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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Ionising radiation is radiation that can break molecules into electrically charged particles called ions. Radiation passing through you from a machine outside the body does not make you radioactive. If your treatment involved putting radioactive substances in or on your body this would make you temporarily radioactive, but only for as long as the substance was actually present. As soon as it was removed or lost its radioactivity you would no longer be radioactive and it would be perfectly safe for anyone to come into close contact with you.

All forms of ionising radiation are invisible, travel in straight lines, can pass through the body painlessly and are capable of damaging all living cells. Radiation treatment does not burn you. You don’t feel anything while it is actually passing through you. X-rays are one form of ionising radiation. For treating cancer very, very much stronger (higher voltage) X-rays are used than for taking X-ray pictures for diagnosis. Other forms of radiation are also used to treat cancer—these are all closely related to X-rays.

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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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About twenty different types of prostaglandins are found in nearly every cell and are responsible for many functions. As with any other hormone in the body, there are adverse side effects when prostaglandins are produced in overabundance, we are most concerned with the prostaglandin involved with menstruation, the one that causes uterine contractions; F2 (or F2 Alpha). Normally, this hormone it kept in control by the “pregnancy” hormone, progesterone. If a woman conceives, she continues to secrete high levels of progesterone, and F2 Alpha is not released. The body supports conception by blocking prostaglandin production. What happens if conception does not occur?

Prostaglandins released prior to and during menstruation stimulate rhythmic contractions of the uterus. These contractions help shed the uterine lining, causing menstruation. If the level of prostaglandins is higher than normal, menstruation will be accompanied by cruelly disabling cramps and other problems, such as headache, nausea, vomiting, diarrhea, lowered blood pressure, and even fainting spells and fever.

When Dr. Pickles and his team isolated prostaglandins—their so-called menstrual stimulant found in menstrual fluid—they were unable to provide a scientific answer to the question of why one woman secretes a higher level of this substance than another, we still have no satisfactory answer to that question. We can only suppose that, as with other types of body chemistry, such as having oily skin or a proclivity to slenderness, the answer lies in heredity. Whatever the “X” factor, it is proved that certain women will secrete more prostaglandins than others and that those women with higher prostaglandin levels will suffer from menstrual cramps and a tightening of the cervix.

When the cervix tightens, somewhat like a clenched fist, the flow of menstrual blood out of the body is obstructed. The Wood, replete with prostaglandins, is trapped in the womb. The hormone is first absorbed by the uterine muscles, then released, reabsorbed, and released again, creating a destructive and vicious cycle.

Unchecked, the prostaglandins circulate throughout the body without losing their potency. The uterus responds by contracting and cramping until the menstrual blood finally flows out from the vagina, carrying the prostaglandins with it. This release and absorption of prostaglandins can cause uterine contractions far more intense than labor pains during childbirth. There is also the likelihood that the menstrual blood that doesn’t flow out of the body in a normal manner can back up into the fallopian tubes and then out into the abdominal cavity. This “backing up” eventually wreaks far greater havoc than excruciating menstrual cramps—it can lead to endometriosis.

Just as mere is a correlation between high levels of prostaglandins and menstrual cramps, a similar relation exists between regularly painful menstrual cramps and the possibility of the onset of endometriosis. The issue is not, however, quite so simple. Severe cramps may be blatant signals of hormonal fluctuations, but they are not necessarily blatant warning signals to every woman—or physician— that endometriosis may be developing and spreading. In fact, many women who are spared monthly cramps go through life blissfully unaware that they are victims of endometriosis. For these women, endometriosis is finally diagnosed either when they complain of painful symptoms other than menstrual cramps or when they discover that they cannot conceive—or they miscarry.

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There may be delayed healing of wounds, particularly when the preparation is used on varicose ulcers. Various infections, such as tinea, herpes and thrush, will be aggravated and the underlying disorder may become masked. Allergies may occur to the preservative, stabilizer or perfume in the preparation. If an antibiotic is also contained in it, this is again more likely to cause allergy problems.

The use of these preparations for facial acne may aggravate the acne, and cause secondary infections as well. Increased facial hair and depigmentation of the skin may also result. Furthermore, if the preparations are used in or too close to the eye, glaucoma, cataract, or activation of corneal herpes simplex may result.

Although theoretically possible, it is extremely rare for topical preparations to be sufficiently absorbed in large enough amounts to have any significant internal side-effect. The only possible exception is when excessive amounts of strong preparations are used over large areas of a child’s skin for long periods. For most adult patients, who use less than 30 grams of potent corticosteroid a day on less than one-third of the body, there is little evidence of significant internal side-effects (even with plastic occlusion — which increases, absorption tenfold—overnight). Furthermore the only known side-effect, that of diminishing the body’s own corticosteroid production, is completely reversible within two to three days, should it occur.

The likelihood of internal side-effects may be diminished by the appropriate choice of the weakest effective preparation. Similarly, only small amounts of the chosen preparation should be used, and then only when and where necessary. The extent of the area of skin treated is most important, particularly with babies. Occlusive dressings to enhance absorption in thick areas of the skin should not be used over large areas for long periods of time.

Local side-effects may be prevented by using the appropriate strength preparation for as short a period as possible. Small quantities of a preparation are often sufficient besides being more economical, and it is useful to be shown the correct amount to use. For example, a matchhead amount will adequately cover the back of the hand. It is also inadvisable to use these preparations more than twice or possibly three times a day, because of the tendency of the skin to become resistant to then-use as well as the possibility of over-use.

Once the condition is under control, a less potent preparation should be used for maintenance. Where possible, the use of alternative compounds (for example, tar preparations with eczema or dithranol with psoriasis) should replace, or alternate with, that of the corticosteroids. Once the condition has healed, then treatment should be gradually tapered off, to avoid a rebound.

Let me emphasize, however, that although we should be aware of the possible complications of using corticosteroids, this should not deter us from their use. Under careful supervision it is possible to use small quantities of potent preparations for short periods in complete safety, even on the face and creases. Many patients have benefited enormously from their use, and there is no real justification for being left with an uncomfortable, unsightly yet treatable condition because of unwarranted fears of side-effects.

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