Mhinform

The death of someone close is always stressful and upsetting for a child. The level, intensity and duration of grief depends on a number of factors which include the age of the child, his relationship to the person who died (e.g. parent, grandparent, classmate), whether the death was sudden or was anticipated, and so on.

Young children find it difficult to understand the concept of death, and explanations must be couched in language suited to their level of comprehension. Older children experience the same grief reactions as adults. Younger children will possibly fear that they too may die. There will often be intense sadness, loss of appetite, sleep difficulties and sometimes regressive behaviour, such as increased dependency, wetting the bed at night, thumb-sucking, and so on.

It is always best to be open with children at this time. It is important for children to see parents grieving; in a sense, it makes it easier for children to express their feelings without thinking that they should act in a certain way. Like adults, their grief will usually be eased by the passage of time. They should be allowed to talk about the deceased, as a way of working through their grief.

Parents are often uncertain about whether to allow their children to attend the funeral of a family member who has died. There is no hard and fast rule, and parents have to make a decision taking into consideration all the circumstances at the time. Children of school age, and some who are younger, certainly are able to understand what funerals are about, and probably should attend.

Children may also become distressed by the death of a family pet. Parents should not try to diminish their grief by saying things like ‘It was only a dog’ or ‘Don’t cry — we will buy you another one’. It is often a good idea to allow some time to pass before replacing the animal that has died, to allow the child to experience and work through his feelings of grief.

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There are some doctors who will not listen, who will act in a disinterested and impatient way if you try to discuss your pain control with them and who clearly give pain control a low priority. If you have a doctor like this, you would probably be better off changing doctors, as we discussed in the introduction to this chapter. Unfortunately, there is no type of doctor that I can guarantee will be good at pain control. I believe that the ones who are most likely to be well informed about painkillers are doctors who specialise in pain control, in terminal or palliative care, in radiotherapy or chemotherapy treatment. You can ask for a second opinion from one or more doctors from whichever of these categories is available and seems appropriate for you. I hope you strike it lucky first time!

Right, let’s say you now have a doctor who, at the least, seems interested and concerned about your pain. What if this doctor agrees that you need a certain dose of a certain painkiller, say 20 milligrams of physeptone, but tries to send you away with a prescription for twenty tablets of 10 milligrams each and an appointment in two weeks time. However concerned this doctor appears, he or she is making it impossible for you to take your painkillers in an ideal way— regularly. He or she is forcing you to ration yourself, to take them only when your pain is really bad. Don’t let them do this. Tell them you understand it is best to take the painkillers regularly. Ask how long they last if you haven’t already checked it for yourself.

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A brace, using a special collar is also popular to immobilise the neck and allow the injury to heal.

Cases that have persistent symptoms over many months or even years may be due to disruption of the intervertebral disc, the cushion of cartilage between the vertebral bodies.

Operations to remove these discs and then to fuse the vertebral bodies together may be undertaken. But the results are not altogether satisfactory.

The brace, although favored by many doctors, does tend to result in considerable stiffness of the neck.

The most successful form of treatment I have found is gradual active and passive mobilisation of the neck.

This should be under the direction of a doctor and carried out by a qualified physiotherapist.

Treatment may take some months, but the results are worthwhile.

Mobilisation is different from manipulation. In the latter a sudden sharp movement is carried out to break down adhesions, or to reposition subluxated joints.

This may produce good results, but in between manipulations, adhesions reform and lack of mobility occurs.

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Such substances are formed in the bowel but, if absorbed, are detoxified by the liver and can only cause trouble in liver failure.

Traveller’s diarrhoea is usually regarded as being spread by contaminated water. It is unusual in the developed countries, where the standard of personal hygiene is high and proper government measures are taken to assure a clean water supply.

There is still considerable argument about the causative agents. E. coli is a normal inhabitant of the human and animal bowel and many cases of traveller’s diarrhoea are believed to be due to virulent strains of this organism to which the local inhabitants have become immune.

Viruses may be responsible for many cases of traveller’s diarrhoea or there may be more than one culprit.

Staphylococcus is a germ which causes boils and other skin infections. Someone with these conditions may infect food by handling it and the toxin could be absorbed and cause severe symptoms if the food is eaten.

Botulism is another disease caused by such a toxin. The offending germ grows only in conditions where there is virtually no oxygen.

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Women are particulary prone to dermatitis of the hands because they are frequently exposed to water, harsh detergents and a variety of chemicals.

Men may have the same trouble with some jobs or hobbies but women seem to suffer more.

Stress and tension can lower a woman’s resistance and so can hard work. Women who work have two jobs — the paid one and home — and are often under more stress and work harder than their husbands. Those who are prone to eczema or other skin problems are more at risk.

What can women do to lower the risk of dermatitis of the hands?

Prevention is more important than cure. If rubber gloves are worn when washing up, doing the laundry or scrubbing floors, consideration should be given to wearing inner cotton gloves.

Most rubber gloves, especially in hot water, make the hands perspire. Being wet, they are prone to other skin problems such as paronychia or infection at the edge of the nail.

The cotton inner gloves will absorb this perspiration and so further protect the hands. Any chemicals should be quickly wiped from the hands and frequent washing should be avoided.

Once the rash has developed, seeing the doctor and getting some form of cream, usually a cortisone derivative, will generally result in rapid clearing of the rash, but care is needed to prevent its recurrence.

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Remember that we can only know that a treatment is potentially curative if it has been in use for many years. If your practitioner says he or she can cure you with a treatment that has only been in use for a few months or years, don’t believe them. It’s that simple. It could be true that immediately after completing the treatment there are indeed some patients in whom no cancer can be detected by currently available tests. However, as you already know from earlier chapters in this book, this does not necessarily mean that no cancer cells at all are left. Remember, there are no tests currently available that can pick up very tiny seedlings. We can only say that patients have been completely cured in retrospect, that is, after enough time has gone by for any remaining tiny seedlings to activate and form obvious secondary growths. This time is different for different types of cancer, but is never less than two years. Usually it is from five to twenty or more years.

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Does the G.I. factor predict the glycaemic effect of a normal serving of food?

Although the G.L is based on 50 gram carbohydrate portions, the ranking of foods is roughly the same when compared on a per usual serving size, per 1000 kilojoule or per 100 gram food basis. There are some exceptions to this, one being carrots. You can eat as many carrots as you wish despite their high G.I.

Studies have shown that even though the G.L factor has been determined on the basis of a 50 gram carbohydrate portion, it can be used to predict the effect of a normal serve size with a meal. This is why the long-term studies of real people with diabetes eating real low G.L meals have been successful.

Would a person with diabetes need to reduce their insulin dose if they changed to low G.I. foods?

It is possible that if a person with well controlled diabetes changes their carbohydrate to low G.I. types that they could reduce their insulin dosage and maintain the same blood sugar levels. While we have heard anecdotes of this occurring, it has not been demonstrated in any scientific studies.

Does the G.I. factor of a food only apply to a certain quantity of the food?

No. The G.I. factor of a food remains the same whether you eat 10 grams of the food or 1000 grams of the food. Because it is a ranking of one carbohydrate food to another according to glycaemic impact, to make the comparison fair, the amount of each food being compared must be the same. This is why a 50 gram (usually) carbohydrate portion of a food is compared to 50 grams of glucose or a 50 gram carbohydrate portion of white bread, when the G.I. factor is being measured. What does change with the quantity of food, is the actual glycaemic effect of that food in the body. We can eat less of a high G.I. food or more of a low G.I. food and end up with the same blood sugar responses.

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There are many different paradigms for exercise, including resistance training, depending on the end goals.

It has been supposed, that the most effective type of resistance training for fat loss would be that requiring aerobic energy use, e.g. Circuit training. Circuit training is the combination of a range of exercises carried out with light weights but with many repetitions to increase aerobic benefit. There seems to be little argument that this form of exercise would have fat burning benefits. Because it also involves muscular resistance, it could additionally provide metabolic benefits if in no other way than in reducing the loss of muscle mass that may occur through diets alone.

The main questions that remain about circuit training are the appropriate duration, intensity and frequency for optimal fat loss. Based on substrate utilisation, it would appear that the intensity should be moderate (i.e. around 40-60 per cent V02 max), and the duration as long as possible. Because many muscle groups are thought to require at least 48 hours to recover from the micro-cellular damage that results from resistance exercises, it would be inadvisable to carry out circuits, at least with high resistance, on a daily basis. Yet significant fat loss requires regular physical activity over long durations, so circuit training should be combined with other aerobic activities, such as walking, at least on every other day, but possibly also on circuit training days.

Metabolic changes due to muscle gain or maintenance might be expected to take two forms. In the first place, if there is a gain in muscle size in resistance-trained obese people, there is likely to be a gain in energy use due to this increase. Several studies have shown an increase in muscle size, or at least a maintenance of muscle mass due to resistance training in obese people, with or without energy restriction. The increased effect on energy use, however, should not be expected to be great.

The second form may be more important, i.e. the reduction in decline of metabolism that would be expected to occur with loss of total body mass due to food restriction. This can amount to between 5-25 per cent within three weeks on a program using diet alone. If this decline is arrested by resistance training, as it has been shown to do with aerobic exercise, it could have a significant impact on total fat loss. However, to date the appropriate research has not been done in this area.

It is important to point out here that because we are talking about increasing, or at least maintaining muscle mass, this is likely to be reflected in weight gain, even though there may be some fat loss. Hence, use of the scales in this instance is definitely contra-indicated. For most obese people an increase in muscle density and weight, irrespective of fat loss, indicates an increase in body size, which is not generally desired by those looking for a decrease in overall body mass. The main question becomes whether it is more time efficient to carry out long, less vigorous, continuous aerobic exercise in the time that might otherwise be used for resistance training.

In the first place, many obese or overfat people by definition have, or are likely to have, reduced muscular efficiency. They are also likely to have decreased cardiovascular function. Hence, sudden intense activity such as resistance training may be both difficult and dangerous. It would not seem prudent, therefore, to put someone on a resistance training program at the outset of any fat loss regime.

Secondly, there is the issue of motivation. Many people have become fat because of their dislike of the traditional forms of exercise which underly weight training. While they may see themselves walking for fat loss, weight training may not be seen as a preferred option. Third, as mentioned above, there is the question of body perception. Finally, frequency of exercise is important. Because resistance training should not be carried out every day (unless a routine is ’split1 i.e. Upper body one day and lower body the next), it would be difficult to get the amount of exercise required (without becoming bored) if resistance training only was used for fat loss.

Having said this, it should be recognised that there may be some individuals, men in particular, who would prefer this type of activity instead of, or in addition to, aerobic activity. If so, they should be encouraged to combine both. Fitness centres can no longer expect to maintain their overfat clientele by programming a limited amount of exercise in the gym on alternate days. Consideration has to be given to the individual carrying out their own routines at times outside the gym setting and this should be supported and monitored by fitness centre personnel.

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