RECOMMENDATIONS FOR TREATING BDD WITH AN SRI: DON’T GIVE UP ON AN SRI UNTIL YOU’VE TRIED IT FOR 12 TO 16 WEEKS, WHILE REACHING A HIGH ENOUGH DOSEIt’s also important to try the SRI for a long enough time. Taking the SRI for 12 to 16 weeks, and reaching a high dose (unless a lower dose works for you) for at least 3 of those weeks is called an “adequate” trial. If you don’t take a high enough dose, or if you don’t try it for long enough, the SRI trial is considered “inadequate.” In other words, it may not be sufficient to successfully treat BDD.In most published BDD studies and in my clinical practice, people needed to take an SRI, on average, for 6 to 9 weeks before BDD symptoms substantially improved. In my fluoxetine (Prozac) study, two thirds of people substantially improved (i.e., “responded”) between the 4th and 11th week of treatment. In my fluvoxamine (Luvox) study, two thirds improved between the 3rd and 10th week of treatment. However, in my citalopram (Celexa) and escitalopram (Lexapro) studies, people responded to the medicine, on average, after only 4 to 5 weeks (two thirds responded between weeks 1-2 and 7-8). So some people respond to an SRI within several weeks, whereas others have to try it for as long as 12 weeks—or occasionally even 16 weeks—before they respond. This means you’ll need to be patient and wait for the medicine to work. But don’t get discouraged: it often does work!It’s worth emphasizing that these numbers and recommendations are based on studies that increased the SRI dose, and reached the high end of the dosing range, fairly quickly (see the examples above). If you raise your SRI dose more slowlv (i.e.. if vou take more than 9 weeks or so to reach the maximum recommended dose), you may need more than 12 to 16 weeks to get better. If you haven’t gotten to a high enough dose by week 12 to 16, it’s usually advisable to try to raise your dose at that point to see if a higher dose works better than a lower dose. But if you’ve already reached the highest dose recommended by the pharmaceutical company, or the highest dose you can tolerate, by 12 to 16 weeks—and if you’ve been on that highest dose for at least 3 weeks—then it’s probably best to make a change by switching to another SRI or adding another medicine to the SRI. I often see patients who’ve tried lots of SRIs without getting better. A common problem is that they tried the SRI for too brief a time (e.g., only 4 to 8 weeks). In my fluoxetine study, nearly half of the people who eventually responded to the medication still hadn’t responded by the 8th week of treatment. This was the case for one third of the people in my fluvoxamine study. These people generally responded between weeks 8 and 12 of treatment. In addition, many people I’ve seen who didn’t respond to a past SRI never reached a high enough dose. Often such patients have been diagnosed with depression while their BDD was missed. Because their BDD wasn’t recognized or diagnosed, it wasn’t effectively treated. For many, depression didn’t improve either.*258\204\8*

ASTMA IN CHILDREN:THE IGE ANTIBODYThe primary function of the IgE antibody was to provide protection against parasites. Through evolution, the IgE antibody has become harmful. It now overreacts to common everyday substances in the environment.Some individuals who inherit a tendency to overprodtice IgE antibodies, develop an allergic condition such as asthma, hay fever, or food or drug reaction.If a person who produces excessive amounts of antibodies becomes allergic, the IgE antibodies attach themselves to certain cells called mast cells. Millions of these mast cells line our skin, nose, intestines, and bronchial tubes. These mast cells are like a loaded gun waiting to explode. When an invader (antigen or allergen) enters the body and comes into contact with the IgE antibody on the surface of the mast cells, the cells explode, releasing powerful chemicals, also called mediators, into the surrounding tissues. The surrounding tissues get inflamed and swollen.When the mast cells explode, and inflame the surrounding tissues,… in the nose, we sneeze… in the skin, we itch or get hives… in the lungs, we wheeze or develop asthma.The release of this chemical (mediators) causes muscle Contraction, oedema or swelling, and increased mucus secretions in the bronchial tubes. At the same time a signal is sent attracting more cells like eosinophils to the wall of the bronchial tube. This leads to further inflammation, muscle scarring, contraction and even tissue destruction. The bronchial tube becomes sensitive to just about everything that comes into its contact. Such a stage of hypersensitivity is called hyperresponsiveness.Any kind of inhaled stimulus, such as air pollutants, chemical odours, and tobacco smoke, causes the hyperresponsive bronchial tubes to react, thus triggering cough and/or wheeze.*16\260\8*

Mothers often complain that their babies become constipated when they are fed brown rice gruel. It may well be that babies are more sensitive and that rice is more constipating than barley gruel, but because of its nutritional value it should not, on any account, be left out of the child’s diet. The constipation can always be counteracted by natural means. Ground linseed is very good for the bowel action and should be added to the brown rice gruel. The amount to be used depends upon the child’s reaction, but half a teaspoonful will usually be adequate. In this way the child will not be deprived of the goodness of brown rice.

Whole rye also makes a nutritious gruel. It may not be quite so creamy but it is certainly valuable, especially during teething. Rye contains not only calcium but also calcium fluoride, which is essen­tial for the development of tooth enamel.

The best programme is to feed the baby alternatively rice, rye, barley, oat, perhaps even millet and buckwheat gruels, together with various juices, either carrot or fruit. Care must be taken, however, not to mix vegetable juices with fruit juices. In fact, it would be wise to avoid using more than one kind of fruit juice per meal, since sensitive babies may have difficulty in digesting the mixture. It would be better to mix one fruit juice with almond cream. This may be available already prepared from health food stores or can be made by grinding some almonds very finely and crushing them with a pestle and mortar; then mix with water in a blender. Mix the almond cream with the fruit juice in a blender and you will have the best food not only for your baby but even for older children and adults. Babies with cradle cap (see below) should definitely be put on almond milk, and if you want to clear up the condition, Violaforce and calcium must be added to their diet.
*67/28/1*
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For normal development and effective resistance to disease in the years to come, the foundation laid by breast-feeding is of the greatest importance to the baby. Experience and medical statistics prove that breast-fed babies recover from children’s diseases much more easily and with fewer complications than bottle-fed children of a similar constitution.

Young mothers are sometimes unhappy and nervous when the flow of milk does not appear on the very first day. But it should be remembered that this would be quite unnatural as the baby should not receive any food during the first twenty-four hours of life. At the beginning, the breasts produce only the highly nutritious colostrum; the actual milk does not appear before the third, and sometimes on the fourth to the sixth, day. So, young mothers, do not despair when things do not immediately turn out in the way you may have expected. Later, if your milk supply is not enough to satisfy the baby, a few drops of Urtica every day, or a few tablets of calcium complex with Urtica (Urticalcin) will help the flow.
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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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