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.

*189/40/1*

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.

*632/71/1*

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.

*376/71/1*

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.

*125/71/1*

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.

*156/40/1*

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!

*105\42\4*

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.

*169\186\4*

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.

*30\186\4*

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.

*49\87\2*

Activity

Gradually more control of muscular movements is gained. When lying on the back the baby is able to keep the head in the mid position, and is able to rotate the head in many directions, while sitting or while lying down. If a baby so desires, he is able to keep his head erect and still for short periods. He is able to lift his head to a right angle when lying on his tummy.

He frequently lies on his tummy with the arms outstretched, and will often flex the muscles of the lower limbs, partially raising his body. He tends to rock when lying on his abdomen, with the limbs stretched straight out, and the back arched, or he may roll from one side to the other. If pulled to a standing position, he will stand erect for short periods.

He gradually finds he can sit with support for upwards of a quarter of an hour. I lis head may remain steady, and the back quite erect.

He is able to use his hands to do more activities, and uses his fingers and toes. He grasps for objects with his palms, and often takes them between the fingers, either using the thumb and index or the index and second finger.

His aim when grasping is still often inaccurate. But he tends to grab and will follow objects as they pass to his hand. Often he misses an object when trying to grasp it.

Talk

Baby talk gains rhythm and pitch. It is gradually becoming more modulated, and he may continue with his baby babblings for 10 to 15 minutes, or even longer, at a time. His words, even though in baby talk, gradually take on some of the impressions of vowels of more mature speech.

The quality of his voice becomes more normal, and his cry stronger and more definite. He smiles when spoken to, and he often squeals and cooes. He starts to chortle, giggle, grin and goo, and may keep this up for half an hour. He becomes a great imitator.

Mind

Visual ability becomes more adult-like. He is able to discern colour, and his eyes adjust so that he focuses on objects irrespective of their position.

He becomes even more interested in objects and details and activity around him, and may concentrate for an hour. He becomes increasingly responsive.

His head and gaze will tend to follow objects, especially moving ones, in a more co-ordinated fashion. He will immediately react to a noise, such as a rattle or ringing noise.

He tends to co-ordinate his activities, and will make efforts of his muscle groups (arms, legs, body) to reach things he wants. He grabs for objects, including moving objects, with increasing skill and accuracy, although still often wide off the mark. He often carries objects in his mouth; persists in swiping at things whether he hits or misses them.

He starts to appreciate the third dimension, and is aware of height, depth and size. He will stare at a place from which something drops.

He can remember things over a span of 5-10 seconds. Recognition improves and he will often react to a face he knows. He can differentiate between faces and objects. He tends to dislike strangers, preferring the safety of those he is familiar with.

He can tell the difference between his hands and fingers. He smiles at himself in the mirror. His reaction to faces and those he knows or does not know will vary. He becomes aware of his own little act in life, realizing it is something a bit special and different from the general nature of the outside world.

He becomes aware of situations. He can pick and choose between toys. He often transfers a toy from one hand to the other.

Relationships

His personal relationships, both with himself and with others, gradually develop. He learns to laugh, protest, show anticipation, become excited, breathe heavily, as circumstances vary. He learns to soothe himself and often finds music calming. He clasps his fingers when at play. He shows interest in familiar faces, and will smile at his reflection in a mirror and readily reacts to the familiar features of his mother’s face.

He makes a variety of noises; ‘talks’ to himself as if vocalizing and socializing. He generally enjoys being handled and tends to enjoy being helped to sit or stand. He often indicates discontentment when he has to sit down again.

He is interested in his toys, often having a favourite plaything that he prefers. He enjoys playing, games and generally socializing.

His interest in his social surroundings often reduces his interest in eating. When he hears food being prepared, he anticipates its arrival. Will screw up his mouth when he sees food coming, or he is offered a bottle.

Sounds become quite readily distinguishable.

The time interval between feedings and bowel actions tends to become longer.

He obviously enjoys his bath, and will garrolously splash, kick and lift his head.

*4\87\2*