Psoriasis is a common skin disorder which usually runs in families. Its cause is unknown. In children, girls are more frequently affected than boys, although it is more common in adults on the whole. Areas of skin affected by psoriasis have a very rich blood supply, and tend to grow at a much faster rate than normal skin. Psoriasis is not infectious.

Clinical features

Patches of psoriasis may occur anywhere on the body, but are commonly found on the knees, elbows, umbilicus and groin, and less frequently on the scalp. Sometimes psoriasis may appear in areas of recently healed wounds. Nails can also be involved and have a characteristic pitting appearance. The patches look reddened (like plaques) and have white scaley areas within them. Psoriasis rarely appears before the age of 2 years; when it does, it usually affects the nappy area. In children, psoriasis may suddenly appear following a mild respiratory infection such as tonsillitis. In this case, the rash can last for a few months, after which it fades, but the tendency for the child to suffer from recurrent attacks of psoriasis at a later stage is very strong.

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THE ADVANTAGES OF BREASTFEEDING

It is often said that ‘breast is best’. It is true that human breastmilk is the ideal, natural food for young babies. It is convenient, readily available and inexpensive. It does not need to be modified, comes at the right temperature and is perfectly nutritionally balanced. Breastfed babies suffer less from bacterial gastroenteritis, respiratory tract infections and allergies. Their bowel motions generally smell less offensive than those of babies who are formula-fed. In addition, the hormone oxytocin, which is secreted by the mother during breastfeeding, helps the uterus to contract back to its normal size after the delivery.

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1. You must find one more hour, either by getting up earlier or going to bed later, or taking more time from work, or from wherever and however you can steal an extra hour.

2. Circle days on the calendar that will be scheduled sexual-intimacy days, These times don’t mean intercourse necessarily. On these days, except for illness, nothing will prevent holding, touching, and intimacy. It may not be at night, but it will take place.

3. Let the kids know it. The calendar does not just have to be by the bed, it can be on the refrigerator. You come to behave as you feel, so behave intimately. If you don’t schedule it, it will not happen over time.

4. Always, but always, rise together and go to bed together. Eat breakfast together if possible. There is no such thing as too much intimacy. Ignoring the development of a mutual cyclicity will eventually lead to marital lack of coordination, a relationship clumsiness that ends in separation either in fact or by circumstance. This rising and going to bed at the same time was one of the most difficult of tasks for the couples, but one of the most important. It is not necessary for a good marriage, but it is basic to a super marriage.

5. Spontaneity will take care of itself.Just because you schedule intimacy does not mean that extras can’t happen. It is not unromantic to schedule intimacy. Loving and sexuality is as volitional as it is emotional. Getting on a sex cycle together will help you to find your own sexual Tao.

“What a thing this is,” stated one husband. “I was used to sleeping in an extra hour. Now I get up two hours before I have to just to have breakfast with her. But you know, it has added one whole day a week to our marriage. We have gotten kind of arrogant about it and we like to tell our friends. They can’t believe it.”

His wife added, “He’s right. We don’t talk much. We mumble and stagger around. He reads the paper, I get ready for work, and we both yell at the kids. Actually, we take turns yelling at the kids. But now there is that early time for just us to say hello.”

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HUSBAND

Once the message is sent, received, and acknowledged, phase three tends to dominate the interaction. While it would seem that the two persons would be ready to open up to one another, in fact the opposite is true. Now that something important is at stake, a real possibility of a lasting bond, both persons seem to go into “projective” posture.

Persons in the deceptive phase begin to present the “they” that they would like the other person to perceive they are and each of us desperately wants to be. The projected image is not realistic, however. Deception here is as much of self as of the other. The impact on marriage is severe, for it is at this phase that many marriages occur, bonding between two projected images. Partners believe in the “magical mystical healing powers of marriage,” that marriage will somehow in some way solve any problem. The more idealistic the projected images, the more denial is employed, and the more denial before marriage, the more disappointment in marriage. It takes a great amount of energy to keep denying how we really are, and “leakage” occurs. On some level, it takes recognition of what is being denied to maintain the denial, and the recognition is present in both partners. They continue, however, to trust in the illusion of the healing power of marriage without presenting the “real patients.”

One clear dimension of bonding emerges so far. Marriage will only make any problem worse, and that applies most directly to any sexual problem. It probably explains in part why second marriages are almost twice as likely to divorce as first marriages. Marrying at the “deceptive phase,” the time of projection of image, is a mistake. It can be corrected through techniques to be described later, but it is one of the major contributions to the high divorce rate in our country. One of my clinical rules is to tell spouses, “Never divorce someone you don’t know, and be sure you start with yourself.”

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Some four to eight days later, the typical rash appears. It starts as a reddening of the skin, then small blisters filled with a clear fluid develop. They dry up and scab, and finally disappear to leave scars which may persist for months or occasionally years.

If the infection is severe or if the person’s immunity is low, the condition may spread, resulting in a few vesicles like those in chicken pox on other parts of the body. Sometimes the infection can extend along the spinal cord. Occasionally the motor cells of the front of the spinal cord are involved, and this can cause weakness or paralysis of muscles.

The most common area affected is the trunk, when the thoracic part of the spinal cord is involved. But it may affect other areas and the lesions extend down the arm or leg.

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The symptoms of diabetes may be increased thirst, the passing of large quantities of urine and weight loss. Other symptoms are tiredness, muscular weakness, urine infections and thrush. In the juvenile onset type, the person may be thin.

The illness may rapidly progress to ketosis, where the body starts to burn up its fat reserves and acetone is noted on the breath and the urine contains ketones, breakdown products of fat. This can lead to coma and death.

Infection may be the precipitating factor in bringing on the diabetes or in leading to coma in known diabetics.

Those with juvenile onset diabetes almost always require insulin. This must be given by injection as it is destroyed in the stomach and therefore cannot be taken orally. It is prepared from either beef or pig pancreas.

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The term hyperactivity, or hyperkynesis, has now given way in medical circles to “minimal brain dysfunction”.

In children with this condition, there is no demonstrable cause and it occurs in the absence of other neurological abnormalities.

There are some doctors who deny that such a syndrome exists; they feel it is merely an attempt to put label on a group of children who are more difficult than others.

Certainly, most children seem to grow out of this problem but it may still cause them and their parents a great deal of worry and trouble.

Treatment has always been unsatisfactory. Sedatives, antidepressants and even stimulants like amphetamine have been used with less than moderate success.

In 1974, Dr Ben Feingold claimed in the U.S. that he had produced a dramatic 50 per cent improvement in hyperactive children by placing them on a diet which excluded naturally occurring and added salicylates. Other food additives and colorings were also placed on the banned list.

This diet has been widely used in Australia and the U.S., but results so far are still equivocal. The advocates of the elimination diet claim it works well and the sceptics claim any response is due to the placebo effect.

The diet is very restrictive and easily broken, either by accident or design.

The diagnosis of hyperactivity or minimal brain dysfunction, should not be made by the parents but by a doctor skilled in dealing with these cases.

Parents should be wary of starting their children on a restrictive diet without the advice of a dietitian.

Treatment with a drug methylphenidate, marketed as Ritalin, has been shown to give good control for most children.

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However, for that, one needs no more vitamin E than the Recommended Daily Allowance (RDA), which is 10 mg daily for a large man. More than this does harm, and Geriatrics (39#2:69) lists the signs and symptoms that usually result from excessive dosage.

The most serious side effects include: thrombophlebitis (inflammation and tenderness under the skin, with bumps and bruises over the veins), pulmonary embolism (blood clots lodging in the circulation of the lung, causing a dangerous illness, with pain in the chest, shortness of breath and blood spitting), high blood pressure, severe fatigue, and tender enlargement of the breasts. Some more easily seen effects include: chapped lips, sore mouth, blister-like rashes, and very slow healing of wounds. Others are: nausea, diarrhea, intestinal cramps, and night blindness (due to vitamin A deficiency since very large doses of vitamin E antagonize vitamin A).

Since vitamin E capsules containing several times the RDA are on sale, many people must be taking it in dangerously large amounts. The Journal of the American Medical Association (246:129) recently published an article deploring the fashionable habit of taking vitamin E in “megadoses” every day and reported that the author sees many patients with the side effects of overdosage with vitamin E.

Unfortunately, the cause of its bad effects can easily be overlooked since they rarely all appear together or begin until large doses have been taken for many months.

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