NORMAL SLEEP PATTERNS: NEWBORN
The newborn sleeps for 18 hours a day or more, usually in spells of 2 to 4 hours at a time, and awakes only if he is hungry, cold, or otherwise uncomfortable. For the first few weeks of life, it is very difficult to ‘read’ the baby’s behaviour and sleep patterns. He is making a huge transition to the outside world and will be affected by such factors as his level of maturity (whether the baby is premature), any drugs given to the mother during labour, the delivery itself, and so on. Mothers often find it difficult to interpret signals from a newborn baby, and it takes some time, varying from days to many weeks, to settle into any sort of pattern or rhythm. This period of being unsettled can last considerably longer if the baby was very premature or has medical problems during the newborn period. A newborn baby tends to sleep very soundly and is not easily awakened by loud noises or body movements in the way that an older child is.
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GENERAL LACK OF ENERGY/FEELING TIRED ALL THE TIME – NERVOUS TENSION
Nervous tension may be playing some part in producing your lack of energy, especially if you are refusing to acknowledge or express some of your real feelings. It is when you try to force natural feelings like anger, sadness or anxiety underground that they are likely to surface in the form of unpleasant symptoms like extreme tiredness. Don’t force yourself to appear bright, cheerful and optimistic when you don’t really feel like that at all. Talk about and express your feelings—let them out and share them with your loved ones. I am sure that you will all have more energy to deal with what is happening if you can do this.
Try not to burn up energy raging against things that cannot be changed. Use what energy you have positively, to make the most of your situation. If you can no longer manage activities that have been important for you, think about whether you can modify them in some way so that you can manage. Ask for help— obstinately insisting on being independent could mean that you will miss out on some things that you could have managed with a bit of help. Look for appealing alternatives that are within your capabilities. In short, try to make the most of the time and energy that you do have. It is actually quite likely that you will gain energy as a result!
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FRACTURES – DESCRIPTION
A fracture is a broken bone; it may be complete or incomplete, as in a greenstick fracture in a child. It is recognised by pain, swelling and loss of function but sometimes this last sign is not present. Just because somebody can still move his fingers does not mean that the wrist has NOT been broken.
Fractures may be complicated by causing damage to arteries and nerves, or compound, that is involving lacerations or exposing the bone. With large fractures there is always marked loss of blood internally (so you can’t see it) and the risk of shock is present.
The essence of first aid treatment is to immobilise the fractured bone. Don’t try to straighten a crooked limb — splint it as it is.
Splints are easily improvised. Strap one leg to another or one arm to the side of the body, or put one arm in a sling. A piece of wood, a stick, even a ruler, bandaged against the broken limb will do to immobilise the ends of the broken bone.
All suspected fractures must be seen by a doctor. FINGERS
These may be splinted with bandages, or by strapping to the adjoining fingers. BONES OF THE ARM
May be immobilised in a sling, or strapped to the side.
CLAVICLE (COLLARBONE)
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GALLSTONES – TREATMENT
At times, it is necessary to open and explore the common bile duct, as when there is a history of jaundice or if there are indications at operation that a small stone may lie within the duct.
When the duct is explored, it usually extends the stay in hospital to 10 to 14 days.
In the past, quacks often gained a reputation for themselves by claiming to cure gallstones. Their potions usually consisted of one part of oil and another of alkali. These reacted in the bowel to form a soap which collected as one or more pellets.
When these were passed in the motion, the quack claimed he had rid the person of their stones.
While researchers have long sought to dissolve stones, rather than operate, it is only recently that this has become possible.
Chenodeoxycholic acid (CDC) is a naturally occurring bile acid which can be given by mouth in large quantities and can both prevent and dissolve the cholesterol stones.
It only works for these rather than the pigment or mixed stones and, even then, is only effective in about 20 per cent of cases, although up to half the stones may be reduced in size.
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EXCESSIVE BODY HAIR – GENERAL INFORMATION
Shaving is probably the most used method and can be done by a blade or an electric shaver. While most women seem happy to shave their legs and under their arms, they have a reluctance to shave their faces, perhaps because it seems unfeminine.
Many still believe shaving tends to increase hair growth and to make it coarser. Tests have shown that hairs cut across by shaving have a stubbly appearance and feel, but do not become thicker or harder.
Chemical means of removing hairs are available and effective. They may irritate sensitive skins and have little benefit over shaving, except that the regrowth does not feel as rough as after shaving.
Plucking the hairs is the most popular means of reducing the number in the eyebrows and is effective elsewhere. It is painful and may lead to irritation of the follicles.
Electrolysis or burning out the hair follicle by an electric current is a popular method of treatment. If the hair follicle is destroyed, there should be no regrowth and permanent cure results, but this is not easy to achieve.
Repeated treatments are usually necessary and some hairs in their “resting” stage may not be destroyed. This method may lead to inflammation and even to scarring or an increase in pigmentation.
So there is no one satisfactory method of clearing those unwanted and unsightly hairs.
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EXPRESSIONS USED TO DESCRIBE EFFECTS OF TREATMENT – WHAT YOU NEED TO KNOW TO MAKE THE BEST DECISIONS (PART 3)
What can we conclude now? You have cancer and that is bad news, whichever way you look at it. There are probably difficult times ahead of you, whatever you do. If you meekly accept all your practitioner’s recommendations, it is likely that life will be much less pleasant for you than it could be. If you try to make your own decisions, it is likely that you will have difficulty getting the cooperation and information you need from your practitioner. Seek support from family, friends, nurses, social workers, or other practitioners. Trust your own judgement and gut feelings about what is right for you. Don’t let your practitioner talk you out of your decisions with medical jargon, scientific explanations, bullying or sweet-talking. These are techniques that authority figures such as fathers and teachers use with children. Switch to a practitioner who doesn’t do this, if possible. If not, just remember that you are not a child and that they can only hold a position of power and authority over you if you let them.
Here is a thought that might help you a little. Every time you refuse to let a practitioner treat you like a helpless child, you make it that tiny bit easier for the next patient to do the same. It is only through pressure from patients like you that doctors and other practitioners will be forced to change their approach, I believe this is the most important way in which you can use your disease to help future patients.
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THE G.I. FACTOR AND WEIGHT REDUCTION: THE NEED FOR EXERCISE
A ‘fast metabolism’ is not necessarily a matter of luck. Exercise, or any physical activity, speeds up our metabolic rate. By increasing our kilo-joule expenditure, exercise helps to balance our sometimes excessive kilojoule intake from food.
Exercise also makes our muscles better at using fat as a source of fuel. By improving the way insulin works, exercise increases the amount of fat we burn. A low G.I. diet has the same effect. Low G.L foods reduce the amount of insulin we need which makes fat easier to burn and harder to store. Since body fat is what you want to get rid of when you lose weight, exercise in combination with a low G.L diet makes a lot of sense!
Why exercise keeps you moving. The effect of exercise doesn’t stop when you stop moving. People who exercise have higher metabolic rates and their bodies bum more kilojoules per minute even when they are asleep!
The body loves to store fat. It is a way of protecting us in case of famine. In the midst of plenty we are building up our fat stores.
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FAT LOSS: COUNTERACTING ENERGY SPARING ADAPTATIONS
The loss of body fat can lead to a range of physiological outcomes which, in turn, affect the further loss of body fat. Physiological adaptation to weight and fat loss can be divided into predictable changes (such as the decline in RMR in response to the loss of lean mass) and adaptive changes (where the body actively works to reduce the rate of weight loss). Dr Rudy Leibel and his colleagues from Rockefeller University in New York have tried to quantify the adaptive changes in lean and obese people as they lose weight. For a 10 per cent weight loss, they found that total energy expenditure declined by about 450kcal, of which about half could be explained by the changes in body composition and half could be considered adaptive.
The main way of counteracting the adaptive reductions in energy expenditure is through physical activity. This has been shown in several studies to counteract the energy sparing effects of dietary restriction. It does this by increasing energy expenditure both during and after exercise and by maintaining lean body mass. Studies examining exercise, however, have not always been convincing, possibly due to the difficulty in getting people to comply with the exercise regimens that have been set for them. There is still enough evidence to suggest that exercise can help with those who do comply and indeed may be the most effective form of continuing fat loss in the maintenance stage. There is little argument amongst scientists that diet appears to have the most immediate effect on fat loss, but it is now also becoming increasingly clear that exercise should be the mainstay in any fat loss maintenance program
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THE FATE OF FAT IN FOOD
Fatty acid molecules travel through the blood as either FFAs or as triglycerides OTGs) which is a group of three fatty acid chains joined by a glycerol molecule. An analogy may be footballers
roaming the streets on their own, or joined by a team manager. Triglycerides cannot get directly into the fat cell because their molecules are too big, so the team needs to be broken down into FFAs and glycerol units like the footballers having to pass single file through the door into a nightclub. Once inside the nightclub (fat cell), they join up with the glycerol into a ‘team’ again and are stored as TGs.
Keeping the nightclub analogy, our footballers have to get past a doorman. In the fat cell, the main ‘doorman’ is the hormone insulin, which is formed in the pancreas and secreted into the bloodstream in response to a rise in blood sugars. Before a meal (low insulin), the doorman has the exit open allowing FFAs to leave to supply energy for the body. After a meal (high insulin), the doorman closes the exit and opens the entrance to allow FFAs to enter. Insulin also activates an enzyme, lipoprotein lipase (LPL) in the fat cell. This acts like a ’spruiker’ outside the nightclub touting for business. Adipose lipoprotein lipase (ALPL) breaks FFAs off the TG so that they can enter the fat cell.
Insulin also acts as a doorman for the muscle cell but here the functions are somewhat different because he has two entrances to control. Before a meal he has the ‘fat door” open to allow FFAs into the muscle cell to provide it with energy. He also activates muscle LPL which breaks down the TG teams passing by to allow FFAs to get through the door. After a meal, he closes the fat door and opens the ‘glucose door’ so the muscle switches from running on fat to running on glucose. (Interestingly, if the muscle needs a lot of energy such as during exercise, the glucose goes straight in through another door that insulin has no control over.)
Basically, when the body needs more energy than is currently available from food, triglycerides in the fat pool are broken down into FFAs plus glycerol and sent to the muscle via the bloodstream to help out. It’s as if someone has run into our ‘nightclub’ and called all the footballers out to help out in another building down the road. The process is triggered by another enzyme which, like all enzymes, causes a reaction but doesn’t take part in that reaction. Hormone Sensitive Lipase (HSL) is the enzyme involved in this removal of fats from the fat pool. It does
so under orders from a range of chemical ‘alarmists’ in the bloodstream, particularly the catecholamines, or hormones secreted from the adrenal glands at the top of the kidneys. The catecholamines, therefore, facilitate lipolysis, but inhibit lipogenesis. Insulin, on the other hand, facilitates lipogenesis, but inhibits lipolysis.
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BABY AND CHILDHOOD INFECTIOUS DISEASES: POLIOMYELITIS
The prevention of poliomyelitis, commonly known as polio, is the conquest of the current quarter of a century. Once a disastrous and diabolical disease with a high mortality rate, and an even higher harbinger of partially paralysed bodies, it is now seldom seen in the acute stage. Until the mid-1950s it regularly left a trail of wreckage and havoc on the Australian population, and in fact in all Western countries, to say nothing of the appalling disasters it wrought in the developing lands.
But in the mid-1950s, all that changed. The sudden development of a suitable and highly effective vaccine by Dr Salk, and mass immunization campaigns, brought the disease to a sudden halt. Since then, Salk injections have been largely replaced by Sabin oral vaccine, and this is currently recommended for all babies from the age of two months. The death rate from polio plummeted, and the figure has been zero for several years now.
But it will remain this way only as long as parents are vigilant and continue to have their infants immunized along the recommended lines. Polio is still as rampant as ever in the Third World, which is not very far from Australia’s shores. If our national immunization rates fall, then polio could rapidly make a come back in Australia. It is perfectly feasible that it could even return to the pre-vaccination days and again become a major killer and paralyser. It is unlikely that, if the present trend for vaccination against polio continues, many doctors (or anybody for that matter) will witness a case of polio during their lifetime. However, it is worth knowing the symptoms, if only to alert parents to the horrid consequences if they happen to become careless in not arranging for a child to receive the proper course of immunization.
Early symptoms are often vague. They may simulate an oncoming bout of the flu, and the patient may seem to recover temporarily. But a recurrence of fever, backache, neck stiffness, nausea and vomiting may supervene. This may ’smoulder’ for several days, perhaps up to a week.
Then suddenly the major symptom occurs: paralysis. It may accompany the fever. It is often very variable, ranging from minor weakness of a single muscle group, to severe debilitating loss of function of any section of the body. The most important is the respiratory system; if this is affected, death may be imminent unless immediate emergency facilities are available. These entail the use of an artificial respirator, and its use for an ongoing period of time may be essential to maintain life.
Treatment
Symptoms such as those mentioned above, occurring in an unvaccinated child, require the urgent attention of the doctor. Prompt treatment may be essential to preserve life, especially if the breathing mechanism is affected. Treatment must be carried out in hospitals where the attention of experts is available and full facilities aimed at preserving life are available. This is no game for amateurs or do-it-yourself methods at home.
Younger generations of parents have only heard about polio. With the passage of time and the paucity of cases heard about, stories of the disastrous consequences of yesteryear often fall on deaf ears. And as the likelihood of contracting polio seems minimal there is a general tendency for young people to be complacent. ‘It can’t happen to me or to my child. It’s history … old hat… something in granny’s day.’ All too often apathy can set in. Do not be lulled into a false sense of security and neglect to have your babies immunized against this potential killer. It is simply not worth the risk.
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