Nappy rash is common and may occur despite the most careful attention to your baby. Almost all children get nappy rash at some stage if they wear nappies. In cultures where nappies are not worn, nappy rash is unheard of. Cloth nappies tend to cause fewer problems than disposables, which do not let air circulate. Plastic pants should not be used if possible, for the same reason.

Cause

Various factors combine to cause nappy rash. The main cause is prolonged contact of a wet or dirty nappy with the baby’s skin. Ammonia may be released from the urine and this further irritates the skin. The use of plastic pants may make the rash worse because air cannot reach the skin, and as a result of this moisture is retained. Associated conditions such as eczema or thrush (Candida albicans) may make the rash worse.

Clinical features

The skin in the nappy region looks red and sore. Some areas of skin may be raised or swollen and there may even be ulcers present. Skin folds are usually not involved because they are protected from exposure to urine. The rash may cause discomfort or pain, which may make the baby irritable and he may cry more.

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In recent years there has been a trend back to breastfeeding. Sometimes the pressure placed upon new mothers to breastfeed can be very strong. Although the advantages of breastfeeding seem clear, if you choose to bottle-feed, you can rest assured that your baby will not suffer. The most important thing is that you and your partner feel comfortable with whichever method you choose for feeding your baby. Attempting to breastfeed when you have real difficulties or clearly do not enjoy it will only make you edgy and irritable, and you will communicate these feelings to your baby. Feeding is a time for closeness, where a special relationship develops between parent and baby. It is an opportunity for both to relax and enjoy each other’s company. If you decide not to breastfeed, whatever the reason, you can still achieve this closeness if you make the effort to regard feeding as a ‘special’ time together rather than just a chore. Bottle-feeding is discussed in more detail later in this chapter.

PREPARATION FOR BREASTFEEDING

If you decide that you would like to breastfeed, no preparation is necessary during pregnancy. In particular, there is no need to use special creams to make your nipples tougher, nor should you try to express colostrum before the birth of your baby. If your breasts become bigger during pregnancy, you may need to buy a comfortable maternity bra to give you added support.

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Many of the couples lacked effective verbal communication skills regarding sex. “I want to tell her to suck me down there, but it sounds dirty,” said the husband. “I hate the sound of that,” answered his wife. “It just sounds crude.” To help with this problem, couples are asked to play the sexual-synonym game. They write down all the words for the genitals, breasts, and intercourse that they can think of and talk about them. This exercise helps in the building of a marital sexual vocabulary, not to mention the fun of the marriage. “She said her synonym for penis was ‘Richard’ because the word ‘dick’ was too dirty,” said the husband, laughing. “Right,” said his wife. “But I really broke up when you called cunnilingus ‘eating at the Y.’ ”

“Okay,” responded the husband. “You want to reveal your creative name for the penis and the testicles? It is really quite artistic. She called them the light tower on the rocks.”

This banter came from the same couple who weeks earlier could not discuss sex in other than the most cryptic of terms.

Sometimes spouses became trapped in projected roles, seeing themselves in ways they feel they must behave rather than allowing themselves to change and develop sexually. “She would never in a million years say the F word,” said the husband. “I would, too,” answered his wife. “The trouble is, you use it too much and always in anger.” By talking about such differences and perhaps false expectations and assigned roles, years of barriers to sexual expression can begin to fall.

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I’m not sure what it means. I really love her. But I wonder how it would have been with someone else.

HUSBAND

It is true that we are probably not by nature monogamous. Monogamy makes little sense genetically or in strictly evolutionary terms. It makes sense in a personal, spiritual, feeling, and loving sense. It is our nature to reflect, to wonder, to imagine how others would be with us and we would be with them. Such wonder is not a symptom of marital weakness; it is a natural phase of loving. Only fear, insecurity, and denial will prevent it.

Why did we marry this person and why at this time in our life? It is much better to ask this question before reflection becomes recollection, trying to remember after the divorce. Take the time to reflect openly with your partner. Steal from other fantasy relationships ideas for the constant changing of your own relationship. Do not fear your natural curiosity and attraction to the different and unique.

“I noticed as we sat at the traffic light in our car that I was looking at him and my husband was looking at her. They were doing the same,” reported the wife. It is not so much that the grass is always greener in someone else’s lawn, it is just that it is a different lawn. Talk about those feelings, and your own lawn can grow greener by the mental cross-pollination. This is a way to re-court, to rediscover some of the energy behind your pairing, if only in your imagery.

A word of warning. During courtship or the re-courtship I am proposing, there will be several negatives. “I can’t stand that little bit of spit that comes out when he gets excited when he talks,” shared one wife. “She picks at her cuticles. It drives me nuts. I have seen her bite them and eat them,” said one husband. These negatives are all a part of reflection. Share them gently and with as much tolerance as you can muster. You may want to work on correcting some of them. But remember, as the wife who bit her cuticles said, “Jeez, Sam. Everybody does something.”

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The sinuses are cavities in the bones around the eye sockets. They are lined with the same tissue as in the nose and all of them communicate into the nasal cavity.

The frontal sinus is in the bones of the forehead, just above the eye. The maxillary sinus, often called the antrum, is in the cheekbone just below the eye.

On either side of, and behind the bridge of the nose, are the ethmoidal and sphenoidal sinuses in small bones which form the nasal side of the eye sockets.

Many people come to the doctor and complain: “It’s my sinus.”

I’m never sure what they really mean by this, whether their symptoms refer to headache, a blocked or running nose, or something else.

Acute infection in the sinus is not uncommon. The maxillary sinus is the one usually affected. Infection may spread upwards from the nose, usually during the course of a cold.

The lining of the sinus becomes swollen and sometimes blocks the small opening leading into the nose. This causes collection of pus and mucus under pressure and it is responsible for the severe pain.

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Would you like to lose weight? It really is quite simple. All you do is eat properly — and that usually means eating less. Obesity has reached epidemic proportions in the developed world while in the poorer countries many still die of starvation.

Obesity only occurs when the food eaten has a high joule value compared to the amount of fibre it contains. Kilojoules do count. They are the measure of energy that the food contains.

With food that is highly processed, the bulk of fibre is removed. This applies mostly to the carbohydrates or starches and these foods become concentrated. The villain is sugar. It is added to so many foods.

You are obese when your weight is 20 per cent or more greater than the ideal weight. This ideal weight for sex, height and age has been worked out by studying life insurance statistics. Those who are at an ideal weight for their height and age live longer than those who are above the ideal. And the greater the weight, the shorter the life span.

Eating is not only a necessity, we also eat for other reasons — social, pleasure, habit and sometimes to satisfy a hunger for attention or to cope with our anxieties and depression.

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Most infectious diseases provoke a response of antibodies which remain forever and leave a “blueprint” in the immune system so that further antibodies can be rapidly made if the germ strikes again.

Thus, one attack of the disease confers lifetime immunity against another attack.

A vaccine is designed to provoke this antibody response without the person getting the disease and suffering its consequences and complications.

The vaccine can be prepared from the toxin or poison of the germ, as in tetanus vaccination.

Other vaccines contain the germ itself, but it’s killed so that it is no longer active. Cholera vaccine is an example.

Others contain the live virus, but attenuated or altered so that, while it still provokes an antibody response, it cannot cause the disease. The measle vaccine is of this type.

Smallpox vaccine is a little different. It contains live virus, not of smallpox but of vaccinia or cowpox. The term vaccine is derived from this word.

The vaccinia virus which causes the mild cowpox is believed to be similar, if not identical, to the virus causing smallpox.

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Zinc, it is now well understood, is no less essential for good nutrition than other minerals, such as calcium and iron. Signs of zinc deficiency include an impaired sense of taste, dry skin, falling hair, and wounds that are slow to heal. In children, zinc deficiency can stunt growth and interfere with sexual maturation.

Zinc deficiency occurs most commonly in children (who may not get enough dietary zinc to allow for growth) and in the very old (who may not eat enough animal protein, the richest source of zinc). Furthermore, Medical World News (24#3:41) reports, since zinc deficiency dulls the appetite by reducing the sense of taste, zinc deficient persons eat less and become even more short of zinc. The extreme of this condition is the anorexia nervosa patient, and we discuss the important role of zinc for this disorder in the article, “Zinc and Anorexia Nervosa,” in the section Anorexia Nervosa.

Zinc deficiency is also very likely to be found in pregnant women, even among those who are eating well. The reason for this paradox, it seems, is twofold. First, the demands of growth require the pregnant woman to provide the fetus with extra zinc, and secondly, this may be occurring at a time when the mother’s ability to absorb zinc is reduced.

Zinc deficiency is understandably a concern for vegetarians since vegetables contain very little zinc and meat is very rich in it. In addition, soy protein and vegetable fiber tightly bind with zinc, holding it in the intestines and stopping it from being absorbed.

A surgical operation or an acute infection (i.e., a cold or the flu), can suddenly bring on signs of zinc deficiency in persons whose status is already borderline. Chronic diarrhea, chronic infection (i.e., tuberculosis), and sickle cell deficiency also increase our need for zinc.

Iron, according to the British Medical Journal (287:1013), when taken together with zinc, competes with zinc for absorption and significantly reduces the amount of zinc that the body is able to retain. Therefore, it seems, it is not efficient to take iron and zinc together, and it is probably better to take them at different times of day, spaced as far as possible apart. What the optimal spacing of these doses might be yet remains to be worked out. It has also been pointed out that, for similar reasons, iron and calcium also should be taken at different times of day.

Dietary zinc is naturally obtained from meat and other high cost protein foods, and for this reason, zinc deficiency is seen more commonly in times of economic stress.

For any of the above reasons, you may be considering taking a zinc supplement. Before you do, read the next article on zinc overdosage, since that can cause problems too.

As noted in the previous article, there are many factors which could contribute to a zinc deficiency, and concerned people will want to make sure they take enough of this important mineral. However, zinc taken regularly in doses greater than three times the minimum daily requirement, according to the American Family Physician (26#2:167), can easily do more harm than good. Thus, for the average person, one capsule daily of 220 mg of zinc sulfate is more than enough and should not be continued for very long.

Too much zinc produces liver disease, with lethargy, upper abdominal pain and fever, and displaces other metals from the body (producing anemia, etc.). It is important, therefore, to avoid taking extra zinc as a supplement unless one really needs it.

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