Dandruff is caused by the shedding of tiny flakes of dead skin from the scalp. This skin shedding is part of a normal process which occurs all over the body, but is usually more apparent in the hair because the flakes can accumulate there. Dandruff is just an exaggeration of this process on the scalp, and its cause is unknown.

Clinical features

Your child may have a very itchy scalp, and you will notice excessive tiny white flakes of dead skin in his hair and on his clothes. If your child scratches a lot, the scalp may become red and sore.

Treatment

Dandruff can usually be controlled by washing the hair daily with a medicated shampoo. Make sure you brush your child’s hair well before shampooing, to remove as many dead flakes of skin as possible. Do not brush too vigorously as this may hurt the scalp if it is already irritated. Once the dandruff is under control, you may be able to cut back the use of medicated shampoo and wash the hair on alternate days. Alternate between using normal shampoo and antidandruff shampoo.

When to see your doctor

• if the dandruff does not improve after 2-3 weeks using this treatment;

• if your child has thick, flaky patches in the scalp. Although it is uncommon, this may be the first sign of psoriasis

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The kit described below does not make you a do-it-yourself doctor. It is always best to check with your doctor first, before giving any medications to your child. What this kit will provide you with is the means to administer first aid treatment in the event of injury and to treat symptoms such as fever or pain.

A cabinet which is portable is often a good idea, so that you can carry it immediately to where it may be needed, and have everything available beside you. It can also been taken along when travelling. You may wish to check with the Child Safety Centre at your nearest children’s hospital, or the Child Accident Prevention Foundation, who will be more than willing to advise you on the sort of cabinet to purchase. They may even have a recommended design for you if you intend to build a medicine cabinet yourself.

The list below is intended as a guide to what we consider useful for parents to have readily available at home. It is not exhaustive and you may want to add other things to it.

We encourage you to show this list to your doctor and discuss whether there is anything else that he feels should be added for your child. There is room at the end to add these things. Check the list regularly to ensure the medications are current (i.e. that they have not passed their expiry date).

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I had everything the books say, but I didn’t feel it like you would think. It’s a little like being numb. I went through the whole self-help thing, but it’s like 1 still had something more in me.

I did not indicate which of the above reports was from a husband or wife so that you could try to guess for yourself. Can you tell? The first was a husband, the second the wife. Early in the treatment program, 881 men and 492 women reported this problem. More men reported this only because the whole idea of a psychasm was new to them. Once I started asking, they knew just what I meant. The women related more easily to the problem as a concept, but tended to be more holistic in their orientation and more capable of psychasms in some form of their sexual activity.

SEMINAL SEEPAGE: It was a strange sensation, almost like I was peeing. It felt warm, and there wasn’t a thing I could do about it. She didn’t even touch me—touch my penis, I mean—and it all came out. I lost my erection and felt like I just didn’t want to go on, but I never really felt the throbbing I get. It just all came out, almost all at once.

HUSBAND

Nineteen men of the thousand reported similar experiences. Each was associated with anxiety, a performance orientation to the sexual encounter, resulting in excessive and early discharge of the excitation part of the neurohormonal system (the sympathetic nervous system).

URINARY OR SKENE’S GLANDS EMISSION WITHOUT CONTRACTIONS: I felt like I was peeing, like something was coming out down there. It was embarrassing because I have had no control over it, it just happened. I tried to pretend nothing was happening, but I know he knew, too. He never said anything, but sometimes it happens and I can’t control it. It’s not coming or anything. It just comes out.

WIFE

Thirty-eight women of the thousand reported this phenomenon. Since my report is purely subjective, with no visual laboratory investigation, I cannot interpret these reports to support the con-Tsion that women emit an ejaculate. This fluid may be related to he Skene’s glands, some mixture of Skene’s glands fluid and urine, emission of urine related to stress incontinence. Nonetheless, the subjective experience was similar to the male reports of seminal seepage and related to sympathetic (hot) orientations to the sexual encounter.

Since sex research does not focus on “hot or cold” life orientations in favor of a genital focus, it may be yielding inconsistent findings regarding the controversy of female ejaculation.

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WIFE

“To hell with the whole damn government!” said the husband to the anchorman for the evening news. He used the remote control as if it were a small pistol and shot off the television. “New tax system, my foot. Get the little guy every time. Screw ‘em,” he finished as he turned his attention to the sports section of the newspaper that had actually been left in the family room for two days.

His wife sat alone at the dining-room table, four plates around her empty, but hers more than half full. The family dog looked up at her and, with a grunt and a long sigh, finally gave up his vigil and curled in the corner to sleep. Minutes before, the woman had been waitress, busboy, and encounter-group leader, refereeing several mini-conflicts between her three children while her husband talked at her about his day at work.

“Yes, thank you, my sore shoulder is feeling much better,” answered the deserted wife and mother to no one. “Oh yes, my day was very busy. No, that tooth did not need a cap. As a matter of fact, the dentist had sex with me three times. He drilled me, filled me, and thrilled me.”

“Did you say something, honey?” asked the husband without looking up from his newspaper. Of course, he knew she had said something, but he had learned that by asking this question, he would not have to listen to her response.

“No, not really” was the answer he had expected and received. “Bye, Mom!” she heard from one of her three children. Voice changes accompanying adolescence made identification of the exiting child almost impossible.

“Where are you going?” yelled the mother as rapidly as she could. It was too late; the side door slammed before the words were out of her mouth. Sometime ago, she would have run to the door and demanded an accounting, or an apology for rudeness. This time she remained seated. She folded her arms in front of her, rested her head on her arms, and began to cry.

She must have fallen asleep, because she was startled to awareness by two cold hands up her sweatshirt, one cupping each breast. “How ’bout some action, sweet cheeks. The kids out for a while?”

His erection pushed against her left arm through his jeans. She wondered if he had become aroused by his successful shooting of the anchorperson, the stimulation of days-old baseball scores, or the fact that he had a few minutes before his softball game with the guys.

“Maybe later. I’ve got to get this table cleared off,” she bargained.

“That’s just what I mean. We have no spontaneity in our sex life. You’re always so inhibited. Can’t you just let go? Every sex manual in the world tells you to let go.” The husband was angry, frustrated, and knew that he would be too tired later for sex after a night with the guys lying about work, sports, and their sex life.

The wife had learned that, for her husband, “to let go” meant to respond to his needs whenever they arose. His needs never seemed to arise in response to her, but had a life of their own. She unzipped his fly, rubbed his penis vigorously, and looked up at him standing beside her. She knew this would not take long.

As he finished, he asked her hurriedly, “Where did you put the tissues? The kids could come home any minute.”

“In the drawer by the knives,” she said, wondering why she was thinking of knives at this moment.

“Now, you see? We can have a quickie. We can let go. See what I mean?” he said as he prepared to ask his wife about the location of his baseball glove.

“It’s in the trunk of your car,” she said, using her well-developed one-directional family mental telepathy.

“Bye!” he said. As the door slammed, she looked at the remote-control device on the family-room floor and wondered if it worked on husbands as well as anchorpersons.

This scene and its finite variations were reported by the thousand couples. It is an explicit sex scene, containing every element necessary to understand the sexual problem that brought this couple to my clinic. The husband complained that his wife was “frigid, always distracted, and not orgasmic.” The wife reluctantly reported in confidence that her husband was a “premature ejaculator” and that she felt “totally asexual.” They had read the sex manuals, had been to two sex therapists over the past three years, and, by the husband’s report, “even tried one of those adult hotels with the mirrors, but it wasn’t much.”

The couple had been taught postures and techniques. They had been shown films. They were given some special cream to numb the husband’s penis so he could “last longer.” They had been taught to look for the wife’s “G spot,” in hopes that its discovery would free her for sexual bliss. They had not been taught that it was their system, not their sex, that was their problem.

Take the following sexual system test with your partner. Make time to discuss each issue. Sexual problems are disorders of a system, a disruption of natural flow between marital partners, and between the marriage and the rest of the world. The Chinese refer to the natural flow of life as the Tao, and there is a Tao of marital sex. When our major reproductive organ, our brain, does not function with the “sexual Tao” of the marriage, we experience sexual disease. Super marital sex depends upon establishing a flow, an ease within the system that the couple I am describing has lost.

The test you are about to take is based on what we know about natural systems. Worry less about your actual score on this test and focus instead on the interaction with your partner as you examine each item. Before you put away the dishes or go to the Softball game, sit down and see what is meant by “going with the flow.”

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There is a sudden onset of chest pain, usually made worse by breathing, associated with shortness of breath. The symptoms are marked and often distress the victim so much he is convinced he has suffered a heart attack.

Examination by the doctor should provide the correct diagnosis and could be confirmed by an X-ray of the chest.

Small pneumothoraces may be left to resorb the air and allow the lung to re-expand. Larger ones will require drainage of the air.

This is achieved by inserting a rubber catheter or tube into the pleural space from the upper chest and connecting this tube to an underwater seal.

As the person breathes and coughs, the air is forced down the tube and bubbles out through the water, but the water rises in the tube and prevents more air from entering the pleural space.

In recurrent cases of spontaneous pneumothorax, it may be necessary to obliterate the pleural space to prevent recurrence.

This can be achieved by operation or instilling irritants into the pleural cavity to cause inflammation of the surfaces of the pleura so that they stick together.

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The patient’s age, general condition and occupation are all considered before operation. Several investigations may be necessary to establish the extent of the disease and which arteries are involved and where is the narrowed portion.

These investigations include an electrocardiogram (ECG) and chest X-ray. Echograms using ultrasound may show the outlines of the heart chambers.

Stress testing, where the person is exercised and monitored with cardiographs, may indicate not only the presence of artery disease, but also its extent. The most important investigation however, is the procedure of coronary angiography.

In this, a thin flexible tube or catheter is inserted into an artery in the arm or leg and pushed along until it enters the aorta. It is then guided into the opening of the coronary arteries.

A radio-opaque dye is injected through the catheter and flows along the coronary arteries. X-rays are taken and show the arteries and whether they are narrowed or blocked.

A bypass operation is major surgery, but the benefits are certainly greater than the risks.

Coronary artery bypass surgery is no longer experimental. It has an established place in the management of coronary artery disease and can be offered to selected patients as a means of reducing the severe effects of the disease and improving their chances of returning to full and productive life. It also holds the potential of increasing the lifespan of those with established disease in their coronary arteries.

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The exact cause is uncertain but may be due either to some immunological disturbance or to the absence of a specific enzyme which prevents the complete breakdown of gluten so that a toxic substance is formed, damaging the cells forming the wall of the small intestine.

It tends to run in families, but in identical twins the abnormality has been reported only in one of the pair. It occurs in about one in 4000 and may start at any age although it is more common in children.

In childhood, it usually starts soon after gluten is added to the diet. At this stage, the child may produce loose stools, become pot-bellied and may develop anaemia, general wasting, irritability and failure to thrive.

Although the disease has been recognised in Europe for many centuries, it was only in 1950 that Dr W. K. Dicke, of Utrecht, Holland, discovered an effective treatment. He found that the elimination of wheat gluten from the diet of, children with coeliac disease produced a full clinical remission.

Later, the glutens of rye, barley and oats were also regarded as dangerous to these children, but the evidence concerning barley and oats is still controversial.

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Severe itching

Small red dots or black/gray lines on skin

Home care

Give nonprescription antihistamines to relieve itching.

Follow the doctor’s instructions for treating the scabies, and make sure that all family members are treated at the same time.

Launder the infected child’s undergarments, bedding, and towels to destroy the mites.

Precautions

-    If mites attack the skin around a nursing mother’s nipples, scabies can occur on the baby’s face.

-    Secondary infection can occur when the child scratches.

-    Consult a doctor before using any medications for scabies.

-    Consult a doctor before applying any medication to the face of a baby with scabies.

-    Lindane ointment, which is sometimes prescribed to treat scabies, is poisonous and should be kept out of the reach of children.

-    If treatment does not clear up scabies, the person may be re-infested; consult the doctor.

-    Scabies is easily transferred from one person to another, and all family members should be treated at the same time.

Scabies is a skin infection caused by the mite Sarcoptes scabei, a crawling insect barely visible to the eye. These mites burrow under the skin to lay eggs. The eggs hatch quickly and continue to tunnel for two weeks until they mature. Mature mites congregate around hair follicles, mate, and begin the cycle all over again. Scabies is easily transmitted to others and can be spread by direct human contact. It is rarely spread by animals.

The infestation of the mites typically occurs in between the fingers and- toes, on the palms of the hands and undersides of the wrists, in the armpits, at the waistline, and, in males, on the penis. Because mites may also attack the skin around a woman’s nipples, scabies sometimes occurs on the face of a breast-fed infant.

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