Appendicitis is a common condition in childhood and always requires surgical treatment.

Cause

Appendicitis is caused by the inflammation of the appendix, a finger-like projection 0f the large bowel. Just what causes this sudden inflammation is not known. The appendix itself is thought to serve no function in the normal digestive process and it is just thought to be an evolutionary remnant of some sort.

Clinical features

Appendicitis tends to occur more commonly in older children and young adolescents and is rarely seen in children under the age of 2 years. The characteristic symptom of appendicitis is abdominal pain. Initially it is in the middle of the belly and is more like a dull cramp. Within a few hours the pain classically shifts to the lower right side of the belly, where the appendix lies, and becomes sharper. Your child may not be comfortable sitting upright or walking straight. Movement tends to aggravate the pain. A mild fever is usually present, and your child may vomit or pass loose stools. Despite it being a relatively common illness, appendicitis can be difficult to diagnose because the appendix can lie in various positions in different children, and therefore cause pain in different parts of the abdomen.

Although uncommon today, there is always the risk of an inflamed appendix bursting; this can be life-threatening. If your child is extremely unwell and even slight movement irritates him, take him directly to a hospital.

Investigations

Your doctor may perform a urine test to exclude a urinary tract infection, which can mimic appendicitis. A blood test, although not specific for appendicitis, can show evidence of inflammation. If your doctor suspects acute appendicitis after examining your child, you may be advised to take him to hospital immediately before any tests are carried out.

Treatment

Emergency appendicectomy is the treatment of choice for acute appendicitis, and should not be delayed once the diagnosis is suspected.

When to see your doctor

See your doctor immediately if your child complains of the above symptoms.

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Rapid flow of milk

If you have a strong let-down reflex, you may find that your milk gushes out at the beginning of a feed. This can sometimes be a little overwhelming for your baby, who may cough and splutter because he cannot cope with the speed at which the milk is being delivered. This problem can usually be overcome by expressing a little milk at the commencement of each feed before putting your baby to the breast. This can be continued for a few days until your milk supply is regulated.

Babies who bite

Being bitten by your baby while breastfeeding can be a very unpleasant experience. Often a baby will bite for the first time while it is teething, due to sore gums. If your baby does bite you, take him off the breast immediately and firmly say ‘no’. If he gives you a repeat performance when you put him back to the breast, take him off and say ‘no’ again. Leave him off the breast for a while. In this way he will learn that this behaviour is not acceptable to you.

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Meet people who almost lost their sexual intimacy for the rest of their lives.

Wife: “You said to schedule sex. You said to get up an hour earlier. We did and we do, but now the hour is all used up. Any time we have gets sucked right in. We really don’t have time for sex. We really don’t have much time for doing much of anything. I swear, someone once said that life is eighty percent maintenance, and for us, it’s more like ninety-eight percent.”

HUSBAND: “Now I have to file my taxes four times a year. I have to go to school conferences, doctors’ offices, kids’ activities, business meetings, call repairmen, pay bills, and it is all so frustrating. The school, the IRS, the dentist, and the plumbing and heating guy all screwed up on the billing. I have written four letters to the phone company about a bill on a phone I don’t have, and now I’m getting a penalty charge on this stupid bill I don’t even owe. What’s worse is I can’t talk to anybody. When I do, they don’t seem to give a damn. They even criticize their own company. I am so distracted and trapped that it’s no wonder I can’t come during sex. I just feel all uptight.”

WIFE: “After twenty-seven years of marriage, I still go to church alone. We don’t even talk about it anymore. He hated the church and I love it. It has always been a part of me. He wants sex but I can’t do the things he wants to do. If he can’t even go to church with me, how can he expect me to make love with him? It’s cheap, just cheap thrills. If he loved me, he would be part of my life and my religion. I can’t respect a man who doesn’t honor his faith, any faith.”

Any hope for super marital sex depends more upon our living than our genitals. No one really has a sex life. We have one life, a life we lead as a part of a system, and the twelve problem areas below can be transitional or even permanent blocks to our intimacy.

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The following mini-quiz may help you understand the difference between limerence, the one-dimensional and unstable feeling state similar to drug addiction, and love, the complex, more stable and ‘ controlled state of bonding.

1. Does your feeling state depend upon your partner’s feeling state?

2. Do you experience intense jealousy regarding your partner?

3. Do you feel palpitations, digestive and eating problems, or other metabolic upset when you are in the presence of your partner or even when you just think about your partner?

4. Do you feel “swept away,” dizzy, light-headed, out of control when near your partner?

5. Are you in an altered state of consciousness, disconnected from the world, when near your partner or even when just thinking about your partner?

6. Do you have constant genital stirrings, erotic feelings about your partner?

7. Do you “long” or pine for your partner in his or her absence?

8. Do you feel lucky that your partner accepts you, almost not believing your luck?

9. Does everything else in life diminish in significance compared to being with your partner?

10. Do you feel that, without your partner, life would be barely worth living?

If you answer yes to more than two of these questions, you are leaning more toward limerence than love, experiencing a one-dimensional feeling that you can be sure will not last. Data indicate that this state is a lust state that lasts only a few months. Sit down and this “love seizure” is likely to pass.

When I talk with adolescents about sex and love, they ask many different questions, but the question they ask most often is, How do you know if you are in love? I answer the question this way: If you think you’re in love, you are certainly in something. It could be love and it could be lust. Lust is distracting, worrisome, takes away your attention at school, at home, takes time away from your friends. Love will cause you to be more involved in many people and find energy for your school, religious, and family life in general. If you’re in lust, it will never last because you are hooked on some “quick high” brain chemicals. If you allow time for love, which can follow lust sometimes, you are in for a treat, for the chemicals of love are the heavy-duty, long-acting type.

So limerence is a feeling. Love is only partly feeling, and much more behavior, thought, commitment, and belief. Most of the love songs you hear are really limerence songs, and when you hear them, remember, they may not be playing your song, a song of super love.

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The thyroid gland, which lies in the neck in front of the windpipe just below the Adam’s apple, produces a hormone thyroxin affecting the general metabolism of the body.

Underactivity of the gland causes myxoedema — the metabolism slows down causing lethargy, extra weight, and the person feels cold and becomes markedly constipated.

Thyrotoxicosis is excess production of thyroxin and the symptoms are the reverse. The person is overactive, restless, agitated, with a rapid pulse, loses weight, and may develop diarrhoea.

As well the person may develop a staring gaze and the eyes might actually become more prominent.

A familiar disorder, it is often thought to be inherited. Women are more often affected than men.

It is now thought to be one of the auto-immune diseases where the body becomes allergic to its own tissues and develops antibodies which lock on to and destroy those tissues.

There are now three accepted methods of treatment.

Anti-thyroid drugs control the over-activity of the thyroid gland and are usually considered for people under 25. They must be continued for about 18 months to two years.

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When infection is present in the pocket, antibiotics are usually necessary. Severe recurrent attacks which are not prevented by diet and medical means may lead to operation. If only a short segment of the bowel is involved, it can be removed and the cut ends rejoined.

Haemorrhage or bleeding may occur from an inflamed diverticulum and may be severe. Thickening of the inflamed area may lead to obstruction or an abscess may form alongside the bowel, due to perforation through the inflamed wall of the colon.

If the infection is not confined, peritonitis or inflammation of the lining of the abdomen may result.

Cancer of the bowel and diverticulosis are not related except, perhaps, in having a similar cause but they may co-exist and be mistaken for each other.

In most cases, if operation is considered, the resection and rejoining procedure is all that is necessary.

However, if penetration through the bowel wall or an intestinal obstruction has occurred, it may be necessary to carry out a temporary colostomy, where the bowel is opened out on to the skin of the abdominal wall and the discharging contents usually collected in a bag.

Later, when the bowel has healed, it is possible to close the colostomy and rejoin the bowel so that it functions normally. A permanent colostomy may be necessary in cancer of the rectum if it involves the anal area.

Now that we are aware of the cause, it should be possible, by changing our dietary habits, to reduce the incidence of diverticular disease and those other conditions of the bowel caused by our civilised, low residue diet. Good nutrition is the basis of good health.

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Obesity is one of the major illnesses of the western world; yet in the midst of plenty exists an illness which is just the reverse.

Anorexia nervosa, or what has been called “The Twiggy Syndrome,” is a disorder of affluent societies and is more common in wealthy, intelligent, high-achieving families.

Although it has undoubtedly occurred before, this disorder was first described about 100 years ago.

It usually affects young girls just out of puberty or in their late teens or early 20s. Occasionally, it can occur in girls before puberty, or even in young boys.

In anorexia nervosa there is a disturbance of eating. Although the word anorexia means loss of appetite, there is really no loss of appetite but a refusal of food and a preoccupation with dieting and with weight.

This disturbance of the control of food appears to be the primary problem and not a result of some other psychological disturbance.

The girls affected are usually obsessive — compulsive in personality, perfectionist, conscientious, hard working and rigid in outlook. Many give an outward appearance of confidence but most are consumed with self-doubt and feelings of inferiority. They tend to withdraw and to be isolated from their peers.

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If surgical removal or radiotherapy treatment aimed at completely eradicating the cancer is being considered, it is very important to check the extent of the primary cancer very carefully. In all other situations it is not usually important to know the exact extent of the primary growth.

The same sorts of considerations apply to cancer in any part of the body. By taking a history of symptoms, doing a careful clinical examination and arranging appropriate tests your doctor should have an accurate idea of the extent of the primary cancer before surgery or radiotherapy is commenced. Even so, the surgeon may still discover only after opening the patient up that complete removal of the cancer is not possible. This can happen even after the most careful pre-operative assessment. Of course, the chances of it happening are greatest when the pre-operative assessment is least thorough.

Remember that the extent of the primary growth is only important when local treatment is planned. As a rule, if secondary growths are known to be present and/or if treatment which goes right through the body is to be used, it is not necessary to know the exact extent of the primary growth.

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