There are numerous causes for a ‘tummy ache’. It is most often due to excessive gas or indigestion which are not serious. Anxiety or stress can also cause ‘butterflies’ in the tummy. Abdominal pain may herald the onset of food poisoning or gastroenteritis. Severe pain may be due to more serious illness such as appendicitis or intussusception. Recurrent abdominal pain may be associated with constipation or urinary tract infection, although it is common for no cause to be found.

Clinical features

The nature of abdominal pain varies according to the specific cause. Pain may be crampy and general, such as with excess gas, or sharp and in one area only, as with full blown appendicitis. It may occur in recurrent bouts or as an isolated acute event. Other symptoms often associated with abdominal pain include loss of appetite, nausea, vomiting and diarrhoea. The pain is more likely to indicate something potentially serious if it wakes the child from his sleep, or it is in a specific, localised part of the abdomen, i.e. away from the umbilicus.

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COMMON PROBLEMS WITH BREASTFEEDING

Although breastfeeding is natural, it does not always ‘come naturally’. Ask for help if you need it, and don’t feel embarrassed. Most breastfeeding problems can be solved with a little good advice and a lot of patience. If things do start to go wrong, ask for help early on; do not wait until you are distraught and ready to give up.

Inverted nipples

If your nipples turn inwards, or do not stick out, it may be more difficult for the baby to attach properly to your breast. Commercial nipple shields are available which may make feeding easier, and these should be used in addition to expressing with a breast pump to draw the nipple out. It is always wise to seek advice from a breastfeeding counsellor if you have inverted nipples. The baby’s sucking is usually in itself enough to draw out the nipple.

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“Are you serious?” asked one wife. “You want us to make our own X-rated tapes?”

That’s up to both of you. I am suggesting short tapes of the two of you talking, dancing, doing things together. If you check your family pictures and movies, most of them do not contain pictures of the two of you together. Videotapes of your communication, of dinners and other interactions could teach you much about your pattern of interaction. The videotapes of couples communicating in the clinic are among the most helpful of clinical tools, especially when the couples review them carefully. By discussing the tapes, each partner becomes aware of the other’s style of relating, emphasizing self-analysis and the responsibility of each partner to the interaction. The communication styles reflected the reports of sexual styles. Videotapes can be to marriage improvement what X rays have been to medicine. They can be abused and dangerous if overdone, but if carefully used in moderation, they can help us see through a lot of marital problems.

It may be helpful to set up a role-rehearsal tape where there are preassigned situations, such as a vignette in which one or the other partner must announce something to the spouse that the spouse typically gets angry about. Study your marriage and see if there are not some good role-rehearsal patterns you could use.

More couples make their own sex tapes than are willing to admit it. Fifty-six couples of the thousand stated that they did so. Watching yourselves make love can teach much if the couple approaches this opportunity with humor, sensitivity, and mutual concern for intimacy and respect. If one partner is “just going along” with this idea it is probably not productive to do it. M-rated (“M” for marriage) tapes are certainly of much more value than the X-rated tapes of complete strangers, because they are modeling the sex of the first three perspectives while you are trying to learn a fourth. The tragedy of the couple in the introduction to this book was that they were looking to the couple in the tape to find the intimacy that was right there between them, they failed to realize they are the stars of their own intimate drama.

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Sheila was treated in my clinic for loneliness and depression. She felt that she would never love or be loved again. During her therapy, she reported another trip to another bar. By her report, this particular bar was one of the darkest she had ever been in. It seems that most bars are quite dark, perhaps another way of promoting deception in the courtship ritual?

“I went this time just to hear the band. I got a soft drink and sat far enough from the speakers to hear quality instead of volume. Well, I really got into the music. This man came and sat beside me. We didn’t talk, but I could tell he was really into the music, too. We listened to the whole set, about forty minutes, I’d say.” Sheila continued to describe a meeting that would begin an entirely new relationship.

“I spoke first,” Sheila continued. “Not really to him, just sharing how I felt. I didn’t even look at him. I told him that the last song made me want to cry because it reminded me of my ex-husband. He answered, “Me, too. And by the way, you look familiar.”

“Well, I know you won’t believe this, but I was familiar. It was my ex-husband,” continued Shelia. “He had seen me sitting here and come over to talk. He didn’t want to bother me when I was so engrossed in the music and was kind of embarrassed about the whole scene. We laughed, but I think we were crying. You know what? I’m going out with him this Friday night. I hope we do it right this time.”

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How can we prevent tetanus? Active immunisation is the answer.

A vaccine, tetanus-toxoid, is given by injection into the muscles. Three injections are necessary.

The first two are given six weeks apart and the second and third injections some six months or so apart.

Primary immunisation is carried out in infants usually associated with prevention against diphtheria and whooping cough by the use of triple antigen.

After the age of two reactions to the whooping cough vaccine are common and so this is dropped.

CDT, or combined diphtheria-tetanus vaccine is used instead. Later tetanus-toxoid vaccine is given alone.

Recently an adult combined diphtheria-tetanus vaccine (ADT) has been recommended so as to boost the adult’s immunisation against diphtheria.

If immediate passive protection is required in those who are unimmunised, or whose immunisation may have waned with time, then tetanus immunoglobulin which is prepared from human serum is used.

This rarely causes any reaction.

Triple antigen is given to children starting at eight to 12 weeks of age. There are three injections usually a month or so apart.

At 18 months a booster of triple antigen is given. At five years a CDT and at 12 years a tetanus-toxoid vaccine alone completes the course of immunisation in the child.

If a tetanus-prone wound should happen and more than two years have passed since the last injection then a booster of tetanus-toxoid should be given.

If over 10 years has passed and a tetanus-prone wound occurs then not only the tetanus-toxoid but the tetanus immunoglobulin should also be given.

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Now, diverticular disease is the commonest bowel disorder, with more than a third of those over the age of 40 suffering from it.

A diverticulum is a pocket or blowout of the lower bowel. It is really a hernia of the inner coat of the bowel wall, the mucosa, through the muscular coat at the point where the blood vessels penetrate and leave a weak spot.

The increase of this disease is thought to be due to the change in the diet of Western nations. As affluence increases, so diet changes, with indigestible fibre or bulk being removed and foods becoming highly refined.

We once thought this bulk was unnecessary. Now we realise that our bowel needs it to function properly.

In those countries which have this refined diet and in those developing countries changing their diet, several unrelated diseases of the bowel have become more common. These are appendicitis, haemorrhoids or piles, diverticulitis and cancer of the bowel.

When the diet is high in fibre or indigestible residue, the transit time for passage of food through the whole gut is about 30 hours.

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Basically, tests to determine the extent of a cancer should be done only if the results would influence your treatment and care. Keep this in mind when tests are being arranged. Ask your doctor to explain the reasons for the tests he or she recommends, especially if you can’t see what difference their results would make. Some doctors keep arranging more and more tests rather than face up to telling a person that their cancer cannot be cured, or some other unpleasant news. They do this to protect themselves, and at your expense. Don’t let them get away with it. Only agree to tests that are being done for a good reason that you understand.

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Unfortunately, there is nothing ordinary about measles. It is a serious disorder, with many complications.

German measles, while a mild illness, can cause severe complications in a developing child if a woman contracts it during pregnancy. Let’s have a look at these two disorders which are both labelled “measles”.

German Measles is more properly called rubella and this name should always be used so that no confusion arises between it and measles.

Rubella is a common and mild illness due to a virus. It has an incubation period of between 14 and 21 days.

It can occur at any age, but most infections are contracted in childhood. Nearly 90 per cent of women have had the infection by the time they become pregnant.

There may be a mild illness for a few days but, usually, the rash develops first. It is a fine, discrete, pink rash affecting the face, trunk and limbs. It only lasts a short time, often less than two days.

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