Archive for May, 2009


Thursday, May 21st, 2009

Acne (also known as pimples or acne vulgaris) is most common during the teenage years. Most teenagers will have acne at some stage. Its usual onset is at puberty, and it can occasionally continue on into the twenties. It can range from a very mild case of pimples for a few weeks, to ongoing severe cystic acne, which can leave permanent scars if not treated adequately.


Acne is caused by the overactivity of oil-producing glands (sebaceous glands) in the skin. With the secretion of too much oil, these glands become blocked, and the subsequent accumulation of oil leads to the formation of pimples, blackheads and whiteheads. The greatest influence on the development of acne are hormonal changes during puberty and adolescence. Contrary to popular belief, there is no evidence that certain foods cause acne or make it worse. It also has nothing to do with hygiene, although good skin care can help avoid aggravation of the condition.

Clinical features

Acne most commonly affects the face, chest and back. In particular it can affect the brow, the nose and the chin. The pimples initially appear as red lumps under the skin, which soon form a head. Sometimes when the secreted oils reach the surface of the skin, the contact with air turns the pimples black, forming blackheads. In more severe cases cysts, filled with a cheesy material (sebum or oil) may appear, and become quite large and unsightly.

There are a few basic measures which can improve most cases of acne:

1. Wash the skin gently twice a day, morning and evening, with a mild soap. Do not use medicated soap, as this can be too harsh on the skin. Make sure the skin does not become too dry from overwashing. Do not scrub the skin.

2. Wash hair daily with a mild shampoo, and tie it back if it covers the face, or rubs against the neck. Do not apply greasy hair gels.

3. Encourage your teenager not to squeeze pimples or pick at his skin. As tempting as this may be, it can lead to permanent scarring, which is unsightly.

4. Do not cover pimples with makeup. This can aggravate the condition by blocking off the oil glands.

In addition, your doctor may recommend certain specific treatments, depending on the severity of the acne. These may include lotions or creams containing benzoyl peroxide, which helps to destroy bacteria. Sometimes antibiotics taken in small doses for several weeks may be helpful. In very severe cases of acne, a skin specialist may recommend the use of retinoic acid. Whatever the treatment, your teenager will need to have patience. Acne may take weeks or even months to clear up, and very often recurs periodically — a fluctuating pattern of severity is very common.

When to see your doctor

• if despite the above simple measures, the acne does not improve after 4-6 weeks;

• there are boils or cysts present;

• your teenager is distressed by the appearance of his skin and needs some reassurance that something can be done about it.


Acne cannot be prevented. Attention to skin care as described above and a healthy, balanced diet may minimise the severity.


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Monday, May 18th, 2009

“Don’t a lot of these drugs we are taking knock out our sex life?”

Anything we do can affect our sex life, and that certainly includes whatever drugs we take. It’s important to ask your doctor at least three questions about drugs. First and foremost: “Is this drug necessary?” Necessary, lifemaintaining drugs make up less than 10 percent of prescriptions written every year. Second, ask “Are these painkillers or sedatives necessary?” These drugs can have real affect on sexuality and usually do not deal with the health problem you are trying to solve. Finally, ask if better health habits such as regulating weight, exercising in moderation, and avoiding junk foods can reduce the need for some drugs prescribed by your doctor. You might also ask about the dosage and time of day you take drugs, because that can affect how the drug works and what the drug might do to your sexuality.


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Monday, May 18th, 2009

I was raised to be special, I mean that sex was special If he wanted a tramp, he should have married one.


This wife assumes her husband’s projected image of her and becomes the pure, motherly, sisterly person in her husband’s life rather than his equal partner. This wife feels elevated to a pedestal, lonely and on display. She senses that her husband sees other women as more sexual and sees her as a “nice woman.” She adjusts by either filling the madonna role even more or tries, usually in vain, to compete with the vague image of a “loose” woman. Both attempts fail because she is neither. She struggles unsuccessfully to find her lost sexual identity because she is looking for it through her husband’s eyes rather than her own. Her love map is being drawn for her. The madonna/whore and lover/playboy dichotomies play themselves out in male/female sexual interaction. They are extreme routes on the love maps formed in a punitive, hypocritical society. They are labels that hamper the development of adult sexual maturity.


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Monday, May 18th, 2009

Super Marital Sex Rule: The marriage comes first. All other people and events come after the marriage. Children, parents, work, and play all benefit most by marital priority instead of marital sacrifice, because the marriage is the central unit to all other processes. The stronger the basic unit, the stronger the rest of the system. Super marital sex allows super growth of all elements related to the marriage.

I’d say we spend about ten minutes together alone per day. When we finally get in bed for the night, we are too tired to do much that takes too much time or effort. There is too much taken out of us to have anything left to put into us.


If it is true that we reap what we sow, then marriages are in big trouble, for we sow very little into our relationships proportionate to what we put into our jobs and other activities. If we put as much time in our working as we allow for our loving, we would end up unemployed or bankrupt. We raise our children, go to work and work hard, help our parents, maintain our cars, paint and clean our homes, but American marriage is similar to a neglected child, a child expected somehow to take care of her- or himself. Marriage in America is underfed. We seem to be searching for intimacy, but the harvest is meager for lack of planting and nurturing.

Take the following mini-test that I gave to the thousand couples and you will see what I mean by the priority problem.


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Friday, May 15th, 2009

Prolonged disuse of bones from immobilisation in bed may lead to an increased loss of calcium from the bones, and so they become thinner and more fragile.

Elderly women may sustain fractures of bones from even simple injuries. A common fracture in women is a break in the radius, the major bone of the forearm. A fracture of this bone, just above the wrist, is called a Colles’ fracture.

A fall may result in a fracture of the neck of the femur or thigh bone. This can occur in both elderly men and women, but is far commoner in women. Crush fractures of the vertebral bodies of the spine are not uncommon in elderly women.

These can follow from carrying heavy weights and one cause is from grandmothers lifting and carrying grandchildren.

Elderly women who carry heavy loads from the supermarket can also suffer a crush fracture of the vertebra, usually affecting the bones of the thoracic or chest spine. These fractures cause considerable pain, but require no specific treatment beyond rest.

The deformity from wedging of a crushed vertebra leads to the prominence of the upper back which has been called the “widow’s hump”.


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Friday, May 15th, 2009

The small and medium-sized arteries are affected and it involves most organs. In half the cases, there is an acute onset with fever, aching in the limbs and abdominal pain.

While this also is thought to be an auto-immune disease, some researchers believe it to be a hypersensitivity reaction to infection, particularly to recent infection with the streptococcus germ. This is the common cause of tonsillitis and the skin disease, impetigo.

Rheumatic fever, which affects the joints and sometimes the heart, and acute nephritis, an inflammation of the kidneys, are believed to be hypersensitivities to the streptococcus.

Cortisone can relieve the acute symptoms of polyarteritis but does not appear to alter the course of the disease.

There are a number of other collagen disorders, perhaps the most important of which is Giant Cell Arteritis.

This is a sub acute inflammation of the larger arteries and the temporal artery which lies in the scalp is the most commonly affected.

This form of collagen disease affects the elderly, usually at around 70. There is often a slow, insidious onset, with fever, tiredness and weight loss. The temporal artery may become thickened, easily felt and tender. While this is the most noticeable feature, many other arteries of the body may also be affected.

Early recognition is important, as the retinal arteries which supply the eyes may be involved and this can impair vision.

Cortisone is most effective in this condition. Early treatment results in settling of the inflammation with relief of symptoms, and can save the sight.


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Tuesday, May 12th, 2009

A doctor is often faced with a parent who is concerned that his or her child seems to bleed or bruise easily and there is said to be a relative with a bleeding tendency.

In the past, tests to check whether there was some serious underlying disorder were somewhat complicated.

Doctors now know that a thorough history of the child, how the problem has presented itself, plus a history of the family, can give most of the clues.

A few simple blood tests as well, should be enough for the family doctor to be able to reassure the parents that no real problem exists.

True haemophilia or haemophilia A, which was present among many descendants of Queen Victoria, is due to an absence of factor VIII in the blood. This deficiency is inherited, but is sex linked. It is carried by females and may appear in their sons.

Haemophilia B, or Christmas disease, is due to a lack of factor IX and is also sex linked in inheritance.

Correct diagnosis as to whether a bleeding disorder is present, will lead to the proper treatment if it is needed.

Purpura is a form of bleeding tendency which, in most cases, is acquired rather than inherited, and is usually temporary.


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Tuesday, May 12th, 2009

Firstly, you are entitled to know that the procedure is experimental or unproven. You must be told the reason for the research and exactly what it would involve for you in terms of inconvenience, risk, possible side effects, and financial cost. You must know what the alternative standard procedures or treatments are and be assured that they are not known to be better than the research procedure or treatment. You must be assured of confidentiality— that you will not be identified by name in records going to other centres or when research results are published. You must have the opportunity to ask questions and get answers you can understand. You must be told that, whether or not you agree to take part in the research, you will still be treated by the same practitioner to the best of his or her ability. After entering the research study, you are entitled to withdraw at any stage and still receive treatment from the same practitioner if you wish. You are entitled to take time and consult with others if you wish before deciding whether or not to take part in the research. You must be assured that any adjustments or changes to treatment will be made in your own individual interest. This means, for example, that if the treatment is clearly not helping you or is producing unpleasant or dangerous side effects, it will not be continued.

Naturally, we all hope that advances will be made in cancer research. Taking part in research could be an experience which makes you feel better about yourself. You would be justified in feeling that, in this way, you could use your illness positively to help future patients. However, it is still most important to be fair to yourself and to put your own immediate interests first. Don’t agree to participate in research unless you feel good about it and know exactly what you are agreeing to.

These rights are not so special or extreme, are they? They should sound familiar because, basically, they are the same sorts of rights as should apply in all treatment situations.


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Friday, May 8th, 2009

As mentioned on page 36, this is a new form of ‘no-bleed9 HRT produced in response to the high drop-out rate among women who have not had a hysterectomy and who don’t want to have regular withdrawal bleeds. Although there has not yet been very much published data on it, it is increasingly being prescribed in the expectation that women will be willing to stay on HRT for longer. Different brands should be available soon. The brand currently available is livial, and the manufacturers, Organon, describe it as having ‘combined progestogenic, oestrogenic and androgenic properties’, that is, it works in the same way as progestogens, oestrogens and androgens work. By taking a combination of these hormones in tablet form on a continuous basis (rather than by taking progestogen for just 10—12 days each month), it is hoped that eventually bleeds will stop, though this may take up to a year, doesn’t work in all cases, and can produce irregular bleeding in the meantime. (If you continue to get a withdrawal bleed on ‘no-bleed’ HRT, your doctor may feel it is appropriate to prescribe a one-off dose of progestogen to clear the lining of the uterus, which should prevent further bleeds.) This type of HRT helps mood changes and loss of libido, as well as other symptoms of the menopause. More long-term research is needed before its effectiveness against osteoporosis is known for certain, but a ‘no-bleed HRT’ is definitely a step in the right direction. If you would like to take HRT for its benefits, but really cannot face the return of monthly ‘periods’, why not ask your doctor about this new form? It is only recommended for women at least 12 months past their final period.


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Friday, May 8th, 2009

Surgeons gain access to, and remove, one or more of the reproductive organs in a number of ways. This is the basis for another method of classifying hysterectomy.

If the reproductive organs are accessed through the vagina, the operation is called a vaginal hysterectomy. This approach may be considered when:

• a woman has a prolapse and her uterus, bowel or bladder has already started to intrude into her vagina

• there are fibroids that are small enough to enable the uterus to be pulled down and out through the vagina

• the ovaries are to be left intact.

Vaginal hysterectomy is unsuitable when the uterus is very large or contains one or more sizeable fibroids. It is more difficult to perform than abdominal hysterectomy and should always begin and end with a laparoscopic inspection of the pelvis. This helps ensure that any abnormalities, such as ovarian cysts, are identified prior to surgery and alerts the surgeon to any bleeding that has occurred during the operation. Bleeding must be contained or the patient will form large blood clots in the pelvis which may lead to adhesion formation and infection. Removal of any clots will involve another trip to the operating theatre and an extra two to three days in hospital.

The debate among doctors about the relative merits of abdominal and vaginal hysterectomies is ongoing. Proponents of the vaginal approach argue that it involves less post-operative pain, is less costly and requires a shorter hospital stay. Some research has suggested it may be safer than the abdominal approach, resulting in fewer deaths and a lower complication rate but analysis of Australian hospital data indicates that this is not necessarily so. Nevertheless it is argued that the vaginal approach could be used for most hysterectomies if appropriate training programs for doctors were available.

In contrast, doctors who favour the abdominal approach claim that the types of complications more likely to affect women having a vaginal hysterectomy are a cause for concern. They claim post-operative infection and large blood losses necessitating transfusions are more common with the vaginal approach; and they suggest that there is an increased risk of damage to other pelvic organs due to the confined space in which the surgery is performed. Repairing this damage entails further surgery. They also say that vaginal hysterectomy is more likely than abdominal hysterectomy to result in a vaginal prolapse, where the upper part of the vagina collapses inwards. The upshot is that at present in the US, UK and Australia, about 25% of hysterectomies are performed vaginally.


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