Q: MY husband and I are having some difficulties with our sexual relationship. I don't want to go into the details, but both of us would like to see a counsellor and discuss our problems. What should we be looking for in such a counsellor. Are sex therapists accredited here? Dr Rose writes: You and your husband have taken a big step in admitting that you have a problem and wish to seek help for it. It can certainly be confusing deciding which type of practitioner can best address your needs. Whose services you decide to use will depend on the nature of your problem. If your problem does not involve medical or physical factors, a sex therapist or counsellor is best suited to advise you. However, if you suspect that your problem has a medical or physical component you should seek the services of a sex therapist who works closely with medical professionals or whose training has focused on the medical aspects of sexual problem. Sex therapists in Hongkong are not accredited and there are no laws governing their practice, although some may have been accredited in their home country. Although their practice is not governed by law, sex therapists and counsellors should follow strict ethical guidelines and refrain from sexual interaction with the patients they are treating. As an expatriate, you may wish to see someone who is trained in your home country. Ask you physician and those who have used the services of a therapist for their advice and recommendations. Q: MY family and I went to Phuket for the holidays where we walked on the beach bare-footed on several days. When we returned to Hongkong we all had itchy, funny looking pink tunnels underneath the skin of our feet. Our one-year old had a very severe case. Our doctor said they were little worms which invaded our skin and should pose no further risk with the proper medication. I'm still concerned. Do you think it's possible for the worms to enter our bloodstream or settle in the liver and cause further harm? I am particularly concerned about our daughter. Dr Rose writes: You and your family probably suffered from cutaneous larva migrans (CLM), a self-limited skin eruption. Also known as creeping eruption, sandworm and plumber's itch this condition is caused most frequently by the third stage larvae of dog and cat hookworms. Humans are infected when their bare skin comes into contact with contaminated soil. CLM occurs most frequently in warm tropical or subtropical regions during the rainy months. Children are at increased risk because of the time they spend playing around in the sand and soil. A few hours after the skin is penetrated by a larva a reddish looking patch appears. This is followed by the appearance of a windy track created by the worm as it wanders aimlessly underneath our skin. Affected individuals experience severe itching whichmay disrupt their sleep. Diagnosis is based on clinical history and the appearance of the tracks. Biopsy is not recommended and the majority of cases are responsive to a medicine taken either orally or applied topically on the skin. Even when left untreated the worms die within 2-8 weeks although some may live up to several months. There is no chance that these worms will migrate to other vital organs of your body. In the future, wear shoes or sandals when you walk on the beach. Keep your children away from sand and soil which is frequented by cats and dogs. Use a beach towel when lying on the sand. Q: My son had a small lump on his wrist so I took him to the doctor. She said he probably has a cyst but that it is nothing to worry about. I forgot to ask her what a cyst is, and what it is caused by. Could you please tell me? Dr Rose writes: Cysts are any abnormal swelling or lump. They are filled with fluid and can occur on any part of the body. The most commonly affected areas include the breasts, wrists, face, back and ovaries. Cysts may be caused by any number of reasons. Sometimes an abnormal activity or growth, where there is no opportunity for the fluid to escape, is the cause. Cysts may also result from the blockage of a duct which leads from a fluid-forming gland. Sometimes, cysts are associated with disease. In themselves, cysts are usually harmless. There is little chance that they are cancerous. Yet, it is possible for them to disrupt the functioning of the organs or tissues in which they are located or cause significant pain due to irritation and pressureon the surrounding tissues. When this happens they can be removed surgically, usually in a doctor's office.Dr Rose Ong is a certified family physician licensed in the United States. She welcomes enquiries but cannot answer them individually. Specific questions should be addressed to your own physician. Additional enquiries: Peak Corporate Health Management, 525-6600, fax 525-8100.