•
“With this disease,” says Steven, “you need an escape hatch. Sometimes I zombie out in front of the TV. Or get a hot fudge sundae and eat it slowly.” Lisa goes for long walks, reads what she describes as “trashy love stories,” and drives out into the country. People go away for a weekend, plan an evening away at a play, opera, concert, sports event, movie. For a while, they let themselves drop their worries, they say, and think of nothing except the pleasure of the moment. Some, like Helen, take advantage of the mind’s ability to distract itself with pleasant thoughts. She has learned to recognize these moments of pleasure as they occur and to say to herself, “At this minute I happen to be happy, so I’ll enjoy this minute.”
A lot of people do relaxation exercises and say that relaxation gives them the necessary distance from their problems. Relaxation exercises are part of performing artists’ training, some psychotherapies, meditation routines, and yoga practices. All exercises are pretty much the same. Lie down and get comfortable. Beginning with your feet and working up to your face and scalp, muscle by muscle, first tense the muscle, then relax it. Repeat the tension and relaxation with each muscle several times before going on to the next muscle. Eventually you will notice that you breathe more slowly and regularly, that your body relaxes, and finally, that your mind relaxes. In this state of relaxation, imagine yourself in a place that is comforting to you, a place where you are free and happy, where you feel safe and calm. You can either do this relaxation on your own or buy recorded tapes that direct you through the relaxation or join a group that does the exercises together. In any case, mental health professionals often know where you can get help learning the exercises.
Caregivers especially need to take breaks. “I had no time to think of myself,” said Lisa. “I couldn’t get away from it, it was all-consuming. For a long time, I felt crazy. I just went five hundred miles an hour.” Caregivers often feel guilty about taking breaks, but breaks are essential to good caregiving. Without breaks, caregivers start burning out. Find other supports: nurses, social workers, hospice staff, groups, buddies, home health aides, clergy, all can take some of the heat off, give you some time out. “One of the greatest things a caregiver can do,” said June, “is cry for help. I see myself getting hyperactive and losing control, and I call the doctors or my pastor or my friends who know. I’ve learned to admit weaknesses. With all my wisdom and intelligence and backbone I’m so proud of, there are still things I can’t handle.”
*238\191\2*
HIV: ON LIVING-TAKING CONTROL: TAKE A BREAK”With this disease,” says Steven, “you need an escape hatch. Sometimes I zombie out in front of the TV. Or get a hot fudge sundae and eat it slowly.” Lisa goes for long walks, reads what she describes as “trashy love stories,” and drives out into the country. People go away for a weekend, plan an evening away at a play, opera, concert, sports event, movie. For a while, they let themselves drop their worries, they say, and think of nothing except the pleasure of the moment. Some, like Helen, take advantage of the mind’s ability to distract itself with pleasant thoughts. She has learned to recognize these moments of pleasure as they occur and to say to herself, “At this minute I happen to be happy, so I’ll enjoy this minute.” A lot of people do relaxation exercises and say that relaxation gives them the necessary distance from their problems. Relaxation exercises are part of performing artists’ training, some psychotherapies, meditation routines, and yoga practices. All exercises are pretty much the same. Lie down and get comfortable. Beginning with your feet and working up to your face and scalp, muscle by muscle, first tense the muscle, then relax it. Repeat the tension and relaxation with each muscle several times before going on to the next muscle. Eventually you will notice that you breathe more slowly and regularly, that your body relaxes, and finally, that your mind relaxes. In this state of relaxation, imagine yourself in a place that is comforting to you, a place where you are free and happy, where you feel safe and calm. You can either do this relaxation on your own or buy recorded tapes that direct you through the relaxation or join a group that does the exercises together. In any case, mental health professionals often know where you can get help learning the exercises. Caregivers especially need to take breaks. “I had no time to think of myself,” said Lisa. “I couldn’t get away from it, it was all-consuming. For a long time, I felt crazy. I just went five hundred miles an hour.” Caregivers often feel guilty about taking breaks, but breaks are essential to good caregiving. Without breaks, caregivers start burning out. Find other supports: nurses, social workers, hospice staff, groups, buddies, home health aides, clergy, all can take some of the heat off, give you some time out. “One of the greatest things a caregiver can do,” said June, “is cry for help. I see myself getting hyperactive and losing control, and I call the doctors or my pastor or my friends who know. I’ve learned to admit weaknesses. With all my wisdom and intelligence and backbone I’m so proud of, there are still things I can’t handle.”*238\191\2*
•
Anthrax is caused by Bacillus anthracis, a spore-forming gram-positive rod. Naturally acquired infection results from contact with contaminated animals. No human-to-human transmission of the disease has ever been confirmed.
The virulence of B. anthracis is dependent on its capsule and the two toxins it produces. The poly-D-glutamic acid capsule is antiphagocytic and prevents bacterial lysis of the organism by host proteins. The anthrax toxins have been shown to be composed of three entities that act synergistically to produce the clinical effects of anthrax:
- Protective antigen (so named because it is the main protective constituent of the anthrax vaccine) binds to target cell receptors and then cleaves off a portion of its protein, which allows attachment by either edema or lethal factor.
- Edema factor can bind to the exposed region on protective factor and form edema toxin, which can disrupt cellular water balance, causing intracellular edema.
- Lethal factor, a metalloprotease, can bind to the exposed domain on protective antigen and form lethal toxin, which at sufficient concentrations inhibits neutrophil function and can destroy cellular tissues. Lethal toxin also stimulates macrophages to release tumor necrosis factor and interleukin-1, which contribute to sudden death in cases of systemic anthrax.
Clinical disease can occur when endospores of B. anthracis are introduced into the body by abrasion, inhalation, or ingestion. These spores are ingested by local macrophages and transported to regional lymph nodes, where germination to form vegetative bacilli may occur up to 60 days later. These bacteria release themselves from macrophages and multiply within the lymphatic system, elaborating toxins that overwhelm the clearance ability of regional lymph nodes. Bacteremia and the systemic production of toxins can then ensue.
*206/348/5*
ANTHRAX: PATHOGENESISAnthrax is caused by Bacillus anthracis, a spore-forming gram-positive rod. Naturally acquired infection results from contact with contaminated animals. No human-to-human transmission of the disease has ever been confirmed.The virulence of B. anthracis is dependent on its capsule and the two toxins it produces. The poly-D-glutamic acid capsule is antiphagocytic and prevents bacterial lysis of the organism by host proteins. The anthrax toxins have been shown to be composed of three entities that act synergistically to produce the clinical effects of anthrax:- Protective antigen (so named because it is the main protective constituent of the anthrax vaccine) binds to target cell receptors and then cleaves off a portion of its protein, which allows attachment by either edema or lethal factor.- Edema factor can bind to the exposed region on protective factor and form edema toxin, which can disrupt cellular water balance, causing intracellular edema.- Lethal factor, a metalloprotease, can bind to the exposed domain on protective antigen and form lethal toxin, which at sufficient concentrations inhibits neutrophil function and can destroy cellular tissues. Lethal toxin also stimulates macrophages to release tumor necrosis factor and interleukin-1, which contribute to sudden death in cases of systemic anthrax.Clinical disease can occur when endospores of B. anthracis are introduced into the body by abrasion, inhalation, or ingestion. These spores are ingested by local macrophages and transported to regional lymph nodes, where germination to form vegetative bacilli may occur up to 60 days later. These bacteria release themselves from macrophages and multiply within the lymphatic system, elaborating toxins that overwhelm the clearance ability of regional lymph nodes. Bacteremia and the systemic production of toxins can then ensue.*206/348/5*
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You can do a behavioral experiment alone or with your therapist or a friend: It can be an advantage to take someone with you, because you can get someone else’s input as to whether the hypothesis was confirmed or not. It’s best, at least initially, to do experiments with your therapist, but whether this is feasible will depend on factors such as where your therapist’s office is located and whether there’s enough time during your session.
Do lots of experiments: It takes lots of experiments and lots of practice to get the full benefit of behavioral experiments. It isn’t realistic to think that just a few experiments will get rid of your BDD.
You can combine your behavioral experiments with cognitive restructuring: It can help to try to anticipate the negative thoughts you’ll have about your appearance during the experiment and to do some cognitive restructuring on a thought record form to help you prepare for the behavioral experiment. For example, Lorenzo could have filled out a thought record form for the thought “People will look at me with disgust because I look so bad” before he did his experiment.
*314\204\8*
COGNITIVE-BEHAVIORAL THERAPY FOR BDD: SEVERAL THINGS TO KEEP IN MIND WHEN DESIGNING A GOOD BEHAVIORAL EXPERIMENT – SOME RECOMMENDATIONS FOR DOINGYou can do a behavioral experiment alone or with your therapist or a friend: It can be an advantage to take someone with you, because you can get someone else’s input as to whether the hypothesis was confirmed or not. It’s best, at least initially, to do experiments with your therapist, but whether this is feasible will depend on factors such as where your therapist’s office is located and whether there’s enough time during your session.Do lots of experiments: It takes lots of experiments and lots of practice to get the full benefit of behavioral experiments. It isn’t realistic to think that just a few experiments will get rid of your BDD.You can combine your behavioral experiments with cognitive restructuring: It can help to try to anticipate the negative thoughts you’ll have about your appearance during the experiment and to do some cognitive restructuring on a thought record form to help you prepare for the behavioral experiment. For example, Lorenzo could have filled out a thought record form for the thought “People will look at me with disgust because I look so bad” before he did his experiment.*314\204\8*
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Unfortunately, we don’t know whether it’s better to augment an inadequately effective SRI, or discontinue the SRI and switch to another SRI, because this question hasn’t been well studied. However, in my clinical practice, I found that among patients who hadn’t responded well to an adequate SRI trial, augmenting the first SRI was successful in 33% of cases, whereas switching to another SRI was successful in 44% of cases. This difference wasn’t significantly different statistically.
However, I found something interesting when I considered whether the patient had had no response, versus a partial response, to the first SRI. Of those people who hadn’t responded to the first SRI (i.e., were not “much improved” or “very much improved”), only 18% responded when I added an augmenting medicine to the SRI. But among people who’d had a partial response to the SRI (i.e., were “much improved” or “very much improved”), 41% responded when I added an augmenting medicine. This difference was statistically significant. This finding suggests that you may be better off augmenting an SRI if you’ve partially responded to it, but it may be better to switch to another SRI if you haven’t responded to the first SRI. However, because this study was relatively small and not very scientifically rigorous (because it was based on my clinical practice), it’s best not to draw firm conclusions about which approach is more effective.
There are other things you might want to consider when deciding whether to augment or switch. If you haven’t responded to numerous SRIs (for example, 3 of them) without any attempt at augmentation, it would make sense to try augmentation. Conversely, if you haven’t responded to several augmentation strategies with one SRI, it’s probably best to switch to another SRI.
Another consideration is that the better you’ve responded to an SRI, the less appealing it is to discontinue it and try another one. For example, if you no longer feel suicidal, and your BDD and depression are a lot better (even if not completely better) on an SRI, it may be too risky to discontinue that SRI and try a new one. It’s possible that the second one won’t work or won’t work as well as the first one, and your symptoms could get worse again (although it’s possible that another SRI could work better). Continuing the SRI and adding another medicine allows you to maintain your partial response to the SRI, whereas if you stop the SRI you risk losing whatever response you had.
So when deciding whether to augment or switch, there are several things to consider, including your individual situation and your and your doctor’s preference. The approach you take needs to be tailored to you. If the approach you choose doesn’t work, you can always try the other one.
*264\204\8*
HOW TO SUCCESSFULLY TREAT BDD WITH MEDICATION: WHAT IF AN SRI DOESN’T WORK WELL ENOUGH? YOU CAN “AUGMENT” AN SRI OR “SWITCH” TO ANOTHER SRI; IT ISN’T CLEAR WHICH STRATEGY IS BETTERUnfortunately, we don’t know whether it’s better to augment an inadequately effective SRI, or discontinue the SRI and switch to another SRI, because this question hasn’t been well studied. However, in my clinical practice, I found that among patients who hadn’t responded well to an adequate SRI trial, augmenting the first SRI was successful in 33% of cases, whereas switching to another SRI was successful in 44% of cases. This difference wasn’t significantly different statistically.However, I found something interesting when I considered whether the patient had had no response, versus a partial response, to the first SRI. Of those people who hadn’t responded to the first SRI (i.e., were not “much improved” or “very much improved”), only 18% responded when I added an augmenting medicine to the SRI. But among people who’d had a partial response to the SRI (i.e., were “much improved” or “very much improved”), 41% responded when I added an augmenting medicine. This difference was statistically significant. This finding suggests that you may be better off augmenting an SRI if you’ve partially responded to it, but it may be better to switch to another SRI if you haven’t responded to the first SRI. However, because this study was relatively small and not very scientifically rigorous (because it was based on my clinical practice), it’s best not to draw firm conclusions about which approach is more effective.There are other things you might want to consider when deciding whether to augment or switch. If you haven’t responded to numerous SRIs (for example, 3 of them) without any attempt at augmentation, it would make sense to try augmentation. Conversely, if you haven’t responded to several augmentation strategies with one SRI, it’s probably best to switch to another SRI.Another consideration is that the better you’ve responded to an SRI, the less appealing it is to discontinue it and try another one. For example, if you no longer feel suicidal, and your BDD and depression are a lot better (even if not completely better) on an SRI, it may be too risky to discontinue that SRI and try a new one. It’s possible that the second one won’t work or won’t work as well as the first one, and your symptoms could get worse again (although it’s possible that another SRI could work better). Continuing the SRI and adding another medicine allows you to maintain your partial response to the SRI, whereas if you stop the SRI you risk losing whatever response you had.So when deciding whether to augment or switch, there are several things to consider, including your individual situation and your and your doctor’s preference. The approach you take needs to be tailored to you. If the approach you choose doesn’t work, you can always try the other one.*264\204\8*
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В первое десятилетие нового века во всём мире наблюдается резкий рост аллергических заболеваний, что в значительной мере связано с загрязнением окружающей человека среды различными химическими веществами, отходами химической, машиностроительной промышленности, транспортными газами, ядохимикатами, продуктами бытовой химии и т.п. Перечисленные вещества не только загрязняют воздух, но и проникают в корни растений и воду, а через них попадают в организм животных. В организм человека эти вещества попадают с растительными продуктами, питьевой водой, а также с молоком и мясом животных. Чрезмерное и часто не контролируемое врачами применение лекарственных препаратов также способствует увеличению числа аллергических заболеваний.
На раннее развитие аллергии у детей большое влияние оказывает сокращение сроков грудного вскармливания и перевод на раннее искусственное вскармливание. Имеет значение использование в пищевой промышленности консервантов и красителей. В России заболеваемость аллергическими болезнями на 1000 населения различна и зависит как от климатогеографических условий, так и развития промышленности.
Наибольшее распространение среди аллергических заболеваний занимает бронхиальная астма. Высокая численность больных отмечается во влажных зонах (Калининград, Абхазия), а также в сухих жарких и высокогорных районах. Кожные аллергические заболевания (аллергодерматозы) больше распространены в областях с жарким климатом. Весьма часто стала отмечаться лекарственная аллергия. Лекарственные аллергические реакции чаще всего вызывают антибиотики (особенно, группы пенициллина, тетрациклина, стрептомицина), сульфаниламидные препараты, аспирин и другие жаропонижающие и противоревматические средства. Растёт число аллергических реакций, связанных с применением ядохимикатов в сельском хозяйстве и быту, а также с препаратами бытовой химии, парфюмерии.
лечение депрессии
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A discussion of snoring would be incomplete without acknowledging the fact that snoring in children can be as socially disruptive and as medically demanding as that of adults. One of the problems arising from any discussion of children is the tendency to make generalizations about a group which undergoes complex changes from infancy to adolescence. Size of airways, breathing rate and shape of the chest wall are just some of the variables which change significantly in the first few years of life, highlighting the need to specify the age group in question. Another problem relating to the investigation of young children is the inability of parents to give an adequate description of the child’s symptoms. Difficult breathing during sleep, whether it be described as wheezing, coughing or choking can be symptomatic of any number of disorders, the doctor’s task being made all the more challenging if these symptoms only occur at night.The first priority is to identify these nocturnal events either by having the child observed during a hospital admission or by making a sound recording of the events on a portable tape recorder. Any abnormal breathing associated with sleep should be investigated but for the purpose of this discussion it will be assumed that nocturnal snoring has been confirmed. Data on the incidence of snoring in healthy children is unreliable, ranging between 10% and 25%, a variation possibly arising from different age groups and populations selected from one study to another. It is therefore not an uncommon occurrence and parents should not be alarmed by the observation of occasional snoring.The common factor in both adult and childhood snoring is a comparatively narrow upper airway compromised by a lack of muscle tone during sleep. Whilst accepting that obstructed airways of different age groups have something in common, there are differences in the incidence of underlying causes. Enlarged tonsils and adenoids remains one of the most common findings in snoring children and, although there has been some reticence in recent years to remove tonsils and/or adenoids, surgery is certainly warranted in cases of persistent heavy snoring which is accompanied by complete and repetitive airway closure. Upper respiratory tract infections and nasal congestion are more likely to cause problems in newborns and young children, given the narrow diameter of their airways and susceptibility to collapse. In the absence of other predisposing factors, a return to normal breathing would follow the successful treatment of such infections or allergies.Children born with structural abnormalities of the head and face (or craniofacial abnormalities) will be prone to snore if the structure results in compression or narrowing of the upper airway. There are several well described syndromes, each with characteristic facial and anatomic features which interfere with normal breathing. Children with Down’s Syndrome, for example, with the characteristic flattened face and nose, short neck, small jaw and mouth, and general lack of muscle tone, may have symptoms of obstructive sleep apnoea (OSA) depending on the severity of the syndrome. Other anatomical factors common to both young and older snorers include a large or poorly positioned tongue, abnormal jaw alignment, an excessively fleshy soft palate and obesity.
*17/130/5*
Generics online – no prescription
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These two vitamin deficiencies will be discussed together because they often coexist and have similar symptoms. Vitamin B12 is found in meat (especially liver). It combines with a substance in the stomach and is then absorbed in the small bowel where it enters the bloodstream. It is vital for healthy blood, and it is important in the nervous system. Some elderly people fail to produce the substance in the stomach which vitamin B12 needs in order to get absorbed. Also there are many people who have had part of the stomach removed (usually because of ulcers) and they too may fail to get any B12 in. (The other name for this condition is pernicious anaemia, because of its slow and debilitating onset.) Folic acid is another vitamin found especially in fresh vegetables. It too is needed for blood making and a healthy nervous system. Lack of this vitamin is usually due to a poor diet. Poor diets are probably 20 per cent ignorance and 80 per cent poverty.
The two conditions present in the same way. There are usually complaints of tiredness and lethargy. If the nervous system is affected there may be complaints of abnormal sensation in the arms and especially the legs with unsteadiness and a feeling that one is walking on cotton wool. Walking may become difficult and a gradual onset of confusion may develop. The person looks pale and is usually anaemic. They often have a pale lemon tinge to the colour of their skin. A neurological examination will often reveal many abnormalities and a blood test shows abnormally big red blood cells. All these symptoms lead the doctor to consider the diagnosis and send off more specific tests. Vitamin B12 can be measured in the blood, but as there are numerous causes, often more sophisticated tests have to be done as well. The folic acid content of red blood cells is the best blood test and this is routinely performed.
Unfortunately, vitamin В12 cannot be given by mouth as it is destroyed in the stomach. Therefore, when the diagnosis is made the treatment is by injection of B12. These are usually given every three months. The injections have to be continued for life. Folic acid deficiency is easily treated by either improving the diet generally or by giving folic acid in tablet form daily.
The longer the conditions have been present the less likely all the neurological complications will be reversed. The anaemia seems to improve well, but if established chronic confusion is present there are few reported cases of the mental state going back completely to normal.
*17/128/5*
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Many cosmetics nowadays are advertised as “natural,” but looking at the ingredients can cause you to wonder. To be sure of what you’re getting, read the label carefully. The following explanations of cosmetic ingredients should make things clearer.
Amyl Dimethyl PABA – a sun-screening agent from PABA, a B-complex factor.
Annatto – a vegetable colour obtained from the seeds of a tropical plant.
Avocado oil – a vegetable oil obtained from avocados
Caprylic/Capric triglyceride – an emollient obtained from coconut oil
Carrageenan – a natural thickening agent from dried Irish moss
Castor oil – emollient oil collected from the pressing of castor bean seeds
Cetyl alcohol – a component of vegetable oils
Cetyl palmitate – a component of palm and coconut oils
Citric acid – a natural organic acid found widely in citrus plants
Cocamide DEA – a thickener obtained from coconut oil
Coconut oil – obtained by pressing the kernels of the seeds of the coconut palm
Decyl oleate – obtained from tallow or coconut oil
Disodium monolaneth-5-sulphosuccinate – obtained from lanolin and used to improve the texture of hair
Fragrance – oils obtained from flowers, grasses, roots, and stems that give off a pleasant or agreeable odour
Goat milk whey – protein-rich whey obtained from goat’s milk
Glyceryl stearate – an organic emulsifier obtained from glycerin
Hydrogenated castor oil – a waxy material obtained from castor oil
Imidzaolidinyl urea – a preservative derived naturally as a product of protein metabolism [hydrolysis]
Lanolin alcohol – a constituent of lanolin that performs as an emollient and emulsifier
Laureth-3 – an organic material obtained from coconut and palm oils
Methyl glucoside sesquistearate – an organic emulsifier obtained from a natural simple sugar Mineral oil – an organic emollient and lubricant
Olive oil – a natural oil obtained from olives
Peanut oil – a vegetable oil obtained from peanuts
Pectin – derived from citrus fruits and apple peel PEG lanolin – an emollient and emulsifier obtained from lanolin
Petrolatum – petroleum jelly
P.O.E. [20] methyl glucoside sesquistearate – an organic emulsifier from a simple natural sugar
Potassium sorbate – obtained from sorbic acid found in the berries of mountain ash
Safflower oil-hybrid – a natural emollient obtained from a strain of specially cultivated plants Sesame oil – oil of pressed sesame seeds
Sodium cetyl sulphate – a detergent and emulsifier obtained from coconut oil
Sodium laureth sulphate – a detergent obtained from coconut oil
Sodium lauryl sulphate – a detergent obtained from coconut oil
Sodium PCA – a natural-occurring humectants found in the skin where it acts as the natural moisturizer
Sorbic acid – a natural preservative derived from berries of mountain ash
Tocopherol – a natural vitamin E
Undecylenamide DEA – a natural preservative derived from castor oil
Water – the universal solvent and the major constituent of all living material.
*102/134/5*
GENERAL HEALTH
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You are likely to feel awkward, wanting to be helpful but not knowing what will help. It is a rare person who isn’t nervous about expressing condolences, who doesn’t hate confronting a new widow or widower. Most of us recoil at dealing with strong emotions. Even if we feel that speaking about what has happened is best, it is hard to see crying without taking action to gloss over the hurt. Yet words are so inadequate. The knee-jerk response is to resort to platitudes that sound silly even as they tumble from our mouths: ‘ ‘Think how lucky you were to have those wonderful fifty years.” “Time heals everything.” Experts advise that often the best thing to do is say “I’m sorry” and then listen – to give the widowed person a chance to talk. Your goal is not to make things better; nothing you say really can. Respect the person’s need to open up, but do not force the issue. Respect his or her dignity too.
Keeping occupied has saved my life during these six months. My friends and family have rallied around and are careful not to let me spend a long time by myself. By “being kept busy” I do not mean running away from thoughts of Stanley and the beautiful life we had. Almost every day my daughter Jane calls and we cry together: “Poor Daddy. Why did he have to suffer sol” Hike being with friends who knew and loved us as a couple. We can share memories, and I’m not ashamed to cry. On the other hand, I hate being forced to emote when I don’t want to. This happens most often with acquaintances who think they are being helpful by probing my inner state. The other day I was humiliated to find myself breaking down at the dentist’s. He had asked the question I think widows must hate most: “What a terrible tragedy! How are you getting along?”
Widows and widowers are touchy. Even when you try your hardest to be sensitive, you may feel you are putting your foot in your mouth. But it doesn’t matter. Develop a thick skin and hang in there. Even if you are rebuffed at times, what is important is that you continue to be there. We tend to remember the people who stick by us in adversity. Now is your chance to become – or ensure that you stay – treasured in the life of someone you care about.
Although advising the widowed person on practical matters that you have special knowledge about (such as the burial or taxes) may be helpful, avoid advising on matters of opinion: “You should be going out more.” “Why don’t you sell your house?” Try to restrain yourself when the impulse strikes to intervene in this way. Remember, it is understanding – not advice – that people need most. When you feel like making a suggestion, decide to ask this question instead: ‘ ‘What can I do to help?”
You may need to extend your mental timetable for how long things should take. Do not expect ^someone to have “recovered” after a few months. On the other hand, if more than a year has gone by and absolutely nothing has changed, then step in. You have a responsibility, to put it delicately, to tell your relative or friend that something is wrong: “People are usually not this distraught for this long. Perhaps you might want to think about getting professional help.”
*101/159/5*
GENERAL HEALTH
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UMBILICAL HERNIA
If you notice that your baby has a little lump which protrudes from his umbilicus when he cries or coughs, it is likely that he has an umbilical hernia. This is very common and is caused by the ring which normally surrounds the umbilical cord failing to close completely after birth. An umbilical hernia generally does not cause problems, and usually does not persist beyond 5 years of age. In rare cases, a small loop of bowel can be trapped in the opening and may require surgical removal. Umbilical hernias which do not disappear or are larger than 2-3 cm can be repaired surgically — this is usually for cosmetic rather than medical reasons. Do not tape the hernia — it does not help and may damage the baby’s tender skin.
WIND (FLATULENCE, EXCESSIVE GAS)
Passing bowel gas is a normal and necessary function in humans. Bowel gas is released by gas-producing foods and by the swallowing of air. Children swallow large amounts of air when sucking on empty bottles, and when crying. Carbonated drinks cause excess wind, as do foods which are difficult to digest, such as beans. Occasionally excess wind is a sign of milk intolerance, and gas is increased during bouts of diarrhoea or with marked constipation. No treatment is necessary for excess wind, except perhaps teaching your child, when he is old enough, to pass wind in a socially acceptable manner!
*359\90\8*