The best advice is to pay absolutely no attention to the tics — to ignore them completely. Some parents believe that if they bring the tic to the attention of the child each time it happens, they will help make the child more aware of his behaviour. They feel that this will be the first step in helping him control the tic. It must be emphasised, however, that the tics are not under any voluntary control that is, the child is unable to control them. Drawing the child’s attention to them is likely to make matters worse by increasing his anxiety and making him even more self-conscious.

When to see your doctor

Many parents will take their child to the doctor when the tics first appear, to make sure that there is no underlying medical cause that can be treated. The doctor will undertake a careful history and perform a physical and neurological examination, and perhaps test the child’s vision, but it is rare to find any medical problem. It is almost never necessary to order any special tests.

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This is a specialised radiological technique which uses radio waves to produce an image of highly detailed anatomy of the brain and spinal cord on a screen. No discomfort or pain is experienced, and there is no exposure to radiation. Smaller children may require sedation in order to keep them perfectly still during the procedure.

SKIN TESTS FOR ALLERGY (SENSITIVITY TESTS)

These tests may be recommended by your doctor if your child suffers from allergic conditions such as hayfever. Tiny amounts of various substances which are known to cause allergic reactions (allergens) are placed on the skin. A tiny needle is then used to prick the skin very lightly through the drop of allergen. After 15 minutes the skin is ‘read’ for allergic reactions. If a child is allergic to a certain substance an itchy, red lump will have formed in reaction to it over the area where it was originally placed. Because the solutions used are so diluted, a full-blown allergic reaction will not occur. Sometimes patch tests are used where a particular substance is placed on a small patch on the surface of the skin.

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Will hypnosis help?

Answer

Hypnotism can produce a very positive response in the short term. The result will not last if we have no understanding of the disorder and don’t know how to manage the attacks and anxiety ourselves. In conjunction with panic/anxiety management skills, hypnotism can help while we work with aspects of the disorder. If we use an audio tape of the hypnosis session during periods of high anxiety and attacks, the tape must teach us how to control the anxiety and the attacks. The control does not come from a cassette tape.

Some people use subliminal tapes in an effort to ease their symptoms. We must know what the subliminal message of the tape is and, more importantly, we should consciously know and learn how to manage anxiety and the attacks ourselves.

Question

I have heard about people becoming housebound. I am the opposite. I can’t bear to be in the house. As soon as my husband goes to work I have to get out of the house. I spend my days travelling on buses or walking around shopping centres. Is this part of the disorder?

Answer

This does happen to some people. If they have difficulty in being alone, going out and being around other people is better than staying home. It can also happen to people who were housebound, but for another reason. As people progress in their recovery, some may go through a stage where the thought of being home all day brings back too many memories of their disorder. They prefer to go out as much as they can. This stage does pass.

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Then there are some types of cancer which can rarely be cured by surgery on its own because they almost always release cells into the bloodstream very early, before the primary cancer is big enough to be detected. Examples include some primary bone cancers (Ewing’s sarcoma, osteogenic sarcoma), small cell anaplastic (oat cell) cancer of the lung, cancer of muscle (rhabdomyosarcoma), a type of kidney cancer (Wilm’s tumour) and others. With these types of cancer you will make the best decisions if you simply take it for granted that tiny blood-borne seedlings are present, even when no actual secondary growths can be detected. Obviously these types of cancer are rarely cured simply by removal of the primary growth. Usually the best chance of cure is provided by chemotherapy combined with either surgery and/or radiotheraphy treatment.

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It has been regarded as a malignancy, or cancer, affecting the lymph nodes.

Lymphoid tissues are scattered throughout the body, usually in localised collections such as the tonsils, the adenoids, the spleen, in the wall of the small bowel, and in the lymph nodes or glands in the neck, under the arm and in the groin.

This tissue is concerned with the body’s defence against infection and foreign tissue introduced into the body.

It is part of the immune system and is full of lymphocytes, which are white blood cells — present in the blood and bone marrow and in these collections of lymphoid tissue.

The lymphocytes produce antibodies.

Hodgkin’s disease is now regarded as perhaps two or three different but related disorders.

It occurs more commonly in males than in females. And although it may occur at any age, there are three peaks where it’s more common — in middle childhood, young adulthood and in old age.

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One of the prices we pay for medical control is that pregnancy and childbirth can be thought of as an illness.

But it is only by close monitoring of the mother and the developing baby that complications can be prevented or recognised early and controlled.

A complication that appears to have arisen as part of our highly developed, over-fed civilisation is the condition of toxaemia of pregnancy, or preeclampsia.

The cause of this is unknown but it is rare in

underdeveloped countries and during war time when food is rationed.

In pre-eclampsia there is a generalised constriction of all the blood vessels of the body and a rise in the blood pressure. At least 15 per cent of women with their first pregnancies will develop some rise in blood pressure.

This can damage the kidneys, usually temporarily but occasionally permanently, and shows by the protein albumin leaking out in the urine. As well, sodium along with water is retained in the tissues and causes oedema or swelling.

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Internal dangers are the principal source of human anxiety. Often the patient is unaware of what he is afraid. He may assign his anxiety to his wife, his boss, or a nuclear threat, but these are conscious rationalizations for the most part. The real conflict is usually hidden from the patient, and concerns the self-imposed, unconscious inhibition of instinctual impulses which are regarded as unacceptable. His real fear may lie in the possibility of his carrying out his primitive instinctual drives, particularly those related to sexuality and aggression. The failure of an instinct to find an appropriate outlet may result in its inappropriate discharge, causing tension to be built up to the point where some means of relief must be found. This may result in peptic ulceration, hypertension, migraines, or a skin disorder.

The body, however, conforms to a general biological principle, that of homeostasis. This means that there are automatic regulatory mechanisms which keep the internal environment constant and relatively uninfluenced by sudden external environ-mental shifts. Similarly, in the mind, internal or external dangers are ‘buffered’, the defence being a neurotic reaction. This of course entails a price in discomfort, as does the defensive reaction of a fever (high pulse rate etc) in serious infections. These defence reactions take place spontaneously and automatically. As far as we are concerned the psychosomatic defence reaction to various anxieties is manifested by dysfunction in the skin.

The person with an unsightly skin disease has, however, a special cross to bear because of the irrational and often cruel attitudes of society towards skin abnormalities. We may be sure that repugnance and disgust, in most cases so out of proportion to the medical significance of the skin disorder, is a defensive social response growing out of unconscious fears connected with unhealthy skin. The best example of social irrationality of this kind is that associated with the disease leprosy. Affected persons, though not appreciably contagious or ill, are banished to live in leprosariums, supposedly to render others safe but fundamentally because humans are driven to excesses combating their unconscious fear of skin disease. It would seem, then, that mankind regards the skin as the psychological symbol of spiritual and moral purity. A blot upon it, therefore, may be unconsciously interpreted as a sign of moral impurity. Skin lesions are typically and irrationally regarded as ‘dirty and highly contagious’.

One must, however, beware of blaming all skin disorders on conflicts within the psyche. The flare-up of a skin disorder following an emotional upset is not proof that it is therefore a psychologically-caused (psychogenic) disorder. It is well known that exacerbations of many skin disorders occur under stress, diseases which may well have a real organic basis. For example, psoriasis, acne, or leprosy, which are by no means without their deep organic basis, may all be aggravated by anxieties or stress. On the other hand, the failure to identify an intense stress prior to the onset of symptoms by no means excludes the possibility that the disorder is psychocutaneous. In fact this pattern occurs more often than is realized. Prolonged tension without the benefit of a clear cause, will sooner or later become symptomatic. Patience and skill are necessary to detect the underlying anxiety in some individuals whose typical defence is a superficial serene equanimity. On occasions the skin lesion so successfully defends against the anxiety that the patient is actually unaware of the anxious feelings. Without time and psychological sensitivity, the doctor may fail to realize that emotional illness can be concealed behind such facades. The complete ‘poker face’ more often than not is evidence of repression of anxieties rather than psychic peace.

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Milk. Many people dislike skim milk, particularly when they taste it on its own or in their coffee! However, you can use skim milk in a recipe and no one will notice—and the fat saving is great. For convenience you might want to keep powdered skim milk in the pantry so that can be made up to the desired quantity when you need it. It will taste more like fresh milk if you mix the powder and water according to directions and refrigerate the milk overnight before using it UHT (long life) milk is handy in the cupboard, too.

Nuts. They are valuable for their content of vitamin ?, but they are also high in fat To keep the fat content of a recipe low, the quantity of nuts has to be small.

Oil. Most of our recipes call for no more than 2 teaspoons of oil. Any polyunsaturated or monounsaturated oil is suitable. Cooking spray or brushing oil lightly over the base of the pan is ideal. If you find the amount of oil insufficient, cover your pan, or add a few drops of water and use steam to cook the ingredients without burning. It is a good idea to invest in a nonstick frying pan if you don’t have one!

Pasta. A food to eat more of and a great source of carbohydrate and B vitamins. Fresh or dried, the preparation is easy, lust boil in water until just tender or ‘al dente’, drain and top with a dollop of pesto, a tomato sauce or a sprinkle of Parmesan and pepper. There are many wonderful pasta cookbooks now available. It is definitely worth investing in one to find all sorts of exciting ways to prepare this fabulous low G.I. food. Pasta may appear in your menu as a side dish to meat, as noodles in soup, as a meal in itself with vegetables or sauce or even as an ingredient in a dessert.

Reduce the fat content of minced meat by browning it in a nonstick pan, then placing the meat in a colander and pouring boiling water through it to wash away the fat Return to the pan to continue cooking. It is a good idea to buy the better quality minced beef with less fat.

Stock. If you are prepared to go to the effort of making your own stock —good on you! Prepare it in advance, refrigerate it then skim off the accumulated fat from the top. Prepared stock is available in long-life cartons in the supermarket Stock cubes are another alternative. Look for brands that have reduced salt.

To saut?. Heat the pan first, brush with the recommended amount of oil or less, add the food and cook, stirring lightly over a gentle heat.

Vinegar. A vinaigrette dressing (1 tablespoon vinegar and 2 teaspoons of oil) with your salad can lower the blood sugar response to the whole meal by up to 30 per cent The best types of vinegars for this purpose are red or white wine vinegar or use lemon juice if you prefer.

Weighing. What’s the weight of the meat you’ve buying? Start noticing the weight that appears on the butcher’s scales and consider bow many serves it will give you. With something like steak, that is basically all edible meat,) 20 to 150 grams per serve is sufficient Half a kilogram is more than enough for four serves. Choose lean cuts of meat. Trim the fat off before cooking or before you put it away. Alternate meat or chicken with fish once or twice a week.

Yoghurt. Yoghurt is a valuable food in many ways. It is a good source of calcium, and ‘friendly bacteria’, protein and riboflavin and unlike milk, is suitable for those who are lactose intolerant Low-fat natural yoghurt is a suitable substitute for sour cream. If using yoghurt in a hot sauce or casserole, add it at the last minute and do not let it boil, or it will curdle. It is best if you can bring the yoghurt to room temperature before adding to the hot dish, lb do this, mix a small amount of yoghurt with a little sauce from the dish then stir this mixture back into the bulk of the sauce.

Zero hit is unhealthy, so speak with the professionals (dietitians) about bow to get just the right amount you need. Our bodies need essential fatty acids that can’t be sythesiscd and must be supplied in the diet Pat does add flavour—use it to your advantage.

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