Most children will not need any special investigation. The diagnosis of asthma is usually made on the basis of history and physical examination. Children who have more severe asthma, or who have frequent attacks, may require a chest X-ray. Some children may have special breathing tests, often arranged by a paediatrician or respiratory specialist. This usually applies to those who have ongoing, persistently severe asthma.

Once children with asthma reach 6-7 years of age or thereabouts, their management may involve regular measurement of lung function two or three times each day using a peak flow meter. This is a small device which measures how well the lungs are functioning, and may give early indications that the asthma is worsening.

If your child needs to use a peak flow meter, your child’s doctor will explain how to use it properly and record the results.

*245\90\8*

Since diabetes can result in more frequent infections of all types, vaginitis is a particular problem for sexual functioning. Both partners may experience pain in intercourse related to this and other tissue infection. About one third of women with diabetes have problems with orgasmic contractions, probably related to the same neurological and vascular damage as in the male. Erection of the clitoris would also be expected to be affected. Diabetic women should check for recurrent mild urethral infections, cystitis, and vaginal abscesses, these are all treatable, so there is no reason to continue to have pain in intercourse. If you notice a decrease in natural lubrication (maybe due to microcirculation problems), check with your doctor. Again, do not assume that sexual problems are always related to your disease. If there is a lubrication problem, lubricants can be prescribed or recommended.

As with men, all areas of the sexual-response system remain intact for diabetic women. Interest, arousal, psychasms, and other dimensions do not have to be impaired if open communication and degenitalized approaches are considered and practiced.

Diabetes is like any other disease in that it is helped by positive emotions and intimacy, and hindered by fear and helplessness. Even if your diabetes gets worse, remember, you do not cause it to get worse. Even with your best efforts, diseases run different courses. None of these courses preclude intimacy. Every couple I treated in which one or both partners were diagnosed as diabetic were able at five-year follow-up to experience a mutually pleasing sexual life, even when the diabetes itself might have worsened. There were eighty-seven diabetic men in the sample and forty-seven diabetic women. While initially thirty of the men were considering implants, none of them went ahead with that procedure following counseling.

If severe genital problems have resulted from diabetes, there are still several things that ean be done to enjoy sex. You read about some of these in Chapter Eight. One of the oldest medical jokes relates to a man whose arm hurts every time he tries to raise it. He tells the doctors about his problem and the medical advise is, “If it hurts when you do that, then don’t do that.” I would add, “If it hurts, check out why, if it can’t be helped, try something else.”

*281\97\8*

READINESS: Readiness is the one phase of the ten-phase super sex model that was focused upon by the first three perspectives. Readiness refers to the body’s response to interest and arousal. It is the physiological reaction that accompanies interest and arousal, the tumescence stage, when blood rushes to erotic areas of the body, including the genitals, preparing for body-to-body interaction. Readiness is an entire body response, not just a genital response. Remember, lack of readiness does not mean lack of interest or arousal. Research does not support such a relationship. Readiness is a reflex, and can take place with little arousal and be absent even when there is a great deal of both interest and arousal.

Your own experience teaches you that you have been aroused, but not ready. Sometimes you have awakened ready, but not aroused. You have been interested and ready, but not aroused. You have been ready, but not interested, and your desire, your frequency might or might not have reflected any of these changes in the sexual system, because sex is really not an automatic cycle, it is a system of interactions of different mind and body states. The cycle orientation of the first three perspectives mislead us. Use your own experience as the couples did and you will see that sexuality is not some type of automatic slide, but a complex mind/body interaction. This fourth perspective emphasizes the subjective experiences of the couples rather than the observational orientation of earlier perspectives.

“I know you think I’m ready,” reported the husband. “You think I’m always ready. Well, I’m not. My penis does not speak for me.”

“If I can’t tell by your penis, how am I supposed to know if you are ready?” asked the wife.

The orientation of the first perspectives is clear in this exchange. Both partners have confused what the body does with how the person feels.

*108\97\8*

Previous chapters in this book provided quite some criticism of the practices of conventional medicine.

The indisputable progress in many areas of medical and other related sciences was yet to be mentioned. This would include among others: the life saving emergency treatments, technology and instrumentation for chemical and biological analysis and the breathtaking progress on the frontiers of “mind-body” medicine.

Deepak Chopra, MD, a pioneer of modern mind-body medicine, is the author of numerous inspiring and mind-bending books, which are listed in the References. In his books,* he illustrates the process of mind and body interaction drawing up on many clinical examples as well as research results from medical science and modern quantum physics. He has met and continues to meet with the considerable opposition from his colleagues – conservative medical scientists, who insist that they should see everything under their microscopes to believe it. Deepak Chopra points out, that medical sciences simply ignore monumental advances made in other sciences, mainly in the Quantum Physics.

Not only do microscopes have limited resolution, and the visible bandwidth of light is extremely narrow (0.4-0.7 micrometers), but even if we could separately look at each molecule, atom or an elementary particle – there is exactly nothing to look at ! Physicists have found quite a long time ago, that any elementary particle or atom is just a form of energy, oscillating in some state of equilibrium, and therefore it is essentially 99.999 % empty space. We can see, detect or sense the matter composed from such atoms, only because their energy interacts with us as observers, ie. for example reflects light that is visible to us. On that level of understanding, even physicists agree, that there is essentially no difference between thought and matter. Thought can become matter and matter can become a thought. Deepak Chopra gives some stunning examples of such transformations not from the mysterious ancient past, but from within contemporary India.

If you need more explanation from the modern Quantum Physics point of view, and do not feel an expert in physics, please read an excellent book “Superforce”, by Paul Davies, listed in the References. Paul Davies is a respected professor of physics, and he does a wonderful job of explaining achievements of modern physics to non-experts. It is really worth the effort to read his book.

*7\96\8*

Vertigo (giddiness or loss of balance) may occur with the disorder known as Labyrinthitis. This is thought to be a viral infection. Crops of cases tend to occur at the same time. The attacks are short-lived from a few days to one or two weeks and they pass off completely with no permanent ill effects.

These attacks may be mild, and giddiness only occurs with movement of the head. Nausea and vomiting may be associated with the giddiness and these attacks may come spontaneously even at rest.

The doctor needs to examine the patient to exclude some more serious cause of these symptoms such as vascular accident (stroke) or a tumor.

No treatment in mild cases of labyrinthitis is required, but drugs will reduce the giddiness and the nausea and are used if the symptoms are severe.

*475/71/1*

Operation has a bad reputation among the public and, at times, the profession. There is no doubt that the right operation by the right surgeon on the right patient for the right condition, brings a satisfactory result to all concerned. Perhaps the bad results are due to one of those four conditions being wrong.

Acupuncture is currently being hailed as the treatment for everything from dandruff to corns.

I think there is valid evidence to show it may be of benefit in reducing chronic pain and, therefore, help those who remain in pain despite many different treatments. Its place in the management of the acute stages of back condition has yet to be shown.

The best advice I can give you if you have, or in the future get, a bad back, is to go to a doctor you know and trust and be guided by his advice.

It is this pressure on nerves where they originate and leave the spinal canal which causes the severe pain called sciatica running down the back of the thigh and the outer leg.

*219/71/1*

Typically, a gynecologist knows that a laparoscopy is indicated when his patient’s complaints of pelvic pain persist for at least six months and he finds that she is not responding to conservative treatment, such as painkillers, or to a regimen of antibiotics (if he found signs of infection). He will need to reevaluate her case at this point: did she have endometriosis at the time of her first visit to his office? Let’s assume that the doctor isn’t sure and now she is back at his office, having followed all his instructions. She is not better, but worse, valiantly struggling with her pain and seeking relief her doctor suggests laparoscopy, since it may be endometriosis that’s causing her symptoms. He assures her that even if it is not, the procedure may help reveal any of several other conditions, such as acute ovarian cysts or even an ectopic pregnancy.

Good diagnostician should be about 95 percent sure that his patient has endometriosis just by taking a very detailed medical history and listening to her progression of symptoms. A follow-up laparoscopy, when indicated, could then confirm the diagnosis. We have discovered, however, that there is another side to the issue: many women have had unfortunate experiences not only with misdiagnosis at the time of their initial visit but with laparoscopy as well. As the patient, you should be aware of what steps your doctor is taking before he recommends a laparoscopy:

• If the doctor believes you have an infection, he should have taken a culture to prove that point,

• If the doctor suggests mat you have a pelvic cyst or tumor, it should have been confirmed first with a pelvic ultrasound.

• If you are not responding to any treatment the doctor prescribes based on this findings, you should then be free and able to openly discuss with him (1) how you feel and (2) what other diagnostic and therapeutic steps could be taken.

• If he first retests you for infections, cysts, and tumors and all the tests are negative once again, a laparoscopy might then be called for.

What happens when a woman willingly undergoes this procedure again and again and is either diagnosed correctly or incorrectly, and either way, the disease is mismanaged?

*44\43\4*

Dermatitis is a pattern of skin inflammation which may follow contact with an injurious substance or may develop without any apparent external cause.

The recognition of skin disorders is essentially a visual art. It requires experience to distinguish what is dermatitis or eczema from what is not; disorders that might be confused with dermatitis or eczema include such conditions as diffuse skin malignancies, known as reticuloses, or infections either fungal or parasitic.

Dermatitis which develops in response to contact with a foreign, but not necessarily a newly-contacted, substance is called Contact Dermatitis. There are two broad types: the irritant, and the allergic.

Clothing Apart from rubber there are a variety of other potential sensitizers in clothes. The pattern of eczema follows the area covered by the offending garment, with accentuation Of the eruption in moist zones and those at which the garment makes closest contact with the skin. The responsible chemicals include dyes (which may cross-react with PPD), formaldehyde and other garment finishes. Shoe dermatitis may be caused by these chemicals, also by those in leather and glues.

Cosmetic dermatitis is probably more common than dermatologists suppose, since most women who find that one cosmetic causes them trouble will simply change to another without seeking medical advice. The principal trouble-makers are perfumes, which contain an array of plant extracts, animal oils and synthetic chemicals.

Nail varnish causes contact dermatitis, not on the fingers but where the nails touch the skin, mainly around the eyes and neck. Lipstick sometimes causes contact dermatitis due to eosin or other dyes. Hair dyes which contain PPD or related compounds may cause dermatitis, which is chiefly seen round the hair line. Finally lanolin and some preservatives in creams and ointments may also cause contact dermatitis reactions.

Plants A few plants are powerful sensitizers and well known for causing contact dermatitis. Poison ivy is the most famous in the United States, as is the primula in the United Kingdom. Chrysanthemum and tulip bulbs may sensitize a few people. In Australia the Rhus tree, a close relative of poison ivy, has leaves which provoke a very severe dermatitis in many people. The resulting rash —which may occur where the skin has touched the plant, or on a face which has been touched by contaminated hands—has a streaked appearance.

Medicaments Contact dermatitis as a reaction to a medicament is confusing, since presumably the skin was abnormal before it was applied. The principal causes of such reactions are antibiotics, anti-histammes, local anaesthetics, ointment bases (such as lanolin), ointment preservatives (such as para bens), and stabilizers (such as ethylene diamine).

The number of other possible skin sensitizers is enormous. Other important ones include epoxy-resin, plastic hardeners, formaldehyde resins, pesticides and fungicides.

*71\44\4*

Adopting life-long healthy eating habits requires a lifestyle fit, with minimum disruption and deprivation. After some experimentation.

Each client will discover what she/he has to do (nutritionally) to control body fat. The key is getting the maximum benefit from minimal change. Each individual will need to set dietary priorities, a process which requires a brief explanation.

Although eating for fat loss requires a reduction in energy intake, counting calories is likely to be counter-productive. It is the source of calories which is important and there is a hierarchy for dietary restriction of specific sources. Fat, with the greatest energy content (9 kcal/g) is a suitable first target for dietary modification. Alcohol has 7 kcal/g and is a secondary consideration. Next on the list is carbohydrates as sugars (4 kcal/g), finally followed by carbohydrate as starch (still 4 kcal/g). If body fat goals are met by targeting fat intake alone, then less emphasis on decreasing other energy sources is required.

If clients cut back on fat, alcohol and sugar and still want to get more off their waistlines, the only thing left is to reduce starchy carbohydrate foods like bread, pasta, rice, potato and corn. This last modification will markedly decrease the volume of food intake, but will challenge hunger and appetite regulation. Severe restrictions in food intake may trigger binges and result in a situation.

Worse than existed initially. This will signal that dietary efforts have been too drastic.

This explanation shows that there is a method for success and that at some stage the limitations of dietary change will be experienced. Going short on the body’s preferred energy fuel (starchy carbohydrates) has its hazards. It is important for clients to be aware of this risk and to put effort into increasing their level of movement Increasing energy expenditure will allow them to eat more, giving flexibility to their eating program.

*124\186\4*

To get the best out of your doctor you need to be well-informed and provide honest and accurate information.

In order to be well informed you should read about the menstrual cycle so that you understand how the cycle works, know about hormonal changes and their effect, and understand what endometriosis is. This can be achieved either by yourself or by your doctor suggesting reading material and other sources of information. You can also contact your local women’s health information centre.

It is important to recognise that your doctor is not a mind reader, and that it is up to you to tell her or him what your problems are so that your doctor can get an overall picture of your illness. Identify the major areas of concern for you — infertility, pain control, improvement of lifestyle.

It may be a good idea to keep a diary in which you can record your visits to your doctor and make notes of any side effects of drugs or surgery or other treatments suggested by your doctor and list questions for future visits.

Be honest about symptoms and make sure the information you give is complete, accurate and relevant. It is of no benefit to you to withhold information.

It is important to be able to talk openly to your doctor and to feel that you can discuss your needs and fears.

If you have concerns about the side effects of drug therapy, you should feel comfortable discussing these with your doctor. If you have printed information about drugs or treatment you want to discuss, take this with you to the appointment so that your doctor can comment.

Always report the positive as well as the negative feelings you may be experiencing.

Vital decisions and concerns such as marriage, sexual relationships, careers and children should also be discussed with your doctor since these make up the total picture.

Imp roving consultations

Start by writing down any information you need prior to the appointment. Your questions should also be written down and added to during the consultation.

Repeat information back to the doctor to make sure that you have heard and understood everything correctly. Ask for diagrams and illustrations to help you understand the information the doctor provides.

Take a friend or partner or relative along for moral support; it is important that family and friends be informed about your disease.

During the appointment take notes if necessary and ask the doctor to write down any instructions.

Although difficult at times, try to control your emotions when talking to your doctor as this will make it easier to understand the information and take notes.

Realistic expectations

It is reasonable to expect your doctor to ask if you understand vital aspects of your proposed treatment regime and for that information to be expressed in terms that you understand. To achieve this your doctor first needs to establish your level of knowledge on both the technical and medical aspects of the disease.

It is not reasonable to put doctors on a pedestal and to accept all their advice without question. Let your doctor know what your expectations are — different women will have different needs and expectations.

It is not reasonable to have unrealistic expectations of what your doctor can achieve. For instance, the disease may not always respond to the best treatment available so it would be unfair to get angry with your doctor. Remember, doctors do not have all the answers to endometriosis — or anything else for that matter. They, too, can get frustrated with the lack of ‘cures’.

Making the right decision

Start by evaluating your doctor’s recommendations in the light of your own needs. If you want advice and guidance but also want to make your own decisions about treatment, then let your doctor know.

Trust

No doctor wants to feel that her or his credibility is being challenged but, equally, no woman should ever feel intimidated.

Let your doctor know that you respect her or his opinion but expect open and mutual communication and trust. You should trust your doctor’s level of knowledge just as the doctor should have respect for your judgements.

Confidentiality is also important and you must feel that information is confidential to both you and your doctor.

Your doctor needs to be able to trust that you have followed the treatment plan you both have agreed upon.

What is informed consent

Informed consent occurs when a woman has sufficient information about the proposed treatments or procedures to consider the options without pressure and to accept — or decline — treatment. Informed consent requires an explanation of the proposed treatment as well as an explanation of the risks and benefits. It is essential that a woman be given enough time to ask questions, discuss alternatives; a woman needs to know that she can withdraw her consent at any time.

It is important that you understand what you are consenting to — so a discussion with your doctor is essential. A doctor may make you feel that she or he is a busy person — far too busy to be bothered by trifling questions. However, you must make sure that you understand fully any treatment your doctor is suggesting for you — whether it be drug treatment or surgery — so that you are capable of giving your informed consent.

A woman who understands is far more likely to co-operate with her future treatment. It is reasonable to expect your doctor to ask if you have any further questions or if there is any other information that you would like.

Getting information

If you feel that you do not have enough information to give your informed consent then you should ask for further information This should include a detailed explanation of the diagnosis, what the diagnosis means and the various ways that your condition could be managed. Talk about the options and their likely outcomes. Other considerations should include:

will there be any pain or discomfort

what are the risks of the proposed treatments

what are the side effects

should I get a second opinion

what are the alternatives

what is the outcome if I have no treatment

how much will it cost

will my health fund cover the cost

how long will I be away from work.

To get answers to all of these questions you may have to be assertive. Many women complain they find it difficult to be assertive and demanding with their doctor but remember it is your body and you must take control.

*113\83\2*