Health News and Information

This is obviously closely linked with waking during the night. Some children after waking up will make their way to the parents’ bed and get in. This invades the parents’ privacy and also disrupts their sleep. In some families, once the child enters the parents’ bed, one of them (usually the father) will go to sleep in the child’s bed.

For some cultures and in some families co-sleeping is the norm, and there is no real evidence that it does any long-term harm. For parents who want to put a stop to this habit, the strategy is fairly straightforward, although both parents will need to be certain they want to commit themselves to the process.

The first step is to prepare the child by letting him know that the rules are to be changed, and that now if the child wakes during the night, he must stay in his own bed. During the night, if the child enters the parents’ bed, he is immediately returned to his own bed. There must be no cuddles or conversation — just a matter of fact return to bed. This may need to be repeated a number of times, over a few nights, before the child gets the message.

The next morning the parents should tell the child how good/grown up he is for having stayed in his room all night. The reinforcement of expected and appropriate behaviour is an important part of the strategy.

These strategies will almost always work. If they do not, it is often because parents don’t persist or support each other adequately. Sometimes the help of an interested family doctor, pediatrician or psychologist is a good idea, such a person can act as a sort of ‘coach’ for the parents, especially for the more difficult or stubborn youngsters.

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Our lack of understanding about our disorder has, in many cases, meant years of suffering, and to many people it seems that the future will be no different. One of the first things we need to do is to stop drawing on the past and projecting into the future, which incidentally is only a thought away!

It is difficult for many people to believe recovery is possible. After trying many different treatment methods without success, it is difficult to believe anything will succeed. If we think something isn’t going to work, then it won’t. That’s our problem—our thinking.

The past belongs to the past-except for one major point. Despite the enormous difficulties we have encountered through the disorder, nothing physically has happened to us. None of our major fears have been realised, and they aren’t going to be in the future. The next attack is not going to be the ‘one’ in which our fears come true. If anything were going to happen to us it would have happened in the first attack. We are continually drawing on our past experiences of the anxiety and attacks and projecting them into the future. We don’t concentrate on what is happening now.

If we always have an attack at 7.00 a.m. we expect to have one every morning. When we have an attack we think ‘I knew it would happen’. We expect to have one the following morning, and we do. We don’t see what is happening now because we are too busy anticipating the next attack.

As an example, we need to be aware of our first thoughts when we wake. The first thought is usually ‘where is it’, and we usually feel frightened because we know ‘it’ is going to be there. We turn on our internal radar and check to see wbat is happening. We move down our body. ‘I’m going to have a headache, my throat is tight, my heart is racing, I am having trouble breathing, I feel sick, I’m shaking.’ And a full scale attack may develop. After it subsides we worry about the next one. As we go to sleep at night we think to ourselves, ‘What if I have an attack in the morning?’

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Children are individuals. Each one brings to the issue of sleep his ñ needs, personality, and physical functioning. This does not mean that you need to accept your child’s sleep patterns as “the way it is.” Your goal as pare is to help your child fit smoothly into your family—and into his world. You can recognize his uniqueness, while teaching him skills to make his life easier.

Commonly, after the sleep issue is resolved, parents notice real difference. The child is more easy-going, less frustrated, happier, and more predictable Parents wonder why they didn’t do something sooner. Parents, too, feel m content and self-confident.

In the long-run, the child’s sense of independence and self-esteem enhanced. When he masters sleep problems, he has mastered an important p of life. (He knows it is important by the significance you—and the rest of world—have placed on it.) Sleep and nighttime can be frightening; child need to know that Mom and Dad are in charge.

A child who continually disrupts his parents’ sleep forms an unhealthy vi of life. He learns that his needs are the only important ones. This is a far from what parents intend.

Perhaps this is the message you would like to send: / love you and I want you to grow up to be a happy person. Sleeping is part life. The way you are sleeping now doesn’t fit with the rest of our family. It becoming a problem for us all. Let’s work on it together.

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No one likes to lose the ability to control the passage of urine or faeces (develop incontinence). In our society, many people who develop these symptoms feel ashamed and embarrassed and may even want to keep it a secret. These feelings are understandable, but not appropriate. It is not your fault if you can’t control your bowel or bladder. These symptoms deserve as much attention as any other and you should not feel ashamed to ask for it.

Incontinence falls into two quite different groups. Firstly, there is loss of control of urine or faeces coming through the normal passages. Secondly, there is loss of control of urine or faeces because it is coming away through a passage that doesn’t normally exist. This may be a passage created by your cancer (a fistula) or an artificial opening made surgically (a stoma).

Let’s talk first about incontinence where urine or faeces is coming through the normal passages. This can basically develop for three different reasons, one or more of which could be operating in your case. Firstly, when you can’t tell when your bladder or bowel is full. Secondly, when you can’t control the muscles that empty the bladder or bowel. Thirdly, when the lining of the bladder or bowel is so inflamed that the muscle responsible for emptying it goes into spasm which you cannot control (urge incontinence).

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If untreated, the condition slowly subsides as fibrosis or scarring develops. Strangulation of the haemorrhoids may totally cut off the blood supply and lead to gangrene. This usually requires immediate operation.

Prolapsing piles can lead to a mucoid discharge and soiling of the underclothes.

Sometimes a clot may form in an external pile and this thrombosis produces a hard tender lump which slowly subsides over about five days. It may leave a projecting skin tag which can lead to irritation.

It is amazing how many people will put up with the discomfort of haemorrhoids before seeking treatment. This may be because of embarrassment or because of the unjustified belief that treatment, especially operation, is associated with a lot of pain.

Creams and suppositories to insert into the rectum can produce relief in the early stages. Most contain local anaesthetics and drugs to reduce the congestion. Many tablets, obtained directly from the chemist without prescription, are claimed to reduce or even “cure” piles. These seem to work only because of a mild laxative effect.

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The menopause or change of life is not a disease, but a normal stage in a woman’s life.

How well she masters this stage and the symptoms which might arise, often depend on her knowledge of, and attitudes to, her own body.

Both sexes go through the changes of puberty as men and women enter their reproductive lives.

But, for a woman, this reproductive phase of her life has a definite end. This is the menopause. For a man, there is no such dramatic change and he may continue reproductive ability into old age.

The female reproductive system is under the control of the pituitary gland, which lies at the base of the brain. This produces hormones or chemicals which act on the ovaries.

Each month, due to these hormones, an ovum or egg ripens in the ovary and oestrogen is formed. This hormone causes the endometrium, or lining of the womb, to build up.

When the egg is released, a further hormone is produced by the ovary and makes the regenerated endometrium soft and spongy, ready to receive the fertilised ovum, if conception has occurred.

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Take the diet fitness quiz and see how well you score. It’s a good idea to use this quiz regularly to pick up on areas where you may need to improve your diet.

1. Circle your answer.

Eating patterns

• I eat at least 3 meals a day with no longer than 5 hours in between yes/no

Carbohydrate checker

• 1 eat at least 4 slices of bread each day (1 roll = 2 slices of bread) yes/no

• I eat at least 1 cup of breakfast cereal each day or an extra slice of bread yes/no

• I usually eat 2 or more pieces of fruit each day yes/no

• I eat at least 3 different vegetables or have a salad most days yes/no

• I include carbohydrates like pasta, rice and potato in my diet each day yes/no

Protein checker

• I eat at least 1 and usually 2 serves of meat or meat alternatives (poultry, seafood, eggs, dried peas/beans or nuts) each day yes/no

Fat checker

• I spread butter or margarine thinly on bread or use none at all yes/no

• I eat fried food no more than once per week yes/no

• I use polyunsaturated or mono-unsaturated oil (Canola or olive) for cooking. (Circle yes if you never fry in oil or fat) yes/no

• I avoid oil-based dressings on salads yes/no

• I use reduced fat or low fat dairy products yes/no

• I cut the fat off meat and take the skin off chicken yes/no

• I eat fatty snacks such as chocolate, chips, biscuits or rich desserts/cakes etc. no more than twice a week yes/no

• I eat fast or take-away food no more than once per week Iron checker yes/no

• I eat lean red meat at least 3 times per week or 2 servings of white meat daily or for vegetarians, include at least 1-2 cups of dried peas and beans (e.g. lentils, soy beans, chick peas) daily yes/no

• I include a vitamin C source with meals based on bread, cereals, fruit and vegetables to assist the iron absorption in these ‘plant’ sources of iron yes/No

Calcium checker

• I eat at least 3 serves of dairy food or soy milk alternative each day (1 serve = 200 ml milk or fortified soy milk; 1 slice (30 g) hard cheese; 200 g yoghurt) yes/No

Fluids

• I drink fluids regularly before, during and after exercise yes/No

Alcohol

• When I drink alcohol, I would mostly drink no more than is recommended for the safe drink driving limit (Circle yes if you don’t drink alcohol) yes/No

2. Score 1 point for every ‘yes’ answer

Scoring scale

18-20 Excellent

15-17 Room for improvement

12-14 Just made it

0-12 Poor

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Summary of main points.

• Biological influences on obesity include age, sex, race, hormonal factors (such as puberty, pregnancy and menopause) and a wide range of genetic factors and interactions between these.

• Recent findings have isolated a number of genes associated with various aspects of obesity such as hunger and food preference.

• The propensity to store body fat increases with age, and there are important age by sex, and possibly racial interactions.

There are multiple biological regulators of body fat. These are, in particular, genetics (including sex and race) and age.

Other biological factors. There are some other notable biological factors influencing tat loss which occur at certain periods of life. These include puberty, menses, and menopause and a wide range of genetic factors. Like most biological influences, these are relatively fixed, and hence modifications have generally not been seen as a realistic approach to dealing with the problem. The implications of these biological influences are in accepting factors beyond the control of the obese person. Obesity can no longer be simply ascribed to either ’sloth’ or ‘gluttony’.

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Resting Metabolic Rate (RMR). The term metabolism describes the sum total of the thousands of dynamic chemical reactions that occur in the body to sustain life RMR is the sum total of energy needed to keep the body going at rest. It can be likened to an idling engine. The synthesis of new tissue, for example, during growth and pregnancy have significant metabolic cost. Body size is also related—a bigger person has a generally higher metabolic rate. To extend the analogy of the idling engine, this would be a truck that is required to carry a heavier load. To do this might require a bigger engine which would then burn more fuel while idling. Resting metabolic rate (RMR) can be estimated from equations based on height and weight.

There are two basic factors which determine metabolic rate (MR) at any given moment: the number and size of respiring cells, and the metabolic intensity of those cells as determined by the work being done and how efficiently energy transformation occurs to meet the body’s demands. Resting metabolic rate (RMR) is the energy required to sustain life while an individual is at rest, but still awake. Basal metabolic rate (BMR) is often used synonymously with RMR and the energy required to sustain life at the lowest level, which is during sleep, is called the sleeping metabolic rate (SMR). The main determinants of metabolic rate are fat-free mass (FFM), fat mass (FM), age and sex. A ‘determinant’ is a factor which explains differences in metabolic rate between individuals.

RMR accounts for 60-70 per cent of daily energy expenditure. Excess consumption of energy or overfeeding causes an increase in RMR, while underfeeding, such as very-low-calorie diets (VLCDs) and fasting result in a decreased RMR. Most of these changes are due to changes in fat-free mass (FFM) and the thermic effect of food (which is dependent on the calorie load). There may also be some ‘adaptive’ changes which result in a metabolic rate (MR) which is greater (for overfeeding), or less (for underfeeding) than predicted.

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This is a disease affecting infants and children. It may start to produce symptoms soon after weaning when the infant is introduced to solids. It affects one in 4000, and often there is a family tendency.

The disease affects the small bowel. Frequent and loose bowel actions, general debility, a failure to thrive and a pot belly in children are the usual symptoms. Many become irritable and peevish for no obvious reasons.

The cause is an allergy to the gliadin fraction of gluten. Gluten is the protein part of wheat and certain other grains. In this disease the cells of the jejunum, the first part of the small bowel, are sensitive to gluten and simply cease to function normally. Diagnosis is often overlooked for many years. The fact that the infant does not thrive as well as other members of the family may be accepted without proper medical investigation. A diagnosis is firmly established when a biopsy of the jujenum is performed and the diseased cells examined under the microscope. In 1977 a simple test was invented which consists of a simple injection of the skin. This is much quicker, but it has not yet become generally available.

Treatment

Once an accurate diagnosis has been made, treatment is usually dramatic in its beneficial effects. The patient is placed on a gluten-free diet. Symptoms vanish like magic, often within a few days. A feeling of well-being commences almost immediately. But it may take many months, even up to a year, for the full benefits to become evident. As symptoms have often been present for a long time, reversal and a total cure may be time-consuming. Between 80 and 90 per cent of patients improve dramatically on this simple routine.

Today, Coeliac Societies exist in many countries, and membership is an excellent idea. Recipes for making gluten-free products are made available, and helpful advice offered. Also, lists of commercially available items are regularly mailed to members, allowing them wider selection in foods if they wish to purchase them. In Australia, the address is: The Coeliac Society, P.O. Box 73, Cronulla, N.S.W. 2230.

Parents soon become proficient at making gluten-free bread and other food items. Often this may be conveniently made on a weekly basis, and deep frozen until needed. Once the routine has been commenced, it is usually no great domestic burden, and most parents are only too happy to have discovered a way of helping their child, and seeing the symptoms disappear. The stress and anxiety of caring for a perpetually ill and undernourished child far outweighs any extra work in preparing a gluten-free diet.

Symptoms suggesting coeliac disease should never be dismissed or neglected. Referral to a paediatric physician is usually necessary, so that adequate investigation and treatment can be carried out.

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