Weight Loss

Play is a very important part of childhood and is an indispensable part of learning from an early age. Joining in allows the parent to spend time with the child in a mutually rewarding and enjoyable way, and this ‘quality time’ strengthens the parent/child relationship. As the child gets older, play stimulates curiosity and creativity, and is an important part of the socialisation process whereby the child learns to relate to peers. It can be both a source of relaxation and an outlet for excess energy.

You can do much to facilitate creative and educational play for your child. In infancy, mobiles and bright toys will stimulate the baby to be aware of surroundings. Some babies seem to enjoy music, and will certainly respond to the sound of mother’s voice.

As your baby develops eye/hand manipulative skills, rattles, squeaky toys, large plastic blocks and shapes are all useful. Just make sure that they are safe. Later, play dough, pots and pans, sand play and finger painting will provide the child with an increasing range of experiences (see Toys, below and Books, p. 104). Most toddlers love being read to, and this provides a wonderful opportunity to create a special quiet time between parent and child.

As your child grows older, play becomes increasingly social, and he will involve peers, siblings and parents, although many children still like to spend time playing alone as well.

Make sure you provide a range of play materials appropriate to the child’s age and preferences. All children are different and they will have different preferences for play. What suits one child will not suit another. Parents can obtain information about play materials from a number of sources, including the kindergarten teacher and daycare provider. The local library will certainly have books about play with children, and some have organised reading sessions for young children. Some communities have toy libraries. Remember that toys do not have to be expensive to be creative and enjoyable.

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“I hate that she has to undress me. I can’t undress myself anymore,” reported the husband experiencing multiple sclerosis. “Mhink that’s the worst part of this whole thing. I know that doesn’t make much sense, but I feel like a child being undressed and dressed.”

PARAPLEGIC HUSBAND

All disease requires some sacrifice of autonomy as much as it requires self-responsibility for healing. We all have to turn to someone for help, support, covering for us at work, bringing the chicken soup, pushing the wheelchair in some hard-to-go places, holding the door while we struggle with a cane or crutch. Disease reminds us firmly that we all belong together, and healing depends on acting as if we really believe that.

“Is it that you are being undressed or that you can’t undress your wife, too, that really seems to bother you the most?” was my question to this husband.

“Well, she undresses herself, and I watch her, but when she turns to me and has to do me, too, that’s what gets me,” he answered.

“I have two suggestions, and they both may seem crazy,” I answered. “First, why take your clothes off every time anyway? Dress in clothing sometimes that is comfortable and allows for stimulation you enjoy. Maybe some clothing might even feel good to you. Ask your wife to do the same. Some couples wear jogging suits of a material they like and they don’t wear any underwear. Then, when you feel like sex, no dressing or undressing may be necessary. Second, maybe you have failed to change your sexual pattern to adjust to this disease experience. Making love at the end of the day with your wife getting you undressed was an old pattern. Disease requires change. In fact, some philosophers suggest that this is the purpose of disease, to cause change and growth in the long term. I know it doesn’t matter much in the short term that all disease leads to overall change, but your sex life must reflect this fact. If you are undressed at night, then sleep naked and have s in the morning when no dressing or undressing is necessary. And, remember, you spent much of courtship undressing her. Mayi this disease can cause some role reversal you might enjoy once you get used to it.”

“All of those ideas are crazy but one,” he answered. “I never thought of staying dressed for sex. I guess that could work out, think we’ll try it. Maybe I’ll market these things. Instead of jogging suits, we’ll start a new yuppie fad. Sex suits. It might feel neat.’

The process of reconsideration of the relationship between sexuality and illness starts in just this simple fashion. Talking, sharing modifying, being creative, and designing and redesigning your sexual patterns is part of the healing process.

Since all disease happens within a system, it is important to look at the responsibility issue from the perspective of both partners.’ don’t know what he’s talking about,” said the wife of the man in the example above. “I love undressing him. I just wish he would make more of an effort to solve our problems instead of surrendering of deferring to me. It’s not the undressing part that makes him seem childish, it’s his attitude. I married him for his brains, not hi wardrobe-changing skills.”

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AUTOEROTIC BEHAVIOR

Masturbation is one of the most difficult of all topics for couples to discuss. If your own religious orientation forbids it, it is still an area in which you most likely have strong feelings. I will discuss this further in Chapter Twelve, but for now, discuss it with your partner. You do not have to share what you do, just how you feel.

Remember, autoeroticism is not limited to self-stimulation of the genitals. Taking a long, sensuous bath or shower is a form of autoeroticism. Feeling the wind in your hair (no matter how thin it is) can be erotic. Do not let the genital orientation of our society trap you into the same limited view of you enjoying you, of giving you permission to stimulate yourself.

“I think it is disgusting, unnatural, and a complete waste of time,” said the wife. “I don’t know why anybody does it, and certainly people don’t do it if they have someone.”

Her husband said in his private interview, “Sure I do it. Three or four times a week. It has nothing to do with her or our sex. I just like to look at a few pictures and get off.”

The impact of such different views, totally unshared, is clearly important to marital sex. “At least it’s a cheap date,” said one man during the interviews. “No risk of disease, and you don’t have to get up and get dressed afterward. In fact, you don’t have to get undressed at all.” Humor, comfort, fear, shame, and other emotions are evoked when the topic of self-stimulation is raised. Our love maps are influenced strongly by such feelings about our right to self-pleasure. Don’t let fear prevent you from discussing this issue with the one person with whom you should be able to share anything.

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The tertiary or third stage may not develop for between three and 30 years. At this stage the person is not infectious but the disease can affect any organ and the symptoms may mimic almost any other disease.

During pregnancy, a woman may transmit the infection to the child if she is in the primary or secondary stage of syphilis.

The diagnosis can be established by taking smears from the primary or secondary lesions and examining them under the microscope. As well, there are a number of blood tests which can reveal the diagnosis but these take several weeks to become positive.

The organism causing syphilis is highly sensitive to penicillin, usually given daily, by injection, over 10 or more days. Sometimes, the long-acting penicillin injections may be used.

Oral penicillins are not effective and should not be used. For those who are sensitive to penicillin, the tetracycline antibiotics given by mouth are used but must be taken in an adequate dose for about two weeks.

Follow-up blood tests are also necessary to be certain of cure. Once cured, there are no after effects.

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There are some jobs, such as driving public vehicles or heavy transports or jobs near open fires, unguarded machinery or at heights, which those with epilepsy should not do. But those with other disabilities may be restricted as well.

Those who have been free of daytime fits for three years should be able to obtain a driving licence, subject to renewal annually.

In making a diagnosis of epilepsy, the doctor will be guided by the history, particularly by the description of the attack given by others.

Temper tantrums and breath holding attacks in children need to be distinguished from epilepsy. In adults, hysterical outbursts and over-breathing or hyperventilation attacks may mimic epileptic seizures.

Most sufferers can now be controlled by drugs of which a number are available. Some are controlled with a single drug, others may require a combination of several. Unfortunately, the medication must be taken regularly; but, if it is, the attacks may cease completely.

Some people grow out of their attacks and may have years free from fits without taking any drugs. Most people need to maintain them and many are free of attacks for many years on this routine.

Children who experience a febrile convulsion need not be investigated for epilepsy. But if these convulsions occur two or three times, they should be checked. Most children with petit mal grow out of it in early adolescence, a few only going on the develop grand mal.

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How about X-rays for screening then? These are not completely safe, especially if we consider repeating them every three or four months for years on end. They are simple and convenient but not cheap. False negatives can occur if the cancer is small or situated close to the heart and major blood vessels, making it hard to see. False positives are more common than with cytology, as a number of other conditions can produce similar shadows. Additional tests would be needed to confirm the diagnosis. The smallest cancer we could hope to see would be about a centimetre across, often they would be bigger. The chance of completely curing these cancers by surgical removal is not so good, as some will already have spread.

Bronchoscopy is so expensive, inconvenient and uncomfortable that it couldn’t really be considered as a screening test for large numbers of patients. Remember that it would have to be repeated every few months if we wanted to get all the cancers early. Cancers in the small bronchial tubes or in large ones but not ulcerating through the lining would be missed—those false negatives again. False positives are rare. This test can pick up cancers at a stage where they are surgically curable, but some would already have spread.

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The central nervous system is the brain and spinal cord. Blood-borne metastases to the central nervous system most often take the form of solid round lumps in the brain. Cancer cells can also lodge and grow in the covering of the brain and spinal cord. This covering is called the meninges (you have probably heard of meningitis, which is inflammation of this covering). This covering encloses the cerebro-spinal fluid (CSF), which surrounds and cushions the entire brain and spinal cord.

Cancer in the central nervous system produces symptoms by two completely different means. Firstly, the cancer growths interfere with the function of the part of the brain or spinal cord that they are growing in or near. Secondly, as the cancer deposits grow, they cause a build up of pressure in the whole central nervous system. This happens because the brain and spinal cord are completely enclosed in solid bone—the skull and vertebral column. As the cancer grows, pressure builds up because there is hardly any room for things to enlarge.

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The testes develop inside the abdomen during foetal life and migrate out through the muscles of the abdominal wall to enter the scrotum soon after the eighth foetal month.

Sometimes, this descent is delayed and the testes may lie, somewhere along the path of descent but not in the scrotum.

Usually they will descend of their own accord to take up residence in the scrotum.

At birth, 4 per cent of full-term and 30 per cent of premature infants have undescended testes. By late infancy and early childhood this figure has dropped to 2 per cent.

Unfortunately, in many cases, the problem is not one of non-descent but of mal-descent, that is the testes come through the abdominal wall but instead of entering the scrotum they turn upwards to lie in a fold of skin in the groin known as the superficial inguinal pouch.

These mal-descended testes will never enter the scrotum unless placed there by operation. Sometimes the diagnosis can be in doubt because a firm band of muscle attaches to the testes and spermatic cord and this can constrict up into the groin.

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1. Develop and maintain good rapport and listening skills,

2. Clearly define the services you or your organisation offer, i.e. no ‘quick fixes’, magic formulae or ‘diets’.

3. When taking a client’s history, always ask about prior experiences of dieting, bulimia or anorexia. Identify present behaviours associated with eating, emotional triggers for overeating or bingeing, and whether bulimia is practised currently. The following questions may be useful:

• Have you ever suffered from an eating disorder?

• Has any member of your family had an eating disorder?

• Do you ever binge eat? Do you ever make yourself sick afterwards?

• If yes, what sort of things trigger you to do this? Always refer on someone about whom you have concerns for psychological/psychiatric assessment. Be prepared to work in a supportive role if therapy is necessary. Explore with a client their expectations of dieting and fat loss. Be particularly attentive to unrealistic expectations such as, the speed with which they imagine it will happen, and how they will feel if fat loss does not occur.

6. Your client is entitled to make an informed choice about his or her treatment; you need to explain the current low success rates for long term behavioural maintenance of fat loss (i.e. 5-25 per cent) and the difference between working on this as opposed to long term lifestyle changes, which may not reduce their fat significantly, but may improve well-being.

7. Do not encourage or focus on dieting. If a client is severely obese, he or she will probably need medical assistance to deal with the problem and referral to the appropriate service is called for. For most clients, however, the most important help you can give is to gently challenge their ‘diet’ mentality.

8. Be prepared to counter resistance with 6!

9. Before beginning any change or process have a client keep a record of what they are eating now. Focus on problem times and meals.

10. Institute changes one at a time.

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Carbohydrate mainly comes from plant foods, such as cereal grains, fruits, vegetables and legumes (peas and beans). Milk products also contain carbohydrate. Some foods contain a large amount of carbohydrate (e.g. cereals, potatoes, legumes) while other foods are very dilute sources e.g. carrots, broccoli, salad vegetables. The dilute sources can be eaten freely, but they won’t provide anywhere near enough carbohydrate for our high-carbohydrate diet. A salad is not a meal and must be completed by a carbohydrate-dense food such as bread. The following list includes foods that are high in carbohydrate and provide very little fat. Eat lots of them, sparing the butter, margarine and oil during their preparation. Cereal grains including rice, wheat, oats, barley, rye and anything made from them (bread, pasta, breakfast cereal, flour). Fruits such as apples, oranges, bananas, grapes, peaches, melons etc.

Vegetables such as potatoes, yams, sweet corn, taro and sweet potato are all high in carbohydrate. Legumes, peas and beans including baked beans, lentils, kidney beans, chick peas etc.

Milk contains carbohydrate, in the form of milk sugar or lactose. Lactose is the first carbohydrate we encounter as infants. Use low-fat or skim milk and yoghurt to minimise fat intake.

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