Many of a child’s ongoing problems are actually contributed to by parental intervention. For example, a child who is rocked to sleep every night will come to depend on this, and will not go to sleep without it. The child also soon learns that the rocking will cease as soon as he falls asleep, and will therefore fight to stay awake, thus making him even more irritable and difficult. Similarly, a child who is used to parents coming into the room if he wakes and cries or calls out during the night will come very quickly to depend on this. Many young children have thus never learnr how to get themselves off to sleep, either at the time of going to bed or else when they wake up during the night.

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It is, understandably, an issue charged with an entire range of emotions—anger, guilt, relief, and elation. All parenting issues seem intensely important, but this one seems even more so. Perhaps this is because sleep—or the need for it in both parent and child—can begin to affect one’s decision-making ability and undermine even the most confident parent. It can bring discord to ordinarily happy families and affect parents’ feelings toward their child.

But it is possible to look objectively at the problem, to define it as it appears in your family, and to determine a course of action with which you will feel comfortable. In order to devise a workable plan, you first need some solid information about young children’s sleep.

When a child’s sleep habits cause recurring or continuing problems for the child or his parents, there is a sleep problem.

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I suggest for a start you consider taking some form of laxative regularly. Laxatives work by softening the motion and/or stimulating the bowel muscle—good examples include liquid paraffin, phenolphthalein, dioctyl sodium sulphosuccinate, danthron, lactulose, and senna. If you normally take laxatives anyway, you will need much bigger doses now than someone who is not used to taking them. Other ways of helping the bowels to keep moving are by taking a high-fibre diet (but not if you have a blockage of the bowel), drinking plenty of fluids and exercising as much as is possible and comfortable.

If these measures don’t keep your bowels moving easily, you may also need to use suppositories or enemas, with the help of a nurse. By the way, most nurses know much more about treating constipation than most doctors. I suggest that you ask a nurse for help if you have this symptom. This should be easy if you are in hospital. If you are at home, just ask your doctor to arrange for a nurse to visit you there.

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In a child, the most common causes for a cardiac arrest are drowning, electrocution and suffocation. In an adult, a heart attack is probably the most common. It may also result from poisoning or from gassing.

The signs of cardiac arrest are: loss of consciousness; the patient has gone blue or is pale; there is no pulse; the breathing has stopped or there may be some gasps for a while; the pupils of the eyes dilate and do not respond to light.

The heart is a pump, pumping blood to all the tissues in the body. The aim of treatment is to start this pump again by compressing the heart between the breastbone and the backbone.

Act swiftly, for if the brain is deprived of oxygen for longer than 3-4 minutes, irreversible damage may result.

Lie the patient on a hard, flat surface. Kneel at the side of his chest; tilt the head back to open the airway.

For an adult, place the heel of the hand on the lower part of the breastbone, or sternum, and cover it with the other hand. Rock forward and press down firmly on the breastbone — not on the ribs. The chest wall in an adult should move 2Óã-5 centimetres (1-2 inches).

Do it gently the first few times to assess the resistance of the chest wall. For an adult, keep it up at the rate of 60 a minute. For a child, use only one hand (two fingers for an infant), but increase the rate to 90 a minute. If someone else is present, get them to do mouth-to-mouth resuscitation at the same time as you do cardiac massage. One breath to every five pushes on the chest. If you are alone, you will need to do both actions yourself. Two breaths for every 15 pushes on the chest.

Check to see whether your work has any effect. The pulses will return, the color will improve and the pupils of the eyes will constrict.

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Uric acid builds up in the blood and is deposited as urate crystals in joints and the tissues around them. Urates may also be deposited as gouty tophi in other tissues, such as the ear or around the elbow.

The first indication is usually an acute arthritis. In most cases this involves the big toe, but any other joint may be involved. Occasionally, several joints are involved at the same time.

The pain comes on suddenly and is severe and throbbing. The joint is usually swollen and the skin overlying it is hot, reddened and shiny. The whole area is tender, and even light pressure on the skin is painful. Fever may accompany the attack. Unless treated, each such attack may last from five to seven days.

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When, as in most menstrual cycles, conception doesn’t occur, this thick layer of tissue is shed with some bleeding.

When the womb is removed, a woman no longer has periods nor can she become pregnant.

In the past, a partial hysterectomy was common. This removed the body of the womb but left the cervix in place.

This was done because it was an easier and smaller operation for the woman and did not disturb the anatomy of the vagina.

This operation is rarely done now because it leaves the cervix and leaves the woman still vulnerable to develop cancer of the cervix. This cancer is second only to cancer of the breast in frequency in women.

The operation can be carried out through a cut made in the abdomen or by operating through the vagina, so there is no outside cut.

Which approach is used depends on what is wrong with the womb, how large it is and what other procedures are carried out at the same time. It is rarely due to the whim of the surgeon.

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Unlike the fat stores in the body which can release almost unlimited amounts of fatty acids, the carbohydrate stores are small. They are fully depleted after two or three hours of strenuous exercise. This drying up of carbohydrate stores is often called ‘hitting the wall’. The blood glucose concentration begins to decline at this point. If exercise continues at the same rate, blood glucose may drop to levels which interfere with brain function and cause disorientation and unconsciousness. Some athletes refer to this as a ‘hypo’ and in cycling it is known as ‘bonking’.

All else being equal, the eventual winner is the person with the largest stores of muscle glycogen. Any good book on nutrition for sport will tell you how to maximise your muscle glycogen stores by ingesting a high carbohydrate training diet and by ‘carbohydrate loading’ in the days prior to the competition. In this chapter we provide instructions for increasing muscle glycogen as well as using the G.I. to your advantage in sport.

It was not until a highly respected British endocrinologist, professor David Jenkins, published the first list of G.I. Values that people began to listen. Now working in Canada, he and his colleagues showed that many foods containing starch gave blood sugar responses almost as high as an equivalent load of glucose. Further research showed that many sugary foods had lower blood sugar rises than starchy foods. In other words, scientists and medical practitioners all over the world had it the wrong way round. Unfortunately, many still do.

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2. Examine the influences in both the macro and micro environment that limit an individual’s ability to successfully reduce body fat; list these and attempt to plan counter approaches to them.

3. If possible, get spouses and partners involved in the modification of the micro environment for reducing body fat levels.

4. Keep fatty foods either out of the household environment, or not easily accessible.

5. Encourage the use of ‘person power’ through physical activity and ‘incidental activity’, rather than using machinery.

6. Modify the food supply at the micro-environmental level if this can’t be changed at the macro level, e.g. through reading food labels, learning appropriate shopping techniques, etc.

7. Increase awareness of, and access to, facilities for increasing levels of physical activity such as recreation centres, parks, playgrounds, walkways, cycle tracks and stairways in buildings.

8. Encourage walking rather than the use of vehicles where possible (i.e. park away from the destination, walk up the stairs instead of using escalators).

9. Get group support to facilitate physical activity (e.g. walking with a friend or group).

10. Encourage an attitude which regards movement as an ‘opportunity’, rather than an ‘inconvenience’.

11. Discourage the use of labour saving electronic equipment in the home such as remote controls for the TV, automatic garage doors, electronic can openers, toothbrushes etc.

12. Don’t commence a fat loss program at times when social support is likely to be least, i.e. at the end of the week or end of the year in particular.

13. Recognise the potential for environmental change and support individual and public health programs.

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