The wheeze may vary from mild to severe, and it can often be easily heard by parents. Sometimes, however, the child may appear to be breathing normally and quietly, but the doctor will hear signs of airway narrowing by listening to the child’s chest with a stethoscope. The wheeze may be particularly evident when the child is breathing out or exhaling. The wheeze may be present all the time, during a viral infection, or after exercise. It is often worse in the early morning or at night.

Many parents do not realise that coughing is just as much part of the clinical spectrum of asthma as is wheezing. Depending on the age of the child, the cough often sounds ‘fruity’, and older children may even cough up thick yellow sputum. The cough is particularly evident at night, and after physical exertion. Sometimes the cough results in restless sleep, and the child may wake frequently during the night. Often the cough gets in the way of the child participating in sporting activities at school. It must be emphasised that a child does not have to have a wheeze to be suffering from acute or chronic asthma — sometimes a cough is the only manifestation.

On other occasions, there may be neither a cough nor a wheeze, but the child may complain of tightness in the chest, of feeling tired or ‘off colour’, or may lose his appetite. The symptoms of asthma can be vague, and it is only after treatment that parents may notice the difference to their child’s general well-being.

There is also a wide spectrum in the severity and frequency of asthma. Some children wheeze or cough only several times a year, in association with a cold, while others (a small minority) may experience some symptoms every day. The child’s doctor will want to take a very careful history of the frequency and severity of the symptoms, for the treatment plan will be dictated by these two factors.

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There have been many advances in medical approaches for the more than ten million men who experience chronic erective failure, including new research on injection with papaverine hydrochloride and surgical insertion of prosthetic devices into the penis. Prosthetic devices include the fixed rod or inflatable implant, but any such surgery should be considered within the marital context. Remember that the erection is unnecessary for sexual fulfillment in the fourth perspective. As with any surgery, and particularly for the diabetic, there are always risks to be weighed against gains, and the whole process should be a team decision between marital partners and physician.

There has been much less research on diabetes in women regarding sexual functioning, although the effect of diabetes on female fertility has been studied for years. Once again, the biases of the first three sexuality perspectives dominates our medical orientation, including the assumption that women can always “receive” the male, so disease does not affect “them” as much.

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There have been many advances in medical approaches for the more than ten million men who experience chronic erective failure, including new research on injection with papaverine hydrochloride and surgical insertion of prosthetic devices into the penis. Prosthetic devices include the fixed rod or inflatable implant, but any such surgery should be considered within the marital context. Remember that the erection is unnecessary for sexual fulfillment in the fourth perspective. As with any surgery, and particularly for the diabetic, there are always risks to be weighed against gains, and the whole process should be a team decision between marital partners and physician.

There has been much less research on diabetes in women regarding sexual functioning, although the effect of diabetes on female fertility has been studied for years. Once again, the biases of the first three sexuality perspectives dominates our medical orientation, including the assumption that women can always “receive” the male, so disease does not affect “them” as much.

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This factor was also neglected in the early perspectives. Masters and Johnson described sexual response in terms of body cues (contractions, pulsations, emissions). Subjective experience teaches that ‘ ‘emotional arousal” does not have to lead to’ ‘evidence” of genital arousal, yet early in treatment, couples argued over the “fact” of arousal.

“You couldn’t be aroused,” said one wife. “You were as flaccid as a day-old noodle.”

“Neither were you aroused,” replied the husband. “You were as dry as a desert.” Both partners had been well indoctrinated in the early perspective of “you can’t feel it if you don’t show it.”

Both couples in the above two examples had not talked at all about the body to this point. They were talking about thoughts and feelings, two key aspects of the super sex paradigm.

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I highlighted the “bits and pieces”, because they do not form a complete picture of the way our body functions. To a serious scientist their collection poses more questions than it provides answers.

After young doctors complete their University studies and their initial supervised practice, they practice on their own, continuing their “education” during their working life.

Let us analyse, how they update their knowledge. Critical study of Medical Journals and complex results of clinical research requires time and significant effort from doctors, for which they are not being paid. Another source of new information is that concerning new drugs manufactured by chemical companies. This information is simple and quick to absorb: it comes with short and complete instructions on how to prescribe drugs to patients, details of dosages etc. It also comes with “free samples” of drugs to make the doctor familiar with the name of the drug, by being always at hand. Well-informed drug sales representative would offer a doctor personal assistance in acquiring familiarity with any new drug. Each year a multitude of new drugs is introduced to medical practice in this way. After several years of medical practice, most of the doctor’s new knowledge comes from such sales representatives, who usually do not have any medical education at all.

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The balance mechanism which tells us where we are in space is located near the inner ear.

It consists of three semi-circular canals containing fluid and each one is on a different plane.

Movement of our bodies sets up currents in the fluid in these canals and this stimulates the sensitive nerve-endings in the labyrinth.

The nerve impulses are transmitted along part of the eighth cranial nerve to the brain. These impulses are interpreted by the brain and we have a sense of balance.

The eighth cranial nerve also conducts those sensations which the brain interprets as sound.

Disturbances in our balance mechanism can be caused by many factors. Degeneration due to age causes not only diminution in hearing, but also can disturb the related sensory organ, the balance mechanism.

Meniere’s disease is a specific disorder where deafness, tinnitus (or ringing in the ears), and attacks of giddiness occur.

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Some surgeons believe traction helps. This involves strapping weights to the legs.

Physiotherapy with passive and active exercise to mobilise stiff muscles and joints is of proven benefit.

Manipulation is more controversial. It is practised by some physiotherapists and doctors and is the main treatment of chiropractic and osteopathy. There is no doubt that manipulation is a useful form of therapy in some cases.

A spinal brace is designed to prevent movement and to lend support. It can help but it leads to stiffness. Injections, usually of cortisone, into the back to place the drug near the inflamed nerve can also help.

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Although the procedure is a generally safe one, some women should definitely avoid laparoscopy:

• Obese women are not good candidates for laparoscopy. The amount of body fat makes it difficult for the doctor to position the instrument correctly.

• Women with a history of extensive abdominal forgery arc at greater risk for complications. This is because pelvic adhesions (soar tissue) may exist as a result of previous operations. The combination of endometrial growths and adhesions on the bowel can bind it down, making surgery complicated and bowel perforation possible. If the bowel is perforated when a laparoscope is inserted, a chain of needless problems can arise, including serious infection.

• Women with cardiovascular disease and/or high blood pressure are also at greater risk and should not agree to this procedure.

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