Various marks can be present on a baby’s skin from birth, and most of these will fade with time. Certain types of birthmarks which do not disappear can now be lightened using specialised laser techniques when the child grows older. Your doctor will be able to give you specific advice.

Salmon patches (stork bites)

These are pale pink, flat marks which are seen at birth over the baby’s forehead, on the bridge of the nose, on the eyelids, or on the back of the neck. They are very common and most will fade completely with time, leaving no marks after a year or two. Salmon patches on the nape of the neck take a little longer to fade, and sometimes remain throughout adult life.

Strawberry haemangiomas

These are caused by dilated blood vessels, and are usually small at birth. As the baby grows they may start to enlarge, and take on a raised, lumpy appearance. After a year these marks will start to shrink and most will disappear by the time the child is 10 years old.

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“Alone? What are you suggesting? That we old people touch

ourselves? That’s sick.”

It isn’t sick and it has nothing to do with mental or physical illness. You might—and many people do—think that it is wrong to masturbate, to stimulate yourself sexually. If you feel it is wrong, then it would not be something enjoyable, and doing things which are not enjoyable is not good for your overall health. But let’s not stop being honest here. The older you get, the less easy it may be to find partners to hold, to kiss, to cuddle, to have sex with if you want. One important option is to maintain sexual self-stimulation if you want to. It is something that people do, children and babies do. It is part of sexual living.

    ”I just can’t see having intercourse at my age.”

Who said anything about having intercourse? That, too, is an option. We should not just equate sex with intercourse. Touching, holding hands, being close, kissing are important sexual behaviors. All life is a cycle. Our teenagers should learn that all sex is not intercourse. They should be able to touch, to hold, and so should you if you want to. I’m just talking about your rights, not a list of sex assignments.

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    The Misunderstood

If I say faster, he goes so fast it burns. If I say slower, it’s like no movement at all. If I say stop, he keeps going too long or stops too fast. If I say go, he goes wrong. I don’t know. I’m just too fussy I guess.

WIFE

This is the wife who seldom feels understood in her expressions of sexual need. If she wants to be touched faster, she ends up being touched slower. If she wants soft, she gets hard. She feels that “if he really loved me he would know what to do” instead of “if I really love him I will teach and teach until he learns.” It sometimes surprised me how patient couples would be with their children and how impatient they would be with each other. All learning takes time, and sexual learning takes about seventy-five years. Even then, you are just beginning.

The Target

I feel like one of those blow-up dolls. He moves me around like a pillow, does it to me. Next time he wants to do it doggy style, I’ll just bark. Maybe I’ll sit up and beg. Maybe that will please him.

WIFE

This is the wife who feels that her husband’s pelvic thrusts are “aimed” at her rather than “shared” with her. Wives in this category reported being trapped under their husbands, propped up on top of them, or “attacked” from behind. They did not feel that intercourse was a dance, but more of a sparring match with her being the sparring partner. There was little sense of identity, even in the limited sense of “The Piece” who felt she was just “any woman.” “The Target” feels a loss of personhood.

The Caretaker

I’m the dorm mother—three kids, one husband, two dogs, one gerbil. I like the gerbil best. He puts out less crap than all the rest put together, literally.

WIFE

This wife has abandoned her sexual role and identity in favor of providing what she perceives to be “the rest” of her husband’s needs. She picks up after him, cleans for him, takes his messages, and sees to it that he enjoys his life. She may attempt to provide him with sex as just another of his daily living needs, but primarily she has infantilized her husband to such an extent that she feels she is parenting an adult child.

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I help my couples calculate a percentage so they can see what could be compared to what actually is. Watch out for the argument that “it is not how much time but quality time that counts.” That argument has never been a valid one, either in raising a marriage or in raising children. Both quality and quantity are required to nurture a marriage to super marital sex.

Divide your total MIMs by the 1,800 weekly available MIMs. For example, if you estimated a total of 180 MIMs for your marriage, after subtraction of the TV penalty factor, you would divide the 180 minutes by 1,800 for a “Marital Investment Quotient” of Þ percent. By the way, if you were near 10 percent, congratulations! The average MIQ of my thousand couples was less than 1 percent!

Actually, only 732 couples provided data for their MIMs, because I did not start using this test until some months into the program. Now that I have used this test with more than 5,000 couples in the clinic, the average is still less than 1 percent.

How do you and your partner compare? Take a look at each item of the test, including the penalty factor for TV, and discuss where MIMs are lost or gained. Does your investment of time reflect your priority for this marriage, or some out-of-control obligatory life-style robbing your marriage of its potential intimacy?

One last point about MIMs. There were thirty-five couples seen in the clinic program who were having affairs with one another. That is, they came to the clinic and, while married to someone else, wanted help with a sexual problem they were having in their affair. While there are several issues to examine in such cases, it is interesting to note that the average Affair Investment Quotient was 83 percent, based on the average available time of 120 minutes together per week. When these people were together, they were together! Being together was their whole purpose. One percent vs. 83 percent. And we wonder why extramarital sex (Type I) is so popular? Of course, I am using these numbers in exaggerated fashion and the mathematics are far from statistically valid. The point is clear, however, that time put in to the American marriage may be far less than needed for fulfilling intimacy.

Bonus: You deserve credit for purchasing this book and reading this far. Add into your calculations any minutes you are spending discussing with your spouse the issues raised. Did your spouse respond when you called to discuss the couple given the second chance? Add that time in, too. Minutes spent in therapy for your marriage do not count as bonus time, but any time spent implementing the suggestions or ideas coming from your therapy sessions give you extra bonus minutes.

You will have to make choices, not just lists. You will have to choose intimacy and super marital sex, because our society places marital time at the bottom of our priority list. You will never find the time. You must make it.

*15\97\8*

Calcium is the mainstay of treatment but, used alone, it only slows the rate of bone resorption.

One way of improving its effect is to combine calcium with fluoride in large doses and this treatment seems to lead to active bone replacement.

The calcium and fluoride can be given by mouth and injections are not necessary.

One way of determining the extent of the thinning and also of measuring the response to treatment, is to X-ray the head of the femur and to note the crossing lines of bone known as trabeculae. These decrease in number as the bone thins.

The degree of osteoporosis can be measured by taking X-rays of the bones.

Osteomalacia is a similar disorder of bone, where the protein matrix is laid down as normal but there is a reduction in the deposition of calcium salts.

This leads to softening of the bone, so that it may bend and show deformities.

Osteomalacia is the adult form of rickets.

*523/71/1*

Colds and, indeed, most respiratory infections are highly contagious, spreading easily from person to person.

The incubation period is short, from one to three days. The symptoms are so well known as hardly to need describing, but for those few readers who are fortunate enough to escape colds I will outline the most important ones:

A slight fever, mild headache and aches and pains are associated with a blocked or runny nose.

The throat becomes thick or ’scratchy’.

Initially the discharge from the nose is clear, but then becomes thickened with pus due to a secondary bacterial infection.

The infection may spread to the sinuses or to the middle-ear.

It may spread down to the lower respiratory tract and involve the trachea or windpipe and the bronchial tubes.

Despite the marvels of modern medicine, the only effective treatment for a cold is the same advice your grandmother may offer.

Go to bed for a day or two, keep warm, have a hot lemon drink and a couple of aspirin or paracetamol. Whisky or rum is an optional extra, and although I don’t believe in alcohol’s medicinal benefit, it might make you feel better in your misery.

A cough suppressant is helpful at night if coughing keeps you or others awake.

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These are frightening to parents when they first experience it.

They may happen at any time from about six months to four years. They tend to develop as a result of frustration or anger in the child or they may follow a period of denial by the parent, or a fall or when the child can’t get his own way with other children.

In an attack the child breathes right out. Then comes a period when he doesn’t breathe at all. During this period his face may become congested and take on the bluish red tinge of cyanosis. Twitching of the muscles may occur and then he usually loses consciousness. There could be loss of control of the bladder at this time.

After loss of consciousness, the child starts to breathe again and quickly returns to normal. At that stage the parents are left in great panic.

Treatment consists mainly in counselling the parents, who must understand that this is an attention seeking device and that the way to overcome it is to ignore the child.

It is, of course, not easy to tell parents to walk away from the child when he is going blue in the face and losing consciousness.

Children usually grow out of this habit, but by this time a poor parent-child relationship may have developed with the child able to manipulate his parents.

The parents need counselling so that they can fulfil properly the emotional needs of the child and help him overcome his anxiety.

*15/71/1*

Say you are considering having a ‘breast’ reconstructed after a mastectomy (removal of the breast). Ask to be referred to a plastic surgeon who has done a lot of these operations. Only someone with plenty of experience is in a position to explain beforehand exactly what result you can expect, and then to actually produce the promised result.

All of these are just examples. If you are in doubt about the experience of your doctor, ask directly how often he or she has done the procedure in question. Ask whether there are doctors who specialise in the procedure and, if there are, ask to be referred to them.

A word of warning: specialists have advantages when it comes to knowledge, experience and technical skill. However, they also tend to have a major disadvantage — they are less likely to see you as a whole person. Specialists do not take a broad view, on the contrary, they tend to take a very narrow view. Specialists tend to see their patients as caricatures, with the particular aspect they are interested in blown up out of all proportion to everything else. They may even act as though other aspects of their patients don’t exist.

Try to think of your specialists as resource people who have a lot of very specialised knowledge, some of which they can share with you. They also have special expertise which you can take advantage of, if you choose. However, even if, for example, someone knows everything there is to know about chemotherapy and is very experienced at giving it, this still does not make them the best person to decide whether you should have chemotherapy. The best person to decide is someone who knows a bit about your cancer and what you can expect from chemotherapy, and a lot about you—your values, priorities, expectations, strengths and weaknesses. That person is you.

*24/40/1*

The answer to these questions is, ‘It depends on your symptoms’. If you are not bothered by menopausal symptoms, nor at risk of developing osteoporosis or arterial disease, then don’t feel pressured by your friends, family or the media to take it. You do not need it, and to take it would be an unnecessary medical intervention. Despite what the papers say, it will not keep you ‘young and sexy forever’, and if this is why you want to take it perhaps you should look carefully at yourself, your relationships and your underlying fears.

If, however, you are being bothered by hot flushes, night sweats, and the various early signs of the menopause, then you might want to start HRT as soon as these signs start having a negative effect on your life. This may well be while you are still having periods, but you can still start HRT, although it may be difficult to get the level of treatment exactly right.

Although you may accept all this, some women find the higher rate of side-effects and the irregular bleeds put them off HRT completely and they are then reluctant to consider it again in a few years’ time when different symptoms occur.

If you have been put off HRT for this reason, you may find that, in the meantime, new forms of HRT have become available that would reduce the problem. Again, talk to your doctor about this.

*33\42\4*

Any woman on the Pill should come off it a month before surgery, substituting a non-hormonal method of contraception, such as a condom or diaphragm in the meantime. Women who smoke should stop at least a week before a hysterectomy. They should also consider a permanent break from smoking as their risk of heart disease and osteoporosis is likely to increase as a result of the surgery, and smoking will increase this risk still further.

A GnRH agonist may be prescribed prior to surgery in a bid to reduce the size of any fibroids a woman may have. When this approach was systematically studied in 142 women, only half of whom received a GnRH agonist, the results were encouraging. The surgery was less likely to be difficult in the treated women who also experienced significantly less blood loss on average. It has been suggested that the beneficial effect of GnRH agonists is due partly to their ability to shrink fibroids and partly to their reduction of uterine blood flow.

*48\198\4*