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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Low doses of radiation interfere with the ability of the cell to divide. Higher doses kill cells directly. Therefore any cell can be killed by radiation if the dose is high enough.

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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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‘I never heard of this disease until a few months ago. It was confirmed by the sixth doctor I went to and I wish I’d seen him before Jack, my fianc?, took off Jack was pretty fed up with me and my condition and all our trips to emergency rooms, occasionally in the middle of the night. I would double over with pain and sometime could barely breathe.

“Jade said he loved me and that he’d do anything to help, but he didn’t exactly love what he’d been hearing from the doctors: that my pain was from V.D.! It’s humiliating to be told by three different doctors on three different occasions over eight months that your symptoms—most of all your pain—add up to an advanced stage of venereal disease. Especially when you’re clean! Two other doctors treated me for a bladder disorder, vaginal infections, and once for a spastic colon. I had the reeling that they were wrong and that it was something deeper, more serious, but I didn’t know why I felt that. It scared me.

‘I was living on sulfa drugs, antibiotics, and assorted painkillers. The severest pain lasted about three or four days. Then I’d feel achy, and then okay for a while. I heard from a friend that orgasm relieved pelvic tension, so I’d try to be more sexually active. The irony was char intercourse hurt, leaving both Jack and me frustrated and angry. Jack was beginning to accuse me of faking the pain and cheating on him. It was die last test, the one for chlamydia, chat did it tor Jack. His sympathy had been strained to the limit and he left me. The pain increased in frequency and duration.

“About six months ago, I was telling a friend and her sister about the problem and I got an answer. My friend’s sister was a sufferer, too. She’d been through ten yean of misery and suffered the loss of an ovary, and she still had some problems. She said she felt as if she were reliving her own history by listening to me. When I heard about endometriosis tor the first time, the pain made sense. I finally felt I had a chance.”

It’s always sad to hear such stories of women who don’t get any emotional support or effective medical care for long periods of time. Not once was Alexa’s pain taken seriously. This is the real crisis in diagnosing endometriosis. What is the problem?

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The study of genetics concerns heredity. One has only to observe the colour and texture of one’s own skin and that of one’s children or one’s parents, to note the general similarity between them; they are, in fact, genetically alike in most respects. Such characteristics, and others, are transmitted from one generation to another by chromosomes. Chromosomes are rod-like structures, or threads, which carry a definite number of genes. The gene is composed of molecules of deoxyribonucleic acid (DNA), and the hereditary information which any one gene carries is dependent on the arrangement of the DNA molecules. The information is carried by a messenger substance to the cytoplasm by a complicated sequence of manoeuvres.

The skin defects which may be found on a baby are called developmental. Small defects are common. They are generally considered to have environmental or genetic causes. Environmental causes involve injuries to the embryo, or to the gene cells before fertilization occurs, and genetic causes are transmitted from parents.

One of the commonest defects in the skin involves the underlying blood vessels, or the pigment cells. Such small defects are called naevi or, more colloquially, birthmarks. There is no known cause for them, and usually no genetic reason. In former days they were incorrectly attributed to some shock the mother sustained during her pregnancy, or a mild illness, and some of them are still called ‘mother’s marks’ in country districts.

Birthmarks or naevi are found in over 95 per cent of white people of either sex, and to confuse the issue it must be stated that most of them are not present at birth at all.

Naevi may arise from all of the various tissues which make up the skin. The more obvious ones are those arising from the blood vessels. The most common of these is the ‘salmon paten or ‘stork bite”, which is present in about 60 per cent of infants. This type of naevus usually appears about the head and neck and usually fades completely within one year. The excessive blood vessels are very superficially situated.

With the ‘port-wine stain’, the excessive vessels are more deeply situated. These naevi also frequently appear on the head and neck, but unfortunately, usually persist. There is no effective treatment, although good masking cosmetics are available to camouflage them.

The ‘strawberry mark’ is composed of numerous capillary vessels. Such naevi are frequently multiple, and are more common on the head and neck. Most are small, but some can be very large. About 10 per cent of all infants have them, and they usually appear within the first month of life. Frequently, they enlarge quite rapidly for the first few months before stabilizing. Parents are naturally alarmed by these naevi. However they usually disappear on their own, without any treatment, by the time the child is 7 or 8 and frequently much earlier. No treatment is required unless the naevus is situated in a place where it interfere with vision or sucking, of if ulceration or haemor-rhaging occurs. Then either medical or surgical intervention may be required.

The first indication of a strawberry mark’s regression is usually a deepening of the colour, with tiny white or grey flecks appearing. These flecks then enlarge, and pale depressed areas form. Eventually the naevus shrinks and disappears, occasionally leaving a small white patch where it had been.

Those naeyi arising from pigment cells are commonly known as ‘moles’. In fact very few moles are present at birth. Most of them appear during childhood or adolescence, and are discussed elsewhere.

Various other types of naevi exist, including the so-called verrucous or ‘warty’ birthmark. These usually appear at or soon after birth, and have a linear appearance, often along one of the limbs. They normally only grow in proportion to overall growth, and invariably persist. The most opportune time to have these naevi surgically removed would seem to be either before a child commences school (about age 4) or about age 14, when the patient could have some say in the decision.

It must be remembered that all these abnormalities of the skin, although developmental In origin, may first appear at any age. They are made up of normal skin components, the proportions of which are abnormal. Therefore they are best termed naevi rather than birthmarks.

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