Separation and divorce make for a stressful and even traumatic time for parents and children alike. Usually there has been a period of marital disharmony before the separation, so the actual event may come as a relief but it inevitably brings with it enormous emotional, domestic and often financial stress. Parents may have difficulty keeping themselves going during the ensuing turmoil, and worrying about the children is an additional and very considerable burden, whatever their age.

It is especially important for parents to mobilise family and friends for support during this time. This may include sharing some of the responsibility for childcare or housekeeping, as well as emotional support. Many parents find that professional counselling is invaluable. Your doctor or community nurse can recommend an appropriate counsellor.

Generally speaking, the better the parents cope with the traumas of the separation, the better the children will cope. Coping does not mean putting on a brave face and pretending that everything is all right when it is not. Sweeping problems under the carpet is never a good idea. Coping means facing up to the inevitable emotional and other turmoil that accompanies every divorce and separation.

For children of all ages, apart from the disruption of a stable family unit with its attendant routines, there is sometimes the additional stress of having to move house, change schools, make new friends, and participate in custody arrangements. Often there is a dramatic change in financial circumstances, so that children experience a sense of material deprivation as well.

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Your doctor may want to give you injections. This is not necessary unless you are vomiting, can’t swallow or are too drowsy to take your painkillers by mouth. You can get just as good an effect with tablets or syrup as injections, but not with the same dose. You need two to four times as much by mouth as by injection in order to finish up with the same amount in the bloodstream. Make sure your doctor allows for this if you are changing from injections to tablets or syrup.

You must take responsibility for telling your doctor just how well or how poorly your pain is being relieved. So many people say ‘Not too bad’ in response to a question about pain relief from their doctors and then both parties leave it at that. You’re the only one who knows how it feels and you must tell your doctor about it if you want relief. You have every right to tell your doctor things like these and to expect some positive action on them: ‘You have prescribed my painkiller every six hours, but it only lasts about four hours for me’, or ‘The pain keeps me awake at night’ or ‘I’m comfortable only if I lie completely still and I expect better pain relief than that’.

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First aid treatment for snake bite has been changed in recent years. All of us now should be aware that we do not wash, suck out or cut the wound. A firm constricting bandage should be immediately applied over the bitten area, then the whole limb bandaged.

A splint, made from wood or some other material, should also be applied to stop the limb moving and help should be brought to the victim or he should be transported to hospital resting so as not to increase the risk of the venom spreading.

Recently, an antivenene against the Sydney funnelweb spider has been produced and has been used successfully in a case of funnelweb spider bite.

The venom of poisonous fish and snakes is destroyed by heat. Immersing the bitten part in water that is as hot as can be tolerated may destroy the venom.

But what about all those other nasties, whose sting may not be so serious but which can certainly ruin a holiday?

In the past, recommended treatments have been varied and only of limited value but not any more.

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If you travel to exotic places where the standard of hygiene leaves much to be desired, avoid the water.

If you have to drink the water, boil it first and save some to clean your teeth. Don’t eat raw vegetables or fruit unless properly washed in boiled water. You can obtain tablets to sterilise water, if you are unable to boil it.

The local beer in most countries is usually safe and if you drink the widely known brands of soft drinks, rather than the local variety, you usually can’t go wrong.

If, unfortunately, you do succumb to infection, there are some simple rules. Fluid replacement is important in mild cases and may be life-saving in severe infections.

Boiled water (tap water is all right, if at home), orange juice, lemonade (it need not be flat), glucose drinks, even sweet black tea are all of use. Milk and solid food should be avoided.

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In the ovary, the repeated bleeding leads to the formation of “chocolate” cysts. These cysts may become as large as the size of a baby’s head and are filled with thick chocolate-colored fluid which is old blood.

When the tissue lies deep in the walls of the uterus, it causes enlargement of womb, and often, heavy bleeding with the periods. Pain is a fairly constant symptom with endometriosis, no matter which part is affected.

Women with this condition may also have difficulty conceiving. But, if they do, the absence of menstruation leads to a loss of symptoms and they may remain symptom free for some time, after the pregnancy, even though normal menstruation reestablishes itself.

In the same way, when a woman goes on the pill, the symptoms may totally subside.

The modern treatment of this condition offers the sufferers great hope. It may be treated surgically with either radical or conservative surgery.

In a woman who has finished her family, major surgery to remove the endometriosis-affected tissue and, possibly, hysterectomy can render her symptom-free.

Younger women who wish to retain or establish fertility may require lesser surgical procedures.

A new drug, danazol, which seems to block the action of the female hormones, also gives good results.

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At best, (while you stick to it), a ‘diet’ will reduce your kilo joule intake. At its worst, a ‘diet’ will change your body composition for the fatter. This is because many diets employ the technique of reducing your carbohydrate intake to bring about quick weight loss. The weight you lose, however, is mostly water (that was trapped or held with stored carbohydrate) and eventually muscle (as it is broken down to produce glucose). Once you return to your former way of eating, you regain a little bit more fat. With each desperate repetition of a diet you lose more muscle. Over years, the resultant change in body composition to less muscle and more fat makes it increasingly difficult to lose weight.

Take it as read, that the real aim in losing weight is losing body fat. And perhaps it would be better described as ‘releasing’ body fat. After all, to lose something, suggests that we hope to find it again some day!

Research in Australia and overseas has shown that the type of food you give your body determines what it is going to burn and what it is going to store as body fat. It has also revealed that certain foods are more satisfying to the appetite than others.

This is where the G.I. factor plays a leading role. Low G.L foods have two very special advantages for people wanting to lose weight:

• they fill you up and keep you satisfied for longer,

• they help you burn more of your body fat and less of your body muscle.

Eating to lose weight with low G.1. foods is easier because you don’t have to go hungry and what you end up with is true fat release.

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• Plateaus in fat loss arc common and are due to physiological adjustments and reversion towards old habits.

• Maintenance of fat loss can be extremely difficult due to changes in metabolic rate and body composition.

• Physiological adjustments result in a lower than predicted loss of body fiat with changes in energy balance.

• Adaptations include decreases in metabolic rate, changes in body composition, changes in fat utilisation and modifications of food intake.

• Long term maintenance of fat loss is highest amongst those who exercise regularly, change lifetime eating patterns and have well-developed stress management techniques.

• Plateaus may be countered by change.

As most perennial dieters will tell you, it’s easy to lose fat, but keeping it off is another matter. If fat losses continued in direct proportion to the initial energy deficit (i.e. energy in minus energy out, as proposed in earlier models of fat loss), there would be a steady decline towards a goal given a constant deficit in energy balance, but this is seldom the case. There is an initial significant loss, then the rate of decline decreases until a type of ‘plateauing’ occurs followed often by a return to baseline levels. The challenge is to determine why this is so and if and how this can be modified.

Undoubtedly part of the reason for plateaus and regain is a return to previous habits. People tend to start fat loss programs with great gusto and commitment, but after 3 to 6 months their exercise and dietary habits tend to start slipping back. This is common and understandable given the environment of high-fat foods and labour-saving devices they face. To swim against this environmental ride takes effort and the effort is greater for those more genetically predisposed to obesity. It is not surprising that the effort fades with time. People often find it difficult to admit to a return to old habits and seek metabolic explanations for their plateaus. In truth, for most people the plateaus are due to a combination of behavioural and metabolic factors.

The extent to which metabolic changes slow down fat loss is a matter of some considerable debate. In 1950, the US nutritionist Dr Ancel Keys, wrote: It might seem entirely reasonable that the energetic processes of the body diminish in intensity as the exogenous food supply is reduced. It is reasonable in the sense that a wise man reduces his expenditure when his income is cut.’ This survival tactic has been well-described in animal models of obesity. Studies at Cambridge University on a particular species of desert mouse for example, have shown that when compared with a ‘dry mouse—or one accustomed to plenty of food—the desert mouse is able to adapt to decreases in body weight caused by lack of sustenance by simply slowing down its metabolic processes. Humans have less facility to actively alter metabolic processes to match changes in food intake, although adaptations do certainly occur.

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