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A.    There is evidence in the literature that both short- and long-term cardiotoxicity is related to the peak dose of exposure to the heart.
Decreasing the peak circulating dose by using split/lower weekly doses or continuous infusion has resulted in decreased clinical and pathologic cardiotoxicity for any cumulative dose.
The shortest infusion that has been reported to show benefit is 6 hours, with increasing benefit when the delivery time is prolonged to 72 hours.
B.    The chelator ICRF-187 (Zinecard) has been shown, in adults, to decrease clinical and pathologic cardiotoxicity when given immediately before the administration of doxorubicin.
Smaller studies reported this for daunorubicin and epirubicin as well.
1. These studies have used ICRF-187 in conjunction with delivery of the anthracycline by “push” rather than continuous infusion.
ICRF-187 is currently officially approved for adults who have already received 300 mg/m2 of doxorubicin; it is not yet approved for routine use in children.
It is given as a rapid infusion in a dose that is 10 times the doxorubicin dose, minutes before each dose of doxorubicin.
There have been two promising reports of pediatric use, and larger pediatric studies are planned.
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For the first four or five days, the patient should take fresh fruits or vegetable juices, diluted with water on a 50:50 basis, every two hours from 8 a.m. to 8 p.m.. The fruits and vegetables which can be used for juicing are apple, pineapple, grapes, grapefruit, orange, peach, pear, papaya, carrot, cabbage, celery and beet-root. Beet juice will be especially beneficial. Other beneficial juices are those extracted from carrot, grapes and generally, all dark coloured juices. The purpose of juice fasting is to normalize all the vital body processes, revitalize the liver and other cleansing organs. Juice fasting will cleanse the whole body of accumulated toxins, restore the digestive and assimilative functions of the stomach and intestinal tract, and in general, increase the body’s protective and healing capacity. After the short juice fast, the patient may adopt an exclusive diet of fresh fruits for further five days. In this regime, he should take three meals a day of fresh juicy fruits like apple, pineapple, orange, grapes and grapefruit, at five-hourly intervals. Thereafter, he may gradually embark upon a well-balanced, nourishing, alkaline-based diet.
The diet should consist of 100 per cent natural foods, with emphasis on fresh fruits and raw vegetables, particularly carrots, green leafy vegetables, cabbage, onion, garlic, cucumber, beet and tomatoes. A minimum requirement of high quality protein, mostly from vegetable sources such as almonds, millet, sprouted seeds and grains, may be added to this diet. The short juice fast, followed by an exclusive diet of fresh fruits, may be repeated at regular intervals till this condition improves.
The patient should avoid tea, coffee, cocoa, white flour, white sugar and all products made with white flour and sugar. He should also avoid flesh foods of all kinds, eggs, cheese, dairy butter, strong condiments, pickles, alcohol and smoking. Salt should be used sparingly.
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Certainly in the days before contraception was widely available there were very good reasons for avoiding intercourse before marriage. Women were largely excluded from the workforce, so pregnancy with no independent means of support was a disaster. Safe abortion was not an option so it came down to backyard abortion, adoption, or shotgun wedding. Marriages on the basis of financial support or for social acceptability were pressured from the start. Even today, the implications of unwanted pregnancy or sexually transmitted disease can be tragic, and it is these results of sexual ignorance and misadventure that cause us the most concern.

Obviously, the concept of virginity fails to take into account two important things. Firstly, that most early sexual experience do not involve intercourse. Secondly, it ignores the substantial number of people whose early sexual encounters are with a same-sex partner. Although it is often written about, it is a subject rarely discussed … even between close friends … and may not even be remembered. Research in the United States showed that a third of all males have had at least one same-sex experience leading to orgasm since puberty and the estimates are about the same for women. Of course this need not determine your later sexual orientation.
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We traditionally call that first experience of intercourse losing your virginity’. That always strikes me as a terribly negative way of looking at it. Why do so many words about sexuality sound so negative? Why should it be seen as a ‘loss’ and not a ‘gain’? This concept of loss is so ingrained in our culture that our language simply doesn’t have a word that will describe what you might gain.

And what is a virgin anyway? The very definition of the word implies the male experience of penetration of a woman’s vagina by his penis. It seems a little strange that a woman might have experienced thousands of orgasms without penetration, yet is still technically considered to be a virgin.

Nor is ‘virginity’ a guarantee against pregnancy. If a man ejaculates near the opening of the vagina, whether the hymen is intact or not, the sperm can still make their way into the vagina and result in a pregnancy.

Some cultures define virginity by whether the hymen is intact or not. It is more than likely that the hymen will be perforated by vigorous exercise or inserting tampons long before a penis gets there anyway. Such is the social significance of this piece of skin that partly blocks off the entrance of the vagina that I heard reports of a clinic in Sydney doing a great business in surgically restoring the hymen so that it had the appearance of being intact on the wedding night.

The whole concept of ‘losing your virginity’ is really a pretty bizarre anachronism. Once upon a time it was a loss in more ways than one: a virgin bride was worth more dowry for the husband. That value had a lot to do with the concept of a woman’s sexuality being a possession that could be bought and sold. ‘Damaged goods’ didn’t attract the same price. My dictionary still describes virginity as ‘the condition of being unsullied’. Is that what intercourse is supposed to be? Being sullied? How romantic!
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Mumps is most common in children between the ages of 5-15 years.

Cause

Mumps is caused by a virus. The incubation period is 2-3 weeks and the child remains infectious for a week after the onset of symptoms. The infection is spread by close contact or by droplet spread (coughing and sneezing).

Clinical features

Mumps is usually more severe in adults than in children. At the onset of the illness your child may have a fever and feel generally unwell. Swelling of the gland in front of the ear (parotid gland) and under the chin (salivary gland), usually on one side of the face, may cause pain on chewing or swallowing. Complications are rare with mumps, but include inflammation of the testes in boys. This rarely causes problems with sterility. Meningitis and encephalitis can also occur as a result of infection with mumps.

Treatment

There is no specific treatment for mumps. Treatment is aimed at reducing the severity of symptoms, such as lowering the fever with paracetamol. Try to avoid giving your child sour foods, as this will stimulate the salivary glands and cause further pain. Your child may feel better on a liquid diet, as chewing may cause discomfort.

When to see your doctor

• if you suspect that your child has mumps;

• if your child has mumps and develops a swollen, tender testicle;

• if your child has mumps and complains of a severe headache, becomes drowsy, starts vomiting and is sensitive to light.

Prevention

Routine immunisation is now given to all children against mumps, in combination with measles and rubella (see Chapter 4). It is important to make sure that your child is fully immunised.

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When your children seem to be lying more than you might expect (and remember, lying is a natural part of growing up in our society, whether we like it or not), when they avoid open conversations about sex or other topics, even more discussion is necessary. Accusing them of deception will only lead to more deception. Viewing that deception as pain and fear and a need for knowledge about sexuality and living is much more productive. Deception usually means that children are trying in their own way I not only to protect themselves, but you as well. They are trying to protect you from discovering a “them” they feel you could not accept.

If your children have not talked to you at all about sex issues, no matter what their age, they are deceiving you. You can be sure the concern is there. There is only one perfect age for sex and love education, and that is the age of your child right now. There is no “when” problem for this type of education. Children are always ready and they always need it. Educational experts agree with child! researcher and educational therorist Urie Bronfenbrenner that any child can learn anything at any time. What matters is the teacher! and the type of teaching.

Developmental psychologist Jean Piaget called this problem of the right teaching at the right time in the right way the “problem of match.” As a flower needs not too much or too little water and sun, but just the right amount, so it is with education, and sex! education particularly. Our society is providing plenty of fertilizer, but that will only burn and kill the flower if we don’t counterbalance it with the light of knowledge and the nurturance of love.

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We tried for the first seven years. I just could not come when he was in me. I loved our sex, I loved him holding me, but I could not come in intercourse. I came every other way, but the feeling to get to orgasm wasn’t there.

WIFE

I have already mentioned the difference between orgasm and psychasm. Orgasms are organ-based, physiological reflexes characterized by rhythmic muscular contractions in the pelvic region that are associated with the release of accumulated physiological tension. In women, the uterus, the outer third of the vagina, and the anal sphincter contract. There may be three or four contractions in some of these orgasms to as many as fifteen with other orgasms. This is the Type I orgasm brought on primarily by the stimulation of the Ñ area.

Type II orgasm includes an opening or gaping of the outer third of the vagina. The uterus pulls down, and some researchers say that an “A-frame” shape of the vagina results (unlike the “tenting” of the Type I orgasm, in which there is contraction instead of opening of the outer third of the vagina). Stimulation of the G area seems involved in the Type II orgasm.

Both Type I and Type II or a blend of the two can take place in intercourse or in masturbation. Some researchers call these vulval, uterine, and blended respectively. The women in the couples group seldom experienced orgasm of either type in intercourse. Of the 1,000 wives, 86 reported Type I (56), Type II (20), or blended (3) orgasms in intercourse. Seven wives reported orgasms, but could not differentiate as to type. Their reports are purely subjective, i without observational verification. The husbands substantiated the reports either by repeating what their wives had told them or de- ‘ scribing sensations they detected in their wives. The remainder of the women (914), at five-year follow-up, reported no orgasm in intercourse.

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You know, if we could have raised our first child as if he were our second, things would have been much better, for him and for us. Maybe we should pretend this is our second marriage. Why don’t we save the hassle and money of a divorce and just start our second marriage now? We’ve already met anyway, and we have a head start on our problems. Why start new ones with someone else? Okay. 1 declare us divorced and remarried. This is our last chance. We have to stop acting like this is some sort of stupid rehearsal that doesn’t really matter. We have to stop acting like we are kids in a fire drill. Attention. Attention. This is not a test. I repeat, this is not just a test.

WIPE

Super Marital Sex Rule: Super marital sex depends on remembering that there will never be a better time than now to enhance the sexuality, the intimacy, of your marriage. We behave as if we can fix things later, get to them later, do much better later when there is more time. No excuse can change the fact that now is the best time, the only time to join together for a more intimate marriage.

We watched together as the cleanup of the crash site continued. I had been called by the medical team to talk with the wife. “I’m more worried about her than I am about her husband,” reported the doctor. “She’s just sitting there looking off into space.”

Her eyes never left the cleanup work as she talked. “Another chance. I can’t believe it. Another chance.” With determination and confidence more than sadness or shock, she continued. “I swear to you that I will never, ever take him, take us, for granted again. I almost lost him, lost everything. I swear to you I’ll never let us forget us again. We will be first, not some afterthought, some social convenience, a pair of people who happen to be together.”

Her gaze rose from the pile of clutter to my eyes. She placed a hand on each of my shoulders, looked directly at me, and seemed to appoint me clergyperson, notary public, and certified witness to her personal vow. “Listen. Do you believe me? Do you? I will devote every cell of my body to us. Do you believe me?”

She did not expect an answer, for her vow was to herself and to her husband and their marriage. Her eyes left mine to focus over my shoulder to the gurney being pushed toward us. She rose to embrace her husband, and they cried silently together. “Another chance, darling, another chance.” They sobbed and held each other tightly.

Until this wonderfully terrible moment in their lives, this husband and wife had forgotten their marriage. They had forgotten to share a loving-together, not just a living-together. They had forgotten to touch one another, to nurture the sexuality and intimacy within their relationship. Don’t let this happen to your marriage. Let this book serve as a starting point for a recommitment to intimacy, a second chance before your first chance expires.

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