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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If your situation is not life threatening, for example, a broken bone or a spinal cord under pressure, your decision is relatively straightforward. You basically need to find out simply what difference the operation is likely to make to the quality of your life. What chance is there that pain will be relieved? What chance is there that you will be able to walk after the operation? How soon after? How long would you be in hospital? What is your chance of surviving the operation? What will happen if you don’t have the operation? Is there any other way of relieving the symptoms?

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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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This is the crucial question: Why do implants “take” with some women and not with others? Such is the continuing mystery of endometriosis.

Four basic causes:

• Hereditary factors. You will be more likely to get endometriosis if close female relatives have had the condition, too.

• Immune system stress. Endometrial implants may be more likely to proliferate when this infection-fighting system is weakened.

• Hormone levels. Higher estrogen and prostaglandin levels are associated with more cases of endometriosis and pain from the disease.

• The embryonic theory. One supposition is that you are born with the condition in a dormant state. If the internal environment is right, endometriosis will “take” and grow.

No one knows precisely what combination of factors in what degree will create endometriosis, but I strongly believe that heredity and immune system stress are two major influences. One we cannot change, but the other—immune system stress—can be altered.

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Unfortunately patients and many doctors have come to regard mood-altering drugs as a panacea for all kinds of social, physical and emotional ills. Interestingly enough, many people who would not think of taking alcohol do not seem to mind taking the various psychotrophic drugs available. Nevertheless, the most widely-used drug of all in our society is alcohol. It brings pleasure and relaxation when used carefully, yet misery and destruction when yielded to.

We believe that there is a place for placebos—pills that contain no medication but that nevertheless work because the patient believes they will work. In fact, many ‘genuine’ drugs an? capable of curing people in part because of what is called a placebo effect. Bogus pills, or clinically inappropriate ones, are just the beginning of placebo medicine. Any treatment which has no definable curative powers but which nevertheless improves the patient’s health, qualifies as such. This goes for the miracles at Lourdes, and other examples of faith healing. The best placebo of all, in a way, may well be a good doctor-patient relationship.

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You may focus on your pain by imagining that you are in an open field on a warm sunny day. Just beside you is a helium-filled balloon with a large basket attached. You imagine that you load up the basket with all your pain and discomfort. The balloon now slowly rises up in the air and floats away, taking with it the basket loaded with your pain.

You may focus on your endometriosis by imagining that the endometriosis cells in your body are being invaded by your body’s natural defenders, an array of white blood cells. The white cells destroy the unwanted endometriosis cells and you can visualise your organs healthy once again.

These images may also focus on yourself. You may like to imagine yourself in surroundings that give you enormous pleasure. For example, you may visualise yourself on a tropical island, peacefully lying on the warm golden sands while palm trees gently sway in the breeze and the waves quietly lap onto the shore.

You may like to imagine yourself walking through a field early in the morning, the lush green grass still glistening in the sun from the morning dew. You notice the deep blue sky dotted with wispy white clouds, the golden sun sending forth its warming rays and the spring flowers showing forth a multitude of colours. You then enter a cool dark forest, which feels refreshing after the warm sun. Here you may rest a while, taking in the peace and tranquillity of your surroundings, before returning to reality.

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