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.

*248\90\8*

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.”

*284\97\8*

“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*

Culdoscopy can be a somewhat tricky procedure, requiring experience and skill. A small incision is made in the vaginal wall into the abdominal cavity and a pcriscopelike instrument if inserted through it, offering a view of the uterus, ovaries, and the fallopian tubes. To make ‘hat incision, a woman must remain in a slightly awkward position that requires some other conscious control and cooperation. Because of this positioning, she is not put under general anesthesia.

*47\43\4*

It used to be thought that all melanomas occurred in preexisting moles. The majority of melanomas, however, appear on blemish-free skin, with only about 25 per cent arising from moles.

Australia has the highest incidence of melanomas in the world. Approximately 3500 melanomas are expected to be diagnosed this year in Australia alone. In Queensland, where the majority of cases are found, the annual incidence has doubled from 16 per 100 000 population in 1966 to 33 per 100 000 in 1977. Since 1936, there has in fact been a six-fold increase. This reflects a world-wide trend.

The cause of the melanomas is unknown. However several important observations throw some light on possible causative factors. Genetic studies show that people of Celtic origin, such as the English and Irish (particularly those people with red hair, fair skin and blue eyes), are far more likely to develop a melanoma. The tumour is most uncommon in black races. Hormonal factors also appear to be involved, as females are more prone than males. Furthermore the tumour is extremely rare before puberty. Environment, as you may expect, plays an important part in the development of melanomas. There is considerable evidence that prolonged exposure to sunlight plays a central role in determining the frequency of melanoma. The closer to the Equator, the higher the incidence. This is as true in Europe and America as it is in Australia, where the incidence of melanoma in Queensland is greater than in the southern states.

The earth’s surface is partially protected from the sun’s ionizing radiation by a layer of ozone. This ozone layer is thinnest at the Equator and thickest at the Poles. Over recent years it has, however, been decreasing in thickness, due to the increased use of fluorocarbons. These gases have their sources in industry, car exhausts, spray packs, and supersonic aircraft. Also, at times of increased sunburst activity, there seems to be a concomitant increase in the frequency of melanoma.

The majority of melanomas in males are found on the back, and in females on the leg. However there is an increasing tendency to develop them on the head and neck. There seems little doubt that this distribution, and the increased incidence, must be related to changing fashions and values. Years ago both sexes wore far more protective clothing, in the form of long sleeves, skirts, and hats. Nowadays the quest is for the beautiful brown body. Consequently, the less clothing worn and the more holidays taken in the sun, the more successful you will appear in this quest. Equally, the more likely are your chances of developing this killer disease.

Since a quarter of all melanomas arise from a preceding mole, it is important to know which characteristics in a mole should arouse suspicion. One of the earliest signs of trouble may be an unusual tingling or itchiness in a normally symptomless mole.

Any colour change is suspicious. This may be a darkening, lightening, or simply a variation or irregularity in colouration. A red ring or inflammation around a mole should also be heeded. Similarly, any significant change in shape is important. This may be increased nodularity, enlargement, extension at one side, or ulceration. Obviously if a new ‘mole’ appears well after adolescence, then it should also be viewed with suspicion.

If your doctor suggests a biopsy of a suspicious mole, do not hesitate to have this done. It does not affect the course of the tumour, whether the biopsy is partial or complete. The important thing is to act quickly. When such changes as mentioned above are heeded and medical attention sought, the prognosis is infinitely better than if they go unrecognized or are ignored.

*74\44\4*