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Solutions to be inhaled as a mist from a hand-held inhaler (metered dose inhaler or puffer, often used with a spacer device), or from a nebuliser driven by a pump.

Dry powders to be inhaled from a hand held inhaler (spinhaler or rotahaler).

Liquids, tablets or sprinkles to be swallowed. Combinations of medicines are often necessary.

Inhaled medicines are far more effective than those swallowed. More of the drug reaches the lungs, where it acts on the airways, and very little reaches the bloodstream. Medicines taken by mouth are absorbed into the bloodstream and may sometimes cause unwanted side effects such as a fast heart rate or irritability. Most children over the age of 3 years can be taught to use a spacer or inhaler of some kind. Younger children can use an asthma pump ( these are also used in older children).

Asthma medications can be divided into treaters and preventers. Some children take both these classes of medication. Your doctor will advise the most appropriate medications for your child to take.

Drugs used to treat the symptoms of asthma fall into several groups:

Beta-2 agonists such as salbutamol (Ventolin, Respolin), terbutaline (Bricanyl), fen-oterol (Berotec) These are the most commonly used drugs for the treatment of acute symptoms of asthma.

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ALCOHOLIC HUSBAND

A total of eighty-one men and forty-three women described themselves as alcoholics in the couples groups. Forty-seven of the men reported problems with erections and thirty of the women reported decrease in sexual interest. Even in cases where the physical examination did not reveal liver damage (a frequent consequence of alcoholism and one directly related to sexual problems because of impact on hormonal patterns), erective and sexual-interest problems were present. One woman reported, “I can’t tell you if I am interested in sex or not. I do it a lot. But that doesn’t mean anything. I go to work, too, but that doesn’t mean I want to. When you’re a drunk, you just do things. You’re lucky if you remember what.”

In addition to liver damage, neurological and circulatory problems occur with excessive drinking. Alcohol in the blood directly suppresses the sexual-reflex system. The body’s immune system is seriously jeopardized by alcoholism, and the generally poor and deteriorating health of the alcoholic seriously affects sexuality.

Alcoholism, like all health problems, affects the entire family system. I have found that sexual counseling is not effective until the drinking problem and related family and marriage problems are confronted and remediated wherever possible.

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When you enter someone’s home, you may notice a unique odor. After some time you do not detect it (at least in most homes) because of the olfactory refractory period. The principle is the same in sexual response.

Sexually, refractory periods occur for both men and women. They are not the “beached whale” phenomenon of a man collapsing from sexual fatigue. They are periods of varying duration occurring in both genders during which time direct stimulation to a specific part or area of the body is ineffective, bothersome, or uncomfortable.

Emotionally, there is also a refractory period. We cannot maintain any emotional state indefinitely. In fact, most emotions last only a few seconds. We must change gears or burn out. The same is true for sex. We need to pause, to rest, to take what I call a PON, or post-orgasmic nap; a POR, a post-orgasmic rest, or even a POS, post-orgasmic sleep.

The husband said, “I used to think I had no control over it. I just knew that after I ejaculated, I would be immobilized. I learned that feelings changed in my penis after I ejaculated, but that the refractory thing is the same in my wife and not just in the genitals either. I used to think she could go on forever until she finally told me she felt like I did.”

“Sure,” responded the wife. “I don’t know why men think women are some type of sex machine that once turned on becomes a perpetual-motion instrument that sort of putters out because the man goes to sleep. There are times when to touch my clitoris just hurts. It depends on when, how, and certainly by whom.”

Talk this issue over with your spouse and you can validate it for your own relationship. Refraction is not just physical, not just male, and not always the same. The early perspectives on human sexuality viewed refraction as a response only in the male. It, as with all of the dimensions of sexual response that I have discussed, does not have to follow a predetermined order. Physical and/or emotional refraction can happen anytime in the sexual interaction, depending on emotional state and area of stimulation. If we are bound by the “cycle” concept, we begin to anticipate refraction as the inevitable aftermath of the goal of orgasm, similar to the exhaustion of the long-distance runner. We can touch, hold, talk, and hold, wait and resume sex later. Super sex depends on learning this concept. It will require considerable unlearning, but the rewards for this effort are new levels of intimacy and sexual fulfillment free from psychologically determined physiological limitations.

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All you need to do is not disturb the healing process -protect the wound from getting dirty and keep the separated parts together.

Now let us analyse in more detail, what exactly happens in such a healing process.

When you cut yourself it hurts. The pain informs you, which part of your body requires your attention. When you attend the wound promptly by cleaning it with clean water or your own saliva and covering it perhaps, the pain is greatly reduced. If you do not clean the wound, it would be automatically cleaned by the blood flowing from it, and then the blood flow would be stopped.

During the healing process, the pain is limited or eliminated, unless you try to use the damaged organ too soon -increasing pain informs you immediately that your organ is not yet ready.

The body performs a repair job on itself. All cells which were separated by a cut are growing to join together again. There are many different types of cells and tissues being reconstructed so they can join together again. Without any mistakes, all blood vessels, muscles, nerves etc. are reconstructed and then connected. Even if some of the tissue is missing, the body replaces it. Sometimes a temporary scar tissue is used, which is later replaced by the optimal tissue selected by the body.

Note, that all this microsurgery with perfectly adjusted anaesthetic happens automatically within your body. No one has any right to take any credit for such healing. You did the healing for yourself, with the perfect result.

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Certain notifications are required by law to be made in relation to infectious disease and venereal disease. The doctor is bound to comply with these laws.

There are laws relating to the issuing of death certificates. There are laws relating to the registration of doctors.

A doctor is expected to carry out his practice using due care and skill. If he does so and his patient fails to get better or has a reaction to the treatment employed, then the doctor is protected by the law.

Should a mishap occur and the doctor not use due care and skill, then the patient is protected by the law, and may bring a case for damages against the doctor.

Fortunately in this country, the whole legal system, the judges, the juries and the solicitors and barristers offering advice, appear to use good sense and reason.

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A further refinement is to graft small muscles from the foot on to the paralysed muscles as well as a cross-facial nerve graft.

These intricate procedures have developed with micro-surgery. It may take nine months to assess if these complicated procedures are going to be successful.

Another approach is to do the simpler static sling as well as the complicated procedure. In this way the appearance is improved immediately and, should the complicated graft not take, a reasonable result is achieved.

Those who develop Bell’s palsy can take heart from statistics. Almost nine out of 10 will get completely better. Those unfortunate enough to have persistent paralysis can call on the skill of the plastic surgeon to improve their appearance and, perhaps, restore function to the facial muscles.

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Signs and symptoms

Impetigo typically appears as a fragile blister containing thin, yellow pus. The initial sore often occurs at a point where the skin has been injured or irritated by an insect bite, a scrape, or a skin condition. If the child picks at the nose, the blister may appear in that area. The blister breaks easily, leaving an open, weeping sore that increases in size. The discharge hardens into a yellow crust or scab that looks like hardened honey. Impetigo spreads rapidly and the child can aggravate this by scratching a sore and transferring the discharge on his or her hands to other parts of the body. The infecting bacteria can only be identified through laboratory tests. If the culprit is the streptococcus bacterium, the doctor will watch for the possible development of a kidney condition known as glomerulonephritis.

Home care

If only a few small areas are involved, scrub the crusts of the sores with soap and water. (Streptococcal and staphylococcal infections thrive under the crusts.) Apply a nonprescription antibiotic ointment several times a day. Cover the sores with gauze to keep the ointment in place and to discourage the child from scratching and spreading the disease.

• To prevent impetigo, wash minor scratches and scrapes with soap and water and cover with a sterile bandage.

• Impetigo is highly contagious; if your child has impetigo, watch the rest of the family carefully for signs of the disease and treat cases promptly if they occur.

• Keep the washcloth, towel, and clothing used by the child separate from items used by other family members. This will reduce the chance of the disease spreading.

• Launder the infected child’s clothing and linens frequently; ordinary laundering sterilizes adequately.

• If home treatment for impetigo is effective, do not discontinue the treatment until the sores are completely healed and the skin is smooth; it can take a long time to clear the condition completely.

• If home treatment doesn’t seem to be working within four or five days or if the sores continue to spread or multiply, see your doctor.

Medical treatment

The doctor may culture the sores and, if streptococcal infection is present, prescribe a ten- to 14-day course of penicillin medication. In the case of staphylococcal infection, tests may be required to determine the most effective antibiotic medication.

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‘Drugs’ can include all sorts of substances-from prescribed medications to alcohol, cigarettes and glue-but here we will talk about the drugs that are used illegally. This includes LSD, heroin, cocaine, amphetamines, barbiturates and cannabis.

Drug-taking starts young, often in the teens. Most youngsters start on drugs in much the same way as they start to smoke-to keep in with their friends. Some like the risks involved and others probably do it as part of their general adolescent rebellion against their parents. Others take drugs because they are depressed, unhappy at home, bored, don’t like school, and so on. Sometimes starting on drugs is a cry for help or attention from parents who seem to have no time or inclination to care. It is not easy to tell whether or not your child is taking drugs but here are a few signs that might help. Remember that just because a youngster shows any or even most of these signs it does not necessarily mean that he or she is taking drugs.

• Sudden mood changes.

• Irritability or aggression.

• Poor appetite.

• No interests in hobbies, friends or school.

• Drowsiness and sleepiness.

• Telling lies.

• Shifty and furtive behaviour.

• Unusual smells, stains or marks on the body or clothes.

• The disappearance of money or belongings from around the home (to pay for the drugs).

None of these things is particularly hazardous, of course, but drug abuse can lead to three which are. First, accidental overdose is an ever present problem with any form of drug addiction, and can lead to unconsciousness and even death. Many users of illegal drugs mix them and this can render the dosage totally unpredictable. Drug overdose is now a major cause of death in the under 25s in New York State and there are signs that things are going the same way in the UK. The second hazard of drug abuse is the increased risk of accident. Accidents of all kinds are more common in those taking illegal drugs. Some, such as road accidents, can easily be fatal to the drug-taker or to an innocent party.

Finally, addiction or dependence is the most worrying problem for parents because they see their child trapped in a habit that is extremely difficult to get out of.

On a day-to-day basis drugs can make the youngster confused and have hallucinations, and can cause serious emotional and psychological disturbances. First-time heroin users may be sick, and regular users become constipated. Girls stop having periods. Eventually more serious emotional and physical disorders set in.

The injection of drugs can cause hepatitis (a potentially lethal infection of the liver), sores, abscesses, blood poisoning and jaundice. The social consequences are equally horrifying as the individual becomes desperate for the next fix and steals and resorts to all kinds of other crimes to fund the habit.

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