Self-stimulation of the sexual parts is a common cause of anxiety in both men and women. The habit is almost universal in boys and young men before marriage, so much so that most

authorities assume it to be a normal practice, one that causes harm only when done with excessive frequency—several times a day—or when it is associated with guilt from the warnings of overzealous parents. When there is a certain feeling of guilt, as there often is, the nervous tension may be extremely severe. The unfortunate youth is so ashamed that he tends to suffer his distress rather than seek help; and his fears may become so acute that he comes to think the habit will lead him to the insane asylum, or at least ruin any chance of happy marriage. Such people are greatly relieved by the simple and truthful explanation that a certain amount of

self-stimulation seems to be a natural part of the ordinary process of growing up and leads to no harm of either body or mind.

However, in spite of the knowledge that a certain amount of self-stimulation is almost universal and quite harmless, it is my experience that some boys and young men still remain very disturbed by this practice.

This is an example of knowing a matter to be true with one’s intellect and at the same time inwardly doubting it because the intellectual knowledge is not really integrated with the emotional life of the individual.

There are two categories of youths who consistently remain disturbed by their masturbation. There are those who are very rigid and fixed in their attitudes, who lack the normal flexibility of mind to change their view according to available evidence. They are often rather perfectionistic, and are technically known in psychiatry as obsessives. The other group consists of young men who are taught by their church that masturbation is sinful, and I do not believe that it is in the province of the psychiatrist to challenge a patient’s religious beliefs except under very exceptional circumstances. Accordingly, these two groups—the very rigid and those motivated by religion—are unable to adjust themselves to occasional masturbation, and as a result they must stop it altogether.

A twenty-year-old student was in great distress of mind, worrying about his masturbation, which he seemed quite unable to control.

Religious convictions were not involved here. The young man was extremely rigid and inflexible in his personality, so much so that in ordinary conversation he would talk obsessively about some particular topic. I showed him how to do the relaxing mental exercises. His nervous tension was greatly reduced. Now that he is calmer, he is able to use his will power with real determination, and has found that he has been able to abandon the habit which had caused him so much distress.

*28\57\2*

For a description of St John’s Wort, the plant, also known as Hypericum perforatum, I can do no better than to quote Dr O Phelps Brown, who wrote in 1885: This is a beautiful shrub, and is a great adornment to our meadows. It has a hard and woody root, which abides in the ground many years, shooting anew every year. The stalks run up about two feet high, spreading many branches, having deep-green, ovate, obtuse and opposite leaves, which are full of small holes, which are plainly seen when the leaf is held up to the light. At the tops of the stalks and branches stand yellow flowers of five leaves apiece with many yellow threads in the middle, which, being bruised, yield a reddish juice, like blood, after which come small round heads, wherein is contained small blackish seed, smelling like resin.

This description comes from a book called The Complete Herbalist; or the People Their Own Physicians by the use of Nature’s Remedies; describing the Great Curative Properties Found in the Herbal Kingdom. Over 100 years ago, it seems, people were intrigued by the same possibilities that we are revisiting nowadays – of using Nature’s apothecary as a source of remedies and of healing oneself instead of always seeking out the assistance of a medical practitioner.

The pores in the leaves of St John’s Wort, which look like perforations and give the plant half of its botanical name (perforatum), are thought to contain the plant’s pharmacologically active substances, as do the black spots on the petals. It is these black spots which, when rubbed, yield a reddish liquid that was used for dyeing clothes in earlier times.

*80\75\2*

Anoxia means lack of sufficient oxygen, an essential component of the normal ongoing chemistry of the cell. Cerebral nerve cells are amongst the highest consumers of oxygen in the body, as reflected in the fact that a quarter of all arterial blood goes to the brain. If the oxygen supply is cut off, then damage to nerve cells occurs after a few minutes. Some die, but others are damaged in such a way that they may paroxysm ally discharge in subsequent life.

Anoxia may occur at birth. During each uterine contraction in a prolonged labour the fetal heart rate slows, and the supply of oxygenated blood to the brain is reduced. The umbilical cord may become tightly wound around the baby’s neck. The placenta may separate prematurely. After birth, for a variety of reasons, the child may not breathe for a few minutes. These are four examples of how anoxic brain damage can occur at birth. If severe, the brain damage results in severe learning difficulties, cerebral palsy, or epilepsy. However, as has already been mentioned, the cause of these three is often due to antenatal factors rather than problems with the birth itself.

Anoxia also occurs in febrile convulsions, as has already been discussed. During a seizure the oxygen requirements of brain nerve cells are enormously increased, and yet the resulting convulsion interferes with normal respiration, so that the blood leaving the lungs picks up insufficient oxygen. The combination of excessive demand and inadequate supply may on rare occasions result in anoxic damage to cerebral nerve cells. The nerve cells which seem most susceptible to damage, at the age at which febrile convulsions occur, are in the temporal lobe.

A stroke is usually due to an obstruction to an arterial vessel to one particular part of the brain, so nerve cells in the territory supplied by the blocked vessel either die as a result of lack of oxygen, or become damaged in such a way that they may form a focus for paroxysmal discharges later. Most strokes occur in late adult life, and cerebrovascular disease accounts for much of the epilepsy beginning in old age. Occasionally, however, a stroke may occur in a young adult or even in a child.

*19\188\2*

Symptoms: general weakness and bodily discomfort; sore throat; pus on tonsils; prolonged fever; swelling of lymph glands; prolonged fatigue; mottled red rash.

Home care

Rest, aspirin or paracetamol, and a general diet as tolerated are necessary.

If your doctor finds that the child’s spleen is enlarged, the child’s activities should be restricted.

Precautions

-    If a child who is being treated with antibiotics for a strep throat does not respond to the medication within 24 to 48 hours, inform the doctor; the child may have mono in addition.

-    Do not allow a child who has had mono to return to school or work until weakness and fatigue disappear.

-    Do not allow a child with an enlarged spleen to take part in contact sports or other strenuous activity until the spleen returns to its normal size.

Infectious mononucleosis – often called “mono” – is a fairly common contagious disease. It’s caused by the Epstein-Barr (EB) virus and is transmitted by secretions from the nose and throat -which is why it’s also commonly known as the “kissing disease.” Mono can occur at any age from infancy on, but is most often seen among young people of high school or university age. The disease appears one to six weeks after exposure to the virus, and one attack generally makes a person immune to (able to resist) further bouts.

*126/84/5*

Prevention is more difficult than for most of the subjects because so often the drug taking adolescent has become involved as a result of a complex mixture of personality, social and parental factors. Many of these are deeply rooted in the past, even in the pasts of the parents, and most of the problems are inaccessible to all but the most skilled professional. There are, however, a few preventives that are worth trying:

•     Discuss between you as parents what your views on drugs are. Sort out what you both feel so that should a problem arise you will deal with it more sensibly and compassionately and won’t make it worse by panicking.

•     Give up smoking and drinking yourselves. Research shows that a youngster whose parents are addicted to legal drugs is much more likely to use illegal ones. This also goes for medications from your doctor. Keep all medicines out of the reach of children and youngsters.

•     Make time to create a relationship with your children, from very early on. Give them confidence in the future and show that you care. If they feel that they can turn to you when things get tough you will have done the very best for them. The alternative is that they turn elsewhere and that could involve drugs. Youngsters who can trust their parents and like them as human beings will also be less likely to turn to drugs.

•     Try, when discussing the subject with your children, to steer a course (however difficult it is) between making drug-taking seem acceptable and creating a ‘no-go’ area. When talking about drugs it is best not to talk about it in too dramatic or horror-inspiring terms because if the child knows people who take drugs and enjoy them they simply will not believe you. This will reduce your credibility all round which will be a loss. This is somewhat parallel to scare stories about VD when discussing sex with youngsters.

•     Don’t be suspicious of your children, because if they are not taking drugs this could drive them to do so.

•     Calmly tell your youngsters of the legal problems with drugs. Possession of heroin, cocaine and LSD can lead to prison sentences of up to seven years and trafficking in drugs can put someone in gaol for up to fourteen years. Even possessing fairly ‘harmless’ drugs such as cannabis, amphetamines and barbiturates can result in a five-year sentence.

•     There is no guarantee that any of these preventive measures will in fact stop a youngster from taking drugs-the only sure preventive is a loving, caring, non-judgmental family in which the parents treat their youngsters with respect. This is a way of behaving that cannot just be started in the child’s early teens when you think you might begin having problems with sex and drugs-this is almost certainly too late. Preparation for this kind of relationship starts in the cradle with prolonged breastfeeding whenever the baby or mother wants to feed. The closeness this kind of behaviour produces is a sure foundation for good parent-child relationships and is likely to help the children withstand the certain knocks that life will bring.

*144/72/5*

Many of today’s medicines and drugs originated as natural substances. In some instances so-called savages in the jungles of South America were able to treat diseases in their tribe which all the medical techniques of our ‘civilized’ world could not help one bit. No doubt this still happens, but to a lesser degree, thanks to modern exploration and research techniques.

The process by which some drugs have evolved is governed to a certain extent by economics and commercialism, not always with the best results. Suppose it was discovered that some ethnic group were found to be treating a medical disorder with a certain substance found in, say, the fluid from the bubbles of seaweed. This would not do at all for our society, so our researchers would set to and try to establish what it was in the fluid that gave the therapeutic effect. They might be lucky and find that it seemed to be one particular ingredient. The next move would then be to try and make this ingredient synthetically. If this effort was successful then the synthetic material would be prepared and used. It would probably also be put forward for registry as a drug and, since it could be identified and prepared in a consistent way, would probably be accepted. It is, of course, quite probable that the synthetic preparation would not work as well as the original fluid taken from the weed. It is also quite likely that the synthetic material would show side-effects which did not occur with the original natural substance. This is not an unusual finding in this field of work.

The other possibility, of course, is that the researchers may find that they could not isolate any active ingredient from the fluid. They might find that the crude fluid was effective but attempts to break it down into groups or individual constituents resulted in a loss of activity. This is what happens with the mussel extract. If this was the case, it would be quite possible that the safety and effectiveness of the fluid could be demonstrated but that it could not be accepted as a drug.

Not all synthetic preparations are inferior to their natural counterparts. However, there is little doubt that, in general, a substance present in a combined form produced by nature is more effective than the same substance prepared synthetically and in isolation. In many instances it is the combination form of a substance that is responsible for the activity. The actual material on its own is ineffective.

Other aspects also come into play when a comparison between the reaction of a chemical compound produced synthetically and the same compound present in a natural’ substance is made. There are circumstances in which the same chemical compound will show very different reactions. The reasons for variances like this are several. Amongst them is the different physical form of the molecular structures in the two circumstances. This can result in the reactions of the same material being very different in natural and synthetic forms. Another factor would be the change in the distributive nature of the compound under the two circumstances.

*32/48/5*

Less than 50 per cent of women undergoing breast reconstruction take up the option of nipple reconstruction. When it is done, it is normally better to wait until the breast reconstruction has settled, the scars have softened, and thus the position of the new nipple can be matched as nearly as possible to that of the other breast.

There are various techniques which can be used to create a nipple and areola. The nipple is usually reconstructed from local skin or skin from the other nipple, and the areola from skin grafted from the groin area or from the other areola. Colour may be added to the areola, and its irregularities beneath the skin can be simulated with cartilage grafts.

However, with time, the projection of the nipple may be affected by natural changes which can make the long-term results of this process disappointing. There is also often a difference in the colour of the areola when compared to that on the unaffected breast.

An alternative is to use an external nipple prosthesis, which can sometimes be held in place by suction rather than being attached with adhesive.

Timing of breast reconstruction

Most of the reconstructive procedures described above can be done at the same time as a mastectomy, although the more complex ones are usually best left to a later date – which may be anything from a few weeks to many years.

When reconstruction is undertaken depends largely on the nature of the cancer, on the preferences of the surgeon and the woman herself, and on the availability of a reconstructive surgeon. Do discuss your options with your surgeon and ask for time to consider them if you want to.

Surgery to the opposite breast

The aim of reconstructive surgery is to create a breast which matches the unaffected breast as nearly as possible, and this may sometimes only be achieved by performing additional surgery on the other breast. This surgery may be performed before, at the same time as, or after the reconstructive surgery, and the decision as to when it is done will depend on various factors which the surgeon should discuss with you. Reduction mammoplasty can be carried out to reduce the size of a large breast, but although a normal-looking breast with normal sensation can be achieved, the resulting scars can be quite large. A droopy breast can be uplifted by a process known as mastopexy. Your reconstructive surgeon will be able to discuss these possibilities with you.

*59/39/5*

Primolut N is a hormonal drug occasionally used to treat endometriosis. It is also sometimes used to treat a variety of other conditions including abnormal uterine bleeding, amenorrhoea (absence of periods) and PMS (premenstrual syndrome).

Primolut N is a progestogen (synthetic progesterone) derived from the male hormone testosterone. Its chemical name is norethisterone. It is manufactured by Schering and sold in the form of white 5 milligram tablets.

How Primolut N works

It is thought that Primolut N eradicates endometrial implants by Ppressing ovulation and interfering with the growth of the misplaced endometrial cells, causing them to slowly waste away. Most women will stop ovulating and menstruating during their course of Primolut N.

Dosages of Primolut N generally used

Gynecologists usually recommend 5 to 20 milligrams of Primolut N per day (one to four tablets per day) for four to nine months.

Side effects of Primolut N

The more common side effects are depression, weight gain, malaise, lethargy and tiredness, acne, vaginal bleeding, decreased libido and nausea.

How effective is Primolut N

There are no reliable figures on the effectiveness of Primolut N for the treatment of endometriosis.

Primolut N, pregnancy and breastfeeding

Primolut N should not be used during pregnancy as progestogens derived from testosterone can cause abnormalities in the developing foetus.

The use of Primolut N while breastfeeding is not recommended, as small amounts of progestogens have been found in the milk of mothers taking them and the effect on the child is not known.

*42/41/5*

At one time people thought anorexia might be a form of schizophrenia. We know now, of course, that they are completely different disorders, although in rare cases a person may suffer from both at the same time. An anorexic doesn’t usually have the hallucinations commonly seen in schizophrenia. One primary anorexic symptom – feeling fat when actually being very thin – comes close to being a delusion. However, whereas an anorexic can usually see the difference between her body and that of someone who weighs two hundred pounds, a schizophrenic may not be able to make such a distinction.

About thirty years ago, doctors began treating anorexics with chlorpromazine, more commonly known as Thorazine, an antipsychotic drug used in the treatment of schizophrenia. Although these patients did gain a little more weight, their illness didn’t improve over the long term. What’s more, compared to a control group, a higher percentage of patients on Thorazine developed bulimia. It also took longer for their menstrual periods to return. Although some doctors continue to prescribe Thorazine, its popularity has dropped off substantially.

These medications may perhaps have some particular use for certain very small groups of patients: those who are extremely anxious or who are obsessive-compulsive. Another group may benefit from the drugs’ sedating effects, especially very restless patients who, because of their severe medical condition, must be confined to their beds.

Antipsychotics can cause weight gain, a side effect that, in anorexia anyway, is actually desirable. However, antipsychotic medicines have many drawbacks: lowered blood pressure, the risk of seizures, delayed return of menstruation. These drugs are notorious for causing long-term or even permanent neurologic damage, such as the involuntary muscle movements known as tardive dyskinesia.

*66/35/5*

After years of dieting, Leigh Anne Congdon finally took off—and kept off—30 pounds. She did it, she says, by learning how to think like a thin person.

As a teenager, Leigh Anne was unhappy with her body. She was only a few pounds overweight, but she saw herself as chunky and unattractive. She’d go on self-styled diets of less than 1,000 calories a day for a couple of weeks at a time, and she would lose a few pounds. But once she had returned to her normal eating habits, the weight would always come back.

This cycle of gaining, losing, and regaining continued through high school and college. Then, Leigh Anne made a decision that would turn her eating habits upside down. “When I graduated from college, I moved from Pennsylvania to Colorado with a group of friends,” she explains. “I thought that I could find a job out there, and I was excited about living in another part of the country. I needed the change.”

Away from home and living with her friends, Leigh Anne decided to enjoy herself. That meant not worrying all the time about what she was eating. She joined her friends in a steady diet of pizza, burgers, barbecued ribs, and other foods of which she had deprived herself for so long. Within a year, her weight climbed from 140 to 160 pounds—too heavy for her 5-foot-5-inch frame.

Once again, Leigh Anne decided that it was time for a fresh start. “It wasn’t only my weight,” she says. “It was the part-time jobs, the small apartments. I needed some direction in my life.”

She headed back East and enrolled in graduate school. And she committed to slimming down healthfully and permanently.

Remembering how dieting had failed her in the past, but not wanting to monitor every bite of food that she put in her mouth, Leigh Anne decided to change her mindset. “I had noticed that my friends who were thin didn’t constantly dwell on what they were eating,” she explains. “They ate when they were hungry and said, ‘No, thanks’ when they weren’t. I followed their example and tried to stop obsessing about food. I resolved to think like a thin person.”

Leigh Anne played the part of a thin person on a daily basis. “When I’d get up in the morning, I’d remind myself to think like a thin person,” she says. “I’d eat a little bit of something and then tell myself that I was full, because that’s what a thin person would do.” She ate healthier, too, replacing those burgers and ribs with meatless entrees and salads.

Leigh Anne also increased her activity level, believing that a thin person would be active. She took up hiking, and she rode her bike instead of driving her car.

With her new “thin” attitude, Leigh Anne was able to take off 30 pounds in about 9 months. Now age 42 and a resident of Lock

Haven, Pennsylvania, she has maintained her weight at a healthy 130 pounds ever since.

*120\89\8*