Antidepressants Blog

Glandular fever is a relatively common viral illness which affects mainly older children and adolescents.

Glandular fever is caused by a virus called the Epstein-Barr virus which is commonly transmitted through saliva (hence its nickname of ‘the kissing disease’).

Clinical features

The incubation period for glandular fever is from 3 days to 2 weeks. The onset of the illness is gradual and at first the child may just feel generally unwell and tired. A fever usually develops, followed by a sore throat and tender, swollen lymph glands. The sore throat tends to continue for a week or two, and does not respond to antibiotics. Occasionally your child may complain of upper abdominal pain due to enlargement of the liver and spleen.

A red, spotty rash may appear on the trunk. Symptoms, especially tiredness or general lethargy, can last for weeks or even months.

It is unusual to see complications with glandular fever, and most children recover completely with time. If the spleen is enlarged, it may be wise to avoid body contact sports, because of the increased risk of rupturing or tearing the spleen (although your child may be too tired to participate in sports). Other complications include hepatitis, meningitis and pneumonia.

Investigations

A blood test which is specific for glandular fever (Monospot) will usually confirm the diagnosis.

Treatment

Glandular fever is a viral illness, so there is no specific treatment or cure. It is unwise to use antibiotics; not only are they ineffective against viruses, but ampicil-lin in particular may cause a nasty rash. Treatment is geared towards the relief of symptoms, such as lowering the fever with paracetamol, and making sure that your child gets plenty of rest and eats well.

When to see your doctor

• if your child has a sore throat that does not improve after 3-4 days;

• if your child complains of extreme tiredness which does not improve after a day or two of rest;

• if your child has any combination of the symptoms described above;

• if you are concerned or have any questions.

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In spite of what children say or how they seem to act, if you have raised them in love, they have and know love. They may try to shock you, but in spite of the fact that the boy your daughter is dating has green hair and honks the horn instead of coming to the door, she still has you in her. In spite of the fact that your son is dating a girl who looks as if she might, have invented the words “surly” and “sultry” and puts her gum on the corner of her plate while she eats your Thanksgiving dinner, he has you j” him. Remember that much of your work is already done by how you have loved them and loved each other. That is what will be there in emergency values situations. Another meaning of the term “super marital sex” is that the lesson of your own loving can transcend the moment and provide an infinite lesson of love.

Tell me exactly, in no uncertain terms, what you hope they will do sexually Offer them the use of your home for sex. It’s your choice. They will do it somewhere. Where is up to you. Be explicit and direct. “If you’re going to make out, make out here in your room. It’s safer. Don’t do anything but make out. No intercourse. We won’t interrupt you if you don’t interrupt us when we make out. Of course, we can have intercourse. We’re married.” Don’t let the car, motels, or the homes of less caring or absent parents determine the sexual destiny of your children.

Sexual education does not have to be same-gender-oriented. The “talk to your father” or “go ask your mother” routine is totally unnecessary if both parents are comfortable with sexuality. Your sexual insignia, your genitals, are not prerequisites for sexual educating. As a matter of fact, both parents together are the best arrangement, because you are discussing sex and love education, best illustrated by a model of love and loving. *

The focus in sexual and love education must be on “do’s” and not “don’ts.” Presenting a list of fears and sanctions against sexual behaviors can result in a list of “sounds interesting, I should try that.” Give them ideas of what to do. “Touch, hold, kiss, and fondle” is much more intriguing than “don’t have sex until you’re married.” There are two exceptions to this focus on the “do.” Always teach two “don’ts” along with the “do’s.” Don’t have intercourse until you are married, and don’t ever hurt anyone else.

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I love it, really love it. It’s fast, easy, efficient. No mess, no fuss. Ã always come. Plug it in, turn it on, and it turns you on. The vibrator set me free.

WIFE

I hate the damn thing. Sometimes she wants me to use it on her. I can hear her using it sometimes. Buzz, buzz, buzz. What does she need me for anyway? She says she has better orgasms with her vibrator than with me. The damn thing has three speeds. It probably has an overdrive. I just hope she doesn’t use it near water. If she does, when she comes, she’ll go.

HUSBAND

Invention number two in the quest for quick, convenient female orgasms was the vibrator, an electrical or battery-operated device used to apply direct stimulation to the Ñ area. One sex therapist called it the greatest discovery for women, perhaps as important for sex as the discovery of Pompeii was to world history.

The concept of “vibratory orgasm” grew from the myth of the first perspectives of sexuality that men come by friction and women come by vibration. Men seldom report using vibrators on their penis, and, as the man above, sometimes report a form of “gadget envy” regarding this device.

Research indicates that many women find the vibrator enjoyable. Some women report that they find the vibrator painful, annoying, and distracting to their sexual response. It is not likely that there will be a successful invention for making men come quicker. The male inventions have more to do with making genitals bigger and less sensitive.

As an occasional source of fun, variety, and different stimulation, the vibrator seems to be enjoyable for the women in my group of couples. When it, like anything else, becomes a focus, a replacement, even an expediter to save erotic time, problems result.

“He knows the vibrator always works,” reported one wife.

“Now he just tells me to get it out and start it up. It gets me more than ready, saves us time. We always use it now. I can’t remember a time when we just made love the two of us, without the vibrator. It has gotten so I hate the sound of it. I associate it with orgasm, but not with lovemaking. It’s group sex, and one of us is a sex robot. The thing used to be mine; now it seems to be his, some type of sexual power buffer.”

As you consider the husband’s and wife’s sexual response systems in Chapters Six and Seven, you will see the orgasmic focus for women and ejaculatory focus for men that was so strongly emphasized in the early sexual perspectives. This focus resulted in the destructive effort by men to “hold back” and by women to “hurry up.” Men mislearned that pelvic contractions and emission of fluid were synonymous with sexual fulfillment, while women experienced an obligation to have intense, rapid, and multiple orgasms as a sign not only of their own sexual fulfillment but of the sexual skill of their male partner.

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The sauna is an ancient treatment developed by civilisations living in cold climates. Because of the cold climate, their bodies tend not to sweat much, so these cold climate dwellers invented the sauna to promote improved circulation of body fluids, speed up metabolism and accelerate sweating: a great natural purification and detoxification function of the body.

It is best to experience a sauna in short 10-15 minute sessions, with 5-10 minute “cooling down” intervals, repeating such a cycle 3-4 times. During the “cooling down” intervals do not use pool or showers which have chlorinated water. Ozone treated water, clean river, rain, lake or sea water is OK. Your skin has been cleansed by the flow of the sweat and in such a clean state it will absorb the chlorine from the water into your body. It is best to use a towel to dry the sweat from your body. Do not allow the sweat to evaporate, because it contains toxins your body has just excreted, and you do not want any of them to be reabsorbed back.

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Myalgic encephalomyelitis is rather a mouthful, so it is often abbreviated to ME.

Myalgia means painful muscles, and encephalomyelitis means inflammation of the brain and spinal nerves.

This disease is uncommon and the cause unknown, but it is believed to be either a viral infection or a reaction of the body to recent infection with a virus.

The symptoms vary widely and are often present without specific signs. It is not surprising that many sufferers have been thought to be overreacting to some simple illness or to have emotional rather than physical problems.

Following what appears to be a simple respiratory or bowel infection, the symptoms of ME may come on suddenly or slowly.

There may be headache and muscle pains, but particularly muscle weakness and fatigue.

While there may be sporadic cases, often there is a minor epidemic with a cluster of cases eventually being recognised.

There is no specific treatment. Most sufferers do get better, but relapses are common. In a few, the condition runs a chronic course.

Both sexes and all age groups are susceptible.

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Diabetes predisposes a person to the earlier development of cataract. In most cases, the opacity is present in both eyes although one may be more advanced than the other.

To the sufferer, it seems as if he is looking through glass which is gradually frosting. Even when fully developed, light can always be perceived and shadowy movements may be seen.

The opacity is more marked in the middle of the lens so that vision is often better in dim light when the pupil is dilated and vision is perceived through the edges of the lens.

In bright light, the pupil contracts and light entering the eye must pass through the centre of the lens where the opacity is more marked and so vision is not as clear.

Because the cataract progresses so slowly, treatment may not be necessary for years. Operation is the only effective treatment. Vitamins or drops are of no use. At operation, the lens and sometimes its capsule are removed.

The operation may be done under local or general anaesthetic. After this glasses are necessary to focus the light rays on the retina.

A newer operation is the insertion of an artificial lens following removal of the opaque natural one. This removes the need for thick glasses which may distort vision.

The timing of the operation may depend on how far the vision has deteriorated, the level of vision in the other eye and how important clear vision is to the lifestyle of the person.

The use of contact lenses after the removal of cataracts in association with glasses may avoid the need for very thick glasses and improve vision.

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Don’t feel stupid about asking for information to be explained in a different way and/or repeated as many times as you need. No reasonable person would expect you to understand and remember everything after being told only once.

Many patients hold back from asking questions because they are worried about looking ignorant or stupid. If you don’t understand what your practitioner tells you it is because, whether deliberately or not, he or she hasn’t explained it well enough. Communicating effectively should be an important part of your practitioner’s responsibilities. He or she should be prepared to persevere until you do understand what is being said.

Nothing is so complex that it can’t be made perfectly understandable by someone who is willing to share it with you. It is possible that your practitioner is so familiar with certain words that he or she has forgotten that a non-medical person doesn’t know what they mean. You are not an expert and can’t be expected to understand medical terms so just say if you don’t understand. Sometimes a practitioner uses technical words to cover up his or her own emotions when giving bad news. You might have to help your practitioner by making it very clear that you want straight answers.

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Cancer can be produced by chronic irritation of the skin. In England, in 1775, Dr Percival Pott described cancer of the scrotum in chimneysweeps which was caused by soot. Natives of the northern Himalayas who carry canisters of hot charcoal next to the skin of their abdomens to keep warm, develop cancer in this area. In Australia, sun-exposed areas of skin commonly develop skin cancer.

The word ‘carcinogen’ has become all too familiar in recent years. A carcinogen is something that causes cancer. In our society, sunlight is the most common carcinogen, it being the leading cause of skin cancer which is the most common form of all cancers. (Despite being the most common form of cancer, skin cancer causes only about 2 per cent of all cancer deaths, and such cases could virtually all be prevented.)

Skin cancer is predominantly caused by chronic cell injury induced by prolonged exposure to infra-red and ultraviolet radiation. There is usually, however, quite a long latent period or delay between the exposure to solar radiation and the appearance of skin cancer. The energy from this UVA and UVB radiation is absorbed at various levels of the epidermis, causing cellular damage. Most of the damage occurs in the genetic material known as DNA, which enables cells to duplicate themselves. In most cases a cell manages to repair this damage. Eventually though, it may not be able to do so, in which case the cell may die, contributing to the appearance of premature skin ageing, or may change its character completely. Such changes in cells are called mutations, and some of these mutations may be cancerous.

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‘The psychological problems [of the menopause] tend to be insidious and can impair a woman’s ability to her domestic and work environment . . . They can destroy self-confidence and self-esteem and are an incomprehensible low point in the lives of previously well-adjusted and competent women.’ from The Menopause, J. Studd and M. Whitehead (eds.), 1988.

‘The only word I can use to describe how I felt during this period is wretched. I work in a doctor’s surgery and spend my working day in contact with the patients. I was moody, bad-tempered and thoroughly unpleasant to everyone – yet I couldn’t stop myself being tike that. My feelings about myself reached rock-bottom and my normal self-confidence disappeared completely until I could hardly bring myself to get out of bed in the morning. I think if I’d worked anywhere else I would have lost my job within a few weeks; but luckily the menopause specialist nurse in the practice recognised my changed personality for what it was, suggested I asked my GP about HRT, and I’m now back in the human race again.’

If you have had a similar experience, you are not alone. A great many women between the ages of 40 and 60 find they become moody, unable to concentrate, and very tired. Many of the psychological problems of the menopause are due to night sweats causing disturbed sleep, and will resolve themselves once broken nights come to an end. Others are due more directly to the loss of oestrogen. Part of the brain contains many oestrogen receptors, and if oestrogen levels fall, mood changes may occur; once the oestrogen is replaced by HRT, most women find their confidence and self-esteem restored and their problems with mood swings, forgetfulness and anxiety considerably alleviated. HRT is not as reliable in improving these complaints as it is for flushes and sweats, but if your general wellbeing and feelings about yourself have taken a plunge, then it’s worth asking about HRT. It won’t, however, do anything to alleviate depression, anxiety or unhappiness that existed before the menopause, and which is not due to lowered levels of oestrogen.

Oestrogen seems to have a ‘mental tonic5 effect, and lowered levels of the hormone during and after the menopause can lead to a whole range of psychological problems, such as:

• less energy and drive

• irritability

• mood changes

• headaches

• feelings of unworthiness

• loss of self-esteem

• loss of self-confidence

• feeling unable to cope

• difficulty in concentrating

• feelings of aggressiveness

• depression

• anxiety

• forgetfulness

• fear of loneliness

• unusually prone to tears

• loss of libido (sex drive)

There are still too many doctors who, faced in the surgery with a woman aged between 40 and 60 complaining about any of these problems, will say, ‘I’m afraid it’s just your age, my dear,’ or ‘You’ll just have to live with it -there’s nothing I can give you that a good night’s sleep/doing some voluntary work/joining an evening class won’t cure.”‘ And he writes out a prescription for some antidepressants and hopes she won’t bother him again. (In this book, the doctor is depicted as male, simply to avoid confusion with the patient who, in matters concerning the menopause, is inevitably female.)

Prescribing tranquillisers and anti-depressants for problems in the mind that are caused by a fall in oestrogen is difficult to justify. Yet for many women, even nowadays, that is all they get, and then everyone is surprised that it seldom has the desired effect. It is hardly believable that 30-40 per cent of women aged 45-55 with menopausal depression are still prescribed tranquillisers and anti-depressants despite the fact that replacing their oestrogen will usually reduce these symptoms and thereby, in the majority of cases, lift the depression.

The majority of psychiatrists still believe that anti-depressants, tranquillisers or psychotherapy are the best forms of treatment for women at these three critical times of depression, yet they appear to have a low success rate. By contrast, replacing the oestrogen that is probably causing the depression appears to be very effective in many women. If the psychological symptoms are due to a lack of oestrogen, they will respond to a course of HRT; if they are due to some other cause, then HRT will not bring any real benefit. As HRT is a much cheaper form of treatment than psychotherapy or in-patient psychiatric care, it is surely worth considering as a first-line form of treatment for depression that occurs around the time of the menopause.

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Several nonsteroidal anti-inflammatory drugs (often shortened to NSAIDs) have been used successfully to reduce excessive menstrual bleeding. The NSAIDs concerned include ibuprofen, mefenamic acid, naproxen and flurbiprofen. (Some of these substances, for example mefenamic acid, are also anti-prostaglandin drugs or prostaglandin inhibitors.) While helpful, NSAIDs are not drugs to be taken lightly. The lowest possible dose of the least toxic NSAID should be used initially as this group of drugs produces side-effects in about a third of women, resulting in nausea, vomiting, diarrhoea, headache, dizziness and rashes.

Blood clotting mechanisms. Success in halving blood loss has been reported with several drugs that act on the body’s blood clotting mechanisms. They are of particular value to women with blood clotting defects. The drugs include tranexamic acid and ethamsylate. Once again, however, about a third of women on them experience side-effects of nausea, headache, dizziness, vomiting and rashes. Research studies have also raised the concern that these drugs may precipitate strokes in some women.

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