There are many other family stresses that can influence children at any age. These include any changes in family routine, financial stresses, loss of employment, arguments, a parent who is absent from home for periods of time because of work or any other reason, and so on. If there is tension in the family, children will invariably pick it up, no matter how hard the parents try to keep it from them. It is best to be honest at all times, and explain the circumstances to the child, in terms he can understand. Stresses can also act to bond the family together, so the outcome is not always bad.

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What can you do if you are denied access to enough painkillers to give you continuing pain relief? First of all, I’ll remind you that the usual reason for doctors and nurses limiting supplies of painkillers is not cruelty or sadism, but sheer ignorance! So you may be able to overcome your problem by telling your doctors and nurses some of the things you have learned here. I’m sure I don’t have to warn you to try to be diplomatic about this— we all know how doctors hate to feel that their authority is being undermined in any way!

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Subluxation or partial dislocation of the small joints between the vertebrae bones may occur.

This may cause pressure on the nerves as they leave the spinal cord. Damage to the intervertebral discs may also occur.

The vague symptoms of giddiness and blurred vision are due to involvement of the sympathetic nervous chain which runs in the neck alongside the vertebrae.

This forms part of the autonomic nervous system which governs the involuntary actions of the body, such as control of the blood vessels, the blood pressure, digestion, the action of the heart and the ability of the eye to vary the amount of light entering it.

Doctors differ in their approach to treatment of this condition. Some rely on anti-inflammatory drugs, such as are used for arthritis. Others refer the patient to a physiotherapist.

Manipulation is often employed by both doctors as well as chiropractors.

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Gastro-enteritis, where there is usually nausea, vomiting, abdominal pain, diarrhoea and sometimes fever, may be due either to bacteria or viruses.

Most cases in babies and small children are believed to be due to the Rota virus, discovered only in recent years.

Most stomach and bowel infections are shortlived and spontaneously settle within a couple of days. Antibiotics are widely prescribed for these but, in most cases, are unnecessary and may even be dangerous.

Those cases which are severe or do not rapidly settle should be investigated usually by examination of a stool sample so the specific agent causing the disease may be identified and proper treatment used.

The old name of “ptomaine poisoning” came from the belief that food poisoning was due to the action of ptomaines, toxic substances produced by bacterial decomposition of protein.

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tbe commonest form is primary dysmenorrhoea wmeh occurs in the absence of any abnormality of the pelvic organs.

Occasionally pain can be the result of some inflammatory process and then the treatment is directed to that cause.

We are not certain why women suffer from pain with periods, but it is certainly a common symptom and affects at least 50 per cent of women between the ages of 15 and 24. Pain does tend to get less and to disappear as they get older.

For some time we thought that the cause was somehow associated with ovulation or due to a tight neck of the womb or cervix.

For some years the contraceptive pill has been prescribed for severe dysmenorrhoea or painful periods.

This works in a large number of women but the older higher dose pills appear to be more effective than the new lower-dose pills.

Sometimes this pain is associated with fluid retention and women note that for several days prior to their period they feel bloated and may gain several pounds in weight.

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The area under the curve is thought to reflect the sum total of the glycaemic response, not just the one time point given by the peak. Statisticians recommend use of the area under the curve. There is a very close relationship between the area under the curve and the peak response. That is, if one is high, the other is high and vice versa.

What about resistant starch? What effect does it have on the G.I. factor of a food?

Resistant starch is the starch which completely resists digestion in the small intestine. It cannot contribute to the glycaemic effect of the food because it is not absorbed. Resistant starch should not be included in the 50 gram carbohydrate helping which is the standard for G.I. testing because all of this 50 grams should be available carbohydrate, that is available for absorption in the small intestine.

Resistant starch is not viscous like some forms of soluble fibre that delay absorption in the small intestine and flatten the blood glucose curve. Hence the mere presence of resistant starch in the food will not affect the G.I. factor of a food. Bananas and potato salad both have relatively high amounts of resistant starch but the G.L factors of these two foods are very different. Potatoes have a high G.L factor and bananas an intermediate one.

The difficulty that arises in testing is determining the true available carbohydrate content of food which is high in resistant starch. If the amount of resistant starch is underestimated, it will produce a falsely low G.L factor.

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Resistance training is a standard form of fitness training in most commercial fitness centres. Yet it is a mode of exercise that has not been extensively studied in conjunction with fat loss. From a commercial perspective it might be seen as important because it is a means of maintaining a membership in a commercial centre. However, scientific research carried out to date holds no definite answers on the role of resistance training for fat loss, or indeed to indicate that it may be more relevant to use this than another less vigorous activity. Several studies show an increase in metabolic rate with resistance training in obese people, but other studies show no effect. Some show decreases in body fat levels while others do not. To date there has been little if any conclusive research comparing the two forms of activity over a set period of time in a homogeneous group of individuals.

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Obesity is often associated with increased fat deposition in the tongue and throat structures and this can cause the airway obstruction in many sleep apnoea sufferers. Reducing body fat— even by as little as 10 per cent in some people—can reduce the problems of OSA. OSA is most common in men and has a direct role in injury, particularly in the workplace. Disruption of the deepest stage of sleep at night can lead to excessive daytime sleepiness (EDS), which results in a vicious cycle of reduced exercise capacity, stress, over-eating and hence an even greater level of obesity. Daytime tiredness is now known to increase the risk of injury; truck drivers with OSA are now banned from driving in some countries.

In many instances of OSA it may be necessary to improve sleep patterns before the patient has sufficient daytime energy to break the cycle and carry out physical activity which can lead to fat loss. Devices such as a constant peak airways pressure (CPAP) machine, which keeps the breathing passage open by maintaining a positive pressure in the airways, can be valuable. Although dealing only with symptoms, this allows a patient to feel rested and suffer less excessive daytime sleepiness and thus perhaps to be more active during the day, potentially decreasing the overfatness which caused the problem.

Joint problems, such as knee pain, are also common in very big people. This is because of the extra pressure put on the joints by carrying excessive weight. Often this can be a limiting factor in getting big people to exercise. However, it’s not uncommon to find that these problems improve on a fat reduction program as the individual begins to lose fat, and hence some body weight.

Skin infections can be a further problem. A fungal infection called intertrigo which causes itchiness and a rash, can flourish in the hot, damp environment under the ‘apron’, or fold of belly fat in very big people. Fungal infections are also common on the insteps of the feet, which often never see the light of day, because of the extra weight forcing them into and against the inner surface of the shoes and the heat created by synthetic socks and leather shoes. This is one reason why big men often insist on wearing thongs’ or sandals which air the feet, without knowing that it is their obesity which is causing the problem. Tinea pedis, an infection between the toes or under the feet, is also more common in fat men because of the hot and sweaty micro-environment of the feet. Pitted keralysis is a bubbling form of rash under the soles of the feet, also common in the obese, which causes the feet to smell. Regular washing only aggravates the problem as this reduces the skin’s natural oiliness and dries it out even more. Regular airing by wearing open shoes or punching holes in the insteps of shoes with a nail punch can help overcome the problem. Acanthosis nigrocans is another skin problem, characterised by velvety, pigmented patches around the underarms, sides of the trunk, knuckles and groin. Acanthosis is occasionally a sign of severe insulin resistance.

Finally, sexual difficulties and psycho-social problems can also result from excessive body fatness. In relation to sexual difficulties, poor self-esteem, lack of fitness and lack of flexibility all combine to make this a significant psychological problem. Recent research has also shown that abdominal fatness in men is associated with a decrease in testosterone levels. This is quite contrary to the notion of a ‘pot belly’ being a proxy indication of manhood. Other psycho-social problems come from the widespread prejudice against fatness. Obese people are often judged to be lacking willpower and to be lazy, over-indulgent and stupid; fatness is strongly associated with ugliness.

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