The causes of these episodes are varied and include: convulsions (fits); choking episodes, sometimes due to gastro-oesophageal reflux (food coming up from the stomach and going down the wrong way); cardiac arrhythmias, where the heart loses its rhythm; apnoeic episodes where the baby ‘forgets’ to breathe, which is usually due to an immature central nervous system. Most often, no cause at all is found.

The relationship between ALTE’s and later SIDS is uncertain. If a cause is found for the episode, this is treated. If no cause is found, the parents are assured that it is unlikely to happen again. Sometimes an apnoea alarm is used for a time in case the baby stops breathing again. This is a mat containing wires that sense the movement the baby makes when he breathes. If the movement stops for a predetermined period of time, then an alarm is triggered. However, the use of apnoea alarms is not without its problems. They are not 100% reliable, and great anxiety is engendered in parents, who often say they lie awake at night listening for the alarm to go off.

The whole area of SIDS, ALTE’s and apnoea alarms is complex, and advice about home monitoring and other aspects of prevention of SIDS is best obtained from the local children’s hospital or your doctor.

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In certain circumstances your doctor may recommend more involved tests, which are used to identify certain congenital or hereditary disorders in the foetus before birth. Before you undergo any of these tests, we strongly advise you to discuss the details with your doctor. You and your partner may experience a lot of stress making decisions about having tests, waiting for their results, and then being confronted with what to do if they reveal an abnormality. Talk about it beforehand, and make sure you both understand the full implications of these tests.

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INVISIBLE HUSBAND

Most institutions seem to be able to accomplish only with gross inefficency some of what they are designed to accomplish and with remarkable efficiency the exact opposite of what they are supposed to accomplish. Schools cause what some researches refer to as’ ‘pe-dogenic illness,” actual mental or physical health problems related to just being in school. Hospitals cause what are referred to as “iatrogenic” health problems, negative effects on health due to being in the hospital. Telephone companies struggle with “disconnections” even though they are supposed to help us connect, reach out and touch somebody. Car companies produce “lemons,” banks issue “false statements,” and most recently our national government reportedly has been dealing in what some politicians call “disinformation,” even though our entire democratic system is based on information.

The only strategy currently available to couples to cope with institutions is to reduce the number of them we deal with and to learn to play by the rules of the ones we must deal with. It may not sound at first as if keeping careful, accurate records has much to do with sex, but only by organizing your own files regarding the complexities of daily living will you be able to free yourself from distractions that can lessen sexual activity and enjoyment.

In the counseling program, couples were taught to do a monthly joint review. The stress of year-end or tax-time record organizations can overpower any sexual interest. The small-step approach helped the couples feel a sense of control over the endless record-keeping and required institutional-response requirements, and such control removed some of the pressure and distractability from their intimate relationship. One afternoon each month, both spouses readied themselves for the frustration of re-creating the past four weeks of activity. Sharing the responsibility reduced blame and guilt, and

the monthly adjustments eliminated year-end panic that resulted in family arguments, accusations, and feelings of carrying too much of the burden.

The couples also were taught to share all record-keeping responsibilities. At first, this task was awkward and led to arguments about whose style of organization was best. With practice and patience, the mutual approach took pressure off the marriage. It also lessened the fear of having to deal with such issues alone for the first time should something happen to the partner.

Unless you attend to and plan together for the never-ending institutional requirements of daily life, they will rob your marriage of the opportunity to relax and enjoy itself. A small-step, shared approach worked well for the thousand couples.

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This records the systolic pressure. The same measurement can be taken by feeling the pulse at the wrist.

The recording of the diastolic pressure is still subject to disagreement. Some doctors record it when the sound in the artery is no longer heard; others record it when there is a change in the character of the sound as it becomes muffled before finally disappearing.

The recording machine may either have mercury in a tube or be of the aneroid type using a spring as in the aneroid barometer.

Machines are now available which record the sounds electronically. Recently, these and ordinary sphygmomanometers have been advertised and sold directly to the public.

I must say I do not approve of this. Not because I wish to preserve some mystique of the doctor, but because I believe that one needs special training to be able to interpret the results.

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No. Not every man, whose father gave him a certain set of genes, will develop alcoholism and neither does every child who inherits an allergic tendency develop asthma.

Some alcoholics drink that way right from the beginning and get into trouble at an early age. Others seem to slowly develop their problem over many years.

What every problem drinker has in common is that he drinks too much. There is evidence to show that the more freely alcohol is available the more people drink. The more people drink, the greater the number who get into trouble.

It is, therefore, the opinion of experts who study alcoholism that we should be thinking of making alcohol harder to get.

This doesn’t affect the alcoholic, because he will get it just the same but, for the average person and for the potential alcoholic if it is not available, they tolerate the lack.

All the world’s experts agree that the maximum amount of alcohol which anyone can drink without detriment in a 24-hour period is less than eight to 10 standard drinks.

Moderation has a lot going for it.

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It’s easy to see, therefore, how common infections of the urethra and bladder, known respectively as urethritis and cystitis, can easily spread via the ureters into the kidneys. Known as pyelonephritis, this bacterial kidney infection causes pain in the lower back and sides and fever, as well as the symptoms of cystitis: a raging thirst, the frequent need to urinate and burning pain during urination. Tests of the urine may show up blood cells and pus.

Quite different, rarer and much more serious, is the kidney disease known as nephritis. This occurs when the antibodies in the bloodstream attack the tissue of the kidneys. Symptoms include limited amounts of red, brown or cloudy-brown urine, water retention, headache, backache and high blood pressure. If not seen to by a qualified medical practitioner immediately, nephritis can lead to kidney failure.

Kidney stones result when urine is too highly concentrated. Uric acid or calcium suddenly falls out of solution and crystallises into small stones in either the kidneys or the ureters. Short, sharp pains in the back and abdomen result. The patient should cut down on their intake of calcium and those in hard water areas may even need to drink filtered water to lower the mineral levels in their blood. A naturopath will probably prescribe tonics containing gentle diuretic herbs like dandelion and bearberry (uva ursi).

For general good kidney health make sure you drink plenty of fresh water daily. Dehydration in hot weather concentrates the urine and makes the development of stones and infections much more likely. Empty your bladder regularly and cut down tea, coffee and alchol.

Difficulty or strain when urinating can occur in men when the prostate is enlarged.

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Now, however, Emergency Medicine (18#18:16) reports, quicker control over the bleeding can be achieved if one presses a wet tea bag against the wound. The tannin of the tea leaves, apparently, has a coagulating property that promotes more rapid clotting of the blood. With advantage, one can still put a handkerchief, etc., over the tea bag to make sure that sufficient pressure is brought to bear upon the bleeding laceration.

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Home care:

Massage or apply heat to painful muscles.

Give aspirin or paracetamol for pain.

Having the child wear sturdier shoes may reduce the frequency or severity of the pains.

Growing pains can be quite severe and it’s important to reassure and comfort the child.

Precaution:

If your child complains of frequent pain that occurs at night in the same part of the body, take the child to a doctor.

The term growing pains is half truth and half myth. Growing children do have normal pains, particularly in their legs and feet. These pains, however, are not caused by growing but by excessive use of young muscles and joints that are not yet completely developed. Young children are extremely active, and this extra activity places stress on their still developing muscles and joints.

Signs and symptoms

Growing pains generally occur in different parts of the thighs, calves, and feet. The pains can be severe enough to awaken a child from sleep.

A key symptom of growing pains is that they occur only when the child is at rest—usually at night or during naps. They never occur when the child is active. This fact distinguishes growing pains from pains caused by diseases or abnormalities, which are typically worse when the child is active. Growing pains do not interfere with or interrupt a child’s daily play or routine, and are never accompanied by fever or other symptoms of general illness.

Home care

Apply heat to painful muscles. Massaging the muscles also helps. Giving the child aspirin or paracetamol may relieve pain. Sometimes sturdier shoes reduce the frequency and severity of growing pains. Since the pain can be quite severe, sympathy and understanding are important in comforting the child.

Precaution

• One rare bone disease, osteoid osteoma, causes severe bone pain that occurs almost exclusively at nighttime. If your child complains of frequent pain in the same spot at night, the cause must be checked by your doctor.

Medical treatment

Your doctor will perform a careful examination to rule out other diseases. X rays may be necessary on more than one occasion to check for osteoid osteoma.

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But if you do travel, you’re at risk for diseases virtually unheard of in the good old United States. “Of the 20 million Americans who leave the country each year, 2 million to 3 million go into what we call the Third World,” says Dr. Steven Mostow of the University of Colorado. “And the incidence of disease is very high in that group of countries.”

Examples include cholera, malaria, and dengue fever. Tuberculosis, too, is on the rise worldwide (in the United States, too, in this case). And remember, while AIDS seems to have stabilized in the United States, cases are soaring worldwide. Plus, in some places- Africa, for example-it’s much more prevalent among heterosexuals, so the high-risk sexual preferences are flip-flopped.

Even what seems like child’s play here is deadly in some parts of the world. “In some Third World environments, measles is still a wild, uncontrolled disease,” Dr. Mostow says. “And chickenpox is probably the most contagious virus in the world.”

Furthermore, Dr. Mostow points out, a lot of adventurous travelers aren’t exactly a 3 dollars cab fare away from first-rate treatment. “Papua New Guinea, for example, has some of the best diving in the world,” he says. “But if you contract measles there, you’re in deep doo-doo. The medical care is as primitive as the rest of the island.”

There’s a name for all this: emporiatrics, the study of the diseases of the emerging world. And there’s a way to deal with it as well: travel medicine clinics that specialize in getting you there and back disease-free.

“If you visit a travel clinic before you travel, your chances of getting ill are greatly reduced,” says Dr. Mostow, who set up one such clinic, Rose Travel Medicine, in Denver. “You get all the right shots and information on the food-borne diseases and sexually transmitted diseases. We also go through how you deal with a consulate if you’re in trouble and give you a list of competent doctors who speak English.”

Remember, that visa-required shots are to protect the country you’re going to from you, not the other way around. That’s one reason that travel clinics make sense if your itinerary includes places more exotic than the grand tour of Europe.

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The six tips which follow, while generally recommended as effective means for maintaining good general health, can also help prevent specific problems, including impotence, from ever occurring.

1) Maintain a balanced diet— poor nutrition can result in impotence in several ways. First of all, a diet which is high in salt and fats can promote high blood pressure, and many of the medications used to control hypertension have been linked to impotence. A diet which is high in fats—especially saturated fats and cholesterol—can result in vascular problems which is a major factor in impotence. A diet which includes an excessive carbohydrate intake is a risk factor in diabetes, which is a major cause of impotence.

Experts recommend a diet which emphasizes fish, chicken, fruits, vegetables, and whole grains as a means of getting essential nutrients. Such a diet, along with control of the consumption of salt-and sodium-containing foods, can help prevent many of the factors underlying impotence.

2) Maintain your proper weight— excess weight has been shown to be a directly contributing factor in both diabetes and high blood pressure. Thus, proper nutrition requires that you maintain not only a well-balanced diet but control of your total caloric intake as well. When caloric intake is excessive, a buildup of fatty substances can occur within the vascular system, and that can also contribute to impotence.

3) Get regular exercise— just about everyone is well aware that even moderate exercise provides certain health benefits. Many people however are not aware that exercise helps prevent impotence, or that it does so in several ways. A proper exercise program can improve and maintain general cardiovascular fitness, help to lower blood cholesterol levels and promote weight control.

4) Don’t abuse alcohol and/or other harmful drugs— studies suggest a definite link between excessive alcohol consumption and impotence. While an occasional drink by a nonalcoholic individual does not increase the risk of impotence, consumption that regularly exceeds two drinks per day should be a matter of concern.

In the case of controlled substances, the risk of impotence has been shown to be higher in users than that of non-users. Some legal drugs prescribed by physicians have also been linked to impotence. You should ask your doctor about all possible side effects before you take a prescribed medication.

5) Don’t smoke— given the possible cardiovascular consequences of smoking, any man concerned about or interested in preventing impotence would be well- advised not to smoke. While not always possible or practical, it is also a good idea to avoid secondary tobacco smoke and other airborne pollutants whenever possible.

6) Avoid stress— like avoiding exposure to secondary tobacco smoke avoiding stress isn’t always possible, but none-the-less it is an important part of prevention. If you cope with stress by drinking excessively, chain smoking or by overeating, you increase your risk for such diseases as arteriosclerosis, which could lead to impotence.

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