Archive for

March, 2009

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FAMILY MEDICAL CARE: EDUCATION FOR THE FAMILY

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Besides this, it offers one of the most beneficial opportunities you will ever find to explain to your children the so-called “facts of life.”

It depends to a certain extent on the age of the other offspring. But it is surprising how intelligent in these matters even very young children happen to be. They are unusually observant. Even toddlers are geared for absorbing sounds and sights in their environment. Indeed, this is all part of the growing-up routine. It is nature’s way of establishing in their minds sets of standards which will stay with them for the remainder of their lives.

Most will come to recognize the gradual alteration in the shape of mummy’s tummy. Questions will be posed. The simplest and easiest way out is to offer straightforward, honest answers.

Tell them Mummy is expecting a new baby. Let each member touch the expanding stomach. Let him feel for himself, and have a listen. Children’s tactile senses are very acute. They can readily sense internal movements as the foetus moves about. This will give them an amazing sense of pride and happiness.

If the opportunity arises, and in many cases it will, explain in some detail how baby got there. Don’t be shy and embarrassed. Your children will not be, so why should you?

Show them how the little seed got inside. Indicate how baby will get out. Don4 point to the navel and say “through there.” It’s done by unthinking mothers-to-be every day of the week, and it is foolish. Make the most of every opportunity, and you will never be embarrassed to discover that your children one day will be sat down and told the facts of life – perhaps crudely and by some precocious child.

You will have already told them, little by gentle little. This is the most natural, effective and beneficial way to present the story of life, of sex and reproduction to your growing family. Grasp every opportunity, and make the most of the situation while it lasts.

At bath time is often a good time. On such occasions, everyone is peeled down to the bare essentials. It can be an excellent opportunity for a highly profitable discussion of the body, its functions and potentials.

Even in these enlightened days, enormous numbers of youngsters still do not get a comprehensive story of sex and reproduction. They learn the hard way, the questionable way. Magazines and popular books abound. But so many give only a garbled version of the seamy side, the sensational, and dwell abnormally on sensuous gratification, that too many young people consider this to be the only side to the picture.

The simple words of a pregnant mother, talking to her young children in words that they can understand, will often form the basic framework on which a sensible, reliable understanding of sex in all its true beauty may be imparted. Use the opportunity as often as it arises.

Youngsters, even in early childhood, are accumulating their yardsticks and values. They face life honestly. They will accept, usually without question, information imparted to them.

So take advantage of this. Give them honest answers. Do not pretend, do not fool, and do not be dishonest. In this simple way, you may be establishing very important subconscious masses of important data in the memory banks of your children. It will serve them well for the rest of their lives, whether you recognize the fact or not. So, be natural, direct and as forthright as the age of the child indicates. It will pay handsome dividends.

Do this and the terrible day when you feel obliged to tell your child the facts of life will never eventuate. He will already know them. He has built on the basics you provided, and has a clean, intelligent outlook on life. In today’s world, this is of inestimable value.

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WHY MARRIAGES FAIL: FROM BAD TO WORSE

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So, a situation once started, rapidly goes from bad to worse. Many women, during pregnancy, or even many who are taking contraceptive measures such as the contraceptive pill feel less inclined to participate in the intimate side of marriage, and the sex act becomes either a chore or entirely devoid of satisfaction. Instead of seeing the doctor and doing something about it (and it is quite possible to get help in the form of medication these days), they grumble, feel sorry for themselves, and hate their partners all the more. Thus the marital situation deteriorates.

Psychologically, hate readily breeds hate. It can smoulder on silently, but may flare up often. Inevitably, matters become worse and worse. Fights develop. Dissension, lack of feeling, lack of consideration for each other, bring about the inevitable breach.

When sex does occur, it is often solely for male gratification. The more this occurs, the less the wife enjoys it. Often it may make her feel off-colour or quite ill. It may even hurt. With little emotional interest, this can reflexly aggravate the condition. If pregnancy is present, this may make it even worse. Aware that the domestic situation is in a bad way, the husband often feels aggrieved, and will go out of his way to find satisfaction in other sources. It may be sexually, but often he resorts to alcoholic excesses in an attempt to make him feel a real man (in his own eyes and those of his acquaintances). If he only knew, it invariably makes him look more of an idiot than a man.

All this does little to help the domestic front. Arriving home often late, disheveled, and frequently devoid of a good part of his weekly pay packet (alcohol is not cheap, and poker machines and cigarettes are expensive luxuries at present also), he is not very welcome. There is a cold shoulder, an empty fridge, and a disgruntled spouse who is in no mood for fulfilling his sexual desires (demands?), or even giving him a kindly word.

More fights inevitably result. The situation often stumbles on, going from bad to worse. Sometimes the addition of a new baby will temporarily ease the problems, but almost invariably the couple will get off on the wrong track again.

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FAMILY PLANNING: SIDE-EFFECTS OF THE PILL

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The side-effects of the pill have often been documented. There are effects attributable to the oestrogen component and those blamed on the progestogen content.

The oestrogen component may produce some or all of the following side-effects: menstrual migraine, and increased risk of blood clots forming, and increased blood pressure; a weight increase due to salt and fluid retention; slight breast development. Indeed, this may be quite pronounced, and many younger women poorly endowed by nature often take the Pill essentially for this reason.

There may be an increase in the fat deposits around the buttocks. Often leg cramps appear, which are usually worse at night. Nausea and depression are fairly common. Some women notice a reduced sexual desire, a rather ironical side-effect when it is considered what the Pill is intended to provide – normal and free sexual intercourse without the risk of pregnancy. Many take the Pill, and find they no longer have any sexual desire in any case, which makes the entire exercise redundant. This has often led to marital disputes, the male, believing his wife is “protected,” and is just being mean and un -cooperative in refusing to participate in what he believes is a normal part of marriage – sexual relations.

Often the vaginal secretions are increased. This may reach a stage where it can become embarrassing. Suppression of lactation occurs, and this is more likely to be seen when the Pill is re-started after a confinement.

On the other hand the progestogen content of the Pill can also create its own set of side-effects. Often there is an early weight gain. Frequently there are nervous reactions such as depression, irritability, chronic fatigue, and a loss of interest in normal sexual activity. Often this lack of interest increases progressively as the Pill is continued. These side-effects are much like those induced by progesterone formation before a normal menstrual period occurs, in the so-called “pre-menstrual tension” syndrome which will be discussed in another chapter.

If the patient suffers from facial pimples, these are invariably worsened. (Similarly, in the non-pill-takers, pimples are notorious in the week preceding menstruation.) There may be an increase in “breakthrough bleeding” (that is, bleeding occurring part way through a packet of the pills).

In many women, blotchy markings appear on the face and parts exposed to the sun. This is termed “chloasma.” It may look unattractive and can upset some women who are self-conscious about facial skin appearances. It may also appear on the abdomen, chest, back, and old surgical scars. Usually the areolar area—the normally pinkish area surrounding the nipples -turns a darker shade also. When this occurs, it remains darker for the rest of one’s life. Incidentally, this occurs about the third month of pregnancy as well, and occurs for the same reason in women who have not taken the Pill before. Often there may be delay in reestablishing normal menstrual periods after the Pill has been discontinued. This is often a very worrying problem, and will be further considered later on.

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MARRIAGE AND FINANCES: THE RAINY DAY

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However you plan your finances, always make certain that you have a little put aside for the inevitable rainy day. In these days of economic uncertainty, many suddenly lose their jobs. Even the best workers can find their positions fold up overnight. It is nice to know that you have a few dollars salted away against such an experience, for ‘ ‘it can’t happen to me” simply may reverse itself one day, and you find yourself alone on the pavement, jobless.

Also, one never knows when sickness o: adversity may strike. It is always nice to have some funds that you can call on in a hurry if need be.

Make sure that each partner has a certain amount of money “for your own personal needs.” No wife likes begging for a few dollars for a new dress. Even those living on a tight budget should allow something for the little personal extras that make life livable. Birthday, Christmas, wedding gifts; the odds and ends; dental accounts; extra costs related to unexpected guests; a sudden trip that was not anticipated; things for in-laws and relatives. The list can be quite large. These things must come into your budgeting. Often, unless these things are considered and taken into account, trouble may start here and quickly increase.

Finance is often cited in divorce cases as being a big factor in breeding marital unhappiness. It is sad to see this happen, for in most cases it is totally unnecessary. A sensible partnership, working together in harmony, should be able to take care of the finances in a manner that suits both.

I must mention here that often one partner is obviously better at handling money than the other. Often it is a good idea to let the more financially astute member take care of the overall financial situation.

Many wives make excellent financiers. They frequently run rings around men, when it comes to balancing the budget, doing the banking, working out the finer details, caring for the income-tax returns, and so on. If this is so, husband, don’t think your wife is ‘ ‘taking over.” Sensible husbands will realize the value of a woman with these capabilities and happily let her take the financial reins and look after the books, often completely.

Do not think you are giving up your manliness, or masculinity, or surrendering your position as head of the house. You are not. You are being smart and merely “delegating responsibility.” Most bright general managers of major businesses learnt years ago that the task of delegating responsibility is the smartest move they ever made. What G.M. could be bothered with the hack work of running the company’s books? Hardly one. He is more interested in the total concept.

Get this idea into your head, and you are way ahead. Likewise, the wife shouldn’t feel that she is being given a boring assignment of merely routine work. If this is her special capability, she should be proud to be able to look after the finances of the “company”—the husband-and-wife partnership. It is a responsibility of no mean order, and many women thrive on it.

In any case, the situation will often become obvious. Sharing, being sensible, being in agreement and happy with what is taking place are all very important features of the family budgeting system.

With care and common sense, virtually any married couple today can achieve most of the comfort and financial pleasures that they so desire.

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ABOUT MARRIAGE: ROLES AND DUTIES OF PARTNERS

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By working out your respective duties, in general principle, this will also solve once and for all who is “boss.” Now every working unit must have a head. That is undoubted. But in the marital game, things are different today from what they were a few years ago.

In some instances, because of the personality types involved, one person may appear to be the dominant partner. The other one may automatically tend to be more submissive. There is nothing wrong with either, for a submissive outward character is not necessarily a weakling. Neither is an aggressive, apparent born leader necessarily just that either. Often the bombastic, vocal person is all talk and easily deflated, and deep down this is his/her subconscious way of trying to boost his/her own ego, and get noticed in the world. In a sense it may be his/her “ego-tripping method.”

Frequently it is best if there is no boss, in the true sense of the word. Rather, a workable partnership is far more happy and peaceful. Often these are the family units that tend to stay together and last longer than the other type.

Actually there is no hard-and-fast rule about all this. Some units may find it more satisfactory if one tends to make the decisions, and act as the leader of the team. One may prefer this. Conversely, if both have an equal say, and if each respects the opinions of the other, this is often the most rewarding and, in the long run, the most satisfactory arrangement.

A marriage deal is a fifty-fifty arrangement. The role of the wife can be extremely important, even before there are any children involved. Through her ability, attitudes, opinions, she can wield an enormous influence. Often women who are quietly spoken are very forceful in their own way. The words they speak, and the attitudes they reveal can have an enormous on-going effect on the total home picture. A husband should never underestimate the power of a woman. He who does is a fool!

At the same time, the influence of the husband can be major. Expressing his feelings, attitudes and opinions can also have a major influence on the home, both before as well as after children arrive. Wives are well advised to listen to what their husbands have to say, and take note, for often (believe it or not), what they say makes sense. Not always, certainly, but often. Frequently their ideas can be tempered with added ideas from the wife, and the final composite picture can be a rewarding one for the family unit.

Any partner who thinks he or she is always right is also heading for trouble. In this world, nobody is right all the time. In fact, experience has shown (as we can all remember if we look back on life), that in a great number of cases, probably the majority, ideas and thoughts we expressed at one time, feeling we were 100 per cent right, later turned out to be extremely foolish and unsuccessful notions.

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HYSTERECTOMY

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There was a time when it seemed every second woman was having her uterus removed. In fact she was. Well, nearly. In Australia until recently, about 40 per cent of women could expect to have a hysterectomy during their lifetime. The figures are likely to be altered in the future by the use of endometrial ablation as an alternative to hysterectomy, and the wider use of hormone replacement therapy, which has a protective effect against the development of endometrial cancer.

Hysterectomy has been a contentious issue for some time, as it has been seen by some as an over-used treatment, not without potential side-effects. Gynaecologists have been accused, as a group, of whipping out uteri willy-nilly, as a cure-all, without much consideration for the risks and benefits for the individual woman.

Of course there are many women who benefit from hysterectomy, and for whom it is the treatment of choice, after careful consideration of the options. Now that there are more options available, and women are becoming more aware of the issues surrounding hysterectomy, hopefully we will see a more rational approach and response to this operation.

A hysterectomy is simply surgical removal of the uterus. The ovaries are not necessarily removed at the same time, although they may be.

Aims:

To remove a diseased or damaged uterus.

Indications. These include:

1. Cancers—cancer of the uterus, or cancer of the cervix which has spread to involve the body of the uterus.

2. Benign (non-cancerous) tumours such as fibroids, particularly if large (greater than 6 to 8 centimetres).

3. Abnormal bleeding which has failed to respond to other treatments (like hormone treatment or endometrial ablation).

4. Painful conditions which have failed to respond to non-surgical treatments.

5. Emergency life-saving measure such as for some complications of childbirth, or following damage to the uterus during another surgical procedure.

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BREAST CANCER: SIDE-EFFECTS OF SURGERY

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Some women have specific problems after surgery. Because the axilla is operated on, the normal drainage of lymphatic fluid from the arm can be disrupted. Swelling of the arm can occur in some women, although this particular side-effect has decreased considerably since less extensive operations became more popular. Also, the nerves to the arm may be affected, which can cause some abnormal sensation to the skin around the armpit.

Depending on the extent of the surgery, the muscles to the arm may be damaged, leading to some change in function. More commonly, though, the problem is a stiff shoulder, due to lack of movement following the operation, and this can gradually recover. After a mastectomy it is important that a woman has information about possible problems and ways of preventing complications. Physiotherapy and exercise can be helpful in avoiding them.

Success rates. Earlier detection of breast cancer and the newer methods of treatment seem to be associated with improved survival rates from this disease, but we may not see great improvements in the statistics for breast cancer for several years.

The overall five-year survival rate from breast cancer in Australia is about 70 per cent. Like most cancers, survival rates vary with the stage the disease is at when treatment is started. For example, a woman who has a tumour of less than 2 centimetres, and no evidence of spread beyond the breast, has a five-year survival rate of around 90 per cent.

Breast cancer can unfortunately sometimes recur, often years after initial treatment. Distant or local spread may suddenly become apparent even thirty years after initial treatment, which makes it difficult to give women the ‘all clear’. It is impossible to predict who will have a late recurrence, but a small chance usually remains. This chance is less if the disease is detected and treated earlier.

Women who are being treated for breast cancer will be given more information about their own chances of cure and recurrence, based on their individual circumstances.

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FEMALE STERILISATION (MICRO-INSERTS): QUESTIONS PEOPLE ASK ABOUT IT

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Q. Do I have to get my partner’s consent if I want to have micro-inserts?

A. No, as with other methods of sterilization, you don’t need your partner’s consent It is good to talk over such a big decision together and it is best if you agree. However, in the end it is your body and your decision.

Q, If I have micro-inserts, will that bring on menopause?

A. No, micro-inserts have no effect on menopause. Your ovaries function as usual and you still have periods until you would normally experience menopause.

Q. Will the micro-inserts affect the way I feel about sex?

A. Micro-inserts have no physical effect on your body other than to block the egg from meeting a sperm and being fertilised. So they should not affect the way you feel about sex except that you may enjoy it more if you feel relieved that you will not get pregnant.

Q. Can you have an operation to remove the micro-inserts so that you can get pregnant again?

A. It is extremely unlikely that there is any way to reverse the blockage caused by the micro-inserts so you could get pregnant again. It is not even possible to have IVF (in-vitro fertilization), since the micro-inserts would still be inside the uterus where the pregnancy would be growing. You must look at having micro-inserts as absolutely permanent.

If you have any doubts about having this procedure, it is best to wait and use another method of contraception until you feel sure it is what you want. Then if your life changes in ways you had not imagined, and you regret having the micro-inserts, you will know that you really felt it was the best decision at the time.

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PROGESTOGEN IUD: HOW TO REMOVE IT

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How is the Progestogen IUD removed? The Progestogen IUD can stay in place for five years. If you want to become pregnant or if you decide that you do not want the IUD anymore for other reasons, it can be removed earlier. You will be given another vaginal/pelvic examination. Then the doctor will use a special instrument to remove the IUD by gently pulling on the string that can be seen coming through the cervix. This only takes a couple of minutes. Some women find it a little uncomfortable but some women don’t feel much at all.

Things to remember if you use a Progestogen IUD

• It’s really important to learn to check the suing each month after a period to make sure your IUD is still in place.

• If you have any unusual symptoms, like a discharge from your vagina or pain low in your abdomen, that could be an infection, so see your doctor right away.

• If your period is more than a week overdue, you should see your doctor or go to a clinic for a pregnancy test.

• If you or any sexual partner ever have casual sex, or if you have a new sexual partner, use a condom every time you have sex until you both have been checked for sexually transmitted infections (STIs).

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THE COMBINED ORAL CONTRACEPTIVE PILL: QUESTIONS PEOPLE ASK ABOUT THE PILL

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Q. If I take the Pill every day just as it says on the pack, how could I get pregnant accidentally?

A. The Pill is not 100 percent effective even if it is taken exactly as directed. Also if you are sick you could lose the effects of the Pill by vomiting or having diarrhoea before it has a chance to work. If you do vomit or have diarrhoea it would be best to follow the instructions for missed pills to be sure you are protected.

Another thing to watch for is that some antibiotics and other medications, and even natural therapies, may react with the Pill and stop it from working. You really need to talk to your doctor about this. If you have to see a different doctor for any reason, tell them that you are taking the Pill, so you are not given medication that could react with it.

Q. If I want to get pregnant, can I stop taking the Pill and get pregnant right away?

A. It takes the average woman about six months of trying to get pregnant even if she’s not taking the Pill and maybe a couple of months extra if she has been on the Pill. The problem is that this is an average. Some women get pregnant in the first month after they stop taking the Pill, and some perfectly normal women will still not be pregnant after 12 months of trying. If your periods aren’t back to normal after three or four months, or if you have been trying to get pregnant for more than twelve months, see your doctor or Family Planning Centre for advice.

Q, What if I miss a period when I’m taking the Pill?

A. You may miss a period while you are on the Pill. This is common and is usually nothing to worry about. As long as you have been taking the pills as directed, just keep taking them as usual. If you miss a second period see your doctor or Family Planning Centre for advice.

Q. Since I started taking the Pill my periods have been really short, and only last a few days and there hasn’t been much blood. The colour is darker too. Is this okay?

A. This is quite normal and happens to most women when they are taking the Pill.

Q. Should I have any special check ups when I am on the Pill?

A. You should check your own breasts every month after your period. If you don’t know how to do it, ask your doctor or a nurse to show you, or ask for a pamphlet on how to do it.

It’s a good idea to have your blood pressure taken, and your breasts checked for lumps when you go for a new prescription for the Pill. Ask the doctor or nurse to do these checks if they are not routine. You should also have a Pap test every two years, and sometimes more often if your Pap tests have been abnormal in the past.

Q. I know of someone who got brown blotches on her skin when she was sunbaking after she started taking the Pill. Is this common?

A. No, it isn’t common, but it can happen. These type of blotches are called chloasma, and are caused by an uneven skin response to the sun because of the oestrogen in the Pill. Once you are on the Pill it’s good to wear a hat and use a factor 15+ blockout sunscreen on any exposed skin if you’re out in the sun. If you get this skin reaction and it becomes a problem for you, the minipill (or other methods of contraception that don’t contain oestrogen) may suit you better.

Q. I have to have an operation and a friend told me I’ll have to stop taking the Pill before I go in to hospital. Is that true?

A. Yes, probably it is. You need to talk to your doctor as soon as possible because most women are asked to stop taking the Pill from between four to six weeks before they have surgery. If you do have to stop taking the Pill, remember to use other contraception like condoms, if you have sex. You should also stop taking the Pill if you have to stay in bed for a long time, or you have a leg in plaster. This is because if you are not moving around normally there is a risk that you could get blood clots.

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