Sometimes called ‘controlled crying’, this is a steplike way of achieving the same thing, and may be more acceptable for some parents, though in many ways it is more demanding. They should go into the room, and stroke and reassure the child without picking him up, changing the nappy, or giving a drink. Once the child has calmed down, even if the crying has not stopped completely, the parent leaves the room. For continued crying, the parent then waits a longer period, say 3 to 5 minutes, before going in again, where the child is soothed by stroking and soothing, and then leaving. The next time the interval is increased again, until finally the child falls asleep. It is important to attend to the child in a less than enthusiastic way, so that he is reassured but not rewarded. This should continue each night until the child gets the message that the parents have no intention of backing down.




The wedding of Jan’s daughter was six months away and the planning for it was gaining momentum. Instead of feeling excited, Jan was feeling desperate. What if she had a panic attack on the day of the wedding? What if she had to leave the church or the reception? What would everyone think? She didn’t want to make a fool of herself or disrupt the wedding in any way. What if she couldn’t even make it to the wedding at all? She was feeling anxious about it already, yet it was still six months away. Jan wanted to prevent her anxiety from increasing, but she didn’t know how.

Marilyn’s counsellor had told her that clinging to the memory of her first panic attack was not helping her as she worked on her recovery. Marilyn felt quite angry with the counsellor. What did the counsellor know anyway? That first panic attack was dreadful. Marilyn had been in the local shopping mall when it happened. She had no idea what it was and had thought she was dying. She had asked a few people to help her, but they didn’t respond. They must have thought she was either drunk or crazy. Marilyn get back to her car and drive herself home, where she stayed for the next four years. Although she had made it home safely every time she tried to go out since then, Marilyn would think of her first attack and naturally she would become anxious. She didn’t want to go through that again. How could she not think about that attack? It was that attack which caused all the ongoing problems. Marilyn thought the counsellor, like all the rest she had seen, didn’t really understand and wouldn’t be able to help her.



The bags under your eyes, the weight you have been losing or gaining, the grumpiness and sheer exhaustion—these are the obvious reasons to make some changes. Your child’s physical and emotional well-being are also reasons.

Dr. Burton White, author of The First Three Years of Life, feels that sleep problems understandably occur in families where children are loved and whose needs have been met. So, in some ways, the emergence of sleep problems is not necessarily a bad sign. He notes that it is the continuance of sleep disturbances that can cause deeper problems.

Dr. If your child has not learned them, then his functioning during wakefulness is not “optimal.”2 Put simply, a sleep-deprived child (waking several times a night or missing out on even an hour) is not at his best. His cognitive processes will be fuzzy and his social functioning will be marked by grumpy unpredictability.

A child can “adjust” to whatever sleep patterns he has fallen into. (Look at how you have “adjusted.” Do you say “I didn’t know it was possible to exist with so little sleep”?) However, there are signs—some subtle, some blatant—that he is not at his best.

It is the parents’ job to insist on healthy sleep, just as they insist on healthy nutrition, to give the child the strongest base from which to grow. Good sleep habits do not necessarily happen spontaneously. This is a skill that can be learned by children and facilitated by parents.



Too much calcium in the blood usually means that your cancer has spread to the bones, especially if your cancer started in the breast. However, the reverse is not true—in general, cancer does not usually cause excessive release of calcium when it spreads to the bones. Some particular types of cancer can also cause high calcium levels in the blood without spreading at all, but this is unusual. The ones that can do it include squamous cancer of the lung and cancers of the kidney and ovary.

Of course this may either be impossible or so costly that you decide that it is not worth trying. The main alternative is to work on reducing the high calcium levels, either instead of attacking the responsible cancer, or while you are waiting for anti-cancer treatment to work. Some of the ways of reducing high calcium levels include flushing the calcium through the system with a lot of intravenous fluids, or by using mithramycin, phosphate mixtures taken by mouth or corticosteroids.



The congestion of the internal veins which occurs from the pressure of the enlarged womb during pregnancy is also a common cause.

It is also said that, when man assumed the upright stance, he not ony threw a strain on his back but on his lower bowel as well. Except for a few old, fat dogs, haemorrhoids are rare in animals.

The most common symptom is bleeding. This tends to be bright blood and to occur at the end of a motion. The blood is not mixed with it but tends to splatter or drip into the pan. It may be noticed on the toilet paper. This is the sign of first degree piles.

Third degree piles prolapse outside and remain there, unless replaced manually. They may also come out when the person stands for long periods or becomes tired.

Prolapsing piles may become squeezed by the tight anal margin and become strangulated. This pressure can lead to thrombosis, the formation of a clot, and is painful.



It appears everyone agrees induction of labor for purely social or medical convenience is bad medicine.

Normal, uncomplicated labor and delivery usually occur where the standard of pre-natal care is good and complicating factors are recognised and dealt with early in the pregnancy.

In these cases, home delivery would be possible. But most doctors are reluctant to return to this form of obstetrics, because, when complications arise, they are likely to do so quickly and it is then difficult to summon aid promptly.

A compromise, with delivery in surroundings approximating home conditions and with the husband and other family members present, seems to offer the advantages of both extreme positions.

Induction too early, with possible prematurity, constitutes a risk. Conversely, allowing the pregnancy to go on too long is associated with some risks to the baby, in the form of post-maturity (over-term).

The answer to what is best for both the mother and the child has not been universally accepted.

But what is best for the doctor and the hospital must remain subservient to the needs of the two patients involved for each pregnancy.



It’s not just your pre-and post-event meals that influence your performance. Consuming a high carbohydrate diet every day will help you reach peak performance. The G.I. factor of the carbohydrate is not important here, only the amount of carbohydrate. It has been proven scientifically, unlike many other rumours involving dietary supplements, that eating lots of high carbohydrate foods will maximise muscle glycogen stores and thereby increase endurance.

The reason for this is that carbohydrate stores need to be replenished after each training session, not just after a race. If you train on a number of days per week, make sure you consume a high carbohydrate diet throughout the whole week.

Keep alcohol intake moderate—no more than one to three standard drinks per day and try to have two alcohol-free days a week. A standard drink is equivalent to one glass of wine (120 ml), one middy of beer (285 ml) or one nip of spirits (30 ml).

Beer is not a good source of carbohydrate. When athletes fail to consume adequate carbohydrate each day, muscle and liver glycogen stores may eventually became depleted. Dr Ted Costill at the University of Texas showed that the gradual and chronic depletion of stored glycogen may decrease endurance and exercise performance. Intense work-outs often two to three times a day, draw heavily on the athlete’s muscle glycogen stores. Athletes on a low carbohydrate diet will not perform their best because muscle stores of fuel are low.

If the diet provides inadequate amounts of carbohydrate, the reduction in muscle glycogen will be critical. A heavily training athlete should consume about 500 to 800 grams of carbohydrate a day (about two to three times normal) to help prevent carbohydrate depletion. In practice, few Australian athletes achieve this enormous figure. As a comparison, a typical Australian man or woman eats only 240 grams of carbohydrate each day.



New research on the effects of ageing on body fat suggest that there are a number of components of ageing which mean that gaining fat stores with age is a ‘natural’ process and that losing fat becomes more difficult. Changes with age that promote fat gain are:

• a decrease in lean body mass: and therefore a reduction in metabolic rate. This may be compensated for by such activities as resistance training, although the extent to which this can occur is not dear at this stage. Metabolic rate is thought to decrease naturally by about 2 per cent per decade after the age of 20.

• changes in fat oxidation. The rate at which the body bums fat as an energy source in contrast to blood sugars, decreases with age, possibly as a result of the increase in body fat mass. This means fat is stored more readily and used less easily as a fuel source in the elderly.

changes in the influences of stimuli which ‘break down’ fat (lipolytic stimuli). Hormones such as growth hormone and testosterone all decrease with age and catecholamines from the adrenal glands appear less effective with age. Hence, the normal status of older people promotes fat gain

As well as a decrease in physical activity (through sport and games) it now appears that even if older people consciously exercise vigorously to lose fat, they may unconsciously decrease their rate of physical activity at other times during the day: they simply get more tired than young people as a result of exercise, and unless an effort is made to maintain SPA, the net effect may be no real gain in overall physical activity.

• increased associated health conditions: heart disease, arthritis and other muscular-skeletal problems.

• a decrease in intra-muscular fat as an energy source. There are significant stores of fat in muscle tissue. The storage of fat in the muscle tissue decreases with age as the binding protein decreases. This means fat from the muscle is less readily available as an energy source during exercise and a greater reliance is placed on other energy stores.

• increased eating. Although this is often under-reported, there is evidence to suggest that eating and drinking may actually increase with age, rather than decrease or remain stable, as would be necessary to stabilise body fat. Accurate monitoring of food intake in the elderly will be necessary before this can be verified.

On the positive side, it appears that moderate fat gains with ageing do not appear to be as dangerous as those in the young and a BM up to 27kg/m2 is considered within the normal range for older people. However, this point is still hotly debated and in the meantime caution is still advised.



When dealing with the area of managing body fat levels we must have a basic understanding of how energy is balanced in the body. We consume on average anywhere from 1500kcal-2500kcal per day. This adds up to an energy intake of about 555 000-1 million kcal (2.33-4.17 kj) per year. But what about expenditure? How does the body balance energy intake with expenditure? Why can some individuals seemingly consume relatively greater quantities of food than others, and at the same time end up with lower stores of body fat? Dr Klaas Westerterp and his group from the University of Limberg in the Netherlands, have estimated that over the course of a lifetime, there is an actual discrepancy between energy intake and energy expenditure of only around 1 per cent, making the system an extremely well balanced one.2 What this implies, of course, is that body weight is not just equal to the amount of energy intake minus energy expenditure, but that energy intake + expenditure must change, as a function of a number of factors, to help balance the system. To understand this, we need to understand the components of energy expenditure. There are three main components of energy expenditure.

1. Resting metabolic rate (RMR) or basal metabolic rate (BMR), which equals sleeping metabolic rate (SMR) and arousal.

3. Exercise, or daily physical activity and spontaneous physical activity (SPA).

The vast majority (i.e. around 70 per cent) of daily energy expenditure (EE) in the average person is accounted for by RMR. Thermogenesis contributes about 15 per cent and daily physical activity is the most variable being around 10-25 per cent in sedentary individuals.



This is one of the most serious, and potentially most dangerous surgical emergencies of childhood. It is most common between the ages of five and twelve months. It is not often seen and most family doctors will see only a small number of cases in their professional lifetime, unless dealing with large numbers of infants. In most cases no specific cause can be found.

The chief event is telescoping of one part of the bowel into the part of the bowel that follows on. It can only get worse, and the risk is that the blood supply to the telescoped part is impaired. If this happens, the bowel will die. It is essential that the bowel be disentangled as urgently as possible. Necrosis (death) of the affected part of bowel may take place within 12 to 36 hours.

Symptoms are usually clear cut. The child appears fit and healthy. Then there is a sudden onset of sharp recurring abdominal pain. It comes and goes. The child tends to perspire with the discomfort and draws the legs up in an attempt to gain relief from the pain. For the first two hours, the child seems all right in the pain-free intervals between the attacks. Vomiting may set in, but not necessarily. The condition tends to become progressively more severe with the passage of time.

A fever sets in. After five hours or more, the patient becomes dehydrated. The eyes tend to sink in. Often a sausage-shaped mass can be detected in the abdomen by the doctor, when carefully felt. If there is a bowel action, it may have a dark red coloration.


With symptoms of this nature, urgent medical attention is essential. Never neglect abdominal pain occurring in a child. This is even more vital in a normally healthy child who suddenly complains. If associated with vomiting, a fever or abnormal bowel actions, the situation becomes more acute. Surgery is the usual method of treatment. When carried out early, the results are excellent. The longer the child is left, the higher the risk factor, and the chances of a prompt, successful outcome progressively lessen also.