Shigella species require an inoculum of only 10 to 100 organisms and thus is highly communicable. Outbreaks have been traced to food and water, but most infections are transmitted person-to-person. Shigella is, therefore, a major pathogen in day care centers and nursing homes. Variable in its morbidity, Shigella produces Shiga toxin, which causes fever, malaise, cramping, tenesemus, and voluminous diarrhea that is initially watery and often becomes bloody. Because most cases are self-limited and resistance is increasing, antimicrobial therapy may not be indicated, especially if the patient is improving at presentation. But, in cases of moderate to severe illness, patients at the extremes of age, and patients with comorbid illness, antibiotic therapy should not be withheld because may decrease symptoms and shorten fecal excretion. Trimethoprim-sulfamethoxazole, ampicilline, tetracyclines, and fluoroquinolones are acceptable agents, but resistance is becoming more common.*68/348/5*
Does mother often do this?’ Sue Usiskin’s young son was asked by an indignant customer, as Sue lay on the floor after a seizure in a butcher’s shop.Children are going to be exposed to other people’s ignorance or intolerance early on and so it is doubly important that the message you give them about epilepsy is a positive one.Having a parent with epilepsy can have a huge emotional and social impact on a child. How they respond and how well they cope with it will depend more than anything else on how they see their parents behave. Children are great imitators. If their parents’ response to a seizure is calm and matter-of-fact, and their attitude is that it is no big deal, then this is the attitude the child is most likely to adopt too.Parents who have epilepsy need to talk to their children about it, to give them some kind of explanation about what is happening when they have a seizure and to reassure them that it is not dangerous. But many parents do not do this. One survey showed that less than a quarter of parents with epilepsy told their children about it. Sometimes the first a child knows about a parent’s epilepsy is when they see that parent having a seizure, a situation which can be very frightening.Sometimes the problem is that the parents themselves have only a vague understanding of what epilepsy is, and so obviously they find it hard to explain what is wrong to their child. Or they may simply be too embarrassed to talk about it, feeling that their condition is something to be ashamed of and hidden from their children – an attitude which the children themselves will inevitably pick up and reflect.In some families parents even try to avoid the word epilepsy. They may describe the seizure as a blackout, or a funny turn. Yet these euphemisms may confuse the child even more. Worse still is if the parents decide to tell the child nothing.The more reluctant parents are to answer questions or give reassurance, the more the child is likely to assume that something is very badly wrong. Inevitably the child will try to piece together an answer for him or herself, and inevitably they will come up with one that is largely based on their own fears. What they imagine to be the truth is almost always infinitely worse than the reality.Your child’s worst fear may be that their parent will die. At the very least, seeing their mother or father taking pills every day, the child is quite likely to assume that they are ill. They may need reassurance that you take medicine not because you are ill, but so that you can stay well. And if your child has seen you having a generalized tonic clonic seizure it is a good thing to tell them quite clearly, even if they do not ask, that seizures are not painful.If a parent is taken into hospital a young child may worry that they have been abandoned, and that the parent will never return. Children who are told what is happening, and allowed if possible to see or at least speak to the parent while they have to be in hospital, are much less likely to be clingy and insecure when the parent does finally come home.Older children are often afraid that they too will develop seizures. They need to know that while they may have a higher than average risk, having a parent with seizures does not necessarily mean that they will develop seizures themselves.HELPING CHILDREN COPEWhen a parent has epilepsy there may be times when the natural order of things is reversed, and the parent becomes helpless and dependent while the child finds him or herself temporarily in the role of responsible carer in a situation over which he or she has no control. How can you best prepare your child to meet this situation?One way is to make sure that your child knows what they can do to help if you have a seizure when they are there. Sue Usiskin, who has epilepsy and is an epilepsy counsellor, recommends giving children a simple, practical task to carry out. When her own children were small and she had a seizure, her son would run to get a cloth to place under her face to protect it, while her daughter would sit stroking her face, comforting her. Even very young children can be given some small part to play, and this will make them feel less helpless and less afraid.Occasionally, in families where the parent finds it difficult to cope with their own seizures, or has severe, disabling epilepsy, the parent may not be able to give the children the emotional support they need. Sometimes this situation leads to a child trying to take on too much responsibility for the parent, so that there is a swopping of roles which may not be healthy for either of them. Children are still children and they need their childhood; they should not have to take on responsibility for a parent. They need to feel protected and to be looked after themselves. If the parent can not provide this support, it is important that another adult should do so.*61\193\2*
“I’m just not interested in sex any more”. In painful contrast, of course, to thousands of others who seem to be making out like bandits all the time. You’ve tried X-rated videos, reading the Kama Sutra cover to cover and sideways, too — but nothing seems to get your gonads excited anymore. Libido is what makes us want to have sex in the first place, and if you don’t care one way or the other — though you wish you cared — there’s a long list of possible reasons why your sex drive may have shifted into low gear.The sex hormone that’s responsible for desire or arousal in both, men and women, is testosterone. It is produced in both sexes, beginning from infancy, but increases dramatically around the age of eight or nine; then, during the teenage years, levels stabilise in girls, but continue to increase in boys (in Whom it is also responsible for sex characteristics such as facial hair and a deepening of the voice). Adult men produce about 10 times the amount as adult women. However, as long as some testosterone is present, the vigour of your sex drive does not depend so greatly on how much testosterone your body is producing.What does make a bigger difference is whether you’re with the right partner, in the right mood and the right setting, and whether your libido is not depresssed by causes that can range from the menstrual cycle to recent illness.Most people with low sexual desire are “wired together” correctly, that is, they are physiologically capable of sexual function — it’s just that they are “not interested”. Sometimes they may feel an actual aversion for sex. Among the snags that can trip up desire:Previous sexual trauma such as a clumsy, brutal claiming of “marital rights” by a husband on the wedding night. Many men do not only regard the wedding night as an occasion solely geared to their sexual gratification, but even imagine that as long as they are satisfied their wives will be satisfied too. When his virtual rape does not ignite any fires for his wife, it’s put down by such a man to frigidity. But a woman who has been sexually traumatised on her first night can have her ardour dampened for all the years of her marriage.Anxiety and fears. Severe irrational fears, often arisingfrom faulty conditioning, can cause an aversion to sex. Both,men and women, can be affected by fears. The fear of appearing entirely in the nude before an opposite-sex person, the fear of seeing an opposite-sex person in the nude, the fear of whether you will “do it right”, or please him/her, the fear of AIDS, the fear of an unwanted pregnancy. The list of potential anxieties, phobias and terrors is endless. And they are all anathema to arousal. Some people fear that their sex drive will decline with the passing of the years. But this is not necessarily true; rather, it is the mistaken conviction that your libido will decrease that often sets up the anxiety which can translate into reality if you obsess on it too long.Depression is one of the most common causes of low libido, especially in women.A particular kind of depression known as post-partum depression often sets in after a woman has given birth to a baby. It is quite common for sexual desire to be dampened during this period. (Sometimes, though, it is not post-partum depression, but the stress of coping with the new demands that causes libido problems during this time.)Unresolved anger or conflicts. Sex does not take place in a vacuum. If you are seething with hidden anger, resentment or hostility toward your partner because of deep-rooted marital problems, you cannot possibly feel turned on by him or her.Poor sexual technique. Even love and loyalty are, in the end, not enough to keep you sexually interested in a partner who’s too clumsy and fumbling under the covers, too ignorant of sexual technique to excite you.Loss of attraction. Over the years, both, men and women can find that their partner is no longer attractive to them. Often, they are reluctant to face up to this fact, and instead try to plumb the depths for other plausible-sounding reasons for their declining interest.Poor body image or self-esteem. Real or imagined physical imperfections can make many women especially feel undesirable. As a woman ages and begins to lose her youthful looks and beauty, she may become increasingly anxious about her appearance — from facial wrinkles to thinning hair. This can translate into a lack of sexual self-confidence which itself can depress arousal.Similarly, although mastectomy (the surgical removal of all or part of a woman’s breast as a cancer treatment) does not affect her capability for sexual response, she herself may feel a loss of sexual desire … and of being desired.Hormonal imbalances. Anything that alters the balance of your sex hormones can lower libido. In women, this includes the contraceptive pill, pregnancy, breast-feeding, menopause, a hysterectomy (surgical removal of the uterus), oophorectomy (surgical removal of the ovaries).Pituitary tumours can produce excessive amounts of prolactin which suppresses the production of testosterone and can affect not only libido but also potency in a man.Medications. There’s a whole range of drugs out there that can lower libido in both, men and women. They include certain blood pressure medications, cholesterol-lowering drugs, some tranquillizers and anti-depressants, anti-ulcer drugs.Alcohol and street drugs can also affect libido over time.*142\332\2*