EDmedblog

This is a stressful transition for everyone involved, including parents (see Chapter and other siblings. There is a major disruption in routine for the whole family. Sleep is invariably disrupted as the baby’s needs are attended to, and tiredness may result in increased tension within the family. There may be increased expectations of other siblings, who will be required to take on increased responsibility and help with the new arrival, and around the house generally.

Sibling rivalry is especially common with the birth of a new sibling. An elder child will often resent the arrival at home of a new sibling. Frequently he will regress in his behaviour. Competencies he has acquired, such as being dry at night, will be lost temporarily. He may begin to suck his thumb, wet the bed at night, and will request drinks in a bottle or a nappy at night. He may resent the attention paid to the new baby and want his mother’s attention during feeding time. All of this is normal behaviour, and parents should not be overly concerned.

Sometimes the sibling rivalry may be expressed physically, with a toddler actually hitting the baby, out of anger at the intruder. After a time, this usually settles down, but may resurface again when the new baby becomes mobile at around 12 months of age. Again the new sibling’s ability to interfere with the older child’s activities may give rise to feelings of irritation and anger. This sets the scene for what often seems an ongoing battle.

*140\90\8*

So, think about what you can do to take your mind off your pain and to reduce your feelings of fear and anxiety. Try to express and explore your feelings with family and friends and see if you can come to accept the aspects of your situation that you cannot change. Try to deal with your fear of the future by confronting it rather than by letting your imagination run riot. Fear feeds on the unknown. So ask a doctor, nurse, social worker or someone else you can trust about what is likely to happen to you. Ask them directly about any particular bogey you have— is it really likely to happen, and what could be done about it if it does? I am sure that if you can do this you will feel more at ease and your pain will be less of a problem for you.

If your pain proves really difficult to control, in spite of following the approaches I have recommended, think about what you are gaining from it. No, that’s not a misprint, I do mean gaining. Are you frightened of being discharged from hospital? Does the fact that you still have pain mean you can stay there, where you feel safer? Does your pain mean that you are less likely to be left on your own? If something like this is happening for you, there may be other, much less unpleasant ways of getting what you need. Perhaps you could tell friends, family, nurses, social worker, chaplain or someone else you trust just what it is you need. Perhaps you could try to work out what it is about hospital that makes it feel safer and then see what you could do to make home feel safer. Perhaps you could ask to have someone to keep you company just because you’re lonely and frightened, accepting that you don’t need to have pain to ask for this. Basically, try to ask for what you need directly instead of through your pain. You may be surprised at the results.

*178/40/1*

Whiplash injury to the neck is a phenomenon associated with the car.

The sudden acceleration and then deceleration of the head and neck when the car is struck from behind is likened to the way a whip is cracked.

On the day of injury there is a little stiffness and soreness and then over several days it tends to get worse, rather than better.

So, often, if you do see a doctor in the first week both you and he tend to treat it lightly.

By the second week it is not improving. Perhaps then an X-ray is taken. The report is usually normal.

By the third week the symptoms have worsened. As well as pain and stiffness you may be experiencing giddiness, blurred vision and a ringing in the ears.

And in view of the normal X-ray, both you and your doctor are thinking that perhaps at the worst the symptoms are due to nervous tension.

Whiplash injury to the neck is poorly treated by many doctors at the moment and poorly understood by most patients.

The pathology or underlying injury is not fully understood.

*621/71/1*

Food poisoning is the term for attacks of vomiting and diarrhoea which can happen within 24 hours of eating food contaminated with bacteria, toxins or chemicals.

However, it is also possible for the same disease to pass from person to person or, more commonly, to be spread by infected water.

The outbreak may involve many people or come from a source where many might be affected and prompt notification can lead the inspectors to investigate, find and contain the source before too many are stricken.

In recent years there was an Australia-wide outbreak of gastro-enteritis due to contaminated oysters from the St. George River in NSW and, before that, over 60 cases of typhoid occurred in Victoria from a carrier working in a takeaway food store. And infected salami caused an outbreak and temporarily closed the factory making the salami.

Typhoid and paratyphoid fevers are specific diseases due to specific germs.

*364/71/1*

During the ’50s, diethylstilboestrol or DES, a synthetic oestrogen or female hormone, was widely used in treating cases of threatened miscarriage.

It has been shown that the daughters of women exposed to this hormone during pregnancy have an increased rate of developing cancer of the vagina although further research has shown the incidence is not as high as first supposed.

There is, however, a high incidence of genital and urinary abnormalities in the sons and daughters of women exposed to the hormone.

There does not appear to be any reduction of fertility in these individuals, although continuing research is necessary as more enter the reproductive age group.

Unfortunately, proper scientific research may be hindered by the intrusion of claims for damages in the litigation-prone U.S.

Special clinics have now been established at some of the major Australian women’s hospitals to investigate and monitor women exposed to DES.

*113/71/1*

Don’t forget that you have the right to refuse to take part in clinical trials. If you do agree, you have the right to withdraw at any stage simply because you don’t want to keep having the randomly allotted treatment—you don’t need any more reason than that. If you refuse from the start or withdraw later, your doctors are obliged to continue to treat you to the best of their ability and without prejudice. If you know or suspect they are not doing this, it would be best to switch to another doctor, if this is possible.

As you know, your informed consent (usually written) is supposedly necessary before you can be treated in any form of research trial. I know that, definitely in Australia, and probably in other countries, some patients are treated in clinical trials without their knowledge or consent. Some doctors randomise their patients and then tell them that they recommend the treatment to which they have in fact already been allotted by chance. The only way you could suspect this is happening is if your doctor is particularly adamant that you follow his or her recommendation (although of course this may simply be a reaction to the fact that your questioning is undermining your doctor’s authority). You should ask directly if you suspect that you are being treated in a research project without your consent.

*144/40/1*

If foods containing refined sugar have an intermediate G.I. factor, does this mean that people with diabetes can eat as much sugar as they want?

Research has clearly shown that the G.I. factor of refined sugar is the same in people that have diabetes and people that don’t. Moderate consumption of sugar (which means 40 to 60 grams of refined sugars a day) does not compromise blood sugar control. In fact, excluding sugar from the diet has important psychological consequences.

Sugar is not just empty kilojoules, but a source of pleasure and reward and it helps to limit the intake of fatty foods and high G.I. carbohydrate foods.

Our advice is to spread your sugar budget over a variety of nutrient rich foods that become more palatable with the addition of sugar, e.g. yoghurt, porridge and other breakfast cereals, milk drinks, fruit desserts, jam on toast.

Bread and potatoes have high G.I. factors (70 to 80). Does this mean a person with diabetes should avoid bread and potatoes?

Potatoes and bread can play a major role in a high carbohydrate and low-fat diet, even if a secondary goal is to reduce the overall G.I. factor. Only about half the carbohydrate has to be exchanged from high G.I. to low G.I. to achieve measurable improvements in diabetes. So, there is still room for bread and potatoes. Of course, some types of bread and potatoes have a lower G.I. factor than others and these should be preferred if the goal is to lower the G.I. as much as possible.

In the overall management of diabetes, the most important message is that the diet should be low in fat and high in carbohydrate. This will help people not only to lose weight, but to keep it off and improve their overall blood glucose and lipid control.

There are so few low G.I. foods that anyone wanting to follow a low G.I. diet would have to narrow the range of foods that he or she eats. Isn’t this a bad thing?

It is a myth that you have to narrow the range of foods you eat on a low G.I. diet In fact, some people have told us the opposite. They have found that the advent of the G.I. factor has expanded the range of foods they can eat because foods containing sugar are not unduly restricted.

The rumour that all low G.I. foods are high in fibre and not very palatable also needs dispelling. It is true that legumes and All-Bran may not be everyone’s favourite foods, but pasta, oats, fruit and many favourite Mediterranean recipes using cracked wheat and lentils etc. are low G.I. and delicious. To dispel such myths finally, we have included many mouth-watering recipes using legumes and lentils in Part II.

*94\42\4*

There are few specific exercise prescriptions for heterogeneous groups that can be scientifically supported at the moment, but those with most promise appear to be the following:

• long duration, low intensity exercise for pre-menopausal women

• any form of physical activity (high or low intensity) for younger men

• increased resistance training for seniors

• walking is a simple, low cost, moderate intensity activity easily incorporated into lifestyle

• a greater emphasis on dietary change rather than exercise in the initial stages for the obese

• emphasis on small, additive increases in daily physical activity in the obese

• non-weight-bearing exercise (e.g. Aquarobics, cycling) in the initial stages for the very overfat

• increased emphasis on SPA and ‘incidental’ activity with older people

• shorter cumulative bouts of aerobic activity for the unfit.

Hypothesised prescription parameters for some overfat groupings are tentative and are proposed here as a model for further testing. They are likely to provide a more focused approach to prescription, however, than dealing with all cases of overfatness and obesity as homogeneous.

*158\186\4*