynaud’s disease require no treatment, only care in avoiding the precipitating factor of cold exposure.

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The person may feel that no one really cares for him. He may blame others for his problems. The depression may deepen and self-pity turn to self-blame and guilt.

He feels he is letting down his family, his employer and his friends. He assumes he is worthless and nothing can help him.

Depression may not get deeper but may arrest at any level or persist for many years. Some people are chronically depressed.

Depression may be masked and thus not recognised by doctor or patient. This is more common in those individuals who cannot accept the idea of emotional illness and regard it as a sign of weakness.

This depression may show more in physical symptoms. Pain, particularly chronic pain, may be the means of a person expressing his underlying depression. This pain is real, not imaginary or a form of malingering. The doctor may recognise that the patient is depressed but believe the depression is the result of the chronic pain rather than the cause of it. Treatment of the depression will usually relieve or minimise the associated pain.

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Diphtheria, the severe disease of childhood, is now rare, mainly due to widespread immunisation.

But we should not be complacent and neglect to immunise our children as isolated outbreaks still occur, especially in unimmunised children, and the germ is still common, even if the infection is rare.

Some people, especially adults, while not actually developing the disease, may be carriers and cause its spread. They harbor the bacterium in their nose and may infect unimmunised people.

Many adults have a waning or poor immunity to diphtheria, but can be “boosted” by having an injection. Diphtheria vaccine is combined with tetanus vaccine and is available to adults.

When having a tetanus “shot” to bring this immunisation up to date, it would be valuable to have a “shot” of adult CDT, that is, combined diphtheria and tetanus vaccine.

Triple Antigen is the usual vaccine given to babies. This contains vaccines against diphtheria, tetanus and whooping cough. The whooping cough vaccine is prone to cause reactions in older children, so is dropped from the vaccine for this age group and CDT, combined tetanus and diphtheria vaccine, used instead.

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Without effective treatment, the primary cancer continues to grow at a fairly steady rate, pressing on, and eventually growing through, nearby structures. Sooner or later, nearly all untreated

or unsuccessfully treated cancers give rise to secondary growths.

For each particular type of cancer, there is a characteristic or average pattern. For example, a cancer starting in the bone usually spreads through the bloodstream very early, and the first

secondary growths are nearly always in the lungs. A cancer starting in the bowel usually takes quite a few months before it metastasizes. It then generally goes first through the lymph

channels and next through the bloodstream. The first blood- borne secondary growths usually appear in the liver. Of course, as with all averages, we do not see the same pattern in every

individual. One person with a bowel cancer may not have any warning signs of the disease until a complete blockage of the bowel develops. At the operation, the surgeon may find no traces

of cancer elsewhere. Another person with exactly the same size primary bowel cancer could have multiple secondary growths in the liver, with no symptoms at all from the primary tumour.

Everyone is different, but there are average or usual patterns to guide you and your practitioner in best planning your tests and treatment.

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