Playing with hair is a common activity for children and adults alike. There is considerable pleasure to be had from brushing, combing, twirling and curling hair. For many it is a self-comforting activity. In young children it is occasionally associated with thumb-sucking, and is also transient. In some children this leads to actually pulling hair out. This is not common, but it is distressing to parents when it does occur.

Cause

While there is uncertainty as to the exact reason why some children pull out their hair, in the majority of cases it is associated with stress, anxiety or other underlying psychological causes. It is seen more commonly in children who are mentally retarded, and those who are institutionalised. Sometimes there is an underlying scalp condition which can cause irritation and itchiness, and may make the hair more brittle.

Clinical features

There is wide variation in the clinical features. Most of these children continually twist and play with their hair, as if by habit. Some pull out single strands, others pull out whole clumps of hair. There is no predictable pattern with respect to frequency or duration. In many children there is other evidence of anxiety or depression, such as sleep problems, erratic appetite, social or school difficulties, and so on.

*187\90\8*

Body image-is like home base on the love map. Take a good, long look in the mirror, naked if you have the courage, and describe out loud how your body looks and feels. If you really have courage, try this with your partner standing by your side.

“There we stood,” said the wife. “It was surprising. We didn’t get past the hair on our heads. We looked at our own, each other’s,

and talked about it. Maybe it was just safer to talk about that, but I never realized he felt his was too thin. I have always felt mine was too thin. It has bothered me for years.”

How we think we look is a key in our love map, a type of legend and scale for interpreting the map and for reading other persons’ maps, for we tend to pick partners that we perceive as maybe just a few steps up from our own place on the body market. Even children rapidly develop good or poor body images, which sometimes sentence them to the sidelines at dances and to a loneliness that is based on a hypercritical, usually unrealistic self-appraisal.

I have three hundred slides of the work of major artists. These are all nude paintings, and I have my patients pick the one painting they feel most resembles them. This assignment is usually fun and sometimes most enlightening, especially when I also have them select a slide that most resembles their partner. Looking at and discussing these pictures usually helps defuse the anxiety over the body-image issue and teaches about the wide range of human appearance and the perceptions of that appearance.

I help my patients discuss feelings about their genitals and other erotic zones. Most men seem to feel that penises come in one size, too small. Women seldom talk much about genital appearance, but describe their breasts in two sizes, too big or too small. It is helpful to break down the barriers that exist between the body generally and the erotic zones specifically, integrating both into a sensuous gestalt.

When I lectured on this concept of the sensuous gestalt, one woman told me after the lecture that she thought “sensuous hole” might be a better term. She added, “After all, I think I have what I call a ‘grand opening.’ Let me tell you, women do not have penis envy; men might have vaginal awe.” Even in her humor, you can see the anxiety we have about perhaps the least important element of the sexual system, the genitalia.

*87\97\8*

The seemingly inherent negativity of the disorder can actually be the most positive experience of our life. How many other people are given such an opportunity! The disorder has done so much of the hard work for us. It has stripped away the image of who we thought we should be, and has returned us to the basis of who we could be.

Life isn’t just about growing up, having a career, getting married, having children and so on. These are things we do during life, but they are not life. Life is continual evolution and development.

Our need to be in control of ourselves and our environment is our unconscious effort to try to stop this change. Although there are many external changes in our life, we fight to control any internal changes and development of ourselves. We need to be in control to keep the image we have, and the image other people have, of ourselves. We haven’t been able to let our image change in case it meant we did not meet the expectations of other people. We are now paying dearly for this.

Our continual suppression of self means we have blocked the ongoing development of our self. Although we have always wanted to be able to express and develop our self, we have never been willing to take the risk. How many times have we ignored the call to self, or not heard its almost silent whisperings? This time it is not whispering. It is shouting.

Anxiety disorders are destructive. They tear away the very fabric of our whole being. They destroy our way of life. The attacks and the anxiety terrify us sometimes to the extent that normal everyday living is non-existent. Yet we do not recognise in this destruction an equally positive force. The destruction can be a positive turning point in becoming our real self.

*101\94\8*

Steps can be taken to prevent such a situation from arising in the first place. Your surgeon can greatly reduce the chance of finding something unexpected during an operation by checking you carefully beforehand. This means getting a detailed history of your symptoms, examining you carefully, and arranging, with your agreement, whatever tests are necessary to provide a complete picture. In the example I have described, there would probably have been bladder symptoms such as burning, or passing urine more frequently, and/or in smaller amounts than normal. There may have been obvious blood passed or if not, traces of blood would probably have been found in the urine by testing. Special contrast X-rays or endoscopic examination of the bladder (cystoscopy) could have confirmed bladder involvement by the cancer. If the true situation had been established before operating, this person could have had control over the treatment decision, and surgeon would not have been placed in a dilemma.

Here is how to be as sure as possible that your surgeon will be able to carry out the operation you have agreed to. When your surgeon recommends a certain operation, ask how sure he or she is that this operation will be possible. For example, if the aim of the operation is complete removal and possible cure, ask whether the diagnosis of cancer is definite and the exact type known. Ask whether the cancer has already spread into nearby organs. Have the appropriate tests been done to check this? How does your rpe of cancer usually spread? How sure are they that it as not already spread to nearby lymph glands or through the bloodstream? How can the likely sites for secondary growths be checked? These questions apply in the case of potentially curative surgery. Later in this chapter I will give you some idea of what should be known before attempting surgery that has various other aims.

*226/40/1*

We Australians are a race of sun-worshippers and rush to expose our bodies to the warmth of the sun as we lie on the beach, around a home pool or even working in the garden.

But, for most of us, sun tanning presents a hazard. Our genes are derived from ancestors who lived in northern Europe and had fair skin.

Genetically, we have not had long enough living in this different climate to develop a darker skin color. Those of us who are naturally more olive skinned or who come from Southern Europe have better protection but we all need to exercise care.

Ultraviolet rays from the sun stimulate the pigment-producing cells in the skin to produce melanin which leads to tanning, but fairer skin contains little pigment and its ability to produce it under the stimulation of ultraviolet light is limited. These rays can damage the skin and cause both acute and chronic changes.

Ultraviolet or UV rays can penetrate cloud layers and so affect the skin even on overcast days. They can be reflected from water or sand and sneak up on you even as you cringe under a beach umbrella.

*414/71/1*

Prolapse may occur at any age and even in women who have never borne children.

But it is far more common in those who have had several pregnancies and in those past the menopause.

Some women are prepared to tolerate the discomforts, but most are aware of the medical care available and seek treatment.

The female pelvic organs are held in place by a number of structures. Ligaments of the womb are attached to the side walls of the pelvis and form a sling to support the uterus.

Two main muscles stretch across the lower pelvis and offer support and a thick piece of tissue sits just under the skin between the opening of the vagina and the rectum.

A prolapse is like a hernia of the female genital organs. Three main problems usually occur together, but there may be a combination of two or one only.

There is descent of the womb; the bladder may fall backwards through the lax front wall of the vagina; the rectum may fall forwards through the lax back wall.

*160/71/1*

Collagen creams. Collagen may be the ‘wonder’ ingredient in the cosmetic world’s coffers but it does not appear to do much for the skin.

Advertisements implying anything to the contrary are misleading. Collagen is a protein substance found in the connective tissue, cartilage, and bone of the body. While it is true that changes in collagen fibres contribute to wrinkles and the appearance of ageing skin, adding collagen to a cosmetic will not affect the collagen in the skin, nor in any way reverse the changes that have taken place.

Hormone creams. It has been claimed that hormone creams containing the female hormone oestrogen may cause thickening of the thinner skin of the elderly person. While such creams can be absorbed by the skin, there is however, no evidence of such thickening effects on facial skin. Nor is there any evidence that the addition of hormones will make skin creams more effective in relieving dryness. Indeed, there is no evidence to indicate that the thinner, less hydra ted dermis or subcutaneous fat layer of the elderly has any capacity to become thicker or more hydra ted with the addition of topical hormones. Furthermore, excessive use of such preparations may have harmful internal effects and therefore should be avoided.

Medicated creams. The practice of incorporating antibacterial agents into soap, cosmetics, and other toilet preparations has increased markedly in recent years. These medicated’ preparations in fact have the effect of limiting bacterial contamination of the product rather than of the user. Furthermore their potential harm often outweighs their benefits. People can become allergic to these anti-bacterials, and thereby allergic to many other commonly used products containing the same ingredients. As a result some of these people may develop a sensitivity to chemically related compounds, which is in itself a considerable disability.

*10\44\4*

The chance of developing heart disease is increased if you smoke tobacco, have high blood pressure, have diabetes, have high blood cholesterol (which may be due to eating too much fat in your diet), are overweight or obese and/or do not take enough physical exercise.

• Smoking of tobacco is now clearly established as a cause of atherosclerosis. Few authorities now dispute the evidence. There are however some interesting dietary aspects: Did you know that smokers tend to eat less fruit and vegetables compared to non-smokers (and thus eat less of the protective anti-oxidant plant compounds)? Did you know that smokers tend to eat more fat and more salt than non-smokers? These characteristics of the smoker’s diet may be caused by a desire to seek stronger food flavours as a consequence of the taste-blunting effect of smoking. While these dietary differences may make the smoker at greater risk of heart disease there is only one piece of advice for anyone who smokes: please stop smoking!

• High blood pressure causes changes in the walls of arteries. The muscle layer (remember an artery is not a rigid pipe, it is a muscular tube, which when healthy can change its size to control the flow of blood) becomes thickened and atherosclerosis is more likely to develop. Treatments for blood pressure have become more effective over the last thirty years, but it is only now becoming clear which types of treatment for blood pressure are also effective at reducing heart disease risk.

• Diabetes is caused by a lack of insulin—either the body does not produce enough or the body ‘demands’ more than normal (because It has become insensitive to insulin). In diabetes some of the chemical (metabolic) processes which take place tend to accelerate atherosclerosis. Diabetes may also result in raised blood fats. The increased risk of heart disease is a major reason why so much effort is put into achieving normal control of blood sugar in diabetic patients, and also why all people with diabetes should be checked for the other risk factors of heart disease.

• High blood cholesterol increases the risk of heart disease. Your blood cholesterol is determined by genetic (inherited) factors— which you cannot change—and lifestyle factors—which you can change. There are some relatively rare conditions in which particularly high blood cholesterol levels occur. People who have inherited these conditions need a thorough ‘work-up’ by a specialist doctor followed by life-long drug treatment. In most people high blood cholesterol is partly determined by their genes, which have ’set’ the cholesterol slightly high and lifestyle factors which push it up more. The most important dietary factor is fat. The Sets prescribed for blood cholesterol lowering are low fat (low saturated fat), high carbohydrate, high fibre diets. Body weight also affects blood cholesterol—in some people being overweight has a significant effect on the levels—attaining a reasonable weight can be helpful. The blood also contains triglycerides, another type of fat which is particularly high after meals. High triglycerides may be linked with increased risk of heart disease in some people.

• Overweight and obese people are more likely to have high blood pressure and to have diabetes. They are also at increased risk of getting heart disease. Some of that increased risk is due to the high blood pressure, and the tendency to diabetes, but there is a separate ‘independent’ effect of the obesity. When increased fatness develops it can be distributed evenly all over the body or it may occur centrally—in and around the abdomen (tummy). This central obesity is particularly strongly associated with the risk of heart disease.

Thus every effort should be made to get body weights nearer to normal – especially if the extra weight is ‘middle-age spread’.

• Exercise has several benefits for the heart. Cardiovascular fitness is improved by regular strenuous exercise and the blood supply to the heart may be ‘improved’. Exercise is also important in maintaining body weight and has effects on metabolism and some factors related to blood dotting. Getting regular exercise is clearly important.

*140\33\4*

Fat distribution is now regarded as of equal or greater importance to total fat as a health risk and new techniques of measuring fat distribution have recently been developed. Abdominal fat has been regarded as one of the key indicators and measures of this include waist-to-hip ratio (WHR) and the Gonidty or C-Index. Visceral fat, which in the future is likely to prove to be the most powerful predictor of disease, can only be measured in vivo, or in live organisms, through the imaging machines discussed below. How-ever, estimates can be made from techniques that measure abdominal fat including WHR, and the C-index, and more recently using techniques to measure sagittal diameter (SAD), or a measure of abdominal thickness known as the abdominal diameter index (ADI).

Conicity Index (C-Index). The C-Index was developed by Dr Radolfo Valdez and colleagues from Pennsylvania State University in an attempt to combine the best aspects of BMI with WHR or body fat distribution. The C-Index quantifies fat shapes as lying between two extremes; the first a cyclinder, i.e. very lean, and the second, bi-conical.

So far the C-Index has had only limited validatory research carried out on it, some suggesting it may not add significandy to other anthropometric measures. However, variations to this in the future may offer promise for a more sensitive measure.

The C-Index requires measures of height, weight and waist circumference and the following formula:

C = abdominal girth (at umbilicus) in metres/0.109/weight (kg)/height(m)

The range of scores is from 1.00 to 1.73 but, as yet there are no normative figures for comparison. People scoring towards the low end i.e 1.00, are closer to the ideal than those scoring towards the high end i.e. 1.73. The validity of the measure is so far unknown, although reliability and sensitivity could be expected to be quite high.

*65\186\4*

The body contains a system of special glands called the endocrines. These are scattered throughout the body, from the head to the pelvis. They produce important chemicals called hormones. All play a vital part in keeping the body healthy. If too little or too much hormone is produced, then symptoms develop.

Some of these conditions are fairly common, whilst others are rare and will never be seen by the average parent. Some are readily and successfully treated, whilst others are extremely difficult to diagnose and even more difficult to successfully treat.

Many children with symptoms may be referred by family doctors to special centres, usually located in large hospitals, where special investigations may be carried out to help decide the diagnosis; also, facilities are available there to treat the patients. As some of these conditions may continue for a long time, getting linked to a major centre is often the best idea. So, if your family doctor finds your child’s symptoms puzzling and suggests referral to a centre of this nature, go along with this suggestion. In the long run it will be to everyone’s advantage, child and parent, and for the doctor also, who wants the best for the patient.

The endocrine glands that will be discussed here include the pituitary gland, in the brain, which stimulates the activity of other endocrine glands. In the neck are the thyroid gland and the parathyroid glands, located near the back of the thyroids.

The pancreas is situated in the abdominal cavity and is responsible for diabetes, if diseased. The gonads are the sex organs (ovaries in females, testes in males), and these are responsible for some conditions which need care and attention. The adrenal glands are small organs sitting on top of the kidneys; disorders of these are rare but serious.

Phenylketonuria (P.K.U.) is not really related to the endocrines but is included in this section. It is an inherited disease which can now be detected at birth and readily and successfully treated. Early detection of P.K.U. in Australian babies in the past few years is one of the major forward steps in neo-natal care. The results are now strikingly successful—once, a missed diagnosis was responsible for serious forms of mental retardation which could be lifelong.

*89\87\2*