Comprehensive men's sexual health information, tips and news about men's sexual health.

Cause

Regurgitation of food can occur in babies if the valve-like mechanism between their oesophagus (gullet) and stomach is weak. The exact cause of this is unknown but the condition is often associated with the presence of a hernia (protrusion of bowel) upwards through the diaphragm (hiatus hernia).

Clinical features

The symptoms of reflux usually develop within the first month after birth. Your baby may begin to vomit feeds and this becomes consistent during, between and after feeds. It should not be confused with normal posseting of small amounts of milk, which is seenthis problem by the time they become toddlers, presumably because by this age they are spending more time in an upright position, as well as eating more solid foods. A small number may continue to have symptoms beyond the toddler period. In babies, the regurgitating of the acid contents of the stomach into the gullet may cause pain and discomfort, and may be a cause of colic.

Investigations

The doctor may order an X-ray study of the gullet and stomach (barium swallow) to demonstrate the reflux. In a small number of children, pH monitoring may demonstrate the presence of acid from the stomach in the gullet. It is also possible that in a few children the doctor may wish to have a look at the lining of the gullet. This is done under anaesthetic.

Treatment

If your baby’s reflux is mild, and his weight gain is satisfactory, all you may need to do to ease the problem is to nurse him in a more upright position. Propping the child up for an hour after feeds can be beneficial. Feeds can be thickened with cereals to make them easier to keep down.

If your child seems to be in pain after regurgitation, the use of a mild antacid may help. Other medications can sometimes be added to the feeds to enhance the emptying of the stomach. Your doctor can advise you on the most appropriate treatment for your baby. It is always advisable to consult your doctor if your baby is vomiting a lot with feeding.

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Here are some general strategies that may help to minimise the frequency, duration or intensity of your baby’s crying and fussing. Remember that different things may help different babies, and that something which has worked once may not always work — you may have to try something else. Remember also that the crying and fussing are part of the normal development of most babies, and that they will pass in time. The interventions described below will not magically stop your baby from crying but they may make things more bearable until he grows older and can communicate more clearly to you what his needs are. If one of these strategies does not work after a period of time, then try another.

1. Carry the baby frequently, not only when he is crying. Respond quickly to your baby when he begins to cry or fuss. Do not worry about spoiling him — this will not happen.

2. Check to see if the baby’s nappy needs changing, or if he is too hot or too cold, or is uncomfortable in his cot or basket.

3. Offer a feed if you sense he may be hungry, or if the last feed was more than 2 hours ago.

4. Sometimes the baby is not hungry but wants to suck. Offer him a dummy, or the breast, or encourage him to soothe himself by helping him find his own fingers or thumb to suck.

5. Speak softly to your baby, or sing to him, or play soft music. Your presence and voice may help soothe him.

6. Gently rock or carry your baby in a baby carrier or sling — sometimes the movement and close proximity to a parent is soothing. Some babies quieten when taken for a walk in the pram. The movement, vibration and noise of a car ride may also lull a baby to sleep.

7. Some babies are bored and need the simulation of been held, rocked or spoken to. Others appear to be easily overstimulated and need peace and quiet. Turn down the lights, and try to calm things down.

8. Try baby massage. This will calm the baby and help you relax, as well as facilitating the close communication that is such a special part of infancy.

9. A warm bath may settle your baby and promote sleep.

10. Drugs have a very limited place in the modern management of ‘colic’. There is no evidence that babies suffer from wind or intestinal spasm, so the composition of some of the colic mixtures has no logical basis. Other medications are used to sedate the baby. This may be indicated in special situations for a short period of time, but only under close supervision. They should not take the place of the strategies listed above, but can be used in conjunction with them.

11. Changes of maternal diet (if breastfeeding) or changes of formula (if bottle-feeding) are strategies which are used far too often. There is very little evidence that babies are allergic to either a particular type of milk, or else to substances ingested by the mother and passed to the baby in the breast milk. True milk allergy is relatively rare, and the changes of formula are demoralising for the parents and quite unhelpful to the baby in most cases. Occasionally, the mother will notice a change in the baby’s behaviour after she has eaten something in particular. If this occurs then, of course, this substance is best avoided. However, changes in the diet of the baby or mother are rarely indicated as a treatment for crying and fussing.

12. Last but not least, it is important to seek the advice of your maternal and child health nurse. She will be able to reassure you about your baby’s health, as well as checking your feeding techniques and providing valuable advice on how to handle your baby.

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The Nest Filler: This is the spouse who symbolically returns home, fills the empty nest while trying to maintain his or her marital and family life. The Nest Filler returns to “dating” his or her spouse fitting him or her into a new “home life.” The Nest Filler feels guilty when with the parent and guilty when with the spouse. This guilt gets in the way of sex with the partner as the Nest Filler tries to please everyone but him- or herself. The guilt also prevents enjoyment of time with the parent.

The Nest Filler tends to regress, becoming more childlike, dependent on the parent being cared for, and defaulting in their parenting and spousing duties at home. He or she may feel trapped, unappreciated, taken for granted, and overtly or covertly angry at his or her own lack of personal growth.

The Converter: This spouse feels so trapped between the parent and the spouse that he or she decides to have two spouses (parent and the actual spouse, regardless of gender of the parent) or two parents. This distortion of roles results in the parent, the spouse, and the children resenting this alteration of perception. Serious communication and sexual problems can result. The spouse’s own children may rebel through school problems, delayed development, or depression. The child may begin to resent the parent’s parent, causing a counterreaction by the father or mother, especially since the child may be expressing the feelings that the Converter has repressed. Serious family problems start to brew. Sexual intimacy never flourishes when there are unresolved family conflicts, or when anyone is “converted” to artificial roles.

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Love maps begin to develop very early and are written in some very dark ink. The husbands and wives often had to be prodded into remembering a sex scene they witnessed, but each of them could. It does not matter that it is really the first, or that it ever really happened at all. It is the memory, the image, that gets itself placed on the map.

I still get nervous talking about it, even thinking about it. I was sleeping in the loft with my cousin. We giggled away half the night together. Then, we got tired. It must have been 3 A.M. Her parents were sleeping in sleeping bags on the main floor just beneath the loft. They must have waited for hours for us to shut up and fall asleep. When we quieted and were just lying there exhausted from laughter, we could hear a sound like someone rubbing something back and forth. I heard it and looked at my cousin. We were twelve and we had talked about sex, but this was amazing. We seemed to know what the rubbing was. I still remember that sound, and I am aware of it when my husband and I make love. Rubbing, back and forth. We looked out over the railing and saw them. His sleeping bag was going up and down, up and down. He would make a little noise and she would tell him to “be quiet, they’ll hear.” She seemed so disinterested. She looked up at the railing and we pulled back. I will never know if she saw us. All I remember is that the rubbing stopped, I heard the toilet flush, and when we looked again, they were in their own sleeping bags.

WIFE

Further questioning revealed that the passivity of the wife, the mystery of why the toilet flushed after sex, and the rubbing had remained key parts of this woman’s love map. She continued to be easily aroused by rubbing sounds and was alert to any escape of

“sex sounds” during her own lovemaking. As you re-create your own first witnessed sex scene, check it for such “imprints,” as they may affect your sexual life.

The way in which love maps are formed, why we see and remember or do not see or forget various sexual happenings in our lives remains a mystery. The answers to this mystery probably rest somewhere between prenatal influences and neurohormonal predispositions and the influence of learning. Your own relationship will be enhanced, however, if you take the time to re-examine some of the influences that make you love whom you love and how you love.

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It is usually relieved by taking food, antacids, or by vomiting.

Indigestion present over weeks or months always requires investigation, usually by means of barium meal X-ray.

Barium is a radio-opaque substance which when swallowed outlines the hollow stomach and bowel on the X-ray plate.

Another way is to pass a flexible tube, known as a gastroscope, down the gullet into the stomach, where the inside can be seen on direct vision; the fibre-optic qualities of this instrument allowing light rays to be “bent.”

In the past, bed rest, special diets and a variety of antacids were ordered, and when these failed we suggested surgery.

Now we no longer consider diet of great importance, advising patients only to avoid anything which upsets them and to have small meals frequently rather than large meals infrequently.

Smoking and alcohol are not helpful in healing ulcers. Alcohol is the most potent drug available in stimulating the stomach to produce acid.

The rule is, no acid — no ulcer. A new drug, cimetidine, acts on the acid producing cells in the stomach and stops its production. This drug can now heal about 80 per cent of ulcers within a couple of months.

Some stomach ulcers may be cancerous and require a biopsy — that is a small portion removed for examination under the microscope to be certain of the diagnosis.

If cancer is present then an operation is indicated.

Failure of the ulcer to heal after a prolonged course of cimetidine may lead the doctor to suggest an operation. Whereas in the past we removed the acid forming portion of the stomach, now all that is suggested is that the nerves which stimulate the stomach to produce acid are cut.

This does surgically what the cimetidine does medically.

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“Well I am going to let you into those secrets. I am going to reveal the major mysteries which preoccupy the grey men behind those somewhat awesome doors. No, these complaints are not accusations of malpractice. And they do not involve bitterness over fees. The activities of licentious doctors are hardly ever mentioned. The major forces of public anger are fired at doctors who are guilty of little more than human indifference.

“Patients fume most because they are treated insensitively. It is clinical bluntness that causes them to smoulder. The public curse is brought down on the profession by the callous clinician.”

We are all aware that there is an epidemic of litigation against doctors in the U.S. There is growing evidence that, in Australia, more and more patients are seeking legal advice about suing their doctors.

Yet I heard a wise and senior American doctor say that “Patients don’t sue the doctor who sits on the side of the bed and talks to them.”

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What about the bones—how do we check for secondary deposits there? Pain is the most common symptom that leads your doctor to suspect cancer in the bones. However, the pain may just be in one bone when a number are affected and sometimes there is no pain at all. In some cases the diagnosis is made only after a fracture in a weakened bone occurs. However, it is very rare for a fracture to occur at a site that hasn’t been at all painful beforehand.

If the cancer in the bones fills up a lot of the bone marrow cavity, this prevents you from making new blood cells normally. Any one or all three of the red cells, white cells and platelets may be affected. Too few red cells is anaemia, which can make you tired and lacking in energy. Too few white cells makes you liable to get infections more easily than normal. Too few platelets means the blood doesn’t clot properly, so that you bruise and bleed easily.

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In 1910, Arthur Legg, an Englishman, Jacques Calve, a Frenchman, and Georg Perthes, a German, all independently described a bony disorder of the hip.

Its full name is Legg-Calve-Perthes’ disease but this is commonly shortened to Perthes’ disease.

It affects the epiphysis or growing plate at the end of the bones.

For some reason, as yet not understood, there is interference with the blood supply and this leads to the death of the bone around the growing epiphysis resulting in distortion of the head of the femur or thigh bone where it forms the hip joint.

Boys are affected four times as often as girls but the reason for this statistical discrepancy is obscure. It commonly occurs between the ages of 3 and 10.

The child usually complains of pain in the hip and a limp is noticed. The diagnosis can be confirmed by X-ray.

The younger the patient, the better the outlook and the more chance there is for the blood supply to improve and for almost normal development of the joint to take place.

The most effective way of achieving this is to stop all weight-bearing on the hip by confining the child to bed for two to three years.

This is usually unacceptable and, following a period in plaster, an operation to re-align the hip joint and the weight-bearing area is undertaken.

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Biliopancreatric diversion has a number of elements:

• Part of the stomach is removed leaving a pouch of between 200-400cc. This reduces the volume of food that can be eaten but not as drastically as with gastric partitioning.

• The small bowel is divided at a point 250cm from where it enters the large bowel. This lower part of the small bowel is attached to the stomach pouch so that food from the stomach has a shorter length of small bowel to digest it before it enters the colon.

• The upper 3-4 metres of small bowel is attached to the lower large bowel at a point 50cm from where it joins the colon. This part of the bowel carries the digestive juices from the liver and pancreas. Instead of having the usual 5-6 metres of small bowel to mix with and digest the food, the digestive juices can only act on the food for a distance of 50cm.

• The gallbladder, if present, is removed.

The effect of these measures is to produce restriction of food intake and to cause malabsorption of the food that is eaten, particularly of fats. Initially the effect is rapid weight reduction often accompanied by diarrhoea and feelings of weakness. However, by twelve months, the body adjusts allowing normal sized meals of any food types to be eaten and bowel actions to stabilise at about three bowel actions per day. Often adult onset diabetes and high cholesterol are cured by this procedure. There is no problem with acid reflux or vomiting. Weight control is well maintained even ten years after surgery. However, it is a major operation with risk of leaks, abscesses, adhesions, etc, in the short term, and of deficiencies of protein, iron, calcium and vitamins long term. Patients must remain under review and have six-monthly blood tests so that any developing deficiencies may be detected early and supplements prescribed to correct the problem before it becomes serious.

*215\186\4*

Biliopancreatric diversion has a number of elements:

• Part of the stomach is removed leaving a pouch of between 200-400cc. This reduces the volume of food that can be eaten but not as drastically as with gastric partitioning.

• The small bowel is divided at a point 250cm from where it enters the large bowel. This lower part of the small bowel is attached to the stomach pouch so that food from the stomach has a shorter length of small bowel to digest it before it enters the colon.

• The upper 3-4 metres of small bowel is attached to the lower large bowel at a point 50cm from where it joins the colon. This part of the bowel carries the digestive juices from the liver and pancreas. Instead of having the usual 5-6 metres of small bowel to mix with and digest the food, the digestive juices can only act on the food for a distance of 50cm.

• The gallbladder, if present, is removed.

The effect of these measures is to produce restriction of food intake and to cause malabsorption of the food that is eaten, particularly of fats. Initially the effect is rapid weight reduction often accompanied by diarrhoea and feelings of weakness. However, by twelve months, the body adjusts allowing normal sized meals of any food types to be eaten and bowel actions to stabilise at about three bowel actions per day. Often adult onset diabetes and high cholesterol are cured by this procedure. There is no problem with acid reflux or vomiting. Weight control is well maintained even ten years after surgery. However, it is a major operation with risk of leaks, abscesses, adhesions, etc, in the short term, and of deficiencies of protein, iron, calcium and vitamins long term. Patients must remain under review and have six-monthly blood tests so that any developing deficiencies may be detected early and supplements prescribed to correct the problem before it becomes serious.

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