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The following set of guidelines for the proper treatment of asthmatic schoolchildren has been distributed to teaching staff throughout Victoria. This plan may be used in the promotion of asthma awareness and management among school staff in other localities.

ASTHMA MANAGEMENT AND AWARENESS
Asthmatic students attending the school should always carry, or have available in the school, appropriate medication including, for example, a bronchodilator metered dose aerosol puffer.
The following information on every asthmatic student should be recorded:
Name;
Normal maintenance medical program;
Medication to be used when symptoms develop;
Medication to be used during crisis situations;
Name, address, telephone number of an emergency contact;
Name, address and telephone number (including an after hours number) of the child’s doctor;
Name and telephone number of the child’s pharmacist.
(Teachers must be sure they can alert an appropriate carer without delay: deteriorating asthma cannot wait hours for attention.)
If an emergency contact cannot be made, call the Ambulance Service. All ambulance officers are trained in asthma management.

EMERGENCY CARE
In the event of a child developing what appears to be an asthma attack:
Allow the child to sit in a restful atmosphere, keeping others away so that there is adequate fresh air;
If the child is capable of self-medicating, encourage immediate use of the prescribed medication to be used when symptoms develop;
If necessary, use the medication prescribed for a crisis situation;

. Should the prescribed medications not be available, assist the child to take 2-4 doses of the bronchodilator from the school’s first aid kit hand-held metered dose aerosol puffer;
. If the child does not show improvement within 10 minutes of taking the bronchodilator medication, medical assistance must be sought without delay — use the telephone contacts recorded. Maintain the above treatment regimen until assistance is obtained.
Note 1: Bronchodilator metered dose aerosol puffers are quite safe. An overdose cannot be given by following the above instructions, and their use may be life saving. They will do no harm even if the observed symptoms are not asthmatic in origin.
Note 2: Devices can easily be sterilised by the use of hot water and soap to prevent cross-infection.
Each school’s first aid cabinet should contain a hand-held metered dose aerosol bronchodilator — puffer brand names being Ventolin, Alupent, Berotec, Bricanyl or Respolin. It is also desirable that a large volume spacer be available — Nebuhaler or Volumatic — as an aid for using the puffer. As with all medication, attention should be given to the expiry date.
Pharmacists dispensing aerosols for inclusion in school first aid kits will be able to give instructions about dosage, precautions and the recognition of the therapeutic need for aerosol use to the representative of the principal of the school when the aerosol is supplied.

EXERCISE-INDUCED ASTHMA
Children with asthma should be encouraged to exercise because it builds up their muscles, including those used in breathing, and thus improves their ability to cope with asthma. However, it must be taken into account that exercise — particularly strenuous exercise in any form — will frequently bring on exercised-induced asthma in about 85 percent of children who have asthma. They will experience the general symptoms of asthma, including tightness in the chest, shortness of breath, difficulty in breathing and coughing.
If children experience an onset of symptoms while exercising, they should immediately cease the exertion, rest and take appropriate medication — usually a bronchodilator, using a hand-held metered dose aerosol inhaler. Once all symptoms disappear, they may be able to resume their exercise program. However, if symptoms persist and the asthma worsens, medical assistance should be sought.
Exercise-induced asthma can frequently be prevented by a simple warm up period and premedication a few minutes prior to commencing strenuous exercise, usually 2-4 puffs of a bronchodilator, Intal (using a puffer), or other medication as recommended by a doctor.
A small percentage of children with experience of severe exercise-induced asthma may be advised not to engage in any strenuous exercise. These children should have a doctor’s note to present to the school.
Note: Exercise-induced asthma often is most noticeable some time after exercise — maybe 20 – 30 minutes after stopping the activity — and should be treated as above.
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Sweating is a beneficent thing for us, but men are obtuse and often unappreciative of their blessings. There are unpleasant aspects about it. One of its disagreeable associations is prickly heat. The dermatologists, wonderfully clever in nomenclature, call this miliaria, because the spots seen on the skin are the size of millet seeds. Probably neither you nor I have ever seen a millet seed so we cannot dispute the reasonableness of this name.
The sweat glands are deep in the skin and send their mixture of water, salt, and some of the body’s waste products up to the surface by long narrow tubes. The openings of the tubes are mighty small so that it does not take much to block them. The sweat, continually forming, pushes up the plugs and gives an appearance of little blisters. Usually these break easily but if they get firmly plugged and inflamed they bulge and turn red. They tingle and burn and hence are called prickly heat. Most people fear cold and fond mothers are especially certain that it is a grave danger to their offspring. So they swaddle the poor youngsters, and prickly heat results.
The treatment is theoretically simple: stop sweating. But tons of lotions, powders, and ointments are expended yearly in the fight against miliaria.   Any irritable effects they have on the skin are rapidly transformed into more plugging of the sweat glands. Wear light, airy clothing, clear everything off the skin, and there will not be much prickly heat. All this is a striking example of what is very common, over-treatment of skin conditions.
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What role does Vitamin C play in the prevention and treat¬ment of disease of heart and arteries — that greatest killer of the twentieth century?
Ever since the discovery of ascorbic acid hundreds of researches have been conducted in both guinea pigs (which like us cannot make their own ascorbic acid) and man. They all show the vital importance of ascorbic acid in the main¬tenance of the integrity of artery walls.
Ascorbic acid is essential for the formation and strength of the colloid substance that forms the tough tissue of the walls and the delicate lining of arteries, veins and capillaries, whether they be in the heart, the brain or in any other part of the body.
As early as 1941 deficiency of C was found to be a factor in coronary thrombosis due to impaired collagen produc¬tion, causing capillary rupture and haemorrhage into the arterial walls.
As an example, measurements of the ascorbic acid in the blood in 455 consecutive adult patients admitted to the Ottawa Civic Hospital in Canada over a 7 month period — 81 per cent of the coronary cases had extremely low ascor¬bic acid (less than half normal, 0.5%). Another survey in 1947 showed that low ascorbic acid levels were not confined to cardiac patients. Of 556 patients of all classes 123 had heart disease — 42 per cent of all patients had low Vitamin C in their blood, but in 70 per cent of the coronary throm¬bosis cases it was very low (down to 0.35 mg per cent).
Other papers throughout the 1950s and 1960s all show how valuable Vitamin C is in maintaining the integrity of artery walls, in lowering the blood cholesterol, in prevent¬ing the formation of plaques on artery walls and in prevent¬ing coronary thrombosis.
Again and again it was suggested that ascorbic acid be used as an addition to the usual methods of treatment, especially in the long range after-care of coronary infarcts — but the suggestions were never followed by the cardiologists.
Dr Constance Spittle, Consultant pathologist at Britain’s Pinderfields General Hospital, Waterfield, West Yorkshire, has conducted trials among her patients.
In 80 subjects she found that Vitamin C reduced their blood cholesterol levels in 25 per cent of young patients; while it increased blood fat in the older ones, already with atherosclerosis.
Dr Spittle believes that Vitamin C causes excess choles¬terol to remain dissolved in the bloodstream until it reaches the liver where it is normally converted into bile acids.
In Dr Spittle’s opinion and that of other researchers, namely Dr Ginter of Czechoslovakia, this increased serum cholesterol comes from formerly hardened cholesterol de¬posits which the vitamin has mobilised or reamed out from the arterial walls and is still circulating in the blood.
Thus, she believes, the high readings signify decreased not increased cholesterol danger, Vitamin C acting to re¬move cholesterol away from the artery walls.
It has also been found that Vitamin C deficiency greatly increases the actual synthesis of cholesterol in the body, whereas its presence brings down the cholesterol levels in the blood.
Recently, in 1977, a team of Australian scientists at the John Curtin School of Medical Research in Canberra have taken a long hard look at all this evidence. As a result, they are calling for larger studies to test the ability of Vitamin C to reduce the risk of heart attacks — and are already finding out that it does. <
Dr Irwin Stone concludes that all this research into the role of Vitamin C in heart and artery disease over the last 40 years indicates that the simple taking of 3 to 5 grams of Vitamin C a day in several spaced doses would be sufficient to prevent the continuing high incidence of heart disease, and strokes that plague civilized countries today. It should also be used as a supportive adjunct to orthodox treatment in the cardiac intensive care units of all hospitals, and as a follow up treatment to improve the competence of the whole blood vessel system throughout the body.
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Animal studies have demonstrated that calcium and Vita­min C given together produce earlier and quicker healing of fractures. The strength of the bone is increased and healing time reduced by 30 per cent.

Orthopaedic doctors and general practitioners very often administer these supplements to their fracture cases with excellent results.

Dr Phillip Thorek, President of Thorek Hospital and Medi­cal Centre in Chicago says that Vitamin C is the surgeon’s vitamin because wounds heal much faster and more com­pletely when Vitamin C supplements are given to the patient before and after any surgery.

It is indeed, the most important link in the healing chain of events in the formation of collagen, the glue-like substance which holds cells together and makes healing possible.

Vitamin A and the mineral zinc are both important in the production of the collagen that holds wounds together, but without Vitamin C collagen formation will be in­adequate and wounds will not heal — either healing is very slow or the wound ‘breaks down’ — and many more days must be spent in hospital.

A British study in the Lancet (7/9/74) found that 500 mg C twice a day (1000 mg a day) hastened healing twice as fast in that final breakdown of tissue — the bed sore.

If Vitamin E is taken by mouth and applied locally, bed sores will heal even faster. Indeed, bed sores can be pre­vented altogether from occurring if these two vitamins are amply supplied in the diet, coupled, of course, with good hygiene and nutrition.

Gangrene is another breakdown of tissue that can be healed by large doses of Vitamin C, and Vitamin E.

Five cases of long standing gangrene of the legs and feet due to atherosclerosis and scheduled for amputation at the Jewish Memorial Hospital, New York, were so greatly improved with 5 grams of sodium ascorbate daily — plus other treatment, that they were completely healed in a few weeks and amputation was avoided.

The tissue of animals which synthesize their own ascorbic acid is very rich in the vitamin. The pituitary or master gland of the body is richest, the adrenal glands next and the eyes are richer than any other organ, particularly the clear transparent tissues of the cornea and the lens; while the retina or actual seeing membrane lining the eyeball is also saturated with ascorbic acid.

Cataracts are a leading cause of blindness. It is due to chemical changes in the lens that gradually make it opaque. The normal lens is very rich in ascorbic acid but those that are forming cataracts have been found to be much lower in Vitamin C content.

It has been considered impossible to affect the growth of cataracts when once they start to form, but there have been many promising researches from the 1930s onwards, showing that senile cataracts can be prevented and incipient cataracts slowed down or prevented from developing further over the years by daily doses of ascorbic acid one to three grams a day.

Corneal injuries, burns and ulcers have been found to heal quickly with less opacity than expected when large daily doses of ascorbic acid are taken in addition to the usual course of treatment.

Glaucoma, an increase of the pressure within the eyeball which eventually destroys the nerves supplying the retina, is very common in middle life. It is estimated to be present in 2 percent of all people over 40, and in 8 to 10 per cent over 65 — although many do not realize they have it.

It is one of the most insidious thieves of sight.

From 1964 onwards Italian researchers in the Univer­sity of Rome’s Ocular Clinic and Finnish and Swedish doc­tors published many papers on the effects of ascorbic acid on glaucoma. They reported prompt reduction of pressure within the eyes by large doses of Vitamin C and no side effects.

At first, doses of 1000 mg to 2000 mg a day were used, but more complete and spectacular results were obtained with large doses of sodium ascorbate given intravenously — up to 70 grams per treatment.

It is suggested that glaucoma can be prevented and early cases inhibited in the over 40s by taking 3 to 5 grams (3000 mg to 5000 mg) of ascorbic acid a day continuously.

Much research needs to be done on the value of ascor­bic acid in the health of the eyes, especially in counteracting l he ageing processes that so often impair the sight of elderly people. It has already been shown, however, that regular taking of even 1000 mg a day will maintain clearer vision than in those who do not supplement their diet in this way.
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Cellulitis is a skin infection, caused by germs, which spreads between the skin and the deeper layers of soft tissue. It can start from a tiny cut, scratch or splinter, and develop into a nasty infection, which in the worst of cases can cause blood poisoning (septicaemia).

Clinical features

At first, your child may only complain of mild soreness in one area. Look carefully to see if there are any cuts or scratches nearby. The lymph nodes in the area may become enlarged and tender as they attempt to fight local infection. The infected area soon becomes red and swollen, and the skin is hot and hurts if touched. Sometimes pus can be seen in the site of the wound. Your child may also develop a fever, lose his appetite and feel generally unwell.

Treatment

If you suspect that your child has cellulitis, see your doctor immediately. The appropriate antibiotic will be prescribed and should be commenced immediately. If much of the pain. If your child has cellulitis of the leg or arm, it is advisable to immobilise the limb as much as possible, using a sling or a splint. Admittedly, it is not easy to make children comply with the use of slings and splints, but it is worth a try!

Cellulitis usually improves rapidly with antibiotics and immobilisation, but your doctor may want initially to review your child daily until it is clear that the treatment is working. It is helpful to draw a line around the margins of the cellulitis with a felt pen, so that a comparison can be made from day to day to determine whether the infection is spreading or resolving. Do not wash this mark off, so that both you and your doctor can make an objective assessment of the situation.

When to see your doctor

See your doctor if your child has any of the symptoms described above or if you are worried.

Prevention

The only way to reduce the likelihood of cellulitis occurring is by promptly attending to all cuts and abrasions.

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Preschoolers continue to be very active and, although they are increasingly able to understand danger and safety precautions, still need constant reminding and careful supervision. All of the types of injuries described for toddlers are relevant for preschoolers as well; often even more so because the preschooler is stronger, more coordinated and therefore more willing to take greater risks. Review the section on toddler injuries, and make sure that the risks of injury for your preschooler are minimised.

Bicycle safety

Children must be supervised when learning to ride a tricycle or bicycle. Make sure your child wears an approved bicycle helmet at all times, and does not ride on roads. The bicycle must be the correct size, and in good condition.

Playgrounds

Playground injuries are even more common in children of preschool and school age than in the toddler age group. Again make sure that the equipment is safe, and that the surface below it is soft.

Children of school age and adolescents are more able to understand safety concepts, although they cannot always be relied upon to act responsibly, especially under the influence of peers.

Whether the child walks or rides a bicycle to school, pedestrian safety and the rules for crossing roads should be understood. Teach him to cross at lights or at a school crossing, wherever possible. If a crossing is not available, help select a crossing point with maximum visibility for pedestrians and motorists. Crossing skills are not mastered until at least 9 years of age, and often later.

Sporting injuries are common in the school age and adolescent group. Many school sports have modified rules to lessen the risks of injury, and school playgrounds are usually supervised by teachers. If your child engages in contact sports, consider the fitting of a mouthguard. If your child rides a bicycle, make sure the bicycle is properly maintained and in good condition and that he has an approved helmet. Helmets must be worn at all times. Skateboards, rollerblades and trailbikes should only be used with proper protective equipment — helmet, knee and elbow pads. Make sure that you buy this protective equipment at the same time as the bike, skateboard or rollerblades and that your child always wears it.

Make sure that your child can swim, and that he understands the risks associated with water and water sports, such as the danger of diving into water if the depth is unknown, or the danger of swimming at unsupervised surf beaches or isolated waterholes.

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When asked about their feelings rather than their bodies, the couples taught me a diagnostic system based on the systems nature of sexual response. They taught that everyone in every marriage has sexual problems sometimes, and realizing this dynamic nature of human sexual response helped me to learn with the couples to view problems in a wellness rather than a pathology mode. There could be no “good” sex if there was no “bad” sex, just as health has no meaning without illness.

The couples also taught me that sexuality was related to all of life not just their sexual interaction or coitus. You will note that everyone of the early-perspective sex terms was based on a coital model, penetration of vagina and energy release without pain in an appropriate time frame. The following chart is based on the lessons of the spouses in the super marital sex program. Look for the area that you might like to focus on in your own therapy program.

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“If God wanted sex to be fun, He wouldn’t have included children as punishment.”

ED BLUESTONE

Super Marital Sex Rule: The kids do not come first!

I don’t remember how it was before we had kids. I’m sure we must have done something then, but I can’t remember what it could have been. They seem to be everything now.

    HUSBAND

Kids are a unique pressure and joy for marriages, so I have separated the “kid factor” from the ten items above. They deserve their own category, for they are the worst and the best thing that happens to a marriage. I maintain that kid priority has overburdened American marriage, resulting in doing for instead of with our children, applauding only them instead of each other. We fall victim to “P-M-S,” parent manipulation syndrome by our children.

This child focus has an additional twist. Once the child focus dominates a marriage at the expense of the marital relationship, even the parents themselves can become infantalized, childlike in their own behavior and orientation to life. Husbands begin to buy their own toys, to expect to be mothered by their wives, cheered at Softball games, tolerated in their own immaturity. Wives become princesslike, protected, cared for, and idealized. Soon everyone in the family is behaving more like a set of siblings than parents and children.

As many marriages fail because of children as children fail because of faulty marriages. Until we learn that children are not special, but equal in importance to all of us, until we learn that we must not lead our lives and our marriages for children, but with them, we sacrifice our marriages, our own development. After all, wasn’t one of your greatest wishes that your own parents would be happy? Think of giving that gift to your children.

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