Cause

The commonest cause of a murmur in children is an ‘innocent murmur’, which is the result of turbulence or vibration when the blood flows through the heart valves. This can occur, for example, when the child has a fever. The child’s heart is normal, and the murmur usually disappears with time.

Other heart murmurs can signify heart disease, which can either be present from birth (congenital) or acquired later in life. These murmurs are usually caused by aberrant blood flow through a hole in the wall between the heart chambers, or through faulty valves.

Clinical features

A child who has an innocent murmur will have absolutely no symptoms of heart disease. The child is perfectly normal. A child who has a significant murmur, will usually have characteristic symptoms related to heart disease. These may include breathlessness and blueness of the lips and of the fingers and toes. With some congenital abnormalities of the heart, these symptoms may appear immediately or soon after birth.

Investigations

If there is any uncertainty about the significance of your child’s murmur, your doctor may order an ECG and a chest X-ray. Referral to a paediatric cardiologist may be advised, and an echocardiogram, which is an ultrasound of the heart, may be performed.

Treatment

A child with an innocent murmur does not require any treatment. On the other hand, a child with heart- disease invariably requires some form of treatment, which can range from medication to surgery, depending on the nature and severity of the disorder.

The management of heart problems in children is a highly specialised field of medicine. Your family doctor can provide you with further information at your request.

*257\90\8*

“They told us about the tests and the recommendations. They said something about a posture of the future. You know us. We thought that maybe that would get us pregnant, but they just wouldn’t tell us. They laughed and said we would have to find out for ourselves. When your secretary came to get them, they turned to us and the husband said, ‘We love it. You’ll find it. But first, try these juggling bags. Dr. Pearsall gave them to us. They work like magic’ ”

“Well,” she continued, “we persons in fertility will try anything. We would stand on our heads if it would work. We took those things home and laughed like crazy. We got so daffy at home that we got carried away. We had sex on the wrong night. We had never—I mean never—done that. Some weeks later, we got pregnant. When we came to your office to see you, we met the same people. I gave him the bags back and told him that they worked. He laughed and took his wife’s hand. “Do you think we should juggle tonight? Two seventy-year-olds might just juggle themselves more than they could handle.”

Removing the burden of fear, pressure, and misunderstanding that can accompany health problems is the first step to protecting your sexual rights. To review this issue, try the next opportunity.

*293\97\8*

This theory of “male from female” is called “inductor” theory in that the male is induced by androgens and MIS, Mullerian Inhibiting Substance, which causes certain female formations to disappear in utero. Early female development is not dependent on hormones; it is autonomous. Mary Jane Sherfey proposed this idea in her book The Nature and Evolution of Female Sexuality. While not totally accurate and in many ways incomplete, the earlier Freudian notion of male superiority or “penis envy” is further from neurophysiological accuracy than inductor theory.

Of course, masculinity and femininity are not mutually exclusive developmental axes. You can be less feminine in terms of society’s criteria without being more masculine, and you can be more feminine without being less masculine. I had the husbands and wives point to areas on the following lines to show, how they felt about their own gender orientation and share these feelings with one another.

MALENESS    a little    very much    

FEMALENESS    a little    very much    

Throughout life, even throughout the day, people vary on both axes. It is a mistake to ascribe a natural superiority in sexual function to either gender’s sexual response.

*120\97\8*

Eliminate feelings of anger, hate and anxiety. – they also block your mind at all levels, preventing the natural state of well being and spiritual development.

Forgive everyone and everything. Hate and resentment also clog your mind. By nourishing hatred and resentment you cannot gain anything except the same things from others. On the other hand, forgiveness and tolerance could give you a key to gaining respect and love.

Do not think of harming anyone or anything. Think of others the way you would like others to think about you.

*19\96\8*

Treatment may need to be continued for many years.

Rifampicin, an antibiotic, also used to treat ÒÂ, has recently been shown to be effective in curing the disease and may render the person non-infective in a matter of weeks.

Those with the tuberculoid form of the disease do not need isolation.

And those with the lepromatous form can return to their community once the drugs have rendered them non-infectious.

A new vaccine has been developed in Britain and proved successful in the laboratory.

Field trials will soon take place, but it may take 10 years of use before accurate knowledge of its effectiveness is available.

*487/71/1*

Cancer of the bowel is one of the most common forms of cancer in both men and women.

Most cancers of the bowel occur in the rectum or in the lowest portion of the large bowel just above the rectum.

It appears that these cancers are increasing.

As more people are surviving the infections of childhood and early life they are living to an age at which cancer has always been common.

What we eat also appears to be a significant cause of this disorder.

Research, so far, has concentrated on four items of our diet — meat, fat, fibre and alcohol.

There are several studies that show that a high meat diet is one of the causes of the increase in bowel cancer.

Yet, some other studies seem to conflict with this. How a high meat diet can cause cancer, if it does, is as yet unknown.

In the same way, the case against a high amount of fat in the diet as a cause of cancer is equivocal.

*231/71/1*

The toe becomes red, painful, and tender to the touch. The wound produces a thin, watery pus that works its way under the nail. The tenderness, redness, pain, and swelling gradually get worse, eventually involving one entire side of a toenail. Often the nail becomes partly covered by raw, red tissue and a wet crust.

Home care

If you catch it early, you can treat an ingrown toenail successfully by gently cutting out the spur or the ingrown corner of the nail, and then frequently soaking the toe in warm water for long periods. Even if the toe is so tender to the touch that you cannot remove the embedded nail, prolonged soaking in a strong Epsom salts solution (one cup to one liter of water) may cure the condition. Cover the lower foot and toe with a bandage or cloth and soak both foot and bandage thoroughly in the solution. Then cover the dripping foot with plastic wrap or encase the foot in a plastic bag. In this manner the nail can soak for hours with little effort on your part. Because of the delicacy of the nails involved, the ingrown toenail of an infant can often be cured by wiping the area several times a day with rubbing alcohol, and then soaking the toe in clear warm water.

Precautions

•     If your child repeatedly develops ingrown toenails check his or her shoes; they may be too small or too pointed.

•     Teach your child to trim the toenails straight across without leaving sharp spurs that may cause problems.

•     An infection near the nail that lasts for more than a few days is probably an ingrown nail.

Medical treatment

If an ingrown toenail doesn’t clear up with home treatment, your doctor can remove the embedded piece of nail. If the toe is very painful, the doctor may apply a local anesthetic before removing the ingrown area of the nail. If ingrown toenails occur frequently your doctor may suggest minor surgery to narrow the nail and make in-growing less likely.

*133/84/5*

The accumulation of tissue fluid in the body. It is most noticeable in the fingers (rings become tight), around the eyes (eyelids look and feel puffy), and in the abdomen (belts become tight). It is a condition that affects millions of women, often around their period times.

About 60 per cent of the body’s weight is water, which is distributed in the various fluids inside and outside the cells. The average person takes in about 2-3 quarts of fluid a day and the body’s balancing mechanisms ensure that the loss through urine, sweat and on the breath keep the total body water steady. A healthy person can handle at least 8 quarts of fluid a day without retaining any but people with heart disease, liver disease, kidney disease and certain hormonal problems retain fluid abnormally. Water is retained in places that offer least resistance, particularly around the eyes or where gravity exerts its main influence (such as around the feet and ankles). If, when you poke your fingertip into a swollen ankle it leaves a depression, you have about 8-9 lb of water too much in your body overall.

Immediately before a period many women, because of their hormonal changes, retain water-sometimes putting on up to a stone in weight. This produces swollen, tender breasts, pelvic pain, headaches, stomach swelling, nervousness, irritability, a feeling of mental dullness, insomnia and poor concentration. Even the eyeballs can swell and make the wearing of contact lenses impossible. During pregnancy ankle swelling is also common.

What causes it?

• Hormone changes in the premenstrual phase of a woman’s cycle.

• Long periods of standing and walking can cause foot and ankle swelling.

• Pregnancy causes ankle swelling as a result of the pressure of the heavy uterus on the pelvic veins, which reduces their ability to collect fluid from the legs.

• Heart disease (especially heart failure, in which the reduced pumping efficiency of the heart means a smaller blood flow to the kidneys to produce urine).

• Steroid hormones (which cause salt to be retained by the body along with water to dissolve it in). This includes the contraceptive Pill, of course.

• Kidney diseases in which the capability of the kidney to put out normal amounts of urine is impaired.

• Certain allergies cause local fluid retention. This is especially seen in urticaria (hives). The swelling may be generalized, or may affect only the hands, feet and face.

• Too much sodium in the diet. Water always goes hand in hand with sodium so if you eat too much sodium (salt) you will automatically retain too much water.

• Stress and emotional conditions can cause (in men as well as women) too high a production of anti-diuretic hormone which causes the retention of water.

• Very hot weather, especially if humid too, can make some people retain water.

*151/72/5*

Nitrates

The main effect of nitrates is on the large veins, causing blood to pool in them. Less blood returns to the heart at one time so the pressure created inside the heart as it fills is less. This reduces wall tension in the heart, lowering the “preload.” The muscle does less work and therefore needs less oxygen.

Nitrates also open up the smaller arteries in the periphery of the body, the arms and legs for instance; the heart muscles can pump blood more easily through wider bore vessels. By decreasing the “afterload,” the heart muscle again does less work and needs less oxygen.

By dilating collateral channels, nitrates appear to distribute the blood that enters the coronary circulation to areas that may have been deprived during angina attacks. In all three ways, these medicines help return the supply-demand equation normal.

Nitrates can be fast-acting or long-acting. Fast-acting ones such as sublingual nitroglycerine are used to stop angina attacks once they have begun. As soon as the attack begins, stop what you’re doing, sit down, place one fresh tablet under your tongue, and allow it to dissolve unswallowed. If the pain is not relieved in three to five minutes, repeat the medicine. The strength of the tablets and the number used before seeking medical help is determined by your doctor. Your doctor might order the medicine in the form of a spray rather than a tablet.

If you are able to anticipate an angina attack because you know that a particular level of activity leads to pain, you may be able to premedicate yourself with a tablet or spray before you start and avoid an attack altogether. You can make such a plan with your doctor.

Long-acting nitrates are used to prevent attacks throughout the day. These include isosorbide dinitrate, isosorbide mononitrate, and sustained-release nitroglycerine preparations in the form of an ointment or a transdermal patch. These avoid the side effects of headache, dizziness, or nausea that you might encounter with short-acting nitrates, but they also can lead to reduction of the beneficial effects as well. A period of eight to ten hours a day without these medicines is necessary to maintain their effectiveness. Remember that if you begin to need more and more nitrates to control your angina, your condition may be getting worse and you need to consult your doctor.

You will probably want to change the location of ointment or patch each day to avoid skin irritation. The medicine works just as well on hairless skin of the arm, side, or abdomen as it does on the chest.

*90\86\8*

If you could invent something that in every way was guaranteed to give you angina and a heart attack, then smoking would be it. It reduces the oxygen levels in your blood, it narrows further your already narrowed coronary arteries, it poisons your heart muscle with carbon monoxide and your brain with nicotine, it makes your blood much more likely to clot, and it directly damages your most delicate blood vessels.

Yet I have known many patients who continue to smoke after a coronary bypass or a heart attack. I’m sure that they do not wish to kill themselves, but that is exactly what they are doing. It is so unfair to their families, and even to nonsmokers who are waiting for their own bypass operations, and who will benefit far more from the skill and devotion of their surgeons.

Smoking gives people a sallow, unhealthy look, and wrinkles. By the time they are forty, women smokers look ten years older than their nonsmoking counterparts. By the time they are sixty, many of them are already dead. Cancer of the lung and heart attacks, both of them directly due to smoking, cause far more early deaths in women than anything else.

Most smokers lit their first cigarette as teenagers, when they were far too immature to think about the long-term risk. If you are a non-smoker at twenty, it is odds on that you will remain so for the rest of your life. By this time, most people have learned sense!

If you have angina and still smoke, it is not too late to learn sense. To a doctor like myself, who has had to comfort so many families in which smoking has directly led to the deaths of men and women in their forties and fifties, it is frankly incredible that anyone should ever wish to light up a single cigarette. For a smoker who mulls over the facts about his or her habit, continuing to smoke means that cigarettes are worth more than life itself, yet 25 percent of the population continue to smoke them.

*66\86\8*