The blog is about health and gives useful information on health and disease.

Many children attend playgroup before they start a more formal preschool such as kindergarten. Playgroups are sometimes organised by the maternal and child health or community nurse, or the local council or community. Sometimes they are organised on a more informal basis by neighbours or friends, usually in someone’s house.

Generally playgroups are a good idea. They allow youngsters the opportunity to play together and provide them with important socialisation experiences. Parents can benefit too from talking, swapping notes, and generally supporting each other. Many parents find that talking to other parents who have children the same age gives them confidence, as they realise that there are child-rearing issues and difficulties that seem common to all parents. Sometimes playgroups are organised to give the parents in turn a few hours to themselves. This can also be invaluable.

Parents must also be prepared for the hassles that are inevitable in playgroups. Often the children are at an age where they are still learning to play with other children. Some may resent no longer being the centre of attention, while many have not yet learned the idea of sharing. There will usually be arguments about possessions.

Some parents are competitive about the achievements of their offspring, and this can undermine the confidence of other parents. Be aware of this, and do not hesitate to seek the reassurance of your nurse or doctor if you have any concerns. It is important to remember that all young children are individuals and unique in their superior intelligence or accelerated development — it often just indicates a bragging parent. If you cannot tone down a parent’s boastful comments by discussion and gentle feedback, and if this continues to undermine your confidence, you may wish to switch to a different playgroup.

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The reason for starting with the mechanical question is to get it out of the way so that you can look at the more important relationship issues, for these are the areas where disease and handicap have their most profound influence. If we keep taking our banged-up cars into body shops for repair without looking at how we drive in traffic, we will end up with more and more banged-up cars. So it is with disease that, as one paraplegic man stated, “The system is more important than the thing.”

“I just sort of became the chicken-soup type. I mean, I turned over my life to everyone else. My wife became a caretaker, and caretakers are not supposed to screw their patients.” This statement from a husband with multiple sclerosis illustrates the importance of sexual self-concept. Try to answer question two not in terms of skill or attractiveness but on the basis of “how” you are as a person when you are trying to be intimate. If you are experiencing disease, what has the disease process done to your relationship skills. Have you become more dependent, more aggressive, less assertive, more or less withdrawn? What has been the major impact of your illness on you as a person? How people experience disease and illness tells more about how they really are as persons than how they experience health.

I have my patients who are experiencing disease calculate their “N/S Quotient.” This is the balance between nurturance—taking care of someone else—and succorance—being taken care of by another person—that I discussed in Chapter Four. One of the most healing of human experiences, one of the healthiest things you can do, is to help somebody else. When you are sick, you must continue at some level to help others. How would you say your balance is? Do you still profit, even if you are sick, from all the good healing internal chemicals that come from the joy of supporting and helping someone else?

There have been research articles (not many) describing the impact of disease on sexuality. There have been very few articles about the impact of sexuality on disease, on sex as healer, on sexual shamanism. Maintaining and enhancing intimacy throughout the challenge of disease is not only possible but necessary for getting better. Remaining sexually active can actually slow some aging orocesses, protect the genitals to some degree from aging changes, and possibly offer a boost to your immune system. Research has clearly shown that immunoefficiency increases when you love and are loved.

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Masters and Johnson presented a sexual problem-solving book that quickly became the spark for an entirely new form of couples therapy. In Human Sexual Inadequacy and in The Pleasure Bond, they suggest techniques for slowing men down and speeding women up in their sexual response. They present sensate focus, a technique for learning to touch and be touched, and describe the “tease technique” and the “squeeze technique” to help with impotence and premature ejaculation respectively. Their diagnostic categories are based on time, on coming too soon, taking too long, or not spending enough time. Women may have problems having orgasm, but men are always orgasmic if they ejaculate, preferably “on time” for the female. For the first time, we had individual diagnosis based on two people; men were premature, but women were never postmature. Sex clinics proliferated following their work, as Masters and Johnson gave unwilling birth to the Arthur Murray “sex” studios of the seventies. While Masters and Johnson trained only a few teams, their educational programs were offered to hundreds who in turn felt themselves to be “Masters and Johnson” qualified, franchised sexperts. Unlike the first and second perspectives, this third perspective was being directly interpreted for us on talk shows and in popular magazines, each preaching the same “time-frame sex” of this third view of sexuality. Perhaps a society that now had more time to recreate and less need to procreate was more than ready for a perspective on sex that stressed efficient, effective use of our sex time.

There is no question that Masters and Johnson made a significant and lasting contribution to “democratizing” sex. Their treatment program was for couples, and even though their sexual-response model was based on the individual, they treated couples with treatment teams, and saw marriage as much more than a natural state or convenience. They saw it as a challenge, a potential for pleasure and sexual satisfaction as well as companionship, a place where time could be better controlled. In my view, the most significant contribution of Masters and Johnson was not their flawed sexual-response model, which modified the original Ellis model. Their contribution was to focus on a system, an interaction. They were a team, a man-and-woman team, and that allowed the feminist balance so lacking in the first two perspectives. They started the systerns approach to sex that I emphasize in the super marital sex perspective.

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It has not been shown that we marry to make up for a personal deficit, or that we pick partners who balance for some personally perceived deficiency. It is true, however, that our most remarkable (at least in our own eyes) personality deficit influences our bonding.

“I’ve never seen myself as particularly smart, I guess. Just about average,” said a husband. “I’d steer away from real bright people, people with book knowledge. I know my wife is much smarter than I am, but I offer her other things, like steadiness, reliability.”

Our selection of partner may not be determined by our perceived deficits, but you can see in this man’s description that specific areas of experienced inferiority can act themselves out within our relationships.

“I’m not beautiful, but I am smart,” reported one wife. “My husband is beautiful but not too bright. Together, we make a beautifully intelligent marriage.”

Think about your own deficit area on your love map and consider how this may influence your interaction with your spouse.

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Following this, there is a stage of exhaustion where the person goes into a deep sleep for seconds, minutes, or rarely, hours. Sometimes a state of confusion exists for a short time and while conscious he is unaware of his surroundings. He then recovers and can carry on with his normal activities.

The brain is a hive of electrical activity as the cells communicate with each other. An epileptic fit is like an electrical explosion, which sets off a chain of uncontrolled electrical activity. The triggering mechanism may arise in a scar in the brain tissue from an injury or an operation.

Almost all epileptics can have their disorder brought under control and most can lead normal lives, studying, working, marrying and having children. The greatest problem faced by most epileptics is the ignorance and fears of society.

A generalised fit is a frightening thing when seen for the first time. Few people know how to handle such an emergency and their ignorance and fear leads them to shun the sufferer.

Old prejudices die hard and epileptics are often thought to be mentally dull, unduly violent or anti-social. These generalisations are not true.

Many employers are hesitant to give jobs to those who have this disorder, yet their accident or absentee rate is no higher than others.

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Let’s see how close we could get to this for, say, lung cancer. Screening tests we could consider are sputum cytology, X-rays and bronchoscopy. Sputum cytology is simple, safe and convenient for the patient. However, each specimen takes quite a few minutes to examine thoroughly and this must be done by a specially trained technician, so it is not cheap. There are false negatives— not all cancers shed cells into the sputum to be coughed up. Some do so erratically—there may be no cancer cells in the specimen that goes to the laboratory even if there were the day before and the day after. False positives are rare but occasionally other abnormal cells are mistaken for cancer cells. The test can pick up very tiny cancers at a stage when surgical removal would have a good chance of curing the patient. To pick up very early cancers, specimens would have to be examined every few months, which obviously would make it extremely expensive in the long run. Another problem occurs if the cancer is so small that it can’t be seen on X-ray. It then has to be located by bronchoscopy or special types of X-ray before it is possible to go ahead with surgical removal.

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Tests that allow us to ‘see’ the liver are not necessary in every person with cancer. They are usually only recommended when there are clues from symptoms, clinical examinations or blood tests that there is liver abnormality. A radionuclide liver scan shows us the size of the liver and whether there are any areas in it that are not functioning normally. Normal X-rays do not show up the liver. A CT scan does and it may also pick up cancer deposits as they let through less X-rays than the normal liver. In some cases, the combination of symptoms, clinical findings, blood tests and scans build up a picture so typical of liver secondaries that a biopsy for conclusive proof may not be recommended. However, when there is something unusual or unexpected about the situation, or when it is very important to be quite certain, a liver biopsy should be considered.

This can be done with a special type of needle through the skin, under local anaesthetic. Because the liver moves up and down as you breathe, it is important to try hard to hold your breath when the doctor asks you to. Before doing a liver biopsy, your doctor should make quite sure that your blood can clot normally. If not, injections can be given to correct this. Even so, it is possible to bleed internally after a liver biopsy. This is unusual, but has to be watched for carefully. After the biopsy you will be kept lying still for some hours while the tiny hole in the liver seals over. During this time your pulse rate and blood pressure should be checked regularly. The main danger of bleeding is right after the biopsy. Sometimes transfusion is necessary. Very rarely, an operation is needed to stop the bleeding.

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Many children develop a habit, spasm or tic which involves movements which are fast, sudden, unexpected and serve no purpose. The child appears to have no control over them.

The movements can include blinking, twitching of the nose or shrugging of the shoulders. Most of these habits spasms are minor and seem to disappear after several months.

However, in some children these tics are both severe and prolonged. They can involve grunting, throat-clearing and occasionally, uttering obscene words. Sometimes these children repeatedly touch themselves or others in the genital area or on the breast.

This bizarre behavior is extremely distressing to the child suffering from the problem and also to his parents. It is called the Tourette syndrome.

The cause is unknown, it is three times more common in boys than girls and there is some family tendency to it. Onset is usually before the age of 15.

Not all cases of mild habit spasms or tics can properly be labelled the Tourette syndrome, but those who have verbal spasms, particularly the uttering of obscene words, are diagnosed under this classification.

Sometimes children grow out of this, sometimes it persists. Fortunately one of the major tranquillising drugs, haloperidol, has proved of great value in treating this disorder.

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There is no way at present to distinguish between individuals who will or will not develop an eating disorder subsequent to dieting. There is also no way to identify who will or will not be damaged by repeated weight cycling. It is uncertain whether some people will need constant support and monitoring to maintain fat loss. It may be that a different approach needs to be taken for people with a food dependence from the traditional approaches used in behavioural and self-management practice.

A further model for eating disorders has been proposed with reference to obesity and non-purging bulimia, which suggests that repeated cycles of dieting and regaining weight lead to food dependence.” Dependence is defined as ‘the failure to stop using a substance that is deleterious to health and where use results in short term mood alteration’. In this model, food (specifically those foods which are reserved for bingeing episodes) becomes a psychoactive substance. In common with other psychoactive addictions it has the following characteristics:

• food is used in larger amounts, or for longer periods than the person intended

• there is a persistent desire or effort to cut down or control intakes

• there is a continued use of a food despite the knowledge that there is a persistent or recurrent physical, social or psychological problem caused by its consumption

• there are ‘withdrawal’ symptoms—cravings, anxiety, tension, depression—when the food is not available.

Obese and bulimic clients frequently report bingeing in response to stress, frustration, rejection or other negative emotional states, and it seems likely that both uncontrolled eating and the kinds of food used (high carbohydrate/fat) act synergistically to lower the internal arousal state. Few of these clients are able to activate behavioural self-management techniques at these times.

This presents the fat loss counsellor with a major dilemma; on the one hand is the desire to encourage healthy weight loss, but on the other is the concern about encouraging restrictive eating disorders. Unless the counsellor turns away a client, leaving them at the mercy of someone less scrupulous, they have a responsibility to be helpful, and above all, to do no harm. The following are some guidelines for counsellors, based on this ‘do-no-harm’ principle:

Myth-information. Tai Chi, the ancient Chinese art of movement, is a form of relaxation which may, indirectly, have an effect on nervous eating and thereby improve body fat levels. The physical component of Tai Chi alone, however, is not sufficient to create a significant energy deficit.

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Carbohydrate is a part of food. Starch is a carbohydrate, so too are sugars and certain types of fibre. Starches are nature’s reserves created by energy from the sun, carbon dioxide and water. The building block of starch is glucose, a single sugar.

The simplest form of carbohydrate is a single sugar molecule. Chemically, this sugar molecule is known as a monosaccharide (mono meaning one, saccharide meaning sweet). Glucose is a single sugar molecule which occurs in foods and is the most common source of fuel for the cells of the human body.

If two sugar molecules are joined together, the result is a di-saccharide (di meaning two). Sucrose, or common table sugar, is a disaccharide.

Starches are long chains of sugar molecules joined together like the beads in a string of pearls. They are called polysaccharides (poly meaning many). Starches are not sweet to taste.

Dietary fibres also have a complex structure, containing many different sorts of sugar molecules. They are different from starches and sugars in that they are not broken down by human digestive enzymes. Fibre reaches the large intestine without change. Once there, bacteria begin to ferment and break down the fibres.

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