Cradle cap appears as a crusty or scaly, oily covering on areas of the scalp, which looks unsightly, but does not seem to bother the baby at all. It begins soon after birth, and may last for several months if not treated appropriately.

Cause

The exact cause of cradle cap is not known, but it is thought to be related to the influence of the mother’s hormones, which still circulate in the baby’s bloodstream after birth.

Clinical features

Most often cradle cap appears as a pale yellow scale or crust (which has an oily texture) at the back or on the top of the head. It is difficult to peel off. The baby is not irritated by the rash, and it is not itchy or sore.

Treatment

Applying olive oil can help to soften the crusts, and this may be all that is needed. Make sure you wash the oil off after an hour or else it may aggravate the cradle cap. In addition, you may try using an antidandruff shampoo for several days, massaging the scalp firmly for 5 minutes. Try using a soft brush to gently lift out some of the scale. There are special preparations for cradle cap that you can buy across the counter from the chemist. When used as directed, they will clear up most cases of cradle cap in a short period of time.

When to see your doctor

• if the cradle cap does not improve after 2 weeks, despite these simple measures;

• if the rash is red or sore, or your baby is scratching at it;

• if the rash seems to be spreading;

• if you are in any doubt that the rash your baby has is cradle cap.

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In Australia 10% of toddlers receive medical attention for poisoning before their fourth birthday. One to 4 year olds have a very high risk of accidental poisoning, due to their inquisitive natures coupled with their lack of understanding of danger. The severity of the effects of poisoning depends on many factors, not just on the type of poison taken. The age, weight and health of the child, as well as the amount and strength of the poison, are all important factors.

There are many substances around the house which can be poisonous. These include medicines, household cleaners, alcoholic drinks, insecticides and plants. Australia also has more than its fair share of poisonous creatures which can inflict dangerous bites and stings.

Poisons can enter the body via various routes. They can be swallowed, breathed in, splashed in the eyes or on the skin, or transmitted via bites of venomous creatures. There are basic first aid measures for each of these circumstances It is well worth your while to read them now, so that you are prepared for any emergency.

The list given below of things to do will greatly reduce the likelihood of poisoning occurring. Read it now.

• Store medicines in their original containers and away from household products. Never store medicines in food or drink containers. If medicines need to be kept in the fridge, make sure you place them on the top shelf at the back. Seal them inside a separate container.

• Do not put several different medications into the same container.

• Check the label carefully on the product before using it so that you do not confuse one substance for another. Check expiry dates and dosages on medicines.

• Always use substances that have child resistant packaging.

• Do not take medicines in front of children — children tend to copy adults.

• Call medicines by their real name — they are not cute little lollies.

• Keep all handbags out of reach of children — they often contain medications.

• Do not let your child take someone else’s medications. Even one tablet may cause serious side effects.

• Clean out your medicine cabinet every three months, and take old medications to a pharmacy for disposal, or flush them properly down the toilet. Do not dispose of old medications in a rubbish bin.

• Never mix cleaning products together. Dangerous chemical reactions can occur.

• Rinse empty containers before discarding them.

• Make sure areas are well ventilated when using sprays, paints or volatile chemicals. Wear protective clothing, a mask and gloves.

• Keep all alcoholic drinks in a locked cabinet.

Always contact your doctor or Poisons Information Centre if you have any questions or concerns.

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At those times when we are running cold, feeling defeated, inadequate, and passive, our sexual response reflects this life-style. We all run hot and cold at different times, and when we are cold, we

xperience a “learned helplessness,” a feeling that there is little hope, that the world does not live up to our expectations and that our efforts to do much about it are ineffective.

The neuroendocrine system reflects this life orientation and influences sexual response. Here is a list of the cold sexual problems, and remember, the person is not cold, but his or her life-style at this particular time is.

MALE

Diminished pre-ejaculatory fluid

Abbreviated orgasmic contractions

Absence of orgasmic contractions

Diminished F- and/or R-area sensitivity

Prolonged contemplation

Decreased arousal

Absence of psychasms

Diminished sexual interest

Lengthening of refractory period

FEMALE

Diminished lubrication

Abbreviated orgasmic contractions

Absence of orgasmic contractions

Diminished G- and/or C-area sensitivity

Prolonged contemplation

Decreased arousal

Absence of psychasms

Diminished sexual interest

Lengthening of refractory period

Talk with your spouse about the problems you are having or might like to avoid. Remember that you are trying to provide a working diagnosis, not a verdict. Talk as much about how you are living as how you are loving, for they are really one and the same.

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Couples in the clinic were asked to become reacquainted with each other, to meet as if they were meeting for the first time. Using the Marital Intimacy Quotient, as a guide, try the following activity.

Meet as a whole family, kids included. An attention span of ten minutes is all that is required. Sit down once every other day for a week for eleven periods and discuss each of the eleven items. The entire family should know that Mom and Dad are beginning a program for strengthening their marriage and that everyone’s help is required, that everyone is an important part of the marital system.

The meetings are an excellent first step on the way to super marital sex and toward meaningful sex education for you children. Tape-record these brief sessions and listen to them at the end of this book. You may want to rescore yourself then, and you may be surprised to see the changes.

The couple you met at the beginning of this chapter was one of the thousand couples who went through the entire super marital sex program in my clinic. I met them again recently, and you will meet them again at the end of this book. I was visiting a patient on the cardiology unit and saw them standing hand in hand outside one of the hospital rooms.

“How have you been?” I asked.

“We’ve been just fine,” answered the husband. “We were visiting my uncle downstairs. We came up here to look at the sp0 where we got our second chance.”

I hope you won’t wait until the type of crisis this couple experienced before you take a second chance to pay attention to óîur marriage and begin to enhance the intimacy of your own relation ship.

*25\97\8*

The fully expanded lung is covered by a thin membrane called the pleura.

The inside of the chest wall is also covered with the same membrane and, between the two layers of pleura is a thin film of liquid which enables the two surfaces to glide smoothly over each other as the person breathes.

Pleurisy is inflammation of these pleural membranes.

In pneumothorax, air enters this potential cavity between the two pleural layers and air pressure causes the underlying lung to collapse.

In the past, an artificial pneumothorax was created in some cases of tuberculosis so as to collapse and rest the lung.

A pneumothorax may occur from a penetrating wound of the chest or it may arise spontaneously, usually as the result of rupture of a small bleb, or blister-like projection, on the lung surface.

This bulla or bleb is usually a small congenital abnormality. Rupture usually occurs in the teens or early twenties, and men suffer from it five times as commonly as women.

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These bypass channels can be used on one or all three arteries.

There is no doubt that this type of operation can produce substantial benefits for the patient and can improve the quality of his life. Although results seem to indicate that this procedure can prolong life in those with coronary artery disease, there has not been sufficient time to prove it.

The main reason for surgery is severe angina that interferes with the reasonable quality of life and stops him from carrying out normal daily activities.

Operation is also considered in unstable angina. There are several states, coronary insufficiency, crescendo angina and Prinzmetal angina, where the condition appears to worsen over several days and may end in a complete block of the artery. Urgent operation is considered to prevent this catastrophe.

As a result of myocardial infarction, several structural complications may develop within the heart and affect the valves, the dividing septum or the wall of the chambers of the heart. Operation may be necessary to repair this damage and it may be opportune to carry out bypass surgery at the same time.

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When circumcision is carried out as a necessary part of religious or cultural practice, the reasons against the operation may no longer apply.

For those parents who have gone ahead and had their sons circumcised, let me reassure them there is no evidence to indicate that this will cause any later physical or mental trauma.

If you do decide not to have your next son circumcised, then do not be concerned with what effect this will have on him when he discovers he is shaped differently from his brothers and his father. The new generation is more likely to have retained their foreskins and he should be in the majority at school.

There are some indications for removing the prepuce in children — recurrent infection under the foreskin, narrowing of the opening and inability to retract it in the older child.

Circumcision may be necessary in the adult, particularly in the elderly, if a tight foreskin is retracted and then compresses the shaft of the penis.

*26/71/1*

Roseola is an acute, infectious disease characterized by a high fever followed by a rash. It is not known which virus causes the disease. Roseola occurs almost exclusively in children between the ages of six months and three years. The incubation period – the time it takes for symptoms to develop once a child has been exposed to the virus – is seven to 17 days. One attack of roseola provides lifelong immunity.

Signs and symptoms

Roseola begins suddenly with a fever of 40°C to 41 °C. It is one of the more common causes of convulsions with fever, which occur at the onset of the disease. It rarely produces any other symptoms, although sometimes roseola can cause a runny nose, mild redness of the throat, and minimal enlargement of the lymph nodes of the neck. Generally, the fever persists for three or four days and cannot be kept down consistently with aspirin or acetaminophen. Meanwhile, the child appears to be less ill than the degree of fever suggests. The fever disappears abruptly; at the same time, a splotchy, red rash appears on the trunk and spreads to the child’s arms and neck. The rash disappears in one or two days, and the child is well again. Complications are rare.

Roseola is difficult to identify until the fever drops and the rash appears.

Home care

Give aspirin or paracetamol and use lukewarm baths to help control the fever.

Precautions

• Another common illness that produces a high fever but few other symptoms is infection of the urinary tract. This is more common in girls.

• Coughing, vomiting, diarrhea, discharge from the eyes or ears, and extreme fatigue or collapse are not associated with roseola. If these symptoms occur, consult a doctor.

Medical treatment

The doctor will conduct a careful physical examination to rule out other illnesses which cause a high fever. The doctor may order blood or urine tests if he or she is concerned about other illnesses, but usually a few days’ observation will confirm the diagnosis of roseola.

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