In the car

On a long car journey with your children, make sure that you stop frequently to let them stretch and run a little, or to have a drink or a snack. Children hate being cooped up for long periods of time.

Choose your roadside stops carefully, and keep an eye on your children, particularly if there is a lot of traffic around. Take games and toys along with you that are appropriate for children to play in the car. If your child suffers from motion sickness, it is best for him to avoid reading or writing in the car.

Going overseas

If you are travelling overseas with your child, speak to your doctor well before you leave about special immunisations. This varies according to the countries you are travelling to, and is updated constantly. Vaccinations are available against typhoid, cholera, hepatitis B, meningitis, yellow fever, tetanus and polio. Tablets are available against malaria, and gamma globulin injections as prevention against hepatitis A. Your doctor will be able to advise you which, if any, of these your children require oeiore travel, some capital cities also have travel centres where this information is available.

You may want to make up a special travel kit, to carry with you in case of illness. Your doctor can give you advice on what to put in it. If your child takes any medications, be sure to carry a sufficient quantity of them with you. Your doctor can also provide you with a letter giving a summary of your child’s health record.

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Would you risk it? I’m not going to die having sex. I’d sooner live without sex than die trying to have it.

HUSBAND

Fewer than one person in four returns to “pre-heart attack” sexuality. Almost none of these persons have any physical or medical reason not to return to sexual activity, but fear, lack of knowledge, diminished self-concept, general depression, or physician neglect of this important area of their rehabilitation got in the way. There were seldom significant organic reasons to avoid sexual interaction, but poor education from their doctor and reluctance to communicate about sex with their doctor or spouse robbed them of the opportunity to return to intimacy.

My interviews suggest that depression, whether from lack of information, lack of self-esteem, or fear, is at the core of the problem. “Will I ever be able to work again, work like I used to?” asked one man. “I just can’t imagine being like I was before.” I have never talked with a patient who reported such concerns who did not also have sexual concerns, for sex cannot be separated from our concept of self, our work, and our sexual “workability.”

The lack of specific discussion of heart disease and its relationship to sex implies a negative message to the patient. “I thought because he didn’t say a word about it that he thought I’d be crazy to even think it, so I stopped thinking it. At least, I tried. Every time I had sex it was like I decided I would die for it if I had to.” This patient expresses the concern of most of the heart patients with whom I have counseled: forget the whole thing or risk your life.

When some information was given about sex and heart disease, it was usually wrong. Wait about six months for the heart muscle to heal, was a rule of thumb, followed by the now infamous “two flights of stairs” advice. If patients could walk up two flights of stairs without heart symptoms, they could have sex. Medicine apparently assumed that climbing stairs is the closest analogy to having sex. It makes one wonder how doctors have sex. The effect of such advice was to raise anxiety, as the patient waited for the weeks to pass to attempt the stair-climbing. Few health-care workers thought to study the effects of the anxiety caused by such delay and anticipation> the effects that such an emotional state could have on me healing heart.

Research data indicate that maximal heart rate during a typical workday is actually higher than that achieved during orgasmic contractions. Blood-pressure changes with sexual activity also are not at a risk level in the absence of other illness factors. Of course, each case is different, but unless the doctor can tell you why you should not have sex, then you would probably benefit from sex, not just survive it. I have never found that waiting for healing was helpful in any illness. Getting better is an active, not passive state, and diseases of the heart may be healed more easily by loving than waiting.

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Ellis was one of the early writers to describe the “buildup and discharge” model of sexual response, and it became the model for future researchers. He wrote, “Tumescence is the piling on of the fuel; detumescence is the leaping out of the devouring flame.” This energy buildup and energy discharge model was related essentially to the genitalia, although Ellis was also one of the first to describe erogenous or erogenic zones responsive to touch.

Ellis thought that male sexuality was “predominantly open and aggressive,” while female sexual response was “elusive,” slower, and much more elaborate. While men responded to touch, the penis was the focus for them. Even the scrotum was seen as without much sensitivity.

Ellis saw the nongenital areas as sexually responsive in the female. He felt that the breasts were particularly sexually responsive. Women were viewed as sexual “all over their body,” and much more “total” in their sexual response, more mentally and emotionally involved. He wrote, “In a certain sense, their brains are in their wombs.” By this unfortunate phrase, he meant that women were not the asexual beings of Victorian doctrine, that they were in fact highly sexual. The misrepresentation of this view became “women are preoccupied with sex,” are more emotionally involved in it. Women came to be seen as sex objects, sexually driven by some innate procreative and unique feminine drive.

Ellis changed his views of marriage throughout his career. He continued to view it, however, as a natural state, “the most natural expression of an impulse which cannot, as a rule, be so adequately realized in full fruition under conditions involving a less prolonged period of mutual communion and liberty.” He added, “The needs of the emotional life. . . demand that such unions based on mutual attraction should be so far as possible permanent.”

He would later add that some form of erotic variety was necessary, even within marriage, but that such variety should be in the form of sensitive affairs, “liaisons” of love that protected, even enhanced marriage. Like most researchers, he felt that marriage could not compete with variety, his own theories paralleling the change from exclusivity to a search for variety characteristic of many marriages.

Ellis did not think much of traditional Western marriage. He felt that Western marriage deromanticized the marital relationship, making a contract out of a natural state of relating, changing the substantive joining of two people to a formal agreement between two partners. He repeated that marriage was “not a contract, but a fact.” As with all of the theorists of the first three perspectives, Ellis struggled with the conflict between the erotic and hedonistic on one hand and the romantic and intimate on the other.

Richard von Krafft-Ebing, Karl Heinrich Ulrichs, Albert Moll, Edward Carpenter, Auguste Forel, Iwan Block, Magnus Hirsch-feld, and certainly Sigmund Freud were all influential in the period of sexual transition beginning in the 1890s with Ellis’s work. Masters and Johnson’s recent book On Sex and Human Loving traces many of these influences on what philosopher Paul Robinson calls this “modernization of sex.”

*96\97\8*

Once infected, there is no way of eliminating the virus from the body. It usually lies dormant for weeks, months or even years and then flares again. Like cold sores on the lip, the infection may be triggered by a rise in body temperature from a cold or other infection.

Heat, friction or emotional upsets may be the trigger for recurrence in others. It is highly infectious. Women who become pregnant may have the infection cross the placenta to infect the foetus. Infections acquired late in the pregnancy may infect the child during its passage through the birth canal and so caesarean section may be indicated in some cases to prevent the child becoming infected.

Diagnosis is usually obvious from the clinical picture but scrapings from the ulcers may be examined under the microscope or virus cultures be obtained to make sure of the diagnosis.

A variety of local applications to the lesions have been used including painting them with a dye and then exposing the area to ultra-violet light. This has now been abandoned as it is thought to increase the risk of cancer in the area.

Chronic infection of the cervix or neck of the womb with the herpes virus is thought to be one of the causes of cancer of the cervix which is the second most common cancer in women.

But herpes may not be forever as many people eventually mount some sort of immune response and the recurrent flare-ups cease.

*599/71/1*

Many people wear glasses and go regularly to an optometrist or an eye doctor.

Yet most are rather hazy about how their eyes function and why they need glasses.

Light enters through the cornea, or clear window, of the eye.

It passes through the watery fluid of the anterior chamber and enters the back section of the eye through the pupil, a hole in the iris or colored part of the eye.

The iris acts like the lens aperture of a camera, varying in size to admit different amounts of light depending on how bright it is.

The light rays then pass through the lens which focuses them on to the retina at the back of the eyeball.

This is a layer of sensitive nerve endings which when stimulated transmit the impulse through to the brain where it is interpreted as sight.

To test eyesight — or visual acuity — a Snellen’s chart is used.

This consists of letters which diminish in size from above downwards.

The top letter is of such a size that a person of normal sight should be able to see it at a distance of about 60 metres.

*342/71/1*

Some methods of cancer treatment such as meditation and prayer utilise processes about which very little is known. An exceptional person may be able to rid their garden of weeds by meditating or praying over it. Equally rarely, someone may succeed in ridding their body of cancer by these methods. I don’t doubt that the mind has fantastic abilities which unfortunately remain completely unexplored and untapped by most of us in today’s ‘civilised’ and scientific society. Very few have a natural ability to tap into these powers. It seems unlikely that the rest of us could be taught to do so over a short period of time.

What about starving the weeds by depriving them of some of the nutrients they need? Some dietary methods try to ’starve’ the cancer cells, for example the ‘grape diet’. Again the problem is that the normal cells need the same nutrients as the cancer cells. They are not so different that we can starve the cancer cells without starving the normal cells as well.

Diet-based cancer treatments are also said to work by cleansing and purifying the body. Contaminated soil certainly can be the reason for getting a lot of weeds in the first place. However, purifying the soil in some way after the weeds are established seems unlikely to get rid of them. Once established, they are likely to flourish in any soil that suits their close relatives, the normal plants, ‘Cleansing’ the body may prevent cancer but seems unlikely to cure established cancer.

In summary, the basic fact that prevents treatments from curing all cancers is that the cancer cells are too similar to our normal body cells. This fact also means that no effective cancer treatment is completely free of side effects—unwanted effects in the form of damage to normal cells and parts of the body.

*122/40/1*

You will remember from the last chapter that the crucial step in diagnosis of cancer, is to get a sample of the suspicious area for examination under the microscope. This is also true for people with probable secondary deposits and unknown primary. Examination of such a sample is usually necessary to confirm the diagnosis of cancer. In addition, by studying the shape, size, type and arrangement of cells from the secondary growth, the pathologist can often suggest likely primary sites. In deciding what further tests^ to recommend your doctor should consider the appearance and location of the secondary deposits, common cancer types for your age and sex and what treatments might be possible as well as the pathologist’ advice. Once you have ruled out primary cancers which are sensitive to certain particular hormone, chemotherapy or other treatments which go right through the body, there is rarely anything to be gained by searching further for the primary tumour. It may reveal itself later by producing symptoms which can then be dealt with. However, in some cases the primary cancer never causes any problems and is not located before death results from the effects of the secondary growths.

Well, that wasn’t such a difficult or unpleasant chapter, was it? You now have enough background to start thinking about treatment. First of all, it is important for you to understand why certain treatments are recommended. It is also important to understand what sorts of things you will need to know in order to decide whether what is recommended is likely to be best for you. This is what the next chapter is about. It is an extremely important chapter. Don’t miss it.

*116/40/1*

Breast is best! A number of years ago this simple dictum was considered old fashioned, a burden for women and perhaps not the best for the baby. But we have since learned that nature was right and that breast milk is the ideal food for the young infant.

Breast milk is a complete food in the first few months of life and the baby does not need any other.

There are a number of reasons why all mothers should be encouraged to breast feed their babies.

In the first few days after birth before the milk comes in, the secretion from the breast, colostrum, contains immunoglobulins. These give the baby a number of ready made antibodies to protect it against infection while its own immune system is still immature.

Because the transfer of the milk is from the breast straight into the baby’s mouth there is little opportunity for germs to contaminate the supply system as may easily happen with artificial feeding.

This is an important factor in the developing countries where women have been switching from traditional breast feeding to bottle feeding. The standard of hygiene is often poor with the result that gastro-enteritis becomes common and this may well be fatal.

*92/71/1*

The variability of people and the complexity of factors that cause a person to seek help with fatness means that there can be no standard set of rules. You have to make a fresh ethical decision with each new request for help, often even within the handling of one client. Frequently, these decisions need to be made on-the-spot, without the opportunity to seek advice.

It is important to have thought through a general framework for ethical decision-making in advance, that will assist with making on-the-spot judgements and decisions.

There are four domains which are important to consider:

• yourself

• the client

• the treatment resources available

• the social context.

You must also consider the interplay of these four domains.

Yourself. Our past experiences and what we have made of them affect our reactions to people and situations. We see each new thing we encounter through a ‘filter’ of beliefs and expectations that helps us make sense of them. This in turn influences how we respond.

You need to know yourself well, especially your motives, attitudes and feelings regarding obesity, overeating, exercise and health. Failure to understand these things increases the risk that you will act unethically by unintentionally imposing your personal values on your clients.

What do you think is the most important outcome goal for this person? Why? In your work, you are pursuing your own goals as well as your clients’. This means that they hold some power over your job satisfaction—you cannot succeed without their active cooperation. This motivates you to shape their goals in line with your own objectives rather than being there simply for your client. If you are clearly aware of your own choice of goals in a particular case, you can more easily see any conflict between your own goals and those of your client.

What do you believe has made this client obese? How do you feel about that? Your theory about why a particular client is obese will play a big part in the actions you take. In reality, different

people come to be obese along different paths, but the feelings that arise in you because of your theory are very important. For example, you might decide that a particular client is obese because during childhood she learned to select sweet and fatty foods in her diet, following her mother’s choices. This theory may give you reelings that the client is ‘not to blame’ and that her mother was at fault. Indeed, you may have strong feelings about poor childhood nutrition and regard the mother as having been a poor parent or even somewhat abusive of the child for making her obese. This might lead to you feeling sorry for the client and trying to be the ‘good parent’ that her mother was not.

On the other hand, you might think that another client who has had good nutritional advice for years has remained obese because he has not put the advice into practice. This could give you feelings of hopelessness about working with him or even anger that he has wasted other busy helpers’ time and is going to waste yours too.

Do you believe it would be possible to have the things that are important to you personally if you were as obese as this client? Usually, we think that the things that we personally value are desirable to others as well. If you believe that your client needs to lose fat in order to have a chance of getting something that you value in your life, you are less likely to consider or support alternative goals and means of achieving these. For example, the client might be concerned that she needs to lose fat in order to get a partner. If you believe that you would feel this way if you were equally obese, it may be difficult for you to work constructively with her feelings about personal attractiveness and relationships.

What skills do you have with which to respond to this client’s needs? It is generally regarded as unethical to promise what one does not have the ability to provide. It is also your ethical responsibility to respond appropriately to a particular client’s needs. It is possible, perhaps even quite common, for the client to have come to the wrong person for help—they are not always well-informed about their needs and the services that cater to these needs.

This question helps you to think about whether the client has realistic expectations of what you can do. The most ethical response to a particular client may be to decline her request for help and discuss more appropriate alternatives.

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Typical big eaters are:

• teenagers and young adults,

• people working as labourers,

• people doing regular strenuous exercise.

Big eaters need to eat:

• at least 8 slices of bread or the equivalent (crackers, rolls, muffins)

PLUS

• 3 pieces of fruit or the equivalent (juice, dried fruit) PLUS

• at least 2 cups of high carbohydrate vegetables (corn, legumes, potato, sweet potato)

PLUS

• at least 2 cups of cereal or grain food (breakfast cereal or cooked rice, or pasta or other grain)

PLUS

• 2 cups of low-fat milk or the equivalent (yoghurt, ice cream)

This provides 375 grams of carbohydrate which is suitable for a 10 500 kilojoule (2500 Calorie) diet.

An athlete who is training hard would generally need to eat double this quantity of carbohydrate.

WHAT ABOUT THE DIFFERENT TYPES OF CARBOHYDRATE? Traditionally, carbohydrate has been classified in terms of its chemical structure. We now know from scientific research and clinical trials with real people that the whole concept of simple and complex carbohydrates does not tell us anything about how they will actually behave in the body. Until recently, it was widely believed that complex carbohydrates, or starches such as rice and potato, were slowly digested and absorbed and therefore caused only a small rise in blood sugar level. Simple sugars, on the other hand, were assumed to be digested and absorbed quickly, producing a large and rapid increase in blood sugar. These assumptions were wrong.

Forget about the words simple and complex carbohydrate. Think in terms of low G.I. and high G I. factor.

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