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Cold sores are quite common in older children as well as in adults. Cause

Cold sores are due to the Herpes simplex virus, which lies dormant in the body until it is activated by illness, sunburn, exposure to strong winds, or stress and fatigue.

Clinical features

Your child may complain of an itching or tingling sensation around the mouth, lips or nose, and tiny blisters may appear soon after. These usually crust over in 2-3 days but can become quite painful and interfere with eating and drinking. Cold sores generally disappear after 7-10 days, although some children tend to have recurrent episodes several times a year.

Treatment

Simple cold sores usually clear up without specific treatment. If your child is miserable, some paracetamol in recommended doses, may help to ease the pain. In general, creams or ointments do not help speed up the disappearance of the cold sores. Encourage your child not to scratch the sores, and to avoid kissing other people.

When to see your doctor

• if the cold sores are weeping or starting to spread. This may indicate

secondary, or bacterial infection, and antibiotic treatment may be necessary;

• if your child has a fever in addition to cold sores and is generally unwell

• if you notice sores inside your child’s mouth. This may be due to an initial herpes infection;

• if the cold sores prevent your child from drinking fluids as this may lead to dehydration, especially in younger children.

Prevention

Cold sores are highly contagious, so avoid having your child kiss other people. Avoid direct sunlight and exposure to strong winds.

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Making your house safe has two main advantages. Firstly, it decreases the chances of injury to your child and secondly, it lessens the chances of breakages around the house and subsequent anger and frustration on the part of the parents.

When your child is aged about 6 months, just before the age when he becomes mobile, it is a good idea to work your way through the house consciously and systematically and make sure that it is safe for a young child. The checklist below may be useful. You can check off items with a pen as you do them. Do not wait until there has been an accident or breakage — do it now.

• Electrical outlets: put plugs on power points, and curly cords on electrical appliances; install safety switches.

• Cabinets: check kitchen and bathroom cupboards to make sure that poisons and dangerous materials are out of reach, especially those that are sharp, heavy or breakable. Consider locks for the doors of some cabinets, or the purchase of a medicine chest which can be locked.

• Doors: consider door barriers and latches for doors that restrict the child’s access to the outside or to rooms where he can get into trouble.

• Install fire guards, and check heaters and stoves to prevent burns and scalds.

• Place cigarettes, matches, lighters and ashtrays out of reach.

• Check furniture for sharp angles and corners.

• Consider using table mats instead of tablecloths.

• Re-position things that your child can climb on.

• Put away all fragile, breakable and precious objects.

• Safety barriers: put safety barriers on stairs (at the top and bottom).

• Window latches: consider window latches to prevent your child from fully opening them and falling or climbing out.

• Fire extinguishers: consider purchasing a fire extinguisher and have it handy in the kitchen.

• Smoke detector: install approved smoke detectors at strategic positions throughout the house.

• Swimming pool: make sure that the pool has an approved child-resistant fence all around it.

• Gates: make sure all gates around the house have child-resistant latches and/or locks.

• Poisons: make another trip around the house to make sure that all poisons, detergents, dishwashing powders and liquids, medicines, tablets, are safely out of reach. Check the bathroom, kitchen, laundry, garage and bedrooms especially carefully.

• Keep all plastic bags out of reach.

• Take the doors off old fridges in the garage

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At those times when we are running “hot,” when we are feeling hostile, impatient, competitive, and suffering from “hurry illness, “we are in a phase of what I call maladaptive hyperarousal. My interviews indicated that asking about how people were “running” in this regard led to more information than asking how their genitals were working. In “diagnosing” your sexual relationship, ask first if the two of you seem on a “hot” cycle of personal and marital pressure: excessive responsibilities, and feelings of too much to do in too little time, of hyperreaction and agitation.

If you are running hot, your neurohormonal system runs hot too, and the biochemistry of your sexual system interferes with your natural sexual reflex system. These are the hot problems that might result:

MALE

Seminal seepage (losing ejaculate without contractions)

Hyperarousal

Ejaculatory urgency (feelings of not being able to control pelvic contractions)

Shortening of refractory period

Absence of psychasms

Diminished afterglow

Hypersensitivity of F- and/or and R-area response

Diminished contemplation

Pelvic reflex addiction or maladaptive hypersexuality (loss of intimacy)

FEMALE

Skene’s glands or urinary emission without contractions

Hyperarousal

“Emission” urgency (feeling of not being able to control pelvic contractions)

Shortening of refractory period

Absence of psychasms

Diminished afterglow

Hypersensitivity of G- and/or C-area response

Diminished contemplation

Pelvic reflex addiction or maladaptive hypersexuality (loss of intimacy)

All of these “hot” problems are natural responses to daily living styles. There is no reference to lack of orgasm or psychasm in intercourse because the couples reported that coital orgasm was not a major concern. They learned to focus on their feelings and interactions in the general sexual relationship and the interaction between sex and living. They were trying to learn “who,” not “what” was the matter with their sexual life.

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You’d think it would be great for us in bed. But somehow we just don’t mesh. It doesn’t work out. It’s not a Dr. Ruth problem, jusi that something is missing.

WIFE

As a review of this chapter and to get ready for the following lessons in super marital sex, I have provided a brief quiz for you and your spouse. Discuss each item together and score your marriage on a 0-to-10 scale. Scoring 100 points could mean two things. First, you are completely free of the pressures on American marriage I have discussed. Second, you are cheating on this test! We all have these pressures. The idea is to begin to reduce them to make way for a super marriage.

This test and others you will be taking in this book are based on a scoring system of degrees, not yes or no. All systems, particularly marital systems, change. Just the fact that you are taking a test on your marriage changes your marriage. Score and discuss each item in degrees, trends, indications, not absolutes. It will take some time for you to get used to this type of scoring, but learning to see your relationship as an adapting system is a major step in strengthening your marriage and helping it function in harmony with the rules of all world systems.

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Acute bronchitis, like most of the other respiratory infections, may be due to either viruses or bacteria. It usually involves the trachea or windpipe first and then moves down to involve larger and then smaller bronchi. It may follow such illnesses as measles, influenza, whooping cough or typhoid fever.

There is a moderate fever with a cough, initially dry and then productive of sputum and sometimes, a wheeze. The condition can worsen and lead to bronchopneumonia.

Chronic bronchitis is not an infective disease. It is a condition where there is a marked and chronic increase in the amount of secretion by the bronchial tubes. Sputum is coughed up continuously. The illness is caused mainly by smoking and atmospheric pollution.

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Coronary artery disease has reached epidemic proportions in most of the highly developed countries. The risk factors are well known, but we have not accepted them nor taken steps to reduce their influence.

Once this disease is established, the treatment is mainly medical. Over the past 15 years, a surgical technique to improve the outlook has been developed. This is coronary bypass surgery.

In the past, operations to transplant arteries from the chest wall into the heart were tried and then abandoned as of no value.

This new operation has proved to be worthwhile and around 1400 are being done in Australia each year.

There are three main coronary arteries and any, or all, may be involved in the atheromatous changes and narrowed.

What is done is that a vein, usually the long saphenous vein from the leg, is taken and implanted into the aorta. The other end is joined to the coronary artery below the narrowed portion.

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Circumcision just before or during puberty may produce considerable emotional disturbance.

Some psychiatrists talk of the psychological shock to the infant circumcised without anaesthetic but this is difficult to prove.

Your doctor is not being irresponsible if he carries out your request to circumcise your son. Many doctors still consider this a necessary procedure. Others have no strong feeling either way and will agree to operate if the parents wish, but will not recommend it. Others are strongly opposed to circumcision and will not accede to the parents’ wishes. As in other areas of medicine, there are different views on what is correct treatment.

If circumcision has been the habit in your family, discuss with your doctor whether you should go ahead and have your son circumcised. You have the right to request it but your doctor also has the right to refuse if he does not think it necessary.

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Symptom

Scaly, red rash

Home care

Apply a nonprescription antifungal ointment to the infected area until the skin is clear. If you do not know which preparation to use, ask your doctor.

Precautions

-    If a rash does not improve with home treatment, see the doctor. The rash may not be ringworm at all.

-    If home treatment seems to make the rash worse, discontinue treatment and see the doctor. The child’s skin may be sensitive to the medication you’re using.

Ringworm is actually a skin infection caused by a fungus. Ringworm spreads by direct contact with an infected person or pet animal, or by indirect contact with contaminated objects such as combs, pillows, towels, clothing, even the floor.

Signs and symptoms

Different funguses prefer different areas of the body. Ringworm of the scalp (tinea capitis) appears as scaly patches with stubs of broken-off hairs on the scalp. Ringworm of the body (tinea corporis) shows up as round or oval red, scaly patches that enlarge while healing proceeds from the center. Ringworm of the groin (tinea cruris) is characterized by a red or brown scaly rash on the crotch and the genital area and has a sharply defined margin of spread. Ringworm of the feet (athlete’s foot, or tinea pedis) affects the feet and sometimes the ankles and legs. The diagnosis of ringworm is based on your child’s history and close inspection of the rash. The diagnosis is confirmed by laboratory tests.

Home care

Antifungal ointments such as haloprogin, chlortrimazole, tolnaftate, and undecylenic acid ointments can be applied to the infected area until the skin clears.

Precautions

• Several other common rashes resemble ringworm. If a rash does not improve after several days of home treatment see your doctor.

• The preparations used to treat ringworm may cause another rash on sensitive skin. If the rash worsens or changes in any way, stop home treatment and see your doctor.

Medical treatment

Your doctor can confirm a home diagnosis of ringworm by examining your child’s rash under ultraviolet light, and by culturing a skin scraping and examining the results under the microscope. The doctor may prescribe an antifungal ointment to be applied to the skin, or a medication such as griseofulvin fungicide for the child to take by mouth.

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