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Parents and other family members are understandably devastated by SIDS. They feel anger, guilt, frustration and above all, grief. Anger is often directed towards health professionals, for somehow not preventing this from happening, or towards family or friends. Parents will re-examine every moment over the last few hours or days of their child’s life, searching for some clue as to what may have contributed to the death. They will also feel guilty, wondering whether, if they had done things a little differently, the baby might still be alive. They may feel guilty that they did not check on the baby before going to sleep themselves, or that the cot was not in their room, or that they did not wake the baby for a midnight feed. Some of these thoughts are rational, others are not. They are a normal part of the grieving process, and will come up irrespective of any reassurances.

The parents can be reassured that there is absolutely nothing that could have predicted the death of the baby, and nothing that could have been done to prevent it. In each state there now exist branches of the SIDS Foundation, which provides counselling for bereaved families, as well as funding SIDS research and conducting community education about SIDS. It is frequently of enormous assistance to families to talk with trained counsellors from this organisation. The tragedy will also have a devastating effect on siblings, as well as on members of the extended family such as grandparents, and counselling should be considered for these family members too.

Some parents form even closer attachments to surviving children, or to subsequent babies. While this is understandable in the short term, it can be problematic for both those children and the parents in the longer term. Alternatively, pare it may grieve for the dead child to the extent that they neglect the emotional needs of surviving children. There is considerable variation in the way families handle the grieving process. Some may feel the need to talk about their sorrow, while others bottle up their emotions. Others will concentrate on ‘getting on with life’, making themselves very busy, as if to avoid having time to think about their feelings.

Sometimes the death results in increased tension between the parents. This can be due to a number of reasons, from different ways of handling their emotions, to disagreements about having future children. It is very important that families be supported through these times in ways that are appropriate to them, taking into account and respecting the fact that all individuals will have differing needs. Sometimes referral to a trained professional such as a psychologist, social worker, grief counsellor, or seeing a sympathetic family doctor is of immense help, while others may be helped by a minister of religion.

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Alcohol Daily consumption of alcohol during pregnancy, as few as two or three drinks a day, can lead to problems with your baby’s development and growth, the risk of prematurity and even congenital abnormalities including heart problems. Babies of alcoholic mothers are at increased risk of suffering from foetal alcohol syndrome. Babies affected by this have stunted growth, mental retardation and abnormal facial features. Alcohol is best avoided entirely during pregnancy. If you drink more than 2-3 glasses of alcohol per day and are unable to cut down during pregnancy, we suggest you discuss this with your doctor.

Smoking Women who smoke during pregnancy tend to have smaller babies. The chemicals breathed in include nicotine, and interfere with the baby’s growth. Statistics show that, on average, the baby of a mother who smokes during pregnancy weighs around 200 g less than average. (If a baby is significantly underweight when it is born, it is less likely to thrive and remain healthy.) It is also at a higher risk of developing complications at birth, and there is a significant risk of it being born prematurely. Passive smoking may also affect the baby before it is born, so it is advisable for the mother’s partner to refrain from smoking in the house. If you are unable to stop smoking during pregnancy, we suggest you discuss this with your doctor.

Painkillers Check with your doctor before taking any medication during pregnancy. Painkillers in particular can be harmful to the baby in many different ways. Try relaxation techniques, yoga or massage as an alternative for pain relief.

Drugs of addiction These can cause severe problems during pregnancy and birth, and the baby may also be ‘addicted’ and suffer severe withdrawal symptoms after birth. The baby is usually underdeveloped and may become severely ill. It is important that you let your health professional know if you are using any drug of addiction during your pregnancy.

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I just don’t know where time goes, but it goes somewhere. It moves ‘ faster and faster. If you talk to anybody, they will tell you that time seems to be going faster and faster, seasons merging into seasons. No matter what else we do, there just isn’t much time for sex if there isn’t much time for anything.

WIFE

Our concept of time is tied directly to our concept of life and living, how we view our world, those we love, and what we hope for and expect out of life. I have discussed the time issue in earlier chapters, but there is one central point the couples raised that can help all of us view time in a somewhat different way.

“When we are actually having sex,” reported one wife, “while we are doing it, there is no time at all. I mean, time doesn’t stop or go, it just isn’t. Now, after we have sex, we sometimes lean over and check to see what time it is, but during our sex, that is the only time there is no time.”

This wife and other spouses interviewed indicated that sexual intimacy, the total involvement and merging with another person, is not tied to the time dimension. As pointed out earlier, modern physicists, including Einstein and other so-called new physicists, have documented that time is not a concrete, easily measured “thing.” It is, rather, a highly abstract concept that depends on where we are, whom we are with, and what we are doing. During super sex, we are with the person we love, doing what we want to where and when we want to do it. Our consciousness is altered We are more into someone, responding to that someone rather than carried along by the ticks of a clock.

Perhaps time seems to be going so fast because we watch it so much. The abstract, subjective nature of time is reported by the following spouse with cell disease: “I have learned to sit and do nothing or to make love with my husband. Then time stands still or seems to go slowly. When I first learned I had cancer, I started to do everything I could to stay active every moment. I think I was speeding up time”, because the more I did, the less time there was. Now just sitting, even being bored, seems to make more time.” We do not have to be victims of time if we set the rhythm of our own living.

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A rise in blood pressure may be due to other conditions. Most forms of kidney disease can cause it, including congenital anomalies of the kidneys or the arteries leading to them.

It may be due to chronic infection or inflammation of the kidneys. Disorders, particularly tumors, of the adrenal glands, which lie above the kidneys, may also cause hypertension.

Many of these secondary cases can be treated and cured and so, particularly in the young, they should be looked for before the decision to treat the high blood pressure.

The doctor should take a full history, then carry out a complete physical examination and, as in most other medical conditions, this should reveal the true diagnosis.

Special examinations may then be necessary to confirm or deny the diagnosis but do not replace the need for history and examination.

Special tests may not only reveal underlying causes but also any damage to other organs.

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Acne is mainly a problem of teenagers. The overactivity of the oil glands in the skin is due to the action of androgens or male sex hormones.

These are produced in both sexes but, in the female, are dominated by oestrogens or female sex hormones.

When there is an excess of androgens in the female, acne or excess body and facial hair may result.

Diet is no longer regarded as being of great significance in treatment. Local applications of sulphur-containing lotions have been abandoned, as, in some people, it has caused an increase in the number of blackheads.

Sometimes the strongly oestrogenic forms of the Pill have been of benefit in controlling the acne of young women.

Oestrogens given to young men will certainly reduce or clear their acne but at the price of interfering with testicular function. This may cause enlargement of the breasts, a female type of distribution of body fat and a decrease in sexual desire.

The tetracycline group of antibiotics have been widely used for some time. These are given in small doses over a prolonged time. Local applications of benzoyl peroxide or retinoic acid (tretinoin) have replaced other local applications and seem to offer better results.

Young women taking tetracyclines for acne should have adequate contraception if they are sexually active. This drug can, in early pregnancy, lead to disturbance of bone growth as well as causing staining of the baby’s teeth.

The scars left from acne may be unsightly but can be improved by the treatment known as dermabrasion. The superficial layers of the skin are abraded.

Never squeeze a pimple; it only makes it worse, spreading the infection and leading to scars.

No teenager needs to suffer from severe acne as treatment is now available.

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Dental caries, or tooth decay, is caused by an accumulation of plaque deposits on the teeth. Plaque is a colourless mixture of saliva, food particles and bacteria. The bacteria act on starchy and sugary foods to produce lactic acid, which in turn acts on the surfaces of the teeth. Once the enamel is penetrated, the decaying process eventually leads to toothache.

It is impossible to prevent plaque forming, and the use of plaque disclosing tablets will reveal the amount of plaque present on your teeth. The best prevention is reducing the intake of refined sugars and effective oral hygiene, including brushing and flossing. There is also some evidence that vegetarians suffer less from dental caries than the rest of the population.

Toothbrushes should be replaced every three to four months and should not be too hard. Teeth should preferably be brushed after every meal. If this is not possible, rinse the mouth thoroughly with water. Brushing after breakfast and before going to bed is recommended as a minimum to prevent plaque building up.

Brushing technique involves brushing down on upper teeth and up on lower teeth. Brushing should commence at the gums and move to the outer edges of the teeth. Make sure you brush the backs of both upper and lower teeth. Scrub the teeth thoroughly for three minutes.

Flossing is also an important aspect of dental hygiene. Floss is a thin thread which can be purchased from the chemist either waxed or unwaxed. Flossing enables you to remove food particles which have lodged in areas inaccessible to a toothbrush. The floss should be strung tightly between the index fingers, inserted between the teeth and moved up and down to a point just under the tissue of the gum. Flossing massages the gums and improves circulation.

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When kidney failure progresses to the point where urinary waste products accumulate in the bloodstream, either dialysis or a kidney transplant is required. At different times, both may be needed by the same patient. During the first year, for instance, rather than accepting the first available kidney, which may not match well with the recipient’s tissues, it may be safer to continue dialysis until a kidney which matches well becomes available.

However, the record of the hospital where dialysis is being given should be taken into account. For instance, according to Medical World News (22#25:16), the success of dialysis (as measured by the percentage of patients surviving one year), varies from hospital to hospital by as much as from 55 to 85 percent.

After the first year, the success of dialysis falls so dramatically that a transplant then offers a much better chance of survival, even with a kidney that does not closely match the host’s tissues. Three-year transplant survival can vary between 65 and 85 percent, depending on how well the tissues match.

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Symptoms in boys: burning during urination; discharge from penis

Symptoms in girls: vaginal discharge, abdominal pain.

Gonorrhea in girls often shows no symptoms.

Home care: Gonorrhea must be diagnosed and treated by a doctor.

The best preventive measure is to provide your children with appropriate and adequate sex education.

Precautions:

-    Be aware that venereal (sexually transmitted) gonorrhea is being seen with increasing frequency among sexually active teenagers and younger children.

-    Sexually abused children may contract this disease.

-    A mother who has gonorrhea can transmit the disease to her baby as the child passes through the birth canal during delivery.

-    A girl with gonorrhea may show no symptoms and the infection may go undetected and untreated, with serious consequences including sterility (inability to bear children).

-    Some doctors recommend that sexually active girls be tested for gonorrhea at the time of routine school or annual medical checkups.

Gonorrhea is an infection caused by a specific gonococcus germ, which is usually sexually transmitted.

In the days before antibiotics, infants born to mothers who had gonorrhea commonly developed gonorrhea infections of the eyes, which caused blindness. Now antibiotics and the required Credes treatment (placing silver nitrate solution into the eyes of all newborns) have almost eliminated this previously common cause of blindness.

Today, venereal (sexually transmitted) gonorrhea in adolescent and younger boys and girls is being seen with increasing and alarming frequency. One of the dangers of genital gonorrhea is that often a girl who has gonorrhea will show no symptoms; therefore, the infection may not be detected and treat. Serious consequences, including sterility, may result from untreated gonorrhea in females.

Another disease, caused by gonococcus bacteria, is now being recognized in adolescents and even in younger children who have been sexually abused. It causes sore throat and anal infection, with or without fever. Ordinary throat cultures done for sore throats do not grow the gonococcus germ, which leads to the false conclusion that this infection is viral and that no antibiotic need be prescribed.

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