Itching of the skin in any part of the body can have a very large number of causes, some of which I shall list below:

• overcleaning of the skin with soaps and shampoos that remove too much of the natural oil from the skin.

• drying of the skin from long exposure to the sun, which may be helped by oily creams (eg. sorbolene).

• dermatitis of many different causes may result in a minimal rash but a maximal itch. Mild steroid creams may assist.

• psoriasis, a skin disease that is more common in older people, and causes red, scaly, itchy patches, particularly on the scalp, elbows and knees.

• scabies, caused by a tiny insect burrowing under the skin. Small red dots or lines may be seen, but the whole area may be very itchy.

• liver failure can cause a generalised itch of the skin in many parts of the body.

• allergies may occur in any part of the body in response to a wide range of substances in the environment, and result in intensely itchy skin.

• a nerve rash may flare at times of stress and anxiety to cause an itch.

If I continued the list, I would probably fill several pages, but the above suggestions may be helpful. Obviously the best solution is to take youritchy skin to a doctor so that s/he can examine it carefully, make a diagnosis and prescribe appropriate treatment.

The treatment of an acute allergic reaction will depend on where it occurs, its severity, and its duration. Antihistamine drugs are the mainstay of treatment and may be given by tablet, mixture, injection or cream. They are best used early in the course of an allergic reaction or if an exposure to an allergy-provoking situation is expected. Unfortunately, in past years only sedating antihistamines were available, which caused drowsiness as an unacceptable side effect, but now a wide range of safe and effective non-sedating antihistamines are available.

Once the reaction is established, a severe attack may require steroid tablets or injections, adrenaline injections, or, in very severe cases, emergency resuscitation. Other drugs may be used in specific allergy situations (eg. lung-opening drugs in acute asthma).

There are a number of substances that can be used on a regular basis to prevent certain allergic reactions. These include sodium cromoglycate (Intal and Opticrom) and nedocromil sodium (Tilade—asthma spray only) which may prevent hay fever, asthma and allergic conjunctivitis if used several times a day throughout the allergy season (often spring). They are available as inhalers, nasal sprays and eye drops.

A small number of patients are so allergic to certain substances (eg. bee stings or ant bites) that they must carry an emergency supply of an injectable drug (usually adrenaline) with them at all times, and must inject themselves it they suspect that they have been exposed to the allergic substance.

Once the substances that cause an allergy in an individual have been identified, further episodes of allergic reaction may be prevented by desensitisation. This involves giving extremely small doses of the allergy-causing substance to the patient, and then slowly increasing the dose over many weeks or months until the patient can tolerate the substance at the maximum likely exposure level. The desensitisation is normally given by weekly injections.

If you can find out what is causing your allergy reaction, it may be possible to have a course of desensitisation, and be cured.

Embarrassing, unpleasant, uncomfortable, distasteful, offensive, distressing, intolerable and very annoying. Urinary incontinence is all these things, and more, but it is a topic that is never discussed with friends or family, and mentioned to doctors often only after many visits for other more socially acceptable diseases. Incontinence is usually associated with the old man lying semiconscious in a nursing home bed. But it is far more common in women, and many relatively young women in their thirties or earlier can be victims.

Incontinence is the loss of urine from the bladder at times when such loss is not desirable. It can vary from constant bed-wetting, to the occasional dribble when a woman jumps, coughs or laughs.

The most common cause of incontinence is the damage done to the genitals during childbirth, and this is the reason for women being the victims far more frequently than men. Other causes include urinary infections, strokes, confusion in the elderly, bladder injury, epilepsy anddamage to the spinal cord in paraplegics and quadriplegics.

The urethra is the tube that carries urine from the bladder to the outside of the body. In women it is only 1 to 2 cm long. It leaves the bladder at an acute angle, and this angle causes the pressure of the urine inside the bladder to keep the urethra closed. It requires a voluntary muscular effort to open the urethra and allow the urine to escape. The stretching that occurs during childbirth can cause this critical angle to be lost and the urethra to become a straight tube leading from the bladder to the outside. Any pressure put on the bladder, or any significant volume of urine, can then cause incontinence. Unfortunately this straightened tube can also allow bacteria and infection to enter the bladder more easily and cause the pain and discomfort of cystitis (bladder infection).

Because the bladder is controlled by nerves, damage to the nervous system by a stroke or the cutting of the spinal cord in paraplegics may also lead to incontinence.

As with most diseases, the earlier incontinence is treated, the better the results. Prevention is even better than cure. Exercises to strengthen the muscles of the pelvic floor should be undertaken by all women immediately after childbirth. These can also be done in the early stages of incontinence to help control the bladder function as normally as possible. A patient can start by practising stopping and starting the urinary stream several times whenever they go to the toilet. Physiotherapists can teach the finer details of these exercises.

If the problem has progressed beyond control by exercises alone, the options are rather limited. In younger women, an operation to correct the abnormal bladder/urethra angle is usually successful. In older women, a specially shaped rubber ring may be worn inside the vagina to put pressure on the urethra and prevent urine from escaping. These rings must be fitted and regularly checked by a doctor.

In intractable cases it may be necessary to insert a semi-permanent catheter (tube) into a woman’ s bladder that drains urine into a collecting bag. A woman’ s concern about incontinence can become a significant mental problem and a social barrier, and should therefore be treated sooner rather than later.

Men can also have an operation, but it is not as successful as in women. In elderly and paralysed men, it is often more practical to use a collecting bag, as this can be easily attached to the penis.

Once a month, just after a woman releases the egg (at ovulation) from her ovary, the lining of the womb (uterus) is at its peak to allow the embedding of a fertilised egg.

If pregnancy does not occur, the lining of the womb starts to deteriorate as the hormones that sustain it in peak condition alter. After a few days, the lining breaks down completely, sloughs off the wall of the uterus, and is washed away by the blood released from the arteries that supplied it. Contractions of the uterus also help remove the debris.

After 3 to 5 days, the bleeding stops, and a new lining starts to develop ready for the next months ovulation.

It seems strange that a skin and lung disease can be connected, but this is the case. In fact, there is a third disease—hay fever—that is also connected to eczema and asthma. All three are ‘ atopic’ diseases—that is there is a specific type of reaction by the tissue in the lung, skin and nose, often to outside substances such as temperature changes, dust or pollen, but sometimes to internal triggers such as stress or hormone changes.

Patients with these conditions will know that the disease flares and settles without treatment, and usually for no apparent cause. Others will recognise that before a menstrual period, at times of anxiety, in certain seasons or with a particular type of weather, their condition will worsen.

People with one of these three diseases, also have an above average risk of developing one of the others.

It is possible for allergists to desensitise you to any allergies that may be the cause, but this procedure will not work against the other factors. Fortunately there are creams, sprays and medications that can control these diseases, but there is no cure.

There are hundreds of causes. The most common is infection of either the ear canal (eg. swimmers ear), or die middle ear. These can develop very rapidly, and one of the most common causes for a 2 am call in general practice is the rapidly developing car pain from an infection.

Infections of the sinuses may also cause ear pain, as may a blockage with phlegm of the fine tube that leads from the middle ear to the back of the nose.

If you fly or climb a mountain with this eustachian tube blocked, the air in the middle ear will be at a different ptessure to that outside, the ear drum will become distorted by this difference in pressure, and pain will result. A common cold may be all that is necessary to cause this blockage.

The bones around the ear may sometimes become infected and cause earache, and the jaw joint which is just in front of the ear will cause ear pain if it becomes inflamed or injured. Impacted ear wax is another common cause of ear pain.

Dental disease can cause ear pain, and vice versa. Dentists often refer patients to a doctor for treatment of their ear or sinus condition after they have initially seen the dentist for toothache. The list goes on and on, so anyone with an eatache will need assessment and treatment by a doctot (or dentist!).

Some babies are unlucky enough to have a defect in the muscle ring at the bottom of the oesophagus (gullet). This muscle ring is normally contracted shut, and only opens when food is swallowed. This prevents the acid and food in the stomach from running up into the oesophagus when lying down or bending over.

If the muscle is weak or defective, the acid in the stomach can burn the oesophagus, which causes considerable pain to the infant. This is known as reflux oesophagitis.

Most children will grow out of the problem, but medication must be given in the meantime to prevent the burning and pain. This is usually in the form of a mixture which is given after every feed. More sophisticated treatments are available for intractable cases.

Why do babies vomit so much?

It is important to differentiate between vomiting, positing and reflux. Vomiting is not very common, and may be due to some disease process (eg. infection, food allergy). The vomitus is usually altered food and may be green in colour, indicating the presence of bile. It may occur several hours after a feed.

Positing occurs in most infants, and is the regurgitation of milk and food from the mouth, gullet and upper part of the stomach during or immediately after a feed. It is caused by over feeding, rapid feeding or burping, and it does not require any treatment.

Reflux is the regurgitation of the stomach contents immediately after a meal, and for some time afterwards. It is distressing to the child, as stomach acid is bought up, and this burns the gullet. This can be helped by posture feeding, slow feeding and mixtures (such as Infant Gaviscon) that may be given after a meal.

If you are unsure about the problem, have your child assessed by your GP.

The best treatment is that which completely prevents the disease. It is far better to prevent asthma than to deal with acute attacks. If the asthma only occurs every month or two, intermittent treatment may be appropriate. Most patients are being under-medicated, rather than taking too much. This applies particularly to patients who obtain their medication over the counter from chemists rather than seeing a doctor. This habit could prove expensive to your health!

Prevention involves two classes of drugs:

— Intal or Tilade

— Steroids (eg. Becotide, Becloforte, Flixotide, Pulmicort, Aldecin etc.).

Both groups are designed to be used regularly on a long term basis to prevent asthma attacks.

If an attack does occur, treatment is usually by one of a number of sprays (eg. Ventolin, Respolin, Bricanyl, Serevent). These can also be given by a nebuliser (when they are even more effective) or in a tablet or mixture (when they are less effective than a spray).

Combination inhalers are now available (eg. Seretidc) that have both preventive and treatment medication in the one dose.

Tablets or mixtures of a group of drugs called theophyllines can also be given to treat an attack of asthma. These include medications such as Ausryn and Theo-Dur.

If these medications do not work adequately, there are a number of add-on sprays and tablets that can be used including Atrovent and Prednisone.

I must emphasise how important it is to be under the continued care of a doctor when using any of these medications. Asthma can be well controlled with the cooperation of the patient.

Aspirin should not be used in children under 12 years of age unless there is no appropriate alternative, and it is given under medical supervision. This is because of the rare risk of developing Reye syndrome.

90% of the children with this syndrome have taken aspirin or similar medications for a viral infection and fever within a week or two of the onset of the syndrome’ s symptoms.

Children with Reye syndrome (named after the Australian doctor who first identified the condition) have vomiting, convulsions, brain inflammation, rapid breathing, mental confusion and develop liver failure.

Unfortunately there is no specific treatment for Reye syndrome, and about one third of affected children die, while another third may have permanent brain damage.

Although the syndrome is rare (affects only two to four children in Australia every year), it is still better to avoid aspirin in children when there is a good and safer alternative in the form of paracetamol.

After breaking his neck of femur (hip bone) your son’ s leg may have reset at a slightly different angle to before. This, combined with the heavy work he is doing, may have placed abnormal stresses on the hip joint, and resulted in premature arthritis of the joint.

With rest, the joint stiffens as microscopic adhesions form in the joint. With movement in the morning, these are broken down, causing pain for a while until the joint starts moving freely again.

Unfortunately, this problem will slowly worsen with time and the only effective long-term treatment is a hip replacement operation. Anti-inflammatory medications and physiotherapy exercises may help in the short term, but there is no diet that will be of any benefit.

The operation is very successful, and young people who need such an operation usually recover rapidly. There is no reason why the steel hip replacement should not be successful in carrying your son around and allowing him to do heavy work and play sport.

The timing of the operation depends on your son. When the discomfort of the hip worries him enough to want an operation, then he should sec an orthopaedic specialist to have it arranged.