You can minimise these situations by considering the following:

• Do not take your child shopping or visiting. This is obviously the last resort, but may be necessary at times to break a cycle.

• Tell the child before you enter the shop (or a friend’s house) that you expect him to be good, and that if he behaves himself he can expect a reward afterwards.

• If he is good, praise him and give him the reward as promised.

• If he begins to misbehave, try ignoring him (the first rule of behaviour modification). If this is not possible, warn him (once only) that if he does not stop, you will take him straight home and he will go to his room for time-out.

• If he does not stop, carry out your threat immediately, without further discussion. Be consistent. If you do this several times, the child will quickly learn that to misbehave when out shopping inevitably has consequences, and the testing behaviour will likely stop or reduce significantly. The difficult thing, of course, is to carry out the threat, leaving your shopping right in the middle, or curtailing your visit to friends or family. If you are not prepared to do this, then do not threaten to do it.

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Setbacks are unavoidable. In fact, the more we have the better! Each setback teaches us more about ourselves and our disorder, and strengthens and refines our management skills. To work through to recovery we need to understand why setbacks happen.

As an example, our threshold to stress may now be at level zero. Practising our management skills will raise our threshold to stress to level one. We then experience our first breakthrough— we feel no fear or anxiety. This brings a complete clarity of thought and a total sense of freedom. Any stress higher than level one will be enough to start the whole vicious cycle again. Inevitably, this happens and we have a setback.

It is not so much the stress itself which causes the setback as how we think about it. When a stress is higher than our threshold, we automatically slip back into our old way of thinking. Anxiety and attacks follow. We become so caught up in it that we are not even aware that we have fallen back into the cycle. Only when we become aware of it can we do something about it.

Identifying the stress will show why the setback has happened. Whatever the stress is, it will be higher than we can tolerate at this point. If we are working from zero, identification is not difficult, as the normal day-to-day stress will trigger the automatic cycle of thinking.

When we become aware of why it has happened, the next step is to resolve any issues relating to the stress and to let the setback happen. Our threshold to stress will continue to rise as long as we continue with management skills. We will then reach level two. Any stress higher than level two will trigger a set back. Again we go through the principles outlined above. This is when we need to have patience. This is the working-through process.

Steps in the working-through process:

• Isolate the stress/es

• Be aware of how we are thinking about them

• Resolve any issues relating to the stress

• Let go of anxiety-producing thoughts

• Let the setback happen

• Continue with meditation

• Continue to work with our thinking

If we are working from level zero, the first breakthrough usually only lasts for about an hour as the daily stress will trigger the automatic way of thinking. With continued practice of the above, our threshold to stress will continue to rise. We will begin to experience days and then weeks of clarity and freedom. When we have a setback after these periods, everything does seem much worse and more hopeless. It isn’t. Only the comparison between these two ways of being makes it appear so. We will reach the point where there are no more setbacks. Clarity of thought and the sense of freedom will then become our automatic way of thinking and feeling.

If we are not sure why we are having a setback, we can write a list of everything that is currently happening in our life. There may be family problems, a difficult financial or work situation, children home on school holidays. There can be many reasons.

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We all tend to look forward to, and even depend on, the same, or a a similar set of sleep conditions being there for us each time we want l asleep. These are different and personal for each of us. They usually ir things like a dark room, a favorite side of the bed, or that special pillow.

Sleep associations help us get to sleep. Routines and rituals ã important part of most people’s lives—but nowhere are they more common, and more important, than when they center around sleep. They seem to help bridge the gap between day and night, wakeful activity and the unknowns of sleep. Even as adults—logical, rational, and usually wanting more sleep—we go through certain steps to be sure everything is “right” for sleep.

I can’t go to sleep without reading for a while.

I set a glass of water on the nightstand, plump up my pillow, check the alarm twice, and then relax.

Children learn to go to sleep in the conditions that their parents set up.

They learn to expect that old blanket, the night light, the music box, or their special pillow.

Kevin was always rocked to sleep. We made sure that he was fast asleep when we laid him down; otherwise he would cry. If he woke up later, he would cry until we rocked him again.

Since adults are generally in charge of their own lives, they are, theoretically, also in charge of their own sleeping conditions. Imagine what would happen if they were not. Suppose that the parent noted above, when awakened by a windstorm, was all out of water—or, worse yet, discovered someone had hidden her alarm clock. How could she possibly get back to sleep worrying that she might not wake up on time?

Children often find themselves in such frustrating situations. They wake during the night to find that the conditions they went to sleep with somehow changed during the night.

Remember that arousals are a normal part of sleep cycles—a time when we check to be sure everything is as it should be before we fall back to sleep. How lonely a child who has fallen asleep at the breast must feel to discover that it is no longer nearby! The bed must certainly feel less comfortable than Daddy’s arms or the rocking chair. Certainly calling out or crying is a logical, understandable, reaction—an attempt to regain the conditions favorable to sleep.

Difficulty falling asleep and frequent waking are common sleep problems. They may be connected. When a child cannot get to sleep, he will also not be able to get back to sleep. His sleep associations can be the root of it all. Even if you do not suspect this to be your child’s problem, it is important to look at it. Developing independent sleep associations is also a preventive measure.

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If fluid has built up in either your pericardial or pleural spaces, cancer cells growing on their linings is the most likely reason, but other possible reasons include infection and bleeding. The fluid can be examined under the microscope to find out why it has formed. If it is due to cancer, ways of trying to stop it reforming are the same as for fluid in the abdominal cavity (ascites).

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When a patient goes to a doctor with the complaint of headache, a proper history is most important. Only in a few cases of headache will there be any abnormal finding on examination or anything abnormal showing on tests.

One famous physician had a favorite saying: “Let me take the history and I will rely on the examination of the most inexperienced medical student.”

In most cases, the astute doctor can arrive at the correct diagnosis on the history alone, but a full medical examination is always necessary to exclude other illness.

Sometimes it may be necessary to investigate a case of headache which is severe, persistent and does not fit into a readily diagnosed category.

X-rays of the skull may be taken and sometimes more invasive techniques, such as a lumbar puncture, where a needle is inserted into the spinal canal and fluid withdrawn for examination under the microscope, are used. Occasionally, air is injected into the fluid canals in the brain.

In a carotid angiogram, a radio-opaque dye is injected into the carotid artery in the neck and X-rays are taken as the dye flows through the arteries of the brain.

A newer, less invasive technique is the brain scan, where a radioactive substance is injected into a vein and its progress through the brain is monitored.

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But if the bleeding is excessively prolonged then a curette is indicated.

The curette is not only diagnostic in the sense that the lining of the womb can be removed and examined under the microscope but if most of it is removed then it may cure the condition.

But if bleeding recurs at a later stage then a second curette may be necessary. If this treatment fails to control the problem then we may need to consider hysterectomy, or removal of the womb.

Fibroids are benign, that is non-cancerous tumors of muscle and fibrous tissue which develop in the womb. These may be single or multiple. In many cases they cause no symptoms but should one project into the cavity of the womb it may cause excessive bleeding.

Some women have difficulties coming to terms with the loss of the womb and see it as a loss of femininity.

But for women who really have no further use for this organ and which is causing considerable distress, operation comes as a welcome relief.

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If you are having trouble controlling your blood sugar level after a meal look up the G.I. factor for the carbohydrates it contains. See if you can find substitutes with a lower G.I. factor amongst the list. Eating a meal with a lower G.I. factor can lower the blood sugar rise after the meal.

Although we haven’t mentioned them yet, don’t think that fatty foods are not important. They are, especially in people who are overweight. But fatty foods do not increase the sugar levels. Only carbohydrate foods do. However, being overweight and eating fatty foods prevents the body’s insulin from doing its job and indirectly causes the blood sugar levels to rise. So, eating hot chips or fried rice (mixtures of high G.I. carbohydrate and fat) causes double trouble. Not only does the high G.I. factor of potato and rice increase the blood sugar levels, but the extra fat will also eventually stop the body’s insulin from working properly and makes it less effective in clearing

the sugar from the blood. Persistently high blood sugar levels will ultimately damage the body.

The G.I. factor is especially important when carbohydrate is eaten by itself and not as part of a mixed meal. Carbohydrate tends to have a stronger effect on our blood sugar level when it is eaten alone. This is the case with between-meal snacks which most people with diabetes have to have. When choosing a between-meal snack, pick one with a low G.I. factor. For example, an apple with a G.I. factor of 36 is better than a slice of normal toast with a G.I. factor of around 70, and will result in less of a jump in the blood sugar level.

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Obviously this approach requires a different response to the behavioural strategies discussed above; if eating problems are caused by an existential and societal inequality, addressing the issue of powerlessness becomes the theme of both group and individual therapy. However, it is unclear from the feminist perspective how to account for the large numbers of men who acquire excessive fat. Presumably it is not for the same reasons of frustration and powerlessness, nor that they need to be assisted to come to terms with their ‘real’ selves. Perhaps males more easily tall into the trap of the ‘unconscious’ habits which more readily respond to the behaviour modification approaches. It seems highly likely that strategies need to be tailored to suit the individual.

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While the liver may synthesise a small amount of fat from non-fat precursors, other tissues, such as skeletal muscle, may simultaneously be burning fat for fuel. Therefore, net whole body fat synthesis will only be present if the former is greater than the latter, which is rarely the case. Examples of conditions which result in net lipogenesis are forced overfeeding of carbohydrate (i.e. up to 5000kcal of carbohydrate per day in the resting state), some disease states such as cirrhosis or HTV infection, states of malnutrition, direct infusions of simple sugars intravenously (such as during intravenous nutrition) or into the abdominal cavity (such as during peritoneal dialysis). These can swamp the body’s ability to use glucose as an energy fuel or store it as glycogen, and under these conditions, some of the glucose is forced to convert into fat. However, this state is very difficult to achieve by eating or drinking the carbohydrate, even in the form of simple sugars.

In 1988, Dr Kevin Acheson and his colleagues from the University of Lausanne in Switzerland showed that drinking 2000kcal of simple sugar solution (500g of dextrin maltose) resulted in only a few grams of fat production, and even massive carbohydrate overfeeding (about 5000kcal/day, 85 per cent carbohydrate) for several days after saturation of glycogen stores resulted in about 150g/day of new fat production.3 Since that time, these results have been replicated through a number of different studies.

Clearly, net de novo lipogenesis requires forced overfeeding of carbohydrate and does not occur under the conditions of ad libitum (at liberty or free) eating in normal individuals. Excessive consumption of carbohydrate (to the level of 50 per cent more than normal), has been shown to lead to increased fat deposition if maintained over the long term (14 days or more), but the indications are that this is because of fat sparing through increased carbohydrate use as an energy substrate, rather than conversion of excess carbohydrate to fat.

Myth-information. Contrary to popular opinion, carbohydrate-rich foods are not as fattening as those high in fat. This is not only because carbohydrates (sugars) contain less energy, and require more energy for storage, but because carbohydrate is not converted to fat in humans under normal physiological conditions.

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But parents should never overlook the symptoms and should take immediate action if they occur. Pneumonia means the air-containing lung substance has become infected; and areas of lung tissue, normally spongy, become filled with fluid and discharge and may even become a solid mass. This reduces the area available for normal exchanges of oxygen and carbon dioxide. Unless relief is imminent, death may result either from suffocation or from the spread of the disease and toxic effects of the organisms involved.

Onset may be rapid, with a rising fever, chills in older children and probably bouts of shivers. Breathing becomes rapid. There may be a cough. Vomiting and diarrhoea may occur. There may be aches and pains and a stiff neck. In older children there may be severe pain present, particularly in the tummy region. Sometimes the sudden onset of symptoms, especially the fever, may lead to convulsions, which are very worrying to parents. There may be obvious breathing difficulty, and the child may grunt when breathing out. Nostrils may be dilated, cheeks flushed, lips possibly a bluish shade (indicating cyanosis).

Treatment

Any infant or child with symptoms of this nature needs immediate expert medical care. Pneumonia may lead on from a simple upper respiratory tract infection, or it may come on suddenly with no relationship to a previous infection. Never forget that normal respiration is essential to good health and if it is in any way jeopardized, for whatever reason, medical help is vital.

Antibiotics have revolutionized treatment of serious lung infections and pneumonia. The sooner this is started the better. So our advice is prompt attention. See the doctor. Do not delay or waste time in trying self-medication. Time lost could spell disaster.

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