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One of the important advances in asthma management has been the introduction of inhaled steroids. In normal doses, these have virtually no side effects, and certainly none of the problems that are associated with the long-term use of steroids taken by mouth.

Antibiotics have no place in the treatment of asthma, even though they may be prescribed (incorrectly). There is a misconception that because an attack of asthma is often precipitated by an upper respiratory tract infection, that antibiotics are useful in shortening the infection, and therefore the duration of asthma symptoms. However, the majority of infections that trigger acute asthma are viral in nature, and antibiotics will not affect them at all.

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YOUNG WIFE WITH MS

This disease of the lining of the nerves continues to be a mystery as to cause and cure (although some patients have responded to treatment with adrenocorticotropin). Of the 167 men with MS (again these were men that included patients not in the couples group) that I interviewed, 43 reported erective problems. Of the 133 women with MS that were interviewed, the most common sexual complaint (44) was alteration or decrease in clitoral sensitivity. Both men and women reported decreased interest in sex, but interest level varied greatly over time. This variance is probably due to the ever-changing course of this illness, with symptoms coming and going with litde or no warning. It is important for the MS patient to maintain intimacy, for the possibility of return of functions assumed lost always exists. One of my patients with MS stated, “I think MS stands for muddled symptoms. You never know what will happen. I’m MS because I’m much .mrprised most of the time.”

Some of the patients reported spasticity as a symptom and had stopped having sex because of this problem. Counseling focused not on drug treatment of this condition (which may exacerbate sexual problems), but on integrating the spasticity into the sexual relationship. “I learned that slow, gradual, easy, and tender is only one side of the sexual coin. Movement, rigidity, shaking, and other movements feel good, too. Once I learned that, my sexual anxiety went down. When that happened, my symptoms seemed to decrease.” This report from one of the husbands with MS illustrates the important interaction between feelings and symptoms in all disease, and emphasizes the importance of remembering that sexuality can help heal as much as be affected by disease. Sometimes couples can “use” symptoms and not merely try to overcome them.

“I am so tired most of the time,” reported one wife. “So we have learned to be still, to have slow-motion sex. It’s actually a turn-on. You should try it. We do everything at half speed, like a slow-motion film. When we stopped trying to do it like everyone else and do it like us, everything seemed to improve.”

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“I feel it. Well, I don’t actually ‘feel’ as much as I ‘experience it.’ It may be an ‘eargasm,’ or ‘neckasm’ or related to just a ‘cud-dleasm,’ but is clearly an intense orgasm. I really think I never had orgasm, at least not anything but physical orgasms, before I broke my neck.” This report came from a young skier who had injured herself in a fall several years ago. As I worked with her and her uninjured husband, they both reported a clear and distinct difference between physiological and psychological orgasms.

“I learned from her what it meant to really have orgasms, to really come. It wasn’t like just in one place … it was an overwhelming event. It sort of came over me instead of me coming.” Her husband had been freed to experience the difference between physiological reflex in reaction to genital stimulation and psychological experience through a shared body/mind experience.

Psychasm has been one of the most difficult of concepts for me to present at professional programs. “Orgasm is orgasm” is usually the argument, even though basic neurophysiolgy teaches that ejaculation and contractions are not the same as the full orgasmic experience. Discuss the issue with your partner. You will see that you are able to divide the physical from the psychological aspects of orgasm, and be able to take the “organ” out of orgasm.

*111\97\8*

In a similar way, your attention is not engaged in any of the normal functions of your body like digestion, metabolism, blood circulation, temperature control or growing nails.

It seems, that the body self healing described above is also a normal function, deserving no more of your attention than blood circulation, metabolism or growing hair.

It is easy to point out, that the body self-healing described above is not limited to cuts and bruises. On the contrary – it covers every possible organ and every possible function of our body.

Simple logic also suggests, that such healing occurs all the time, and every organ is actually continuously being repaired “on the go” – as required.

When the body performs such self repair without turning our attention to it, we feel healthy and comfortable. Everybody, including medical practitioners recognise such a situation as a state of good health. We feel happy and content, and we never think of seeking any medical advice. We also feel that whatever we do to our body in such a state is right.

A natural question arises: are there any limits to such healing?

Let us come back again to our example of a simple cut.

Again, simple logic supported by practical experience suggests, that the more damage is made to the body – the more difficult will be the corresponding repair job. When the damage is excessive, for example a limb is totally crushed or detached from the body, the healing process becomes extremely difficult.

The above description is a quite simplified explanation of the body self-healing process, which nevertheless offers a sufficient and quite convincing explanation for many of us.

*10\96\8*

But a doctor can hardly complain if he and other colleagues of his are booked by the policeman who once waved a doctor on his way, only to see him turn his car into the golf course and not into the hospital.

Patients often ask the doctor for a certificate stating they are ill so they can use up their sick pay from work.

To agree to do this when the patient is not, in fact, ill is a criminal offence, and the doctor is guilty of fraud, and such a charge is sufficient for the medical board to consider his deregistration.

And yet patients still ask their doctor to carry out this service and appear upset if he refuses.

Some patients go directly to a specialist without a referral, then come back to their own doctor later and request a referral dated prior to the appointment.

For in this way the patient gains a greater rebate from Medicare or his private fund.

The practice is illegal. It is perpetrating fraud. The patient may ask, but the doctor should always refuse. The patient should clearly understand the reasons why.

*478/71/1*

A short course of cortisone is often given to reduce the inflammation and nerve swelling. Most cases respond over weeks, or occasionally months, with no after-effects.

In about 3 per cent, complete paralysis persists. Partial paralysis remains in a little more than 5 per cent.

A hook attached to the teeth may be used to hold up the drooping edge of the mouth and prevent overstretching of the muscles until they recover.

Several operations have been devised to overcome the deformity of persistent paralysis. The “static sling” uses a strip of fascia — thin connective tissue, usually overlying muscle — to thread through the facial muscles and hook them to the bones of, and above, the cheek.

This tries to create natural folds of expression around the mouth and to make both sides look the same. As its name implies, the result is static. There is no muscle movement when the other side moves.

A considerably more ambitious procedure is a nerve graft.

*222/71/1*

Home care

A mild case of impetigo can be treated by scrubbing the crusts of the sores with soap and water, then applying a nonprescription antibiotic ointment at intervals.

Cover the affected area with gauze; this will help keep the child from scratching and spreading the condition.

Precaution:

-    Impetigo is highly contagious (catching).

-    Minor scratches and scrapes on the skin may invite impetigo; to avoid infection, clean such minor wounds with soap and water and cover them with a sterile bandage.

-    Keep an infected child’s clothes and from those used by members; this will help disease from spreading.

    Launder the child’s clothes frequently.

-    If home treatment for impetigo is effective, continue it until all the sores are completely healed; it can take a long time to eliminate the condition.

-    See the doctor if home treatment is not effective.

Impetigo is a highly contagious infection of the outer layers of the skin. It’s caused by staphylococcus and/or streptococcus bacteria. The germs are transmitted by direct contact when the child touches either an infected person or something that person has been using – for example, clothing, towels, or toys. The condition appears two to five days after the child has been exposed to the germs.

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1. Put your cheek against the person’s mouth and feel for breaths.

2. If breathing is not obvious, purse the person’s lips and try your cheek again.

3. Look for chest movements (though these may be difficult to see because of bulky clothes).

If breathing has stopped

1. Lay the person on the ground.

2. See if there is anything in the mouth (vomit, false teeth, foreign body, etc.) that might be causing obstruction. If so, remove it and lay him or her on his or her back. Kneel on the ground on his or her left side.

3. Pull the chin upwards so that the person’s neck is bent backwards. With your left hand pulling the chin up, push the top of the head down with your right. This simple procedure opens the airway at the back of the throat and may re-start breathing. If it does, put the person into the recovery position and stay with him or her.

If breathing does not re-start at once Start artificial respiration while someone else gets a doctor or an ambulance. The best method by far of re-starting breathing is the ‘kiss of life’ (mouth-to-mouth resuscitation).

1. Put the person on his or her back.

2. Tilt head back as far as possible (nostrils then point directly upwards at you), using both hands together.

3. Cup one hand under the chin.

4. Put the heel of the other hand on his or her forehead so that the fingers of that hand can pinch the nose.

5. Pinch the nose shut.

6. Make sure the mouth is open.

7. Take a full breath yourself.

8. Apply your mouth to the person’s, ensuring that there is a good seal all round.

9. Breathe into the open mouth firmly and slowly-don’t puff out hard. As you do this, the person’s chest will rise.

10. Take your mouth away, breathe in fully while the air escapes from the person and repeat the procedure.

11. While you are taking a breath in, the person will breathe out spontaneously.

12. Repeat the breathing into his or her mouth and watch for spontaneous re-starting of breathing as you turn your head away to breathe in yourself.

13. Try to ‘blow’ a breath into the victim about every six seconds. Be guided by common sense on this. For example, the first few breaths can be given much more quickly to get some oxygen into the individual.

14. Stop when the person shows clear signs of re-starting to breathe, but even then keep a close eye on his or her chest movements until professional help arrives.

Some useful hints

1. Don’t blow too hard as this may send air into the stomach and make the person vomit, which is dangerous for him or her and unpleasant for you.

2. Should vomiting occur, turn the person’s head to one side and let the vomit dribble out of the mouth. Clean out the mouth and carry on with resuscitation.

3. If a child is the victim, seal your lips over both nose and mouth after positioning the head as before. Only blow gently. Be guided by what produces a rise and fall of the chest wall. In babies, use only the amount of air you can hold in your cheeks-don’t blow from your lungs.

4. If the abdomen starts to swell up, you will know you are blowing air down the gullet into the stomach instead of down the windpipe. Stop resuscitation for a moment, turn the child to one side and press firmly over the swollen stomach. This will probably force the air out.

5. Check that the person’s heartbeat has not stopped by feeling in the neck beside the Adam’s apple for the carotid pulse from time to time.

How long to continue

Either:

Until the person starts to breathe easily again. Never try breathing into someone who is already breathing spontaneously. It can be helpful, though, to give the odd helping breath if he or she is gasping or breathing irregularly.

Or:

Until professional help arrives. This may take time, so get others to help you. Keep going until a doctor says the person is dead. Don’t give up too readily, especially in cases of drowning. People have been revived after an hour of resuscitation. Once breathing re-starts try not to let the victim die of hypothermia. Remove wet clothing, and wrap him or her in blankets or a sleeping bag. Never give alcohol (which will increase heat loss).

*142/72/5*