Tics are sudden, jerky, irregular and uncontrollable movements of a muscle or group of muscles that occur repeatedly for no apparent reason. They may involve any part of the body, as well as such activities as repeatedly clearing the throat or persistent coughing. They are said to occur in up to 10% of children, to be more common in boys than girls, and to last anywhere from a few weeks to months or sometimes many years. They occur in the school age or adolescent age group, and may persist into adult life. Sometimes tics have not been present during childhood and appear for the first time in adulthood.

Cause

The cause of tics is uncertain, but it is believed somehow to be related to stress. Tics often appear for the first time during a stressful period in the child’s life. Established tics certainly seem to become more frequent and exaggerated when the child is anxious but it is not always possible to identify any stressful events that may have precipitated or worsened the tics. Some children may be more highly strung or have a particular temperament or personality which may predispose them to tics, but even this is only supposition and has not been reliably demonstrated.

Very occasionally tics may have an underlying medical cause. For example, a child who is constantly screwing up his eyes may have a problem with vision, or a child with a persistent cough may have asthma or a chest infection. However, if the tic is caused by an underlying conditions, there will usually be separate evidence of the condition itself. For example, coughing due to a chest infection is present all the time, including when the child is asleep, whereas a habit cough or tic disappears when the child is sleeping.

Clinical features

The tics involve muscles or muscle groups in any part of the body. Sometimes more than one part of the body is affected. Tics often seem an exaggeration of normal movements. The common tics include facial grimacing, smiling, blinking or screwing up the eyes, twisting or stretching of the neck, shrugging of the shoulders, and so on. They also include repeated clearing of the throat or coughing.

They appear most frequently during periods of stress and when the child is anxious, such as when speaking in front of the class or before an examination, and are less prominent when the child is busy or distracted. At these times the tics can disappear for hours at a time. They always disappear during sleep.

Tics cause great concern and irritation to parents and sometimes teachers, and may be a cause of considerable embarrassment and even ridicule to the child who may be teased by his peer group.

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LUNG FUNCTION TESTS (PULMONARY FUNCTION TESTS, SPIROMETRY)

These tests may be used in children who suffer from conditions such as asthma. They are useful in determining the capacity of the lungs and in measuring how well they are functioning. The response to certain drugs which are used to open up the airways and make breathing easier, can also be determined. Chronic conditions such as asthma and cystic fibrosis can also be monitored by lung function testing. Many older children (and adults) with asthma will monitor their lung function daily under their doctor’s supervision, using a simple handheld spirometer. Specialists use more sophisticated machines which provide more detailed information.

MAGNETIC RESONANCE IMAGING (MRI)

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.

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Question

I am not sure what is meant by ‘letting the anxiety and the attacks happen’. They are so much a part of my life I don’t know how to separate them from myself.

Answer

When we are feeling happy, we don’t continually monitor our feeling of happiness or think of how happy we are, we just let the feeling of happiness be there as we get on with whatever we are doing. The same applies to the feelings of anxiety and the attacks. We can separate ourselves from them simply by noting them, ‘this is anxiety, this is an attack’. We just let them be there, without concentrating on them. Not concentrating on them allows us to concentrate on other aspects of our lives. The same is true for temporary feelings of depression. We need to be aware of why we are depressed and we let ourselves be depressed, but we don’t become the depression. If we don’t add to it by continually worrying about how depressed we are, it will disappear because we are not fuelling it. Of course, it does depend on the degree of your depression. If the depression stays with you it will need to be treated by your therapist.

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Here is a self-evident, but very important fact. Surgery can only cure you if all of your cancer is removed. What circumstances are necessary for complete removal to be possible? The primary cancer must be confined to a part of the body that can safely be partly or completely removed. The primary cancer must not have extended directly into surrounding organs that cannot be removed. If it has spread through the lymph system, it must be possible to remove, preferably all in one piece, the primary cancer and the involved nodes. The cancer must not have spread through the blood system at all. How can we be as sure as possible, before operating, whether or not complete removal is feasible? First, we will look only at feasibility. Later we will consider desirability, that is, whether the cost/benefit balance is in favour of the surgery.

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It, therefore, is more common in doctors, nurses and laboratory workers who are collecting and testing blood and those patients with kidney failure who require dialysis in hospital. It is also common in drug addicts who “share the needle” and become contaminated with others’ blood.

The virus has not yet been isolated and cultured but the impure virus has been identified in the blood of carriers and these particles contain the antigens which stimulate anti-body formation.

A vaccine to hepatitis  has been made and initial tests indicate it is 90 to 95 per cent effective.

The third type of hepatitis has us a little stumped. It is called type non-A, non-B rather than type C, because we as yet are uncertain about it. The incidence is not high and researchers are not yet sure whether it is a separate virus or a sub-type of either A or B.

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It appears that having sexual intercourse during pregnancy is accepted as normal behavior. However, the medical profession has been a little hesitant to accept it as being safe, particularly in the latter stages. Doctors have thought that intercourse at this time might bring on premature labor or lead to infection.

Obstetric textbooks have warned doctors to discourage intercourse in late pregnancy, but have offered little evidence to support this opinion.

A joint study in America and Israel has now produced evidence that there is little to support this view. Doctors are no longer justified in discouraging their patients from continuing sexual activity right through pregnancy.

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There is a very close relationship between what goes on in the mind and the state of the skin. There are a number of possible reasons for this, the first being the fact that in the embryo stage, the skin is formed from the same substance as the brain—the ectoderm. The skin and the brain are probably the most fascinating and complicated organs of the body. Like the brain, the skin is still to be fully explored and understood.

Secondly, the bond between the skin and the mind may well be related to the fact that there are more nerve pathways leading to the brain from the skin than from any other organ. These can relay messages to and from the brain faster than the speed of light, instantly recording pleasure, pain, touch, temperature or irritation. It is estimated that in just one square centimetre of skin you will find approximately 100 sweat glands, 10 hairs, one metre of blood vessels, four metres of nerve fibres, hundreds of nerve endings programmed to record pain, 25 pressure receptors sensitive to tactile stimuli, two sensory receptors to record cold, 12 sensory receptors to record heat, countless lymph vessels, and 15 sebaceous glands.

The skin also acts as an important erogenous zone. It is apparent how important in infants the effect of stroking, and caressing, is for satisfactory emotional development. Similarly, the skin has important sexual connotations, as well as being of great psychological importance to us with respect to our external appearance.

There is nothing at all that happens in our minds that does not affect our bodies, and the reverse is also true. The skin is paramount among all the body organs as an instrument of expression. Everyone knows that blushing signifies embarrassment, that anger provokes flushing, that fear is expressed in blanching, that sweating is a response to excessive emotional excitement. Presumably such reactions were, in ancient times, appropriate to some emergency, preparing our ancestors for some form of useful defence. In modem society these reactions have lost their functional aspect because of social disapproval of the expression of primitive instinctual drives; for us blushing, pallor and sweating are cutaneous signs by which the inhibited instincts are betrayed. The manifestation of emotions in the skin are brought about chiefly by neural discharges within the autonomic nervous system and changes in hormones from the endocrine system. There is a very dose association between both these systems and the skin.

Obviously, then, the mind will most definitely influence the type and timing of various skin disorders, and conversely, these disorders will affect the mind. Some doctors will deny that the psyche has any other than a superficial relationship to skin disorders, insisting upon organic causes in every case. Others may see the psyche lurking behind every pimple. It is a clinical fact that patients often react more strongly emotionally to skin diseases which are freely visible than to far more serious internal, and consequently hidden, disorders. The skin occupies a special place in the human psyche, being a kind of outermost representative of the ego. The slightest blemish may call forth deep hidden fears. A small patch of alopecia (hair loss) is not in itself a very serious symptom, but if the patient privately believes that it signifies loss of virility, his or her anxiety over the symptom may not seem so disproportionate. This then poses a special problem for the person making diagnoses. It is often quite difficult to know whether anxiety is causative or reactive, that is, whether the emotional distress caused the akin disease or the skin disease caused the anxiety. Often, of course, both factors are present in a viscious cycle. It may be true that skin diseases are not, on the whole, fatal, but it is also true that many of these disorders ruin life emotionally, even though they spare it physically.

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It is important to eat a high carbohydrate and low-fat diet The following practical tips which we have set out in an easy A to Z format will help you reduce the fat content of some of your favourite recipes at the same time as you are lowering their G.I. factor.

Alcohol. Although excessive alcohol consumption can be fattening, as an ingredient in a recipe, alcohol itself won’t create a high kilojoule dish. Alcohol evaporates during cooking, so you lose the kilojoules and are left with the flavour. A little wine in a sauce can give a delicious flavour, and sherry in an Asian style marinade is essential.

Bacon. Bacon is a valuable ingredient in many dishes because of the flavour it offers. You can make a little bacon go a long way by trimming off all fat and chopping it finely. Lean ham is often a more economical and leaner way to go. In casseroles and soups, a ham or bacon bone imparts a fine flavour without much fat.

Cheese. At around 30 per cent fat (23 per cent of this being saturated)) cheese can contribute quite a lot of fat to a recipe. Although there are a number of fat-reduced cheeses available, many of these lose a lot ricotta from a deli—you may rind the texture and flavour more acceptable than that of the ricotta available in tuba in the supermarket, flavoured cottage cheeses are ideal low-fat toppings for crackers. Try ricotta in lasagne instead of a creamy white sauce.

Cream and sour cream. Keep to very small amounts as these are high In saturated fat. A 300 ml container of cream can be poured into icecube trays and frozen providing small serves of cream easily when you need it Adding one ice-cube block (about 20 ml) of cream to 9 dish, adds only 7 grams of fat.

Dried beans, peas and lentils. These are all low in fat and very nutritious. Incorporating them in a recipe, perhaps as partial substitution of meat, will lower the fat content of the finished product Canned beans, chick peas and lentils are now widely available. They are very convenient to use and a great time saver. They are comparable in food value to the dried ones that you soak and cook yourself.

Eggs. Be conscious of eggs in a recipe as they can add fat. Sometimes just the beaten egg white can be substituted for the whole egg.

Filo pastry. Unlike most other pastry, filo is low in fat. To keep it that way brush between the sheets with skim milk instead of melted butter when you prepare it. Look for it in the freezer section of the supermarket with other prepared pastry and use it as a pie topping or a strudel map.

Grilling. Grill tender cuts of meat, chicken and fish rather than fry. Marinating first will add flavour, moisture and tenderness.

Health food shops. Health food shops can be traps for the unwary. Check out the high fat ingredients, such as hydrogenated vegetable oil, nuts, coconut and palm kernel oil in the products such as muesli bars, nut bars, health cakes and pies (even if made with wholemeal flour) that they stock on their shelves.

Ice cream. A source of carbohydrate, calcium, riboflavin, retinol and protein and low-fat varieties have the lower G.I. factor—definitely a nutritious and icy treat.

Jam. A dollop of jam on toast contains far fewer kilojoules than a smear of butter or margarine on toast. So, enjoy your jam and give fat the flick!

Keep jars of minced garlic, chilli or gingerin the refrigerator to spice up your cooking in an instant.

Lemon juice. Try a fresh squeeze with ground black pepper on vegetables rather than a dob of butter. Lemon Juice provides acidity that slows gastric emptying and lowers the G.I.

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