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Otitis media is caused by infection of the eardrum by either a germ (bacteria) or a virus. Bacteria are responsible for about two-thirds of acute ear infections.

Usually an ear infection is accompanied by general signs of infection. Depending on the age of the child, these may include fever, irritability or drowsiness, loss of appetite, nausea or vomiting and sometimes diarrhoea, and headache.

While sometimes ear infections are ‘silent’ and do not cause any specific symptoms, usually the child will complain of earache or of a feeling of fullness or pressure in the ear. In babies there may be prolonged crying and pulling at the affected ear.

Ear infections may cause a temporary decrease in hearing, so that some children may have noticeable partial deafness during ear infections. Occasionally the eardrum may rupture (perforated eardrum), with a thick and sometimes bloody discharge. This results in relief of the pressure that has built up in the ear as a result of the infection, and eases the pain. The main complication of an acute ear infection is that it will turn into a ‘glue ear’ and affect the child’s hearing over a period of time. This may result in a delay in the child’s language, speech and communication skills.

Investigations

Apart from careful inspection of the child’s ear using an instrument called an otoscope, the doctor (usually a paediatrician or ENT specialist, although some general practitioners may also have this equipment) may perform a procedure called tympanometry, which measures how mobile the eardrum is and may assist in the diagnosis of whether the ear is normal. This is a painless procedure which takes a couple of minutes. If the child has had a number of ear infections, or if the doctor suspects there may be a chronic infection or a glue ear, then he may organise a hearing test. A formal hearing test should always be arranged if you suspect that the child has difficulty hearing.

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Many women experience some nausea and even vomiting during the early stages of pregnancy. Morning sickness is actually a misnomer as nausea can occur at any time of the day or night. You may feel an aversion to certain types of foods and these are best avoided until the period of morning sickness passes. Make sure that you keep up your fluid intake and try to eat small amounts of food at frequent intervals. Do not take any anti-nausea medication as this can be dangerous for your baby whose vital organs are developing at this stage. Make sure you rest a lot, and eat as soon as you feel hungry. Having a cup of tea and toast before you get out of bed in the morning often helps prevent early morning nausea. Avoid greasy or sugary foods. If vomiting persists, or you are losing weight, consult your doctor.

WEIGHT GAIN DURING PREGNANCY

The usual weight gain during pregnancy is 12-15 kg. If you gain an excessive amount of weight, it will be difficult to lose once the baby is born. Try to maintain a healthy diet, and exercise regularly but moderately during pregnancy. If you have concerns about your weight during or after pregnancy, consult your doctor.

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the world. She would watch it all night. She gets turned on to it

and even wants to try some of the stuff. She reads those sex

magazines and gets all turned on. Why does that stuff get her?”

ANSWER: That stuff doesn’t “get” her. She is not responding just to the erotic material. Her arousal, as yours, comes from within, and something about some of this material touches a part of the love maps we discussed. Sometimes just the fact that this material is forbidden is part of the arousal factor. If she feels isolated from you because of it, this isolation will not diminish her interest in it. There are two options here. One is to explore the possibility of setting up your own mutually accepted “erotography” collection, one that you can both accept without labeling each other or criticizing each other’s preferences. Second, a super marital sex rule is that not all sex has to be shared sex. If you cannot, and you certainly do not have to, develop a tolerance or even enjoyment for some of the material she finds arousing, then you should encourage her to enjoy the material in privacy, without overt or covert censure. Her arousal is a part of her and your marriage. It is not determined by or corrupted by this material. The sex you have together is just yours, no matter what factors might have resulted in arousal.

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Some drugs may cross the placenta and affect the child and others may reduce placental circulation. The blood pressure may rise alarmingly during labor.

If it affects the foetus, it may be necessary to induce labor before term and sometimes to cut short the labor by caesarian section.

High blood pressure has few, if any, symptoms but serious complications. There is evidence that treating this condition can reduce the risk of complications and thus be true preventive medicine.

But problems arise for doctors in deciding when to treat and with what, and for their patients in deciding if the long-term result is worth the short-term discomfort.

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Those who adopt a “health foods” diet do so in a belief it will prove healthier than eating meat, food additives and “junk food”.

But those on vegetarian diets may run other risks to health if the diet is not adequately balanced. Strict vegans, who eat no animal products may suffer from vitamin B12 deficiency and so develop a form of pernicious anaemia.

There is now evidence that some pre-school children fed a macrobiotic diet which consists mainly of unrefined cereal grains, vegetables and nuts may develop rickets, a bone disorder where calcium is not laid down properly in the growing bone, due to vitamin D deficiency.

Children on a macrobiotic diet should have a vitamin D supplement, usually cod liver oil and extra calcium and adequate exposure of the skin to sunlight is also necessary as vitamin D is also made in the skin by the action of ultraviolet light.

Things aren’t always as they seem and there are few absolutes. Your alternative healthy diet may still have its problems.

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The most common condition behind attacks of vertigo is Meniere’s disease, a degenerative condition of the middle ear usually affecting people for the first time in their fifties. Apart from the dizzy spells and periodic loss of balance, a person with Meniere’s disease (sometimes known as Meniere’s syndrome) may experience ongoing ringing in the ears (called tinnitus), and gradual hearing impairment. The cause of Meniere’s disease is little understood but believed by some medical practitioners to be caused by congestion of the lymphatic system. While medications such as Dramamine help manage the vertigo, they will not cure the disease and will not prevent the loss of hearing.

Simple motion sickness can lead to vertigo as can bacterial infections of the inner ear and viral infections such as influenza. The sensations may continue even after the patient appears to have recovered from the more acute symptoms of the ‘flu. See separate entries in this book for the treatment of these conditions.

Recurrent attacks of vertigo may also be caused by the pressure of a tumour or non-cancerous growth on the auditory or acoustic nerve. High blood pressure or hardening of the arteries may also be responsible and strokes can bring on vertigo in the elderly. If attacks of vertigo are unexplained and recurrent, you should seek medical advice. Some health practitioners recommend acupuncture with moxibustion for the management of dizziness and vertigo.

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Antacids that contain aluminum, Archives of Internal Medicine (143:657) reports, can become a major factor in weakening the bones. However, since they do not produce any noticeable unpleasant side effects, people continue taking them for stomach pains and indigestion.

These drugs work by binding and neutralizing gastric acid. Unfortunately, they also bind with and prevent the absorption of phosphoric acid, which is then carried away in the stools. To compensate the body for this, the bones release some phosphorus into the bloodstream, together with the calcium with which it was bound. This calcium is quickly carried away through the kidneys.

In this way, aluminum antacids taken year after year can deplete the skeleton of calcium and phosphorus and cause thinning and weakness of all the bones. This results in fractures occurring in response to only trivial trauma, and to pseudofractures, a condition in which bones crack but do not break completely, causing weakness, pain, and stiffness that are often mistaken for arthritis.

Doctors, more and more, are becoming aware of this danger, but aluminum-containing antacids are still widely prescribed and can be purchased without prescription. The trouble is that it takes years for the cumulative bad effects of repeated doses to show up and, later in life, people tend to accept bone pain and fractures as a natural effect of aging.

To compensate for this danger, the Archives recommends, we should take extra calcium and phosphorus when using medications that contain aluminum or, better still, take stomach medicines that are aluminum-free. Aluminum, remember, poses other serious threats as well (see, for example, the articles on Alzheimer’s Disease). One of the least expensive and most readily available forms of calcium in tablet form is the antacid Tums. Before purchasing an antacid, read the list of ingredients on the labeling. The pharmacist can tell you about products that are aluminum-free.

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The major symptoms are nasal congestion, sneezing, clear nasal discharge, and itching of the nose. This runny, itchy nose leads to the frequent rubbing of the nose referred to as an “allergic salute.” Membranes inside the nose are pale and white instead of the normal pink.

The eyes may also be affected. Congestion in the sinuses may cause a headache. The ears feel blocked and are sometimes painful. The child may not hear as well as usual if there is congestion in the Eustachian tubes (which connect the nose with the ears). The child may have bluish bags under the eyes, called “allergic shiners.” The child may snore and complain of fatigue (allergic fatigue syndrome). If oral antihistamines quickly relieve the symptoms, this is often a clue that the congestion is due to an allergy rather than to some other illness.

Secondary (additional) bacterial infections are common complications of hay fever. Symptoms of an additional bacterial infection include fever, moderate to severe earache, swollen glands in the neck, or opaque (green, yellow, or milky) nasal discharge.

Home care

Consult your doctor before giving child medications for hay fever. The most common medications for hay fever are oral antihistamines. Decongestants containing ephedrine, pseudoephedrine, or phenylpropanolamine may provide added relief.

Whenever possible, try to avoid exposing the child to substances that seem to cause hay fever reactions. (The dander of a cat or dog allowed in the house only once can remain in the home for four to six weeks.) Keep the windows closed against pollens, and use an air conditioner if possible. Hot air ducts should have filters at room inlets to reduce the amount of dust in the air. Use non-allergenic (non-allergy-causing) pillows and keep the house as dry and free from humidity as possible.

Precautions

• Rubber pillows, which are considered non-allergenic, may breed molds as they age. • Avoid repeated use of decongestant nose drops and nasal sprays. These can cause worse congestion following the initial, brief relief.

Medical treatment

The doctor will confirm the diagnosis by examining the child’s nose and by testing nasal secretions for allergic white blood cells (called eosinophiles). As well as confirming the diagnosis, your doctor can help identify the offending substances by investigating the child’s medical history and, if necessary, conducting allergy skin tests. Your doctor may recommend desensitization shots for severe cases. These shots decrease the child’s sensitivity to the allergy-causing substances.

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