Toilet training is given a lot of emphasis by parents. There are often pressures outside the family which have the effect of raising the stakes. A kindergarten or daycare centre may have a policy of only enrolling children who are fully trained. Grandparents and relatives may in subtle and not so subtle ways suggest that young Johnnie or Sarah should be toilet trained by now, and family friends may boast that their own child, of similar age, is already toilet trained. Often it seems that the age at which the child is trained is somehow an index of the competence of the parents.

The timing of toilet training and whether it is easy or difficult depends on a combination of characteristics of both the child and the parents. The child has to be physically, neurologically and psychologically ready. This means that for most children there is little point even thinking about toilet training before about 18-24 months of age. To those prerequisites have to be added other individual factors, such as the child’s temperament and the nature of the relationship the child has with his parents. A struggle over training may be yet another episode in the lifelong battle for power and control between the child and the parents. To these factors are added parent expectations, attitudes, and parenting styles, together with their previous experience and confidence. All of these factors suggest that toilet training is very much an individual thing for each child, and it is remarkable that there is in fact reasonable consistency and predictability in the timing and staging of most children gaining control over bladder and bowels.

It is nevertheless difficult to predict for an individual child what course the toilet training will take. For some children, it seems like a non-event and everything goes very smoothly. In others, it really is a struggle for autonomy with the child resisting the very thing the parents most want. Despite the variations, most children will be mostly toilet trained by day at about 3-4 years, and at night by the time they start school. The usual course of events followed by most children is that they will achieve continence for bowels first (night then day) then daytime control over bladder function, and finally will be dry at night. There will still be accidents even after the child is supposedly trained.

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Almost eight out of a hundred women may have breast cancer. Men can have breast cancer, too (at a lower rate). Do a breast self-exam every month. It is a necessary part of any wellness program. If you have breast cancer, you are not alone. Having breast cancer is like having high blood pressure; you are lucky if you found it out. Those who don’t will suffer much more.

You don’t have to be like the women on television. Recently there have been many movies and specials about breast and other forms of cancer and the extraordinary courage of some persons as they face this disease.

You are creating your own special. Adjust in your own way. Heroes are for Hollywood. Cry, complain, sulk, and yell if you want to.

Brief psychotherapy can be of some help if you hire the right therapist. If you feel things are moving too slowly, check Appendix II to determine when you need a therapist for sexual problems. Be careful and help the therapist focus on your problem. As one of my patients stated, “Just because I’m crazy doesn’t mean I need a lot of therapy. I would just like to fine-tune my craziness a little. This breast cancer threw me out of whack. I just need a little adjusting.”

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The sexual-response model of Masters and Johnson maintains the “energy buildup and release” orientation of the first and second perspectivces, but divides energy buildup into excitement and plateau, and energy release into orgasm and resolution. Sex researchers have questioned this four-phase cycle, suggesting that it is far from accurate in the male response and misleading regarding the female response.

The four-phase model suggests that the refractory period, a phase during which continued genital stimulation is ineffective, even uncomfortable, applies only to men and is somehow separate from the four phases. It suggests that excitement and plateau are separate phases, an assertion that does not bear out in subjective experience. The four phases do not identify such issues as desire, interest, or satisfaction, yet problems with desire are the most frequent of sexual problems.

Masters and Johnson indicate that male and female sexual response is essentially the same. They identify the orgasmic platform, or contractions of the outer third of the vaginal barrel, and vaginal lubrication as generally equivalent to the erection of the male penis. In fact, the third perspective of sex contains a “new feminism” that seems to use the female cycle as a model or standard for the male response.

*100\97\8*

The high risk groups in the U.S. are male homosexuals and bisexuals with multiple partners (70 per cent), intravenous drug abusers (18 per cent), Haitians (4 per cent), and haemophiliacs (1 per cent).

The cause is thought to be a virus which has a long incubation time, of maybe two to three years.

The virus seems to affect those whose immunity has already been depressed and then, in turn, part of the action of the virus is to further depress immunity. In this way, the sufferers develop infection from uncommon bacteria, fungi and yeasts. Also, unusual cancers may develop.

Unfortunately there is no effective treatment.

Prevention may be possible and this means trying to get the high-risk groups to alter their behavior. For haemophiliacs who require frequent injections of blood factors, prepared from pooled blood so as to maintain the clotting ability of the blood, the problem is one for the Blood Banks to solve.

*603/71/1*

Physical fitness may mean different things to different people.

To the doctor, it may mean freedom from disease. To the weight lifter, it may mean muscle mass. To a football player, it may mean the ability to play 100 minutes and still have something left.

In our society, because heart disease is so common, it should mean cardiopulmonary fitness — that is, healthy hearts and lungs.

Exercise is the means of achieving fitness. It can also improve strength, stamina, co-ordination, flexibility and give a sense of wellbeing.

People who are fit and who exercise regularly feel calmer, more relaxed and concentrate better.

All of which sounds great but some experts have written about the dangers of exercise and we read sometimes where people jogging or running have dropped dead from heart attack.

What’s the true answer? I suppose that depends on which “expert” you choose to believe.

Is physical exercise good for you?

*346/71/1*

What I have said so far you probably recognise to be true, not because it agrees with what you have been taught but because it agrees with your own experience. If so, you may have already realised that the ‘best’ treatment in the eyes of the doctor is often not the best treatment in the eyes of the person with cancer. Unfortunately, doctors rarely allow patients to come to their own conclusions as to the best treatment. They don’t offer alternatives, they don’t give basic information, often they don’t even justify their own treatment advice. Basically most doctors treat people with cancer like dependent children.

*126/40/1*

Remember, back in Chapter 2, we compared cancer cells with weeds in a garden? Treating cancer is like trying to get rid of weeds once they are established. As with surgical removal of cancer growths, we can just pull the weeds out. This is unlikely to get rid of them permanently because we can only pull out what we can see. We know that any seeds or roots left behind may produce more weeds in the future. In addition, if the weeds are growing close to the normal plants and have extensive root systems it is likely that we will have to pull out and damage normal plants if we are to get rid of all the weeds we can see.

*120/40/1*

Previously, a caesarean section was done in the “classical” manner. The incision in the uterus or womb was straight up and down in the upper part. This left a scar which could rupture during the stress of a subsequent labor.

Now the uterus is opened in its lower segment, with a transverse or crossways cut. There is not the same risk of this scar rupturing and it is often possible for the woman to have a vaginal delivery with the next pregnancy.

Of course, if the same conditions that caused the first caesar are still present, a further caesar is indicated.

The maturity of the foetus is most important when considering inducing labor and birth. This applies no matter how the delivery is to be done.

*96/71/1*

The latin roots of consent, con sentire, mean to feel with. Consent is about mutual understanding. You need to understand how the client sees his or her obesity and its causes, potential solutions, their self-image, skills, etc. You need to explain your own point of view on these issues, what skills you have to offer, and what treatment options are available and valid. Together, you and the client must negotiate a treatment plan that is the best amalgam of yourself, the client, the treatments, and the social context. The quality of the result of this negotiation is a major determinant of the ethics of the treatment.

Gaining the skills to act ethically. Ethical practice is achieved through a combination of attitudes and behaviour that can be learned through reading, discussion, reflection, training and practice. Meeting with colleagues to discuss work problems, particularly ethical anxieties, is a good way to compare your ethical thinking with others and develop confident approaches to practical issues. Training courses in communication and basic counselling skills are readily available. These can increase your understanding of the relationship between client and helper and will assist in the development of skills that promote ethical practice.

Regular application of the skills and concepts relevant to ethical practice, with periodic reflection on your development, will help ensure that this learning is consolidated.

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2. Over the next two hours (or three hours if the volunteer has diabetes), we take a sample of their blood every 15 minutes during the first hour and thereafter every 30 minutes. The blood sugar level of these blood samples is measured in the laboratory and recorded.

3. The blood sugar level is plotted on a graph and the area under the curve is calculated using a computer program.

4. The volunteer’s response to spaghetti (or whatever food is being tested) is compared with his or her blood sugar response to 50 grams of pure glucose (the reference food).

5. The reference food is tested on two or three separate occasions and an average value is calculated. This is done to reduce the effect of day-to-day variation in blood sugar responses.

6. The average G.I. found in 8 to 10 people is the G.I. of that food.

In total, eight to ten people need to be tested and the G.I. factor of the food is the average value of the group. We know this average figure is reproducible and that a different group of volunteers will produce a similar result. Results obtained in a group of people with diabetes are comparable to those without diabetes.

The important point to note is that all foods are tested in equivalent carbohydrate amounts. For example, 100 grams of bread (about 3K slices of sandwich bread) is tested because this contains 50 grams of carbohydrate. Likewise, 60 grams of jelly beans (containing 50 grams of carbohydrate) is compared with the reference food. We know how much carbohydrate is in a food by consulting food composition tables, the manufacturer’s data or measuring it ourselves in the laboratory.

*24\33\4*