Nail-biting is more common in children than it is in adults. It is said that up to half of all children are nail-biters at some stage. It is usually a habit of school age children, and is rarely seen before the age of 5 years. In the majority of children it is a transient habit, and most children do not persist with it into adult life.

Cause

It is not clear why some children bite their nails. It may be a way of discharging tension, and some say it is an extension of thumb-sucking earlier in life and is comforting in some way. Nor is it known why some children continue the habit into adolescence and adult life, while others stop it after a short time. Presumably, as the child matures, he finds other ways of handling stress or discharging tension.

Clinical features

Children bite their nails, or else the cuticle or skin surrounding the nail. Sometimes only one or several fingers are involved, sometimes only one hand, sometimes both hands. Some children will pick at the cuticle or skin, and others will also bite their toenails.

Apart from the unattractive appearance of the nail and cuticle, it is not common for there to be any complications of this habit. Sometimes it causes considerable roughness around the nails, and this may lead to bleeding or infections of the skin or nailbed (paronychia). In some children, the nail-biting may be a manifestation of considerable stress or anxiety. In these youngsters there are often other signs, including difficulty in sleeping, loss of appetite, irritability or moodiness, social difficulties, lack of concentration or problems at school, and so on.

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Most tests can usually be done with a minimum of fuss if parents adopt a sensible and supportive but firm stance, and stay with the child during the procedure.

Doctors are used to hearing comments such as: ‘Be good, Johnny, or the doctor will give you a needle.’ This sort of threat does nothing to enhance the trust which needs to be built up between the doctor and your child.

We encourage more helpful comments, along the lines of: ‘I know you don’t like this, but we have to do it so that we can help you feel better quickly.’ Be honest. Tell your child that the procedure may hurt, but not very much, and only for a second — ‘then it will be all over’.

We realise that it can be very difficult for you as parents to watch your child being subjected to tests, but the child usually picks up on your anxiety, which can make him even more fearful. As difficult as it may be for you, try to remain calm and reassuring for your child’s sake. If you feel distressed about the thought of your child having a test, please discuss this openly with your doctor.

*24\90\8*

At times we will feel tired, defenceless and vulnerable. These feelings don’t last. We will begin to know and understand why we are feeling this way. We will get to know quite a lot about our self, in fact, sometimes we will wish we didn’t know so much! It is a time of learning to listen to the inner voice of the self, which is more than willing to help us. If we stop and take the time to listen, the inner voice will be our guide. All too often we do not hear ourselves.

At some points it may mean rearranging things to make life a little more comfortable and a little bit easier while the integration with the self is worked through. Again, it is a time of learning what our needs are, perhaps learning new skills or trying things we have always wanted to do. Rejecting some, embracing others we didn’t know were there.

We have to become aware we do have a choice in everything. In making the choice we need to be aware of its implications. We can choose and set limits if we need to. We can choose to move at our own pace. It is going to feel unfamiliar, we will feel vulnerable and the fear will be there, but so too is the self s determination to grow.

We must learn to trust our self. Getting to know our self helps us gain that trust. It is taking risks with our self.

*105\94\8*

You will remember that a definite diagnosis of cancer cannot be made without examining cells from the suspicious area under the microscope. I explained in Chapter 3 how the necessary specimens can be obtained.

An actual operation is not usually necessary to make the diagnosis of cancer. Making a diagnosis and having treatment are two quite separate things. Most often the diagnosis can, and should, be definitely proved before any treatment, including surgical treatment, is planned. This is because it is not possible to decide on the best possible treatment until the diagnosis of cancer is confirmed and the particular type known.

What can happen if the diagnosis is not established before operating? Say a patient has a shadow on their chest X-ray which looks very like cancer. One way of definitely finding out would be to remove all or part of the lung—combining diagnosis and treatment in one procedure. Afterwards, when the removed lung is examined under the microscope it might indeed be found to contain primary lung cancer. However, it is also possible that it could contain a secondary cancer deposit from some other part of the body or even some type of infection or inflammatory reaction. Although removal of the lung certainly allows a definite diagnosis to be made, we know that there are far less drastic ways of making a diagnosis! In addition, removal of the lung is not even the best form of treatment for all types of primary lung cancer. It is certainly not the best form of treatment for any of the other conditions that might have been found.

*230/40/1*

A hernia is a protrusion of the bowel through an abnormal opening.

Hernia may occur in the groin (inguinal hernia), at the navel (umbilical hernia) or through the diaphragm (hiatus hernia) and sometimes a portion of bowl can protrude through a weak scar on the abdomen following operation (incisional hernia).

The testes, which develop inside the abdomen during foetal life, migrate through the abdominal wall to enter the scrotum by the eighth foetal month. This leaves a potential weakness in the abdominal muscles in the groin.

Most inguinal hernias are now covered by workers compensation although the connection between strain and the hernia is often tenuous.

The pre-existing weakness is there and maybe the effort of lifting some weight at work is the triggering mechanism which brings on the hernia. Whether it does or not is academic because most employees will be granted compensation.

Hernias occur in babies and children.

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Removal of the womb, or hysterectomy, is not necessary for a satisfactory repair operation.

Hysterectomy may be carried out at the same time if there is a separate reason for so doing.

Repeated heavy bleeding with the periods, fibroids (non-cancerous tumors of the uterus) and other disorders of the uterus, may lead the doctor to consider hysterectomy. This is usually removed through the vagina and there is no cut through the abdomen.

If a woman becomes pregnant following a repair, the doctor may consider delivering the baby by means of a caesarian section. A vaginal delivery may cause a recurrence of the prolapse and require a repeat operation.

A prolapse may occur immediately after a difficult delivery but, as the lax tissues tighten up over the weeks or months following the pregnancy, the condition may regress and the symptoms disappear.

It is possible for the prolapse to recur and for a further operation to be required. Where the symptoms of stress incontinence are not relieved by the repair, further operations have been designed to sling up and support the urethra at its origin from the bladder.

A repair operation may mean a stay in hospital of 10 to 14 days, usually until full bladder control is regained.

Operation is correct treatment for this distressing problem and most women who have it are well satisfied with the results.

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Hair waving is another practice going back many centuries. The Egyptians used to wind the hair on wooden sticks, cover it with mud, and bake it in the sun. Heat waving processes are still used today but for ‘permanent waves’, cold waving techniques are becoming increasingly popular. A permanent wave should maintain the shape of the hair at least through several shampoos; if successful, it may last several months.

Cold waving, being a technique that requires no elaborate heating or drying equipment, can be done at home, indeed, it has made home permanent-waving possible. This process involves wetting the hair with a solution of thioglycolic acid, and then winding it on to rollers; the rollers are left in for 10-30 minutes depending on the type of hair and the desired effect. The hair is then rinsed with a ‘neutralizer’, usually hydrogen peroxide solution. What basically occurs with a perm is that the hair is chemically changed to a flexible form, like jelly, then shaped as desired and allowed to set or harden for a ‘permanent’ effect. Reactions are rather rare considering the widespread use of these products. This may be partly due to the fact that the ‘home perm’ solutions are weaker than those used in the hair-dressing salons. The most common reaction is one of irritation, usually caused by carelessly applying the solution or leaving it on the scalp for too long. Damage to the hair is also a frequent outcome. It occurs most commonly with hair which has been too recently waved or bleached, or in normal hair where the solution is insufficiently diluted or is left on for too long. As a result of this damage the hair may become brittle and frizzy, the ends will very likely split, and the hair may even break and fall out. Such hair damage can, however, be largely prevented by following the directions very carefully, and not assuming that different brands can be used in the same manner. Alternatively ensure that you attend a reputable salon, and make certain that your hair is in good condition before having a perm.

Setting agents, hair lacquers or sprays are mainly based on polyvinyl pyrrolidone or similar polymers. Their effect is shortlived but they are quite safe to use; they do not cause hair damage or dandruff. Occasionally hair sprays may react with some dyes, resulting in discoloured hair.

*14\44\4*

1. Burgen™ Fruit Loaf toast and a hot chocolate drink made with low-fat milk.

2. Toasted Burgenm Fruit Loaf topped with sliced banana.

3. Porridge sprinkled with raisins and brown sugar.

4. A low-fat milkshake.

5. A tub of low-fat yoghurt with a sliced peach and raspberries spooned through.

6. Bowl of All-Bran TO and low-fat milk, topped with canned pear slices.

7. Baked beans on Ploughman’s Loaf™ with a little avocado.

8. A bowl of Guardian™, low-fat milk and a glass of fresh orange juice.

9. Spread Burgen™ loaf with fresh ricotta or light cream cheese and top with sliced apple, pear or nectarine.

10. Vegemite on low G.I. toast finished with a piece of fruit.

TEN LOW G.I. LUNCHES ON THE GO

1. Take some pita bread, spread it with hummus, and fill with tabbouli.

2. Chunky vegetable soup, thick with barley, beans and macaroni.

3. Cook a little pasta and mix through pesto or chopped fresh herbs.

4. Put your favourite sandwich fitting on Burgen™ bread (make it into a jaffle if you like).

5. Beat up a banana smoothie and couple it with a high fibre apple muffin.

6. Top a tub of fruit salad with a pot of yoghurt.

7. Take a green salad with vinaigrette dressing plus some bean salad, add grainy bread and enjoy!

8. Stir-fry tofu, Chinese vegetables and noodles.

9. Smoked salmon on pumpernickel with avocado.

10. Vegetarian lentil burger with chargrilled vegetables on a wholemeal bun.

*146\33\4*

Technological developments in the area have led to a number of different machines now being available for directly or indirectly measuring body fatness. Some of these are extremely expensive and would not be used in the normal day-to-day counseling situation. Others are now becoming more portable and more accessible and provide at least an opportunity for adding to other measures. The current range of machines include: underwater weighing, bio-impedance analysis, near infrared analysis, etc.

Near infrared analysis (NIR). NIR is a technique developed for the US Food, Drug and Agriculture Apartment (FDA) to measure fat content of beef carcases. It is based on the principles of light absorption and reflection using near infrared spectroscopy.

A small, hand-held probe, which emits electromagnetic radiation through a central bundle of optic fibres is placed on the skin at a selected site (usually the biceps for overall fat measurement). Optic fibres on the edge of the same probe absorb the energy reflected back from the tissues and this is then passed on to a spectrometer for measurement. Because muscle tissue is denser than fat, muscle and fat can be determined by the end of the light spectrum reflected back to the machine through several centimetres of tissue. When multiple sites are used, the measure is quite valid. MR machines using only one site, (i.e. the biceps) are now commercially available and reasonably portable (there is even one hand-held device) and within the cost range of someone working in counselling. They require one simple measure which takes about 20 seconds, plus some other information fed into the computer on age, sex, fitness level etc. The whole measurement process takes only 1-2 minutes.

Again, the estimation of body fat is based on algorithms built into the computer and hence the estimates are only as good as the algorithms that support them. In general NTR has been found to be slightly less valid than BIA measures, but reliability is unclear. The sensitivity of the measure is unknown. Used by a skilful operator it can be an effective motivational tool and can be used to measure relative changes in body fat in different body locations, i.e. total and regional fat assessment.

*69\186\4*

This has become one of the best-known serious childhood disorders in recent years. What is more, it is one of the most preventable. An enormous amount of work has been carried out with babies in an effort to detect cases at birth and to treat them immediately.

In Australia almost every baby born is ’screened’ for P.K.U. at birth. In the first few years more than 2.5 million babies were tested, and 222 ‘positives’ were found. In one single year, 18 cases were picked up.

P.K.U. is an inherited disorder in which the body cannot produce certain vital enzymes (chemicals needed to keep the body functioning normally). Those affected are mostly blond, blue-eyed babies who appear normal at birth but soon develop symptoms— these include vomiting, irritability, a strange odour, skin rashes, possibly convulsions and a strange personality. There is invariably mental retardation, and intelligence gradually suffers and deteriorates. The children tend to be hyperactive and have erratic and unpredictable behaviour. Most sweat profusely.

Treatment

Treatment consists of certain fairly simple diet restrictions, and if these are carried out the child has a good chance of normal development. The diet must be continued for many years, possibly well into adult life, but each case will be treated individually. Parents must follow the diet routine very strictly to gain the best results; haphazardly following the routine will not bring success. This is probably one of the most rewarding forms of therapy, in itself very simple, that is available which yields such positive and outstanding beneficial results.

*93\87\2*