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.

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“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.

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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.

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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.

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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.

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In the last fifteen years or so, there has been greater interest in investigating pain control through behavior modification, self-hypnosis, biofeedback, imaging, arid stress management techniques, for the endometriosis sufferer, especially the woman who has severe and chronic pain, such a program can guide her toward feeling more in charge of her body and her life. A good pain-control program will address the psychological as well as physiological realities of the disease. A number of pain clinics across the country are affiliated with medical centers, such as the Pain Management Center at UCLA in California, which operates an outpatient Pelvic Pain Program. Other clinics may be privately run. Finding a pain-control program is a matter of asking your doctor or inquiring at a large hospital or medical association.

A good measure of satisfaction comes from having some success with these alternate techniques, since many of them depend on your commitment to them in time, energy, and a sense of purpose. Unlike conventional medical therapies, they can be something of a challenge in this regard, but they are fascinating nonetheless. When you learn how to control pain without painkilling drugs, you will understand more about who you arc, while having as well the adventure of mastering a new discipline, such as behavior modification, meditation, or yoga.

Many of what are now considered alternate therapies were once the only source of practical medical treatments. They coexist now with supersophisticated surgical techniques (such as laser) and the nearly perfected drugs for treating endometriosis (such as the gonadotropinreleasing hormones, or GnRH). They remain popular, if not without an aspect of controversy attached to whether or not they work.

*57\43\4*

Hirsutism, or increased growth of facial and body hair, is a common complaint amongst women attending endocrinology, gynaecology and dermatology clinics. The presence of fine vellus fuzz on the upper lip and chin is very common in women of all races. After the menopause this vellus hair is frequently accentuated by darker terminal hairs, which may appear interspersed among the finer hairs. There is considerable racial variation as regards hirsutism, with women of southern or eastern European extraction being more prone to excess hair, and women of Asian extraction —particularly the Japanese-being rarely affected. Often there is also a familial tendency to hirsutism.

When women are affected in those areas of the body which normally only develop hair in males, and particularly if this is associated with menstrual abnormalities, deepening of the voice, and frontal scalp recession, then there is most likely to be a correctable hormonal cause for this. Hormonal factors causing excessive hair growth include excessive male hormone production from either the adrenal glands, the pituitary gland, or certain rare ovarian tumours. Occasionally some drugs may be implicated—for example dilantin, streptomycin, penicillamine, diazoxide, psoralens, and corticosteroids. Most women however show no clinical evidence of an endocrine disease or hormone abnormality, and this finding can of course by confirmed with appropriate blood and urine tests. If there is any doubt, these tests should be performed after medical assessment has been sought. In those cases of hirsutism where no abnormalities are suggested or found, the cause is probably excessive sensitivity of the hair follicles to the normal quantities of circulating male hormones, or the manufacture of excessive quantities of male hormones within the skin itself. Stress is also thought to be able to cause excess hair production by stimulating the overproduction of male hormones via the pituitary gland, which has a close relationship with the brain.

Excess hair, particularly facial, has always been thought of as an undesirable characteristic in women; although in men, for some reason, it is thought to denote virility! Witches are frequently illustrated with hair on the nose or chin. Grafitti often shows girls with moustaches, and so forth. Consequently many women become psychologically upset by being hirsute. This commonly results in such feelings as irritability, frigidity, masculine trends, and impaired sexuality. As a result, treatment is frequently sought. Here again, we have a situation likely to be exploited: these unfortunate women are very susceptible to the promises of complete and permanent hair removal. From the number of establishments advertising the myth of permanent hair removal, one can get some idea of how many women must be seeking the hairless face. The actual incidence of hirsutism is impossible to assess. However a survey of women students in Wales, in which the women were actually examined and questioned, showed that over one quarter had terminal hair on the face, and that in about 5 per cent of cases it was considered disfiguring.

*84\44\4*

The Israeli Army diet. This is an eight-day cyclical diet (four by two days) of apples, cheese, chicken, then salad, that has nothing to do with the Israeli Army. It is low energy, nutritionally inadequate, unsound and boring.

The Mayo Clinic diet. This has occurred in various forms, all capitalising on the good name of the Mayo Medical Clinic in the United States. One of the many forms of this diet requires the dieter to eat lots of eggs, in the belief that the energy used to digest them is more than the energy provided. The Mayo Clinic has disowned this diet. Other diets have also used this premise that the energy used to digest and utilise a food will be greater than that provided by the food. This is NOT supported by research but has not stopped people creating many diets, inducting the celery diet and negative calories diet.

The Beverley Hills Diet’. The film stars in Hollywood who gave credence to this diet certainly had no idea of nutrition and neither did its author. It talked of fat-dissolving fruits, and how some other foods were not digested by the body but were trapped as fat. It is a dangerous diet: inadequate, unsound and contrary to any research.

*136\186\4*

Before a diagnosis of fibroids is confirmed, other possible reasons for a mass in the abdomen should be excluded; for example, pregnancy or cancer of the cervix, endometrium or ovaries. To rule out pregnancy in a premenopausal woman, a sample of blood or urine is tested and a result obtained within minutes. To exclude cancer, several diagnostic procedures may be necessary. These include a Pap smear; a colposcopy, which entails viewing the cervix with a magnifying instrument called a colposcope, with or without removing a small sample of tissue (a biopsy) for subsequent examination; dilatation and curettage, in which the cervix is stretched or dilated and an instrument is inserted to scrape away most of the uterine lining; an ultrasound examination conducted via the vagina which produces an image of the uterus and other internal structures; and laparoscope a pelvic examination using a laparoscope (a tubular instrument with a light at one end and an eyepiece at the other) inserted through a small incision in the abdominal wall. Before committing to a diagnosis a doctor may also want to exclude other situations in which similar symptoms can occur, such as endometriosis, a pregnancy in a Fallopian tube, irregular placement of the uterus, bladder cancer, and ascites, which is an accumulation of fluid in the abdomen.

Doctors do not usually recommend removing fibroids if they are not causing problems, and it is estimated that this is the situation for most women who have them. In these women, fibroids tend to be diagnosed during a routine check-up, usually causing suspicion because the uterus is larger than expected but there is no evidence of pregnancy. If a doctor feels a firm, irregularly shaped mass when conducting an abdominal examination, the likelihood is that one or more fibroids are present.

When suggestions are made about removing fibroids that are not producing symptoms, this may be because of concerns that their further growth could make later removal difficult, or could result in serious complications by pressing on nearby organs. Of course doctors do not have crystal balls and predicting which patients will experience a worsening of their symptoms requires a good deal of guesswork. If this is the reason given for hysterectomy, it should be closely questioned. It is reasonable to remove symptomless fibroids if they are blocking the cervix, protruding into the uterine cavity or closing off the Fallopian tubes. Recent estimates suggest that fibroids are involved in about one in fifty cases of infertility in Australian couples.

The cause or causes of fibroids are uncertain although it is clear that stimulation of the myometrium by oestrogen promotes their growth and development. When oestrogen levels are high, as occurs during the reproductive years in general and pregnancy in particular, fibroids tend to increase in size. When oestrogen levels fall, for example after menopause, fibroids tend to shrink. During the past decade, further valuable insights have emerged. Studies of large population groups show that fibroids are much more common in women from certain racial groups. Black women in the US, for example, are three to nine times more likely to develop fibroids than comparable White women. Suspicion has fallen on genetic factors and pelvic infections, but it has also been suggested that a predisposition to fibroid formation occurs in obese women with above-average levels of blood glucose and growth hormone. Oestrogen and growth hormone are synergistic, meaning that their combined effect is greater than the effect of either hormone acting alone. Women on the Pill and those who smoke cigarettes seem to be less likely to develop fibroids.

*10\198\4*