Toys are an important part of childhood. Children (and adults) can choose from a bewildering array of toys, simple or incredibly complex, cheap or expensive. It is often said that play is the work of childhood, and children use toys to play, to learn, and to fertilise their imagination.

There is pressure on both children and parents to purchase certain types of toys. Many parents at some level feel better if they are able to provide a large quantity and variety of toys for their children. There is peer and advertising pressure on children to have certain toys — just look at the saturation advertising on afternoon television which is directed at children. This pressure is often difficult to resist.

Expensive toys are not necessarily better than cheap ones, and there is nothing wrong with toys that are hand-me-downs, provided they are sturdy and still in reasonable condition. It is often a very old soft toy that a child becomes most attached to. Children have very vivid imaginations and rich fantasy lives, and they improvise readily. Anything can be a toy — not necessarily something that is bought from a toy shop. Improvised toys (such as the lid of a saucepan or empty containers) stimulate the child’s creativity.

Let the child choose the toys if possible — they should not be a realisation of parents’ fantasies. However, it is important that you set clear limits in advance on such issues as cost and safety. Toys and play are an important way that parents and children can communicate with each other. They create the opportunity to share quality time together and stimulate the child’s learning and creativity.

*114\90\8*

“Ever since the heart attack, he seems to be trying too hard. 1 mean, he wants to please me, prove something, I think.” The wife described her feelings about the impact of a life-threatening disease on her husband and her marital sex. “He used to really enjoy me, but now he seems to be worried that I will see or think that he is fragile or something.” With catastrophic illnesses, some patients adopt styles that prevent a mutually pleasing sexual interaction. Here are some of the styles, based on my interviews.

The Accepter: This person acts as if the disease is deserved, another negative in a disappointing life. There is little effort to fight back, to change, to adapt, to protect sexuality. Rather, there is surrender and sacrifice of sexuality to the disease process. “The doctor told me that diabetes could cause impotence. He said it, and he was right. So I don’t know why you are asking me about our sex life. I can’t have one,” said the husband. When I asked how his wife felt about that, he responded, “She has no more choice than I do. It is just in the cards. A bad deal, a rotten deal. ” When I suggested that there was no erection at all, the man responded, “Look, you learn to live with what you are given.” To paraphrase T.S. Eliot, if you fail to look inside for the strength to grow at times of crisis, then you must accept whatever life gives you. As this chapter continues, remember one basic principle: No disease prevents sexuality. The Accepter has forgotten this fact.

The Denier: This patients minimizes all illness, indeed all negative events, and in the process sexuality leaves the marriage. This minimizing interferes with sex because the maintenance of intimacy depends first on acknowledging any blocks to that intimacy. “No stroke is going to bother me. It didn’t even faze me, really. We just keep going,” reported the husband. “No way that’s true, Dave,” said his wife. “Can’t you see that we haven’t had sex in months?” The husband could not believe his ears. “It could not have been that long. I’m just as sexy as ever.” He laughed and pinched his wife’s thigh. She slapped his hand and he continued to laugh. “It’s not funny.” She began to cry. “You’re either a liar or a fool. I cannot live this way.”

*265\97\8*

OF EXPRESSION?

Are you a talker, a toucher, a shower, a feeler, a senser, a listener? How do you best express yourself?

One husband said, “I’m a man of few words. My wife has all merest.”

The wife responded, “Oh really? Your few words are worth hundreds of mine, because you never listen anyway. I have to send ten for one to be heard.”

Styles of communication are as different as the people who use them. Try now to identify your basic style: quiet, reflective, passive, active—how do you send your signals?

“I don’t talk about love,” said the man. “I show it, I give it, I demonstrate it.”

“Then I must be blind,” answered the wife. “So try talking a little more. I listen better then I see.”

When you really want to be heard and understood, how do you send your message? How do you communicate, show the road signs along your love map?

*91\97\8*

Gonorrhoea or “clap” is an ancient disease and has been around at least since Biblical times. This is caused by a rounded bacterium, the gonococcus or neisseria gonorrhoea.

The incubation period is shorter than syphilis, being around two to eight days. In men, it usually causes an acute inflammation in the urethra or tube which carries the urine from the bladder to the outside. There is a discharge, often thick and yellow, and considerable pain on passing urine. These symptoms are usually so marked as to make the sufferer seek medical attention quickly.

But, in perhaps 10 per cent of cases, there are no symptoms and so the man may be unaware he has an infection and pass it on to others.

In women, at least 80 per cent have no symptoms and so are more likely to spread the disease. It is uncommon to involve the urethra so there are no symptoms related to passing urine.

It may involve the vagina or cervix and may cause a mild discharge. If the infection ascends and involves the fallopian tubes there may be severe abdominal pain and this infection may block the tubes, leading to sterility.

In both sexes, the mouth, throat or rectum may be involved.

*594/71/1*

There are some simple rules of which we should all be aware if we are called on to render first aid to someone having an epileptic fit.

There is no need to move the person unless he is in danger from a hazard such as traffic or moving machinery.

Do not restrain the convulsive movements. Move furniture, if possible, away from the person.

Do not put your fingers in the mouth of the person, trying to remove dentures or stop him biting his tongue — you may have your fingers severely bitten. Most people feel they should place something in the mouth of the convulsing person to stop the tongue being bitten. Hard objects like spoons or pieces of wood are more likely to break the teeth. A bitten tongue will heal but a knocked-out tooth is gone for ever.

In my experience, it is difficult to insert a soft object such as a rolled handkerchief or a cloth-covered piece of wood, so it is better not to try.

When the convulsion has stopped, the person should be rolled on to the front with head to the side — the coma position — so that saliva or vomit will not be inhaled.

*337/71/1*

Although this all sounds so discouraging, lung cancer screening programmes have been tried. A high-risk population was chosen for testing—males over forty-five who were heavy smokers. X-rays and sputum cytology were repeated every four months. Some early cases were picked up and operated on successfully, but there were still patients who developed symptoms of cancer between screens, that is, in the four month breaks. Some of the cases picked up at screening had already spread. The numbers of patients eventually dying of lung cancer were not convincingly less than those for a group of men who were not screened regularly. Therefore, for lung cancer at least, there is so far no effective method of screening.

Let me stress that all of the above refers to patients with no symptoms. All I am saying is that patients diagnosed by these screening methods did no better in the long run than patients who were diagnosed and treated as soon as they developed symptoms. The screening tests weren’t good enough. They only picked up the same proportion of curable cancers as are picked up ,irf patients who go to the doctor as soon as they develop symptoms. Don’t take this to mean that you shouldn’t go and have tests if you have any symptoms that could be due to cancer. The longer you leave it, the worse your chances. With many types of cancer, the only cases that are ever cured are the ones that haven’t spread before diagnosis and treatment. The later cancer is diagnosed, the more likely it is to have spread.

*84/40/1*

What happens when cancer growths interfere with the function of the brain or spinal cord? Most often there is simply loss of function of whichever part of the body is controlled by the affected area. Thus, if the cancer growth is in the left side of the brain, there may be loss of feeling and strength in the right side of the body. A growth in the spine pressing on the spinal cord can cause paraplegia— loss of feeling and strength in the legs and loss of control of the bladder or bowel. As well as loss of function, cancer growing in the brain can irritate the brain cells, causing twitching or convulsions. This does not happen with lesions in the spinal cord or meninges.

The symptoms of increased pressure in the brain and spinal column can include headache, nausea, vomiting, blurred or double vision and stiffness in the neck and back.

Your doctor should examine you carefully for any loss of feeling or strength, especially if you have any of these symptoms. He or she should also examine the back of your eye, by looking through your pupil with a special lighted instrument called an ophthalmoscope. The end of the optic nerve can easily be seen at the back of the eye with the ophthalmoscope. The optic nerve is actually an out-pouching of the brain itself. Build up in pressure on the brain can cause the end of the optic nerve to swell, producing a typical appearance, which your doctor should recognise. Unfortunately, however, the optic nerve can look quite normal even when the brain pressure is very high, so this is not a foolproof test.

*111/40/1*

It is important not to leave undescended testes, presuming they will come down at puberty. In the past, operation was often delayed until after puberty or male hormones were given just before puberty to try to promote normal descent.

Ectopic or abnormally placed testes are prone to several complications. Function may be impaired in both the production of the male hormone testosterone and also the reduction of sperm.

Testes lying in the groin are prone to injury and are more likely to twist on themselves and this torsion can cut off the blood supply. There is also a higher risk of cancer developing in testes which are not normally lying in the scrotum.

In about 70 per cent of cases the mal-descended testes are associated with hernia and this, in itself, may require operation.

Operation is the treatment of choice and most surgeons prefer to operate before the age of six.

The testes are brought down into the scrotum and anchored there by means of stitches. Late operation, that is, around puberty and particularly after puberty, is associated with a high risk of failure of function of these organs.

*87/71/1*

If an eating disorder is suspected in a client a counsellor should:

1. CHECK your perception with a colleague. Describe the behaviour that makes you concerned, without identifying the person, as a hypothetical case. Find out if they would have the same concern

2. MAINTAIN rapport and relationship with the client.

3. IDENTIFY likely resources in the community to whom you could refer your client. Talk to the professional concerned, again to check your perception of the problem. Notify him or her that you may be referring someone.

4. CHOOSE a time to talk to the client in which you will not be pressured or disturbed and a place which is free from interruptions and is confidential. Notify the switchboard/receptionist that you won’t be available for a little while.

5. LET your client know of your concern and ask if it is OK to discuss the problem. If your client accepts that it is a legitimate concern and is prepared to talk with you, continue to facilitate his or her exploration. Ask if they would be prepared to see another health professional to ascertain what, if any, is appropriate treatment. Keep the focus on developing a healthy sense of self and body, rather than on morbidity or illness. Give your client the professional’s phone number and leave them with the task of making an appointment.

If the client denies there is a problem, especially if the suspected eating disorder is anorexia, ask if there is anyone else who they can talk to about it. Clearly outline the reasons for your concern (for instance, demonstrate where the client is placed on the healthy weight range) and your own disquiet about the situation. Suggest that maybe you could talk about it after they have had time to consider what you have said. Keep a rapport. Be prepared to be firm as well as gentle. This process may need to be repeated several times.

Gyms, fitness centres and lifestyle programs all need a policy of handling of suspected eating disorders so as to promote healthy, rather than inappropriate eating and exercise routines. This policy needs to include guidelines for referral, limitations on the use of exercise machines, weights etc. and the use of broadly based food choices as opposed to diets.

*225\186\4*

Carbohydrate is a part of food. Starch is a carbohydrate, so too are sugars and certain types of fibre. Starches are nature’s reserves created by energy from the sun, carbon dioxide and water. The building block of starch is glucose, a single sugar.

The simplest form of carbohydrate is a single sugar molecule. Chemically, this sugar molecule is known as a monosaccharide (mono meaning one, saccharide meaning sweet). Glucose is a single sugar molecule which occurs in foods and is the most common source of fuel for the cells of the human body.

Eating a high carbohydrate diet means:

? eating carbohydrate-rich foods at every meal and making sure that carbohydrates form a large proportion of the meal,

? eating carbohydrate-rich foods for snacks,

? including at least the minimum quantity of carbohydrate foods suggested for small eat.

Eating a high carbohydrate diet also means:

? not eating too much protein or fat. High fat foods are concentrated source of kilojoules. It takes only a small extra amount of them to throw your diet out of balance. Monounsaturated and polyunsaturated fats may have desirable effects on blood lipid levels but all fats have the same energy value and same propensity for ‘overconsumption.

Remember, if you are eating a high carbohydrate diet then you’ll automatically be eating less fat.

*15\33\4*