Heat rash takes the form of tiny blebs (or blisters) which appear in newborn babies.

Sweat glands are not fully developed in babies, and can become blocked if the baby is too hot. This is why miliaria is commonly seen in newborn babies during summer. It may also appear during a fever, or simply when a baby has been overdressed.

Clinical features

Pinkish blebs or small blisters usually appear over the face, neck and in skin folds, especially in the nappy area. If infected, they may become pus-filled.

Treatment

A tepid bath, light clothing and some fresh air is usually all that is needed for miliaria to disappear. The rash should disappear in 2-3 days. If your baby is scratching the spots, try applying some calamine lotion. Other creams or ointments are useless, and may in fact worsen the rash.

When to see your doctor

• if the spots become red or pus-filled (green). This means that they have become infected, and need treatment;

• if the rash lasts more than 2-3 days;

• if in addition to having a rash, your baby is generally unwell, has a fever or is not feeding well.

Complications

Infection (see above). ,

Prevention

Try not to overdress your baby. Carefully dry all skin folds after each bath.

Don’t dismiss every rash as ‘just a heat rash’. If in doubt, check with your health professional.

*312\90\8*

Health issues are often covered in newspapers and magazines, and on radio and television. The coverage of health issues in the media tends to be simplistic, and reports of new findings or new treatments are often sensationalised. Ask your doctor for information on issues of interest to you, as you are much more likely to obtain accurate and appropriate information.

Hospitalisation is a major stress for the child, and usually for the parents and the rest of the family too. Many parents find the hospital environment impersonal and a little intimidating. It is sometimes disconcerting to have to relate to different health professionals, to have to repeat the medical history a number of times, and to have your child disturbed frequently by repeated examinations or tests. Nurses and doctors may change according to their rosters, so discontinuity of care is the rule rather than the exception. All this can exacerbate your understandable anxiety about the health of your child. The child himself experiences major changes to his routine, a new and sometimes threatening environment, and often pain and a loss of physical well-being. There are a number of things that parents can do to make this time easier for the child and for themselves.

*16\90\8*

ABSENCE OF ORGASMIC CONTRACTIONS: I can enjoy the whole thing, but I do not come. I can go on and on, but I will not, I cannot come.

It gets so bad that I am actually screaming inside at myself to come, come, come. My partner says it. Come, come, come. I can’t, can’t, can’t.

Guess again which report belongs to which gender. The first is a wife, the second a husband. The similarity of sexual response and problems seems clear. Both genders reported problems with orgasmic contractions. One hundred fifty-five husbands and 344 wives reported such problems. When this problem occurred, it took with it in many cases the possibility of psychasm, for these people were taught that orgasm was the ultimate goal, the only goal of the sexual encounter. Without pelvic contractions, there could be no “fulfillment.” This is not true, and, in fact, these spouses learned to enjoy psychasm independent of contractions. When this happened, and the defeated, angry orientation at the center of this problem was removed, orgasmic contractions returned.

*175\97\8*

The super marriage can expand and contract, allow closeness without crowding and distance without diffuseness. A super

marriage is a super system that flows between neguentropy and entropy in an intimate rhythm of life and growth for both partners, a universal dance of intimacy, a Tao of sexuality.

The husband in our example reported, “I really cannot imagine life without her. We just are like one in a strange sort of way. A dance with no song.”

The wife added, “Well, he is not a part of me, I mean a part of me like my, I mean our, children are. I have become a part of him, an extension, sucked into his life. It’s the way a black hole must be, a spiral, with me going down further and further into him.”

This same compensated pattern was reported in the bedroom. “The more things change, the more they stay the same,” said the husband. “We just repeat the same things in the same way. We could practically just call out the numbers or use hand signals. I lie on my right side, stimulate her, then we do it. That only changed once when I broke my right arm in a softball game. I was on her left side then, and it was like making it with a different woman.”

“It’s like a merry-go-round without the merry,” added the wife. “He sort of works on me. He wants me to suck him after I come because that’s the only time I can force myself to do it. Then he goes in, does it, the end.”

Each time this couple makes love, the neguentropy, the merging, becomes stronger. They do not become more intimate, they become more trapped, stuck with each other and suffering together. They crash rather then merge. They have a type of marital implosion.

*35\97\8*

Even when the diagnosis appears certain, it may be necessary for the doctor to carry out a number of specific tests, such as a cardiograph, X-rays or blood examinations, to convince both the patient and himself that there is no underlying organic cause.

It is important for the doctor to give his patient a full explanation of how the symptoms have come about. If the doctor merely tells his patient that the problem is due to “nerves” and gives him a prescription for a tranquilliser, the patient will go away unconvinced.

The doctor should treat these patients with sympathy and understanding. He should not make value judgments about their ability to cope with their stresses. They are suffering from a real illness, even if it tests his ability in diagnosis and treatment.

Teaching the person how to relax and come to terms with the stresses of life is also important.

It may be necessary to use drugs to modify the response of the various organs to these nervous influences. Antispasmodic drugs may stop the overactivity of the bowel in nervous diarrhoea or other drugs slow the heart’s action.

*544/71/1*

Depression can happen to anyone but is more likely in those with certain personalities.The over-conscientious or the compulsive-obsessive personality are more prone.

The house-proud housewife who is a perfectionist in her outlook falls into this category.

The woman who washes on a certain day, shops on another and who must stick to her routine, no matter what, is often deeply anxious and can only cope with her anxieties by adhering to a routine. If this routine is upset and she loses control of it, she may slip into depression.

The same may apply to the male clerk or executive who has a fixed routine and high expectations of his own efficiency.

He is critical of his own work and that of others and cannot delegate responsibility, nor can he accept his own ‘weaknesses’ if he becomes emotionally ill. These people often exhibit what is called masked depression.

Heredity may play a part in depression, as it appears to run in families. There is also the environmental influence of the family.

*287/71/1*

Cystic fibrosis is a common childhood disorder, yet few people know about it.

In Australia, one child in 2500 is born with it, and one person in 25 carries the recessive gene which causes it.

Eighty children with this disease will be born each year in Australia.

Cystic fibrosis (CF for short) is a genetic disorder. Because it is caused by a recessive gene it will develop only if a child receives two recessive genes, one from each parent.

If he has only one such gene, the disease does not develop. That person, however, is a carrier.

If one child in a family has the disease, then each subsequent child will have a risk of one in four of having the same disease.

The basic problem in cystic fibrosis is that there is a widespread disorder of mucus-secreting glands.

It particularly affects the lungs and the pancreas which lies high up on the back wall of the abdomen behind the stomach.

It has two main functions. One is to produce enzymes, and this is the part affected in cystic fibrosis, which pass along a small duct to the first part of the small bowel. These enzymes are necessary for the proper digestion of fat and protein.

*36/71/1*

Firstly, cancer is not inherited. You cannot pass it on to your children, even when cancer develops during pregnancy. There are a few very rare types of childhood cancer which are an exception such as retinoblastoma, a rare cancer of the back of the eye. There are also some rare inherited conditions (such as von Recklinghausen’s disease, xeroderma pigmentosa—ë òàòå skin disease, and some other conditions associated with multiple benign bowel polyps) which are associated with an increased risk of cancer. However, no common type of cancer is inherited. Ask your practitioner about your particular case if you are worried about this.

Secondly, as far as we know, no type of cancer is infectious. No type of cancer can be passed on directly by any form of physical contact, however intimate. However, it is true that some types of infection are linked with some particular types of cancer. For example, many, but not all, patients with a rare cancer called Burkitts’ lymphoma have antibodies to one particular virus, indicating that they have been previously infected by that virus. Many, but by no means all, patients with cancer of the cervix have evidence of previous infection with a certain herpes virus. The cancer called Kaposi’s sarcoma occurs in some patients with

AIDS (Acquired Immune Deficiency Syndrome)— AIDS is caused by a virus. Each of these cancers also occur in patients who have no evidence of previous infection with the particular virus involved. There is not a direct cause and effect relationship—the great majority of people who are infected with these viruses do not get cancer. As with cigarette smoking, it seems that the virus is simply a factor which can operate with other unknown factors to produce cancer in a small proportion of those infected.

*44/40/1*

The commonest side-effects are:

• feelings of nausea

• breast tenderness

• feeling bloated before a period

• slight weight-gain

• disturbances of the digestive system

• leg cramps

• headaches

• feelings of pre-menstrual tension and other complaints caused by taking progestogen

Although this may seem a daunting list, most of these problems are quite short-lived for the majority of women on HRT.

Feelings of nausea. These usually wear off quite quickly, and are much less of a problem with the patch and implant than with tablets.

Breast tenderness. This, too, usually wears off after the first week or two. If it is troublesome, it may be relieved by starring with a low dose of oestrogen and building up once your body has become used to having the hormone again.

Feeling bloated. This is caused by fluid retention, and may include swollen ankles. Talk to your doctor about it; he may prescribe ‘water tablets’, or the symptoms may subside by themselves.

Disturbances of the digestive system (known as gastrointestinal disturbances). These are more common with oral HRT than with other types. If you take the oral form, these symptoms are often relieved by taking the tablet with food, or at bedtime; if this doesn’t help, a non-oral route like the patch or implant may solve the problem.

Leg cramps. Cramp, especially in the calves, sometimes occurs in the first few months of taking HRT. It may be worse at night, and usually disappears before long. If you regularly get cramp in one leg only, mention it to your GP, who will want to check that you are not at risk of developing a thrombosis.

Headaches. These are usually short-lived, too. If you developed migraine at the time of the menopause, HRT may relieve it; if the HRT causes headaches, they should pass, but if they don’t your doctor may suggest changing the dosage or type.

PMT and other symptoms of progestogen These have been covered in Chapter 3. Again, the patch form of progestogen may see the end of many of these troublesome complaints, so should the newer progestogens when they become available.

*54\42\4*

If you are considering any sort of investigation or treatment, Australia’s National Health and Medical Research Council recommends that you ask your practitioner the following sorts of questions:

• What is the possible or likely nature of my illness or disease?

• What is your proposed approach to investigation, diagnosis and treatment?

— what does this approach entail?

— what are its expected benefits?

— what are the common side-effects and risks of the intervention proposed?

— is the intervention a standard procedure or is it experimental?

— who will carry out the intervention? How much of that particular procedure has that person performed? And with what results, including rates of complications in her/his series of patients. (If he/she doesn’t know, this may indicate a reluctance to self-monitor and may be a bad sign.)

• What are the other options for investigation, diagnosis and treatment?

• How certain is the diagnosis?

• How certain is the treatment outcome?

• What is likely to happen if the proposed investigation or treatment does not occur, or if no procedure or treatment is undertaken?

• What significant long-term effects may be associated with particular investigations or treatments?

• How much time is involved in conducting particular investigations or treatments, and in recovering from them?

• What costs are involved, including costs payable after receiving Medicare and health-insurance rebates?

If you find it difficult to ask these sorts of questions, take someone along with you who can.

*68\198\4*