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.

*249\90\8*

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.

*285\97\8*

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.

*112\97\8*

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.

*11\96\8*

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.

*479/71/1*

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.

*223/71/1*

As with laparoscopy, there is a range of therapeutic procedures, though more limited, that may be performed while the culdoscope is in place, fine operating instruments may be inserted through it for use in minor operations, the most common of which are tubal sterilization and the removal of small adhesions.

Aftereffects of culdoscopy are usually not troublesome. If you are scheduled for one, expect minimal pelvic pain for a day or two after surgery. Doctors will advise abstinence from intercourse for three or four weeks or until complete healing has occurred. Unlike laparoscopy, which is not as debilitating, culdoscopy will require rest at home for a week or two and avoidance of stress-filled work schedules.

*48\43\4*

Syphilis is a chronic infectious disease caused by the bacillus Treponema pallidum, which is acquired by intimate contact with an infected person or as a congenital infection in infancy. In the western world it is most easily transmitted, under moist conditions, by genital or oral contact. It may also be transmitted by an infected mother from the fifth month of pregnancy onwards. In underdeveloped countries a form of syphilis occurs which is spread by intimate contact rather than by sexual intercourse; it is usually associated with bad living conditions and poor hygiene.

In Europe, from 30000 to 40000 cases of contagious syphilis are registered every year, the greatest incidence being amongst homosexual men. As with all venereal diseases, it is more common during times of unstable social conditions and war. After World War II cases rapidly declined. However the past 20 years has seen a marked resurgence. The reasons for this are speculative but may include the following: increased travel, both tourist and migratory; altered moral standards; a more liberal attitude to homosexuality; the effect of oral and intrauterine contraceptives on human sexual behaviour; the diminished use of condoms, and the widespread use of drugs.

Syphilis may be thought of as occurring in four stages. Primary infection occurs 10-30 days after contact, and takes the form of a persistent chancre or sore. Associated with this there are enlarged tender lymph glands. The chancre usually appears on the genitals, in the anal area, or in or around the mouth. It may take 3-8 weeks to heal, leaving a small scar. At this stage, it is best diagnosed by a direct bacterial examination of the sore.

Secondary syphilis will usually occur 1-2 months after the primary stage. This stage may manifest a wide variety of different rashes, and is best diagnosed by appropriate blood tests. At this time the person is highly contagious, and bacteria may be found on most parts of the body. This stage may persist for up to two years. The rashes may resemble measles, chicken pox, hives, drug allergies, tinea, eczema, warts, and psoriasis, to name but a few conditions. However invariably there are other associated symptoms, such as a fever, tiredness, patchy hair loss, joint pains and headaches, particularly at night. This stage is also accompanied by enlarged, but not tender, lymph glands.

Latent syphilis, which is the stage without symptoms, may last from 2-20 years. It is only diagnosed from an adequate history and positive blood tests.

The final stage, tertiary syphilis, may affect all organs of the body; more commonly, though, it affects the heart, brain, and liver. In the skin it appears either as odd patterns of grouped nodules or large, painless ulcers. This stage is not infectious.

The treatment for syphilis is penicillin. For primary and secondary stages, this is either given on ten consecutive days or in one very large single dose. These people require follow-up treatment, including blood tests for two years. Contact tracing of people who are likely to have become infected is an essential part of the proper management of this contagious and important disease. Cases of syphilis which are of longer than 12 months duration require more intensive therapy over a longer period.

*76\44\4*