Lice are tiny insects that attach themselves to human beings. Head lice are very common in children, often first noticed due to the presence of eggs (nits) in the child’s hair. Body lice are less common, but are treated in exactly the same way.

Cause

The head louse (Pediculus capitis) is spread from person to person by close contact, despite close attention to hygiene. It can be spread, for example, by wearing an infected person’s hat or by using their comb. The eggs (nits) usually take about a week to hatch. Body lice or pubic lice are not common in children and can be transmitted through clothing or linen. The presence of body lice in a child does not signify sexual contact, nor poor hygiene.

Clinical features

The first sign of head lice is usually itching and scratching of the head. If you look closely at your child’s hair, you will see many small, white, oval-shaped eggs (nits) firmly attached to the root of the hair shaft, close to the scalp. The further away from the scalp, the longer the nit has been there (hair grows at the rate of 0.3 mm a day). The insects themselves move very quickly and they are difficult to see unless you part the hair very quickly. There is no need to chase them; the eggs are good enough evidence of their presence.

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Records kept by parents (‘parent-held record’) are now used in a number of states in Australia, and are given to parents when their child is born. They serve many useful purposes:

• Information about your child’s health is written down in the one place, and can be accessed by health professionals. This is very important if your child sees a number of different doctors, or if you move house or change doctors. Records of visits are noted down, together with any special treatment given to your child. Details of allergies to medications or to foods are also detailed.

• Family health and other information can be recorded.

• Reports of tests or hospital admissions can be stored in the plastic pocket of the record.

• Your child’s changing weight, height and development can be recorded in the record. This information is often valuable to have when the child is older and being assessed by a doctor.

Make sure that your child’s record is kept in a safe place, and do not forget to take it with you whenever you visit a doctor, nurse or hospital. Ask the doctor or nurse to write in it as appropriate, or write details of the visit in it yourself. It is a good idea to take it with you on holiday in case you have to consult a doctor who is not familiar with your child’s history.

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I don’t think about sex unless it jumps up and bites me. I guess I don’t think of much unless it hits me over the head. I just go on leading my life.

HUSBAND

HOW can you really think about sex when you have a million problems in your life? You can only think so much, you can only have so much energy. I am drained just dealing with life.

WIFE

There has been a tendency in sex research to focus on behaviors, sometimes feelings, but seldom thoughts. How we think about sex influences our entire sexual system, and when we are running cold, we tend to lose sexual interest. One hundred fourteen men and 245 women reported problems with sexual interest, and the frequency of sexual-interest differences in marriages is probably much higher than these numbers indicate. Remember, these couples came to the clinic for help with the sexual dimension of their marriage. They had enough interest in sex to try to improve their sexual relationship.

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Sometimes it’s like a mutual trance. We just flow from one thing, one activity, to another. I guess we talk, but 1 don’t really remember. We just seem to be one.

HUSBAND

I can have sex with him and just go through

the motions. It’s like washing your hands. You just do it.

WIFE

Is your marriage free of what I call “friction in activity flow”? Do things get done easily, simply, almost like the performance of a concert pianist who makes it look easy after years of practice (au-tomaticity)? Or are things difficult much of the time, with much friction, awkwardness, like dancing with two followers or two leaders (control)?

Our sample couple scored high toward automaticity. Things flowed from one to another so well that no one seemed to sense that husband and wife were in trouble. “Life goes on,” said the wife, “I just keep it going, hand him his orange juice as he checks the morning paper, hand him his briefcase on the move.”

The husband agreed. “I have to say, we are a team. We get things done. We’re organized. I don’t know if the team is winning, but it’s a team.”

Sexually, this couple typifies the automaticity of the compensated marriage. The wife said, “Our sex is like a pantomime. We are better than Marcel Marceau. We do it, don’t talk, just do it. A silent, well-rehearsed movie.” The husband agreed. “We don’t miss a beat. I hate the way it is just so automatic.”

Too much automaticity and there is no challenge to the system, no reason to grow and change. Too little automatic function and too much awkwardness fatigues the system and results in a surrendering within the system or seeking outside the system for ease to escape this form of disease.

You have now completed all ten items of the sexual system test. Each factor is exactly the same as the factors that physicists know influence all systems. You may have found it difficult to score yourself on this test because you are not used to the absence of good, bett^- and bigger scores. Systems do not work that way. To help you understand how your system is doing at this time in your marital life, use the following score analysis.

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Salt adds flavor to food and has always been highly prized.

Packaged and take-away foods contain a lot of salt which seems to blunt our taste so that we require large amounts or we think food lacks taste.

There is some evidence that an increased intake of salt may be responsible for an increase in the cases of high blood pressure.

It is not suggested we should avoid salt but that salt intake should be reduced. We may miss it for a few weeks until our taste buds recover from the years of excessive intake.

Professor Morgan, professor of medicine at the University of Newcastle, has estimated that, in a population with a high salt intake, the incidence of high blood pressure related to salt intake will be 20 per cent, whereas those on a reduced intake will have an incidence of only five per cent. A low intake will reduce this further to between one and five per cent.

Reducing salt intake is an easier and cheaper method of controlling blood pressure than having to take drugs.

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The patient may misinterpret this and believe that the drugs are depressing him, so he stops them; the anxiety again surfaces and depression recedes.

But the condition is unlikely to improve unless the doctor can recognise that the underlying depression is the more important problem and the anxiety is only a manifestation of it.

There are now two types of drugs for the treatment of depression. These lift the depression and bring the patient back to normal. Then he is in a position to sort out his problems or seek counselling.

The tricyclic anti-depressants are slow to work, taking weeks to show effect. However, if stopped, their effect can be lost in two to four days.

They can make the person drowsy, constipated and dry in the mouth. They may cause sweating, shaking, blurred vision and occasionally slowing of the urinary stream.

The possibility of these symptoms needs to be explained carefully to patients so that, if they do occur, the patients will not abandon treatment. Most of the side effects disappear within two to three weeks. This is usually just after the therapeutic effect has begun.

The other major anti-depressant drugs are the MAO inhibitors. Mono-amines are a group of chemicals like dopamine and S-HT.

Psychotherapy or counselling is usually necessary as well. Counselling often implies the giving of advice but psychotherapy is more than this.

It really means teaching the patient to become aware of himself, what motivates him and what factors led to his depression.

Learning to recognise and cope with these can lift the depression and lead to emotional health.

A few of the tranquillising drugs have some form of anti-depressant action as well and may be of benefit in those cases of depression with marked anxiety.

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These severe symptoms are due to the production of toxin by the invading germ. An antitoxin is available to neutralise this poison and the bacterium which causes diphtheria will usually respond to antibiotics.

Are your children up to date with all their immunisations? Perhaps I should also ask: are you, also up to date?

These injections can be given by your local doctor, or you might have them, free of charge, from your local council.

Do you have neighbors who are migrants and, speaking little English, may be unaware of the availability of immunisation in this country?

A neighborly and perhaps life-saving act would be to talk to them about the advantages of immunisation for their children. If it appears they do not understand you, it is very simple to pick up the telephone and call the Interpreter Service, which will translate your message at once.

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It is useful to think about cancer treatment as falling into two quite different groups. There are cancer treatments which can drastically change the natural course of the disease (that is, change the eventual outcome) and there are those which cannot. I he first group includes all treatments which offer the possibility of a complete and permanent cure. The second group consists of treatments which temporarily arrest the cancer but hold out no chance of an eventual cure. You should insist that your practitioner tells you whether or not it is possible that the proposed treatment will cure you.

This is not to say that treatments from the second group are not sometimes worth having. If your cancer is temporarily arrested, this may result in you feeling better and perhaps living longer. In deciding whether or not the inconveniences and discomforts of treatment are worth the trouble, you need to know what is on the other side of the scale—the potential advantage. Many people who would put up with very unpleasant treatment if there was a chance of being cured, wouldn’t consider having the same treatment for the sake of a few more months before still dying of cancer anyway.

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There is a list of relative contraindications to HRT, that is those conditions in which you and your doctor will need to consider the balance between the risks and the benefits:

• Migraine responds unpredictably to HRT, and your doctor may suggest you try it for a month or two to start with to see how it affects you. If you develop migraine for the first time during or after the menopause, then it may be

Some women find it returns during the days in each month when they are taking progestogen. Unfortunately, in these cases, changing to a different type of progestogen will probably not bring much improvement.

• Women who are overweight can usually take HRT, but very overweight women have a higher-than-average level of oestrogen, and increasing this level with HRT can increase the risk of breast cancer. However, these women, because of their higher oestrogen levels, tend to be less troubled by menopausal symptoms, and are at low risk of developing osteoporosis.

• There is no reason why smokers shouldn’t take HRT, although some doctors advise them to give up smoking while they are on it. Smoking reduces oestrogen levels.

• Varicose veins are not usually connected with deep vein thrombosis, and if this is so for you then there is no reason why you can’t take HRT unless they are acutely inflamed (phlebitis). Superficial inflammation of varicose veins is not a contraindication.

Between 10 and 20 per cent of post-menopausal women have significant contraindications to HRT, and the majority of them have menopausal symptoms that cause them long- or short-term embarrassment or distress. They need treatment to cope with the hot flushes, etc, and to increase their sense of wellbeing, yet many doctors aren’t particularly helpful.

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Any major gynaecological surgery, such as an open myomectomy which entails a large incision and a general anaesthetic, will put sex off the agenda for at least six to eight weeks. This does not mean you cannot enjoy each other in intimate ways. The opportunity to give pleasure to each other through massage can help the recovery process. It can also help the sexual relationship in the longer term by allowing partners to communicate their sexual needs to each other and learn about each other’s sexual responses before sexual intercourse resumes.

One type of activity that most couples find enjoyable, starts with partners giving each other a general body massage. Hand cream or body oil, and an atmosphere that is warm and relaxed, will add to the experience. As the massage occurs, the partner who is being stroked and rubbed describes his or her feelings and desires. In this way each partner learns how the other likes to be stimulated and caressed and unexplored areas of communication and fantasy may be unearthed. The activity may continue to climax.

After a hysterectomy, hysteroscopy, laparoscopy, endometrial ablation or endometrial resection, the desire to give and receive love remains. Most people want to continue with intimacy — the challenge is to be flexible enough to manage this when some of the old ways of being intimate are on hold. Giving and gaining pleasure may be achieved by caressing, cuddling and enjoying each other’s company. The use of a hand-held vibrator on many parts of the body can arouse sensations in areas we do not usually think of as pleasure zones, such as the soles of the feet, the face and the lips. Intercourse can be resumed when bleeding or discharge has stopped and the pelvis feels normal. Depending on the type of procedure and the speed with which your body heals this may be anything from a fortnight to several months. A slow start to the resumption of love-making is usually the best approach, with genital touching and gentle penetration later. If you have any concerns, wait until the postoperative check-up to get the all clear.

Drug treatments which induce a temporary menopause may reduce a woman’s interest in sex and may cause intercourse to become less pleasurable because of a decreased output of secretions in the vagina. Fatigue due to hot flushes and sleep disturbances may also reduce sexual responsiveness. Overcoming these adverse effects calls for lateral thinking as outlined above. It will not occur overnight, so a medium- to long-term approach is vital.

Treatments for excessive bleeding, such as the Pill, progestogens, NSAIDs, danazol, and GnRH agonists are a mixed bag as far as sexual function is concerned. Some, notably progestogens and GnRH agonists, can cause a marked reduction in interest in sex; while others, such as the Pill, may produce little change.

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