Toddlers

By the time children are 1-2 years of age, their sleep patterns tend to be geared to household routines. Most will be awake for lengthy periods during the day, and have a nap in the afternoon, though some may still need two naps a day. Sometimes they will be very tired and not relaxed enough to go to sleep. Some will have fears and phobias which affect sleep patterns, and many will not have learnt adequately how to get themselves off to sleep because of inconsistent parental handling of sleep problems, which are exceedingly common at this age. Parents who always stay with their child until he is asleep will inadvertently teach him to always require a parental presence to fall asleep — he may end up not being able to fall asleep on his own.

Preschoolers

Children of this age sleep on average between 10 and 12 hours a night, and some will only nap occasionally, depending on family routine, attendance at daycare or kindergarten, and their individual temperament characteristics.

Most school age children will sleep between 8 and 12 hours, with great individual variation, and by the time they reach adolescence their sleep requirement will have reduced further to between 7 and 10 hours per night. Sleep patterns are often erratic in later childhood, especially in adolescence, when staying up late is often the norm, and actual times of sleep fluctuate wildly between schooldays and weekends or holidays. Children of this age begin to establish their own sleep patterns based on their particular temperament and lifestyle, and become increasingly independent of family routines or preferences.

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Once the cause(s) for your nausea are found, it may be possible to remove or correct them. For example, if it is due to the cancer itself, some form of anti-cancer treatment would be a possible, but not necessarily the best, way to tackle it. If it is due to cancer in the brain, corticosteroids could relieve the nausea temporarily by reducing the pressure on the brain. If it is due to a bowel blockage, surgical removal or bypass of the blockage may be possible. If it is due to radiotherapy or chemotherapy it may be possible to change the doses, or even stop the responsible treatment. If it is due to, or aggravated by, anxiety, talking about and dealing with some of your worries, learning relaxation techniques and taking sedatives are three approaches you could consider.

The nausea itself must be treated if the cause is not to be emoved—either because this is impossible or because you decide that the likely cost of removing the cause would outweigh the likely benefit. I suggest you read pages 240-42 here. This section is basically about the treatment of nausea due to chemotherapy, but the same sorts of approaches can be followed for nausea due to other reasons. Remember, there are a number of different antinausea medications and it can be a matter of trial and error to find the one that suits you best. Chemical names of some good ones are prochlorperazine, metoclopramide, thiethylperazine maleate and chlorpromazine.

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Stop the bleeding, always use direct pressure … “Put your thumb on it.”

IF MINOR: Clean the wound with clean, running water, follow up by cleaning with an antiseptic solution, then apply an antiseptic dressing — mercurochrome or acriflavine are useful.

Use a clean dressing to cover the wound — a band aid or a bandage — and change it frequently. Dirty dressings rub dirt into the wound and infection results.

IF MAJOR: The wound may require stitching, otherwise the same treatment as above, then see the doctor. Before you do, check your tetanus immunisation, take your record with you. Remember that scalp wounds always bleed a great deal, but direct pressure will always stop it.

Children often break the humerus, or arm bone, near the elbow. This is a very serious break and can cause damage to blood vessels. Immediate medical attention is essential. Splint it by immobilising it in a sling.

When bones in the leg are broken there is often considerable internal bleeding, especially with the thigh bone or femur. Two or three pints of blood may be lost into the thigh of an adult and may only cause a small visible swelling.

Shock due to pain and this loss of blood is quite common. Splint the lower limbs. Do this with a piece of wood (even a broom handle), a flat board or by strapping the two legs together.

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Tonsillitis is a common infection of childhood but is seen less often in adults.

During the teens, a sore throat may be due to tonsillitis or it may be due to glandular fever or infectious mononucleosis.

In the early stages, it may be difficult to tell the difference between them but later the typical greyish-white membrane over the tonsils in glandular fever plus the enlargement of the lymph glands and spleen point to the diagnosis.

This can usually be confirmed by a blood test although this test may be negative in the first few days.

Infectious mononucleosis is believed to be a viral disease common in late childhood and adolescence but uncommon in smaller children and unusual in the older age groups.

It does occur in the 20s, is uncommon in the 30s and rarely seen after 40.

It is usually spread by breathing over people, and particularly by kissing.

Some recent research has shown that it may also be spread sexually.

It normally presents itself with a sore throat, fever and general malaise.

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Normally when specimens of tissue are examined by the pathologist to determine their nature, he sets the tissue in paraffin for about 24 hours before making thin sections to examine under a microscope.

In the technique of frozen section, the piece of tissue removed is frozen by carbon dioxide snow (what we know as “dry ice”).

The tissue is then sliced thinly with a special knife and examined under the microscope. The diagnosis can be given to the surgeon within 10 minutes.

If it is benign, the surgeon can close the wound and the operation is finished. If it proves to be cancer, the most commonly accepted procedure is to go ahead and remove the breast and the lymph glands from the armpit.

This technique of establishing the diagnosis quickly allows the surgeon to proceed with a definitive operation rather than having to wait a day or two, then expect the woman to face up to a second more extensive procedure.

A one-stage operation is also believed to pose less risk of spreading the tumor during the operation.

Fibroadenomas do not become cancer and have no complications. They are only removed because no surgeon can be 100 per cent sure that the lump is benign.

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If you would have accepted a common-sense explanation for it before, you probably should now.

I’m afraid that many doctors and other practitioners who treat people with cancer behave as though symptoms are not important. These practitioners don’t ask about them and will treat you in an inattentive and impatient manner if you try to tell them about the symptoms that are worrying you.

You will have to keep reminding yourself of three things in order to get your symptoms the attention they deserve. Firstly, any symptom that is uncomfortable, restricts your activity, keeps you awake, makes you feel anxious because you don’t know what it means or worries you in any other way, is important. Secondly, because no one else can see or feel your symptoms, they will only know about them if you tell them. Thirdly, your practitioner’s job is to care for you as a whole person, not just to treat your cancer. It is never a waste of his or her time to talk about your symptoms. In fact, your symptoms and their treatment should be discussed every time you see your practitioner.

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For the same amount of kilojoules, you can eat far more carbohydrate food than fatty food, lb prove the point, let’s compare two everyday foods which are almost pure in the nutrition sense. Three teaspoons of sugar (almost pure carbohydrate) has the same number of kilojoules as 1 teaspoon of oil (almost pure fat). This means that you can eat three times the volume of sugar as you could oil for the same kilojoules!

Here are some examples of how you can eat more carbohydrate food than fatty food for about the same number of kilojoules:

• A small grilled T-bone steak (about the size of a slice of bread) has the same kilojoules as 3 medium potatoes.

• 3 slices of bread, thickly buttered, are equivalent to 6 slices of bread with no butter.

• 3 chocolate cream biscuits have more kilojoules than a carton of low-fat chocolate milk.

• Eating 1 piece of crumbed, fried chicken at lunch substitutes for the kilojoules of 6 slices of bread (without butter).

• For every 1 cup of fried rice you eat you could eat 2 cups of boiled rice.

• And if you’re feeling extra hungry next time you stop for a coffee, consider that one slice of mudcake has the kilojoules of 4 slices of lightly buttered raisin toast!

In every case the highest fat foods have the highest kilojoule count. Because carbohydrate has about half the kilojoules of fat, it is safer to eat more carbohydrate-rich food. What’s more, the body will store fat and burn carbohydrate so the kilojoules contribute more to your ’spread’ when they come from fat.

You can eat quantity—just consider the quality!

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Summary of main points.

• Modern technological environments are associated with large increases in obesity in Western countries.

• Environments which influence overfatness can be categorised on size (’macro’ or ‘micro’) and type (’physical’ and ’socio-cultural’).

• Macro environments represent the broader national and international perspective; micro environments are within the immediate family, friends and community.

• Environmental modifications are necessary for decreases in obesity at the population level and without these there are likely to be few major inroads made into the increasing prevalence of obesity.

The influence of the environment on obesity was eloquently shown in a study of six villages in Papua New Guinea. Professor Paul Zimmett and his colleagues from Melbourne University developed an index of ‘modernity to measure how much modern technology was used in a particular population and to see if this is related to obesity levels. The ‘modernity’ index included measures of new technology use such as television and motor veto education levels, occupation, father’s employment, years living in an urban centre and type of housing and graded the six villages on their total modernity scores and correlated these with obesity levels as measured by body mass index (BMI). As the level of ‘modernity’ increased in a village, so did the level of fatness of the population. They concluded that while modern technology is something we might all strive towards for improved quality of life, it has significant side effects on health. This is due particularly to the decreases in physical activity, as well as the increased availability of high energy dense foods, particularly fatty processed foods.

The current environment in modern society in relation to obesity can be compared with that associated with cigarette smoking in the 1960s and 1970s. While individual and group ‘quit’ smoking programs had reasonable success at the individual level, they had little impact on smoking rates in most Western countries until population-wide measures were taken and public attitudes towards smoking changed. Legislation on smoke-free environments, advertising bans, price hikes and a range of other environmental changes have all been major contributors to the decreases in smoking.

There are a number of different environments—macro, micro, physical and socio-cultural—in which human beings operate. These, in turn, can affect aspects of fat/energy input (F/EI) such as food supply or availability, or fat/energy expenditure (F/EE), such as facilities for, and attitudes to, physical activity.

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As well as depot and circulating stores of fatty acids, muscles can call on a more immediate source of fat for energy if required. This is in the form of fat droplets in the muscle tissue itself. Because of its physical proximity, this is probably the first store of fat that is tapped by the muscles once energy demands call on extra fat to help out. It makes sense then that well-trained athletes are able to utilise this source of fat much earlier and more efficiently than the non-trained (probably because of a higher level of LPL in trained muscle and because fat is channelled to muscle in preference to the adipocyte because it is used on a more regular basis). This may also help to explain, along with muscle catabolism, why well-trained endurance athletes tend to be very thin in the muscles which are not being used in their event—the upper body muscles of the marathon runner for example.

Of course, all this is just a cursory glance at what happens in the fat cell and in the muscle tissue. The process is much more complicated and to start to make sense of this, we need to examine the processes of lipogenesis and lipolysis separately.

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Along the course of the intestinal tract, a large number of interesting events take place. As you know, digestion commences when saliva is pumped into the mouth. More juices, mainly acid and certain chemicals, are injected into the stomach. Further along, other chemicals called enzymes are pumped into the intestinal passageways also. All these are aimed at helping the food break down into its simplest component parts. In this form they are more readily absorbed by the villi, tiny finger-like processes that penetrate into the small bowel cavity.

Chemicals manufactured by the liver and stored in the gall bladder find their way into the bowel via the duodenum. These are called bile salts, and they help fats to be digested.

Every so often, even though they have been studying the bowel system for many years, research doctors are discovering new chemicals that are used in the digestive processes, ones they didn’t realize existed before. Just how many different kinds there are we will perhaps never know. But they are all important and do a very valuable job.

The liver, the huge organ in the upper right side of the abdominal cavity, also produces many other chemicals which are vital in the normal functioning of the body. Besides, the liver tears apart unwanted products; it renders them harmless and prepares them for elimination from the system.

The spleen is another massive abdominal organ. This sits in the opposite upper side of the cavity. It has important duties associated with the blood system.

The kidneys, the filtering system, lie in the back part of the abdominal cavity. They are hooked up to the blood system and also do the job of getting rid of unwanted debris from the body.

Certain glands called endocrines are housed in this vast cavity. A very important one is the pancreas. It produces a number of vital hormones. Insulin, which regulates the way in which body sugars are cared for, is manufactured there. If this system is not working properly, a condition called diabetes may occur.

Down below is the pelvis, and the abdominal cavity is continuous with that region. The pelvis houses the bladder and, in women, the reproductive organs—the uterus (womb), the tubes and the ovaries. In males, it houses the prostate gland, which sits just under the bladder (the part which stores urine until it may be voided).

The entire cavity is lined with a thin, slippery, shiny tissue called the peritoneum. This keeps the inner region and all of its contents germ free. It is a wondrous system.

But alas, many things may go wrong within its boundaries. Let’s take a peek at some of the hapless things that can go wrong with our insides.

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