Cause

There are many causes of a cough in children, including infections (both viral and bacterial), irritations (cold air, smoke, inhaled foreign body), allergies (asthma, though strictly speaking it is not always allergic), as well as psychological causes (habit cough).

By far the commonest cause of cough is a viral infection; as part of and after a cold, the child may tend to cough for a period of time. The next most common cause of cough is asthma, in which the child will usually have other symptoms as well, such as a wheeze, but sometimes a cough, especially at night or after exercise, may be the only feature. Other causes of a cough are relatively uncommon.

Clinical features

The exact nature of the cough and any associated symptoms will vary according to its cause. A cough that follows a cold will be loose and sometimes produce mucus.

Often it is worse at night because of post-nasal drip from a still congested upper respiratory tract. The cough may persist for weeks after the other symptoms of the cold have disappeared.

The cough of asthma is worse at night or after exercise, and there may be an associated wheeze and breathing difficulties such as shortness of breath. A barking, hoarse cough is suggestive of croup, while a sudden onset of a cough following a choking episode may suggest an inhaled foreign body.

Investigations

Most children with a cough do not need any investigations, and the diagnosis is made on the basis of careful history and physical examination. In some instances, a chest X-ray will be taken in cases of asthma or to rule out an inhaled foreign body. A blood test may help in the diagnosis of infection.

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Every cell in the human body contains twenty-three pairs of matching chromosomes, which carry the genetic blueprint determining every human characteristic. Each gene on each chromosome has its corresponding gene on the matching chromosome. One gene is usually dominant over the other, and is expressed as a certain characteristic. Only if a recessive, or weaker, gene is present on both chromosomes in a pair will the characteristic it represents be expressed. The twenty-third pair of chromosomes determines the baby’s sex. Females have two large X chromosomes, whereas males have a large X and a smaller Y chromosome.

Chorionic villus biopsy

This recently developed test is used to test for specific genetic abnormalities, such as cystic fibrosis. It can be performed earlier than amniocentesis, but does carry a greater risk of causing a miscarriage. The procedure is similar to amniocentesis, but instead of removing a small amount of fluid, several cells are removed from the developing placenta for testing. If you have a family history of certain hereditary disorders, your doctor will let you know if it is advisable for you to have this procedure performed.

Foetoscopy

This is a procedure in which a fibreoptic instrument, a needle with a tiny camera attached to it, is passed into the womb to inspect the foetus.

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“I love it when he kisses my vagina and my clitoris. I have my

best orgasms that way. He won’t do it anymore. He says it smells

and tastes bad. Does that mean I will never be able to have it

with him?”

ANSWER: If by “it” you mean cunnilingus, then, yes, you will be able to enjoy it with your husband. Based on what you just shared, make sure you do not have any related health problems that could account for any unusual odor or taste. Check out your husband’s health, too, because taste and smell are interactional and depend on two people. Changes in either of you, some type of reaction between you might, although not likely, be getting in the way. A super marital sex rule is that both partners in the marriage must get everything they want sexually. That’s what makes it super sex, not compromised sex. Another rule, though, is that all change takes place by small steps, steps that are approximations, in this case something like cunnilingus, such as kissing the thighs, stomach, and pelvic area and gradually learning of relearning to enjoy this’ activity mutually. Talk further with your husband about his feelings about fellatio and the issue of reciprocity of oral love. I know it doesn’t seem possible that both partners can really get everything they want, but the small-step process usually leads to a new system of relating that pleases both partners in ways they might not have thought of before.

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This is the reason most people stop treatment, or continue with a reduced dose. Another reason for non-compliance with the doctor’s instructions is that tablets are ordered to be taken three or four times a day and many people, with other things on their minds, simply forget to take them.

We have become more aware of this and so are more inclined to order drugs to be taken once or twice a day.

This will depend on their length of action, but we also accept that it is better to have a lower level in the blood for part of the day with less effect than have the patient taking no medication at all.

Most hypotensive or blood pressure-lowering drugs are better taken in combination.

If drugs with different side effects are combined, there is a cumulative effect on the hypertension and yet the side effects are kept to a minimum because the dose of each drug is kept low.

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Sometimes it takes several episodes of an allergic manifestation such as hives before the penny drops and we associate the symptoms with a particular food. If the allergy is due to a breakdown substance, then we may not be able to associate the symptoms with the cause.

Chronic allergic reactions such as eczema present even more difficulties. The presence of an allergen may not be suspected although the allergy itself is known.

I remember one of my young patients who was extremely sensitive to eggs. He developed a severe attack of asthma when his mother washed his hair using a shampoo which contained egg.

It is not only food itself which may cause the trouble. Many substances are added to foods to color or prevent deterioration.

Dr Ben Feingold postulated the theory that substances occurring naturally in food or added to it may cause an allergic-type reaction and lead to hyperactivity in children. This condition is now more commonly known as minimal brain dysfunction.

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You may be more likely to suffer from varicose veins if your family has a history of the problem, but it’s particularly common in women who have had several pregnancies, or who spend a lot of time on their feet. Being overweight can make things worse.

Wearing elastic support hose can be a good preventive measure, and you should avoid tight clothing and tight shoes (massage sandals are great). Exercise is important in getting the blood moving, and bike riding is especially good. If you have to stand or sit for any length of time, try to move your legs and feet as much as possible, and avoid crossing your legs or ankles. Elevate your feet whenever you can.

If you do suffer from varicose veins, herbalists have some useful treatments — a decoction of shepherd’s purse, taken regularly for up to three weeks, for example; yarrow tea (although you should avoid this if you’re pregnant or think you might be); bayberry and chamomile tea. Externally, you could try marigold flowers and distilled witch hazel as a lotion; or cold compresses of calendula, golden seal or witch hazel. Make sure there is lots of fibre in your diet, and supplements of Vitamin E, calcium lactate, rutin, pantothenic acid and Vitamin C may be useful.

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Nowadays, otosclerosis is cured by the operation called fenestration, in which a new inner eardrum is artificially created. The latest news on this front is that oral contraceptive (OC) drugs can bring on otosclerosis. Since OCs highly resemble natural hormones that are produced during pregnancy, this is not surprising.

For this reason, the British Journal of Family Planning (9:134) suggests that, before starting on an OC, women should have hearing tests and be asked if there is deafness in the family. Those with any tendency to otosclerosis or with a family history of deafness should avoid OCs entirely.

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The development of breasts is obvious except when the boy tries to hide gynaecomastia out of embarrassment. If this happens, the parents may not be aware of the problem.

Home care

It is very important to be understanding and to reassure the child that the condition will disappear. In more obvious cases, the boy may need to be excused from activities in physical education that require undressing or showering with other boys.

Precautions

• Ninety-eight percent of all cases of gynaecomastia are normal and will disappear on their own. • Your doctor should examine your boy if the condition persists.

• Take steps to insure that the boy is not subjected to taunting by other children.

Medical treatment

Your doctor will examine your boy carefully. The doctor will check for the presence or absence of true breast tissue; check the coloration of areolae (nipples); and examine the boy’s abdomen, testes, and body hair. The doctor will consider whether any drugs or foods could be causing the problem. If other causes of the condition are ruled out, the doctor can usually only recommend that you patiently support and counsel the child. Hormonal studies or chromosome studies are rarely needed. In severe or prolonged cases, plastic surgery can remove the extra breast tissue without visible scarring.

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Choking. About 1,500 people every year die when they accidentally inhale a bit of food or a foreign object and it becomes lodged in their windpipes. Dr. Thygerson recommends that everyone know how to perform abdominal thrusts (the Heimlich maneuver). For a conscious victim, wrap your arms around the victim’s waist from behind. Make a fist with one hand, and place the thumb side just above the victim’s navel. Grasp that fist with your other hand and press it up and into the victim’s abdomen until whatever is blocking the airway is expelled. You can perform this on yourself, says Dr. Thygerson, by pressing the abdomen (slightly above the navel) quickly over any firm surface, such as the back of a chair, side of a table, or porch railing.

For complete instructions on rescuing a choking victim, or getting cardiopulmonary resuscitation (CPR) certification, contact your local American Red Cross or American Heart Association.

Firearms. Unintentional shootings claim about 1,500 lives each year. And men are almost six times more likely to die at the smoky end of a misfired gun than women. If you have a gun at home, be sure that you and everyone in the house know firearm safety. Keep bullets and guns safely locked away, preferably in different places, says Michael Taylor, manager of the community safety division at the National Safety Council.

Poisonings – gases and vapors. If you don’t have a carbon monoxide detector on each level of your house, you should, says Taylor. Four hundred people each year die from being exposed to poisonous gases and vapors, in particular, carbon monoxide. Cooking and heating equipment as well as idling motor vehicles are major sources of this colorless, odorless, lethal gas.

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We think we’re smarter than animals, but we make the same mistakes the rats did. In fact, our mistakes are worse, because we’re supposed to know better. The rats couldn’t know it was only a recording they were hearing; they couldn’t help turning on their stress response at the wrong time. But we should know better than to respond as stress seekers when we’re caught in traffic, when the boss promotes someone else or when a police officer gives us a ticket.

Remember: Your interpretation of the facts determines your thoughts; thoughts can create or add to stress and stress will sabotage your “doctor within.”

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