This is a condition in which a testicle suddenly becomes twisted, and its blood supply is blocked off. If it is not corrected quickly, the testicle may die.
Cause
The cause of a twisted testicle is uncertain.
Clinical features
Your child may complain of rapid onset of severe pain in the groin and of a sore lower abdomen. Within several hours the scrotum over the affected testicle may become very tender, hot and swollen.
Treatment
You should see your doctor immediately if your child has a swollen or painful testicle. Torsion of the testicle is a surgical emergency and must be operated on immediately if the testicle is to be saved.
The testicle is straightened and sewn into position to prevent twisting from recurring. The other testicle may be sewn into position at the same time, also as a preventive measure.
Prevention
There is no way to prevent this condition from occurring initially.
UNDESCENDED TESTICLE
Cause
In the developing foetus the testicle forms within the abdomen and later moves down into the scrotum. An undescended testicle is one which does not lie fully within the sac of the scrotum. This is a relatively common condition, and 2% of newborn have one or two undescended testicles. Within a year, these usually slip down to lie within the scrotum.
Treatment
If, after a year, this has not occurred, then surgical intervention is usually necessary to prevent damage to the testicle. Consult your doctor if you suspect your child has an undescended testicle.
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Cause
Menstrual cramps are caused by the contraction of the muscles of the uterus, under the influence of hormonal changes occurring at the time of menstruation.
Clinical features
Cramps may begin several hours before the flow of blood appears. They are usually in the lower abdomen and may feel like spasms, occurring frequently and lasting for several minutes at a time. Your daughter may have an associated headache, and even nausea. All these symptoms are usually only present on the first day of the period.
Treatment
A hot water bottle can help ease cramps. Try to encourage your daughter to maintain normal activity if she can. Make sure tampons are changed every 3-4 hours, so that build up of blood (which can lead to severe infection or toxic shock syndrome) does not occur. Sometimes a mild painkiller such as paracetamol may be helpful, but if they become necessary on a continual basis, you should see your doctor. Placing a young girl on the Pill will occasionally improve symptoms of a painful period.
When to see your doctor
• if your daughter’s period pains are significantly interfering with her school attendance;
• if despite the above measures, she has such severe pains that she needs to lie in bed;
• if the pains persist, or she has an offensive vaginal discharge;
• if she has a fever.
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FUSED LABIA
Sometimes baby girls are born with their labia minora (inner lips of the vagina) fused together by a thin membrane. This can also sometimes happen following an infection. The opening of the vagina is sometimes covered over. If you suspect that your daughter has this problem, you should see your doctor to discuss its management.
PENIS, PROBLEMS WITH THE
Hypospadias
Hypospadias is an abnormality of the penis which is present at birth in 1 out of every 350 males. In this condition the opening of the urethra (the tube through which urine is emptied from the bladder) is on the underside of the penis instead of at the tip. If severe, it can be associated with a bent penis (chordee). Surgical repair is essential for hypospadias. Boys with hypospadias should not have a circumcision at birth, because it is sometimes necessary to use this skin to repair the hypospadias. If you notice that your child has hypospadias, it is advisable to seek early medical advice.
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All babies and children are different, each with his own unique set of individual characteristics that makes him special. Yet growth and development do progress along pathways that are predictable. The stages and milestones described in this chapter are ones that most children go through and achieve at around the ages specified.
Remember, however, that there is a good deal of variation between children. The times and stages described here serve only as a guide to the range at which most children achieve milestones. Just because your child does not exactly coincide with these times does not mean that anything is wrong. Please do not worry if your child is different.
On the other hand, if you do have any concerns about your child’s growth and development, do not hesitate to seek professional advice. Do not wait — see your doctor or nurse who will be able to reassure you and give you appropriate advice.
Growth and development take place in the context of a continuing transaction between the child and his environment. Both intrinsic factors within the child and environmental influences (such as nutrition, stimulation, family interactions) are important.
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Let’s start at the beginning. Let’s say that the cause has been checked and your pain is due to your cancer. It may be possible to tackle this cause directly, but this would not necessarily be the best approach. You will have to weigh up the costs and benefits, just as for any other treatment.
In general, radiation is the form of anti-cancer treatment most likely to control cancer pain, especially that due to secondary cancer in the bones. This may entail only a few treatments and very little side effects. Pain due to cancer in other parts of the body, especially if the growth is large, generally requires longer treatment and higher doses and, even then, radiation is less likely to result ill good pain control. Ask your doctor just What your proposed treatment would involve and how likely it is to work.
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An excess of Vitamin A is recognised to cause certain illnesses, and some explorers in the Arctic and Antarctic who have eaten the livers of seals and polar bears — which contain an enormous quantity of Vitamin A — have died from the effects of this.
Vitamin D is found in fish oils, dairy products, eggs. It is also produced in the body by the action of ultraviolet light on substances in the skin. And so in Australia a deficiency of this vitamin is rare.
Vitamin D is necessary for the calcium and phosphorous metabolism of the body and, so, the normal structure of bone. As with Vitamin A, an excess intake can cause serious symptoms.
Vitamin Ê also is a fat-soluble vitamin, and it is used in the liver in the manufacture of prothrombin, an essential factor in the clotting of blood.
Vitamin Ê occurs in green vegetables, and also some of the bacteria which normally live in the bowel manufacture this vitamin which we absorb and use.
An excess of Vitamin Ê has not been shown to cause any serious side-effects.
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Walking is good exercise. To reach and maintain physical fitness, it is necessary to walk 5 km in less than 45 minutes five times a week. The same result is obtained by running 2% km in less than 12 minutes four times a week.
If this is too fast for the middle-aged man or woman, run 3 km in less than 20 minutes, four times a week.
If you prefer to ride a bicycle, you should ride 8 kms in 20 minutes, six times a week.
Swimming is an excellent way of exercising your heart and lungs. Try 750 metres in 20 minutes, five times a week.
If you are competitive and wish to play squash, IV2 hours squash at least three times a week is necessary to maintain fitness.
If you exercise only twice a week, you cannot hope to get fit or maintain fitness. If you exercise only once a week, this is more dangerous to your heart than no exercise at all.
Exercise burns up energy and will slowly burn up excess weight. It may take a long time to burn off those extra kilos of fat but, combined with a proper diet, it can trim you down to an ideal weight.
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Most doctors believe immediate operation following positive biopsy gives better results than closing the wound and operating again later. Psychologically it may be distressing to a woman to face a second operation.
There has been little improvement in the results of treatment of this condition over the last 30 years, despite enormous advances in treatment of other forms of cancer.
Operation remains the treatment of choice. In the past the operation was a radical mastectomy. This removed the affected breast, a large portion of overlying skin, the underlying muscles of the chest wall and the lymph glands under the arms.
The result is disfiguring and makes it hard to fit a prosthesis (breast substitute) under the clothes.
Despite arguments to the contrary suggesting lesser procedures, removal of the breast and the lymph glands is necessary. It is no longer considered necessary to remove the muscles of the chest wall.
Simple mastectomy (removal of the breast alone followed by radiation treatment to the glands under the arm) is advocated by some as an alternative.
Removal of the lump only, the so called lumpectomy, so as to leave a woman with her breast has, in my opinion, no part to play in the proper management of cancer of the breast. The risk of local recurrence is so high, about 60 per cent, that it is not justified.
Apart from operation there is often need for radiation treatment either in the initial treatment of breast cancer or in treatment of recurrences or spread of the tumor.
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Some practitioners are simply unable to tell their patients that control of their cancer is beyond the practitioner’s power. To advise not having, or stopping, anti-cancer treatment would be to admit that this is so. Thus these practitioners keep on recommending highly potent and unpleasant treatments when they are either known to be extremely unlikely to do any good or are experimental. Or course, these practitioners justify their actions to themselves, their colleagues and the patient’s relatives. When questioned they say: ‘I can’t tell that patient that I can do nothing because that would be cruel — it would take all hope away.’ This sort of statement actually confirms my claim that these practitioners are solely concerned with fighting cancer, not with treating whole people. When there is no effective anti-cancer treatment available, they say they can do nothing. When there is no hope of curing the cancer they say that stopping treatment would take all hope away. Practitioners who care for whole people would never think or say that they can do nothing. They know that treating symptoms, giving time, care, reassurance and a sympathetic ear are all doing something! Practitioners who care for whole people know that cure of their cancer is not the only thing that patients hope for. They recognise and try to fulfill other hopes—hopes for relief of pain, for time to spend at home with family and loved ones, for realistic information that will allow time for goodbyes and grieving.
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High fat foods that have a low G.L factor may appear in a falsely favourable light because increases in fat and protein tend to slow the rate of stomach emptying and therefore the rate at which foods are digested in the small intestine. High fat foods will therefore tend to have lower G.I. factors than their low-fat equivalents. For example, potato crisps have a lower G.I. factor (54) than potatoes baked without fat (85). Many sweet biscuits have a lower G.I. factor (55 to 65) than bread (70). But this is not a consistent finding. New boiled potatoes have a lower G.I. factor (62) than French fries (75), despite the latter’s fat content.
Remember, however, we need to eat a low-fat diet, not a high fat one. So, high fat foods of any sort, whether low or high in their G.I. factor, should only be eaten in limited amounts.
Why does pasta have a low G.I. factor? The starting point for making pasta is semolina or cracked wheat, not wheat flour. Durum wheat makes the best pasta because the grain is extremely hard and the wheat breaks cleanly into distinct small pieces. The large particle size of semolina means that starch gelatinisation is more difficult and thus enzyme attack is slowed down. The typical shape of pasta also appears to play a role in slowing down digestion. That’s why pasta of any shape and size has a fairly low G.I. factor (30 to 50). Cracked wheat and couscous used in Middle-Eastern cooking have intermediate G.I. factors.
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