No investigations are necessary. Croup is a clinical diagnosis.

Treatment

The majority of children with croup do not need any specific treatment. You can manage the symptoms in exactly the same way as for a cold. Antibiotics are not necessary because the condition is caused by a virus. Some children seem to benefit from steam, and you may want to take the child into the bathroom with a hot water tap running in the shower. Be very careful to avoid scalding the child if you decide to try this treatment. There is little information available to suggest it makes any significant difference.

A small minority of children with croup will need admission to hospital for observation, to ensure that the breathing tube does not become blocked to the point where they are unable to breathe.

When to see your doctor

• if your child has difficulty breathing;

• if the stridor is easily heard even when he is resting quietly;

• if you are worried.

Prevention

There is no way we can prevent children from getting croup.

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Twins may be identical (homozygous) if they come from the same egg, or non-identical (heterozygous) if they come from separate eggs.

If you are pregnant with twins, you will notice a rapid weight gain early on in your pregnancy, and your final weight will be greater than if you had only had one baby. Careful monitoring of blood pressure, weight and urine are important because of the increased risk of hypertensive disease of pregnancy. It is important to get adequate amounts of rest. Most twins are delivered at 38 weeks, and labour is generally no longer than it is with a single baby. Complications may arise if the babies are in an unnatural position, and in this case Caesarian section may be advised. In addition twins are usually smaller than single babies, and the incidence of prematurity is higher, so they may need special care.

Triplets, quadruplets, quintuplets and so on are uncommon, and usually occur after use of certain fertility drugs and in-vitro fertilisation techniques. In the same way as twins, these babies can be identical or non-identical, or both types may occur in one set (for example, in triplets one baby may develop independently from an adjacent pair of identical babies).

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ANSWER: One of my other patients once asked why her husband yawned so loudly. The answer to that question is the same as the answer to this one. We all express ourselves differently. The words that bother you so much are just expressive sounds. They mean nothing about you or her; they are reflexes just like any other. Such expression is arousing or exciting to some people, but if these words bother you, suggest the words you might like to hear. It will take some time, but such words might work their way into her’ ‘reflexive vocabulary.” Remember that the words are reflexes, not messages, and maybe you won’t be so bothered. It’s a compliment to you, really, that she feels comfortable and safe enough to let loose, to be free in her sexual reflex vocabulary.

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The location is important for two reasons. Firstly, a cancer located in or near tissues which give rise to dangerous or otherwise severe radiation reactions cannot safely be given the same dose as one in a less critical location. Secondly, cancers whose cells look exactly the same under the microscope have different chances of being cured by radiation depending on where in the body they started. The reasons for this are not really understood but it is a fact that should be taken into account by your radiotherapist when planning a treatment. For example, a cancer starting just above the voice-box is less likely to be cured by radiation than exactly the same type of cancer starting in the vocal cords.

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Let me give you an example which proved to be what we all might regard as a suitable solution to a difficult problem.

A husband came home and found his wife in bed with another man. Following an angry scene, he developed a paralysis of his right arm. The paralysis was a symptom of hysteria.

Psychotherapy revealed that it served two purposes. The man’s cultural background led him to believe that he should, as a man wronged, kill both his wife and her lover, but his own ethical standards would not accept this.

The paralysed arm prevented him from carrying out this unacceptable act and, at the same time, led his wife to feel guilty for having caused his paralysis.

In treating such a case it is important not to overcome his paralysis without giving him time to accept some other solution, otherwise he could have been forced into a corner where he had to carry out that action.

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But iron deficient anaemia remains the commonest of the anaemias, and fortunately it is the easiest to treat.

A woman, during her reproductive life, is always potentially anaemic because the blood lost with each period not only represents the blood lost from the body, but also a loss of iron and therefore her intake of iron has to be adequate to make good this loss.

With a man, there is usually no loss of iron from the body except where he also may be losing blood, such as with bleeding haemorrhoids or a peptic ulcer which is slowly bleeding.

Iron is a fairly common constituent of many foods and it is rare for an inadequacy of intake to occur except where there may be poor absorption, or illness, leading to a reduced intake of food, poverty or the development of certain food fads.

All these factors may lead to a deficient intake.

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We are without further medical identification of the disorder until 1696, when the French surgeon Saviard noted the presence of endometrial tissue outside the uterus. Then in 1835 another French doctor, Jean Cruveilhier, described uterine cysts. Twenty-five years later. Dr. K. von Rokitansky, a German doctor, published the first paper on the disease, referring to it as an “adenomyoma,” now called adenomyosis, or endometriosis confined entirely to the muscle wall of the uterus. At the turn of the century, two American doctors further described degrees of the disease, but it was not until 1921 that Dr. Sampson, as noted earlier, recorded his theory of how endometrial tissue implants on internal organs.

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The precise reason why some people develop acne yet others do not, is unknown. However, hormonal factors appear to set the stage for the development of the condition. Except for in the first few months of life, the disease does not develop before puberty, nor does it occur in eunuchs unless they are treated with male hormones. Acne is aggravated by the administration of male hormones, and of course pre-menstrual exacerbations are common in women. Without the natural oils secreted in the skin, known as sebum, there would be no acne. Without male hormones there is little if any sebum. Genetic factors, however, have a definite influence, as do bacteria, which are involved in the development of inflammation. Dietary and emotional factors are sometimes implicated, but have not been completely proven.

The pathology in acne is that the sebaceous duct leading from the gland which produces the sebum becomes blocked. This blockage, if below the skin surface, is called a whitehead, or if above the surface, a blackhead. Following blockage of the duct, at whichever level, the duct, at whichever level, the duct or the gland may rupture, and the sebum escape underneath the skin, setting up an inflammatory reaction. This may be aggravated by the normal bacteria present on the skin.

Looked at objectively, it will be seen that the methods of treatment could include unblocking the duct; decreasing the amount of sebum secreted; changing its composition to make it less irritating; and reducing the amount of bacteria on the skin surface.

Acne occurs at an age when the adolescent is adjusting, sometimes with difficulty, to a major physical and emotional transition. The teenager is often self-conscious, and unduly embarrassed by even minor grades of the disease. To dismiss acne as unimportant demonstrates a considerable lack of understanding, particularly as the disease can be satisfactorily suppressed in the majority of patients, and scarring prevented or minimized.

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2. Calorie counting should be avoided in favour of a low-fat eating plan.

3. Fat reduction should be recommended only in the context of a balanced diet.

4. Although some fats may have better health value than others, it is currently prudent to recommend a decrease in all dietary fets for body fat reduction.

5. A ‘user-friendly’ rule is to try to reduce total daily fat intake to below 40g. Even so, any reduction will be moving in the right direction.

6. Clients can identify sources of dietary fat using the Short Fat Questionnaire.

7. A ‘fat count’ may be a useful exercise to identify more specific sources of dietary fat.

8. Clients should be taught to read food labels, nutrition information panels and ingredient lists to assist the appropriate selection of foods. 9 Clients should be encouraged to eat regular servings of low-fat foods.

10. Spreads such as butter and margarine may be easily minimised or eliminated.

11. The use of oils should be minimised.

12. Clients should be taught low-fat cooking and food preparation procedures.

13- Help clients to determine which food sources of fat they are willing to exclude and which ones they are willing to limit in quantity.

14. Any low-fat eating plan prescribed for fat loss must be one that can be comfortably adhered to for a lifetime.

15. Although of secondary importance to dietary fat reduction, total energy input may need to be reduced if desired fat loss is not achieved with dietary fat reduction alone.

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LUF syndrome is very hard to detect because the usual methods of determining whether or not ovulation has taken place, such as basal body temperature charts and measuring progesterone levels in the second half of the cycle, all indicate that ovulation has occurred. It can only be reliably detected by inspecting the follicle during a laparoscopy or by measuring the size of the follicle during repeated ultrasound scans. In the past many researchers thought that the LUF syndrome was a major cause of infertility in women with endometriosis. However, now many researchers believe that it does not play a significant role and some believe that the LUF syndrome is probably just a random event which occurs in most women from time to time.

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