Symptoms: reddened skin, rough, scaly skin, ammonia odor, red, scaly spots.

Home care:

Keep the baby as dry as possible. Change nappies often.

Avoid airtight outer covering over nappies.

Try changing the products used to launder nappies.

For simple nappy rash, apply petroleum jelly; zinc oxide; vitamin A & D ointment; or an ointment combining zinc oxide, cod liver oil, petrolatum, and lanolin.

For ammonia rash, avoid airtight outer covering over the nappies. Wash the nappy area frequently with clear water.

For allergic rashes, stop giving the child any new foods, beverages, or medicines started in the past month.

For rash from infections, wash the area with soap and water. Apply antibiotic ointment often.

Precautions

-    If the rash is spreading or severe, see your doctor.

-    If the rash worsens after two days of home treatment, see your doctor.

-    If the child has a fever, irritability, loss of appetite, or any other signs of illness, see your doctor.

-    Do not use more than one type of ointment at the same time (unless both were prescribed by your doctor).

Nappy rashes are irritations of the skin in the nappy area. Almost all babies get nappy rash of one form or another. Nappy rashes may be caused by moisture, urine, or irritating chemicals in the nappies.

*156/84/5*

Just lose the weight. Low-fat? High-carbohydrate? Sprout-and-spinach-shake regimen? Don’t worry about how you shed those extra pounds-at least as far as diabetes is concerned. Just shed them. “We don’t really know if any specific diet works best for preventing type II diabetes,” says Eli Ipp, M.D., head of the diabetes section at Harbor-UCLA Medical Center’s division of endocrinology in Torrance, California. “The issue is to lose the weight and keep it off.”

Exercise. Physical activity actually helps your body process glucose, so it helps prevent diabetic complications as well as the disease itself. In fact, medical researchers have actually taken disembodied human muscles, “exercised” them with electric stimulation, and then measured their insulin action. It works.

“Exercise can improve your insulin sensitivity a great deal no matter what your weight is,” Dr. King says. “And the effects can last for two or three days.”

Mix it up. Aerobic exercise is what’s usually emphasized in the prevention of diabetes and its complications because that’s what the subjects did in the studies that first made the connection. But new evidence shows that strength training and even offbeat activities such as tai chi can also improve insulin action, according to Aaron Vinik, M.D., Ph.D., director of research at the Diabetes Institute in Norfolk, Virginia. “All forms of activity have been shown to reduce the likelihood of complications once you have the disease,” he says. “It doesn’t have to be just aerobic exercise.”

A caveat, though: Diabetics with nerve damage or eye disease should stay away from weight training because the strain of lifting weights can cause damaged blood vessels in the eyes to rupture and bleed, according to Dr. Vinik. And if you have nerve damage, you may not be able to sense the damage in your eyes.

Feel your oats. In a 1996 study, Canadian researchers fed four men bread made from oat bran for six months, while another four ate white bread. The oat bran-eaters showed better glucose levels. This finding is consistent with a 1997 study suggesting that diets that emphasize high-fiber whole grains (of which oat bran is one) over refined grains reduces your risk for type II diabetes.

Eliminate it with E. Free radicals- those pesky, tissue-damaging molecules-thrive on diabetes but succumb to antioxidants such as vitamin E.

Also, says Dr. King, vitamin E might help decrease complications for those with diabetes. “Since doses of 100 to 400 International Units are associated with a decrease in heart disease, I would certainly take that much,” he says.

Take your vitamin C. Vitamin C, another antioxidant plentiful in many fruits, may also do the trick. A 1995 study by an Italian research team linked vitamin Ñ to improved glucose metabolism in type II diabetics.

Cool it with the booze. Tee-totaling isn’t required to fight diabetes, but anything more than one shot of liquor or one glass of wine or beer a day is asking for trouble, according to Dr. King. “If you drink too much, you can damage your pancreas,” he warns. “And that’s where the insulin comes from in the first place.”

Watch for the warning signs. Forewarned is forearmed. According to the American Diabetes Association, the following are worth seeing a doctor about: increased thirst; increased need to urinate; an edgy, tired, and sick-to-the-stomach feeling; repeated or hard-to-heal infections of your skin, gums, or bladder; blurred vision; tingling or loss of feeling in your hands or feet; dry, itchy skin.

*2/36/5*

You should first find a multivitamin and mineral supplement designed for pregnancy. There are plenty on the market – good makes that I would recommend are BioCare, Solgar and Foresight and also Fertility Plus.

A special pregnancy supplement like these will include the 400mcg of folic acid you need each day as well as a safe level of vitamin A so you should not need to add these in separately.

Then see what else is in the supplement. You should find that most of the other recommendations are included and the label will give you the amounts. If the amounts are less than those I have recommended (see below) then you should take a separate supplement to ‘top up’ those nutrients.

So, for example, if the multivitamin and mineral contains 50mcg of selenium you will need to supplement with an extra 50mcg to reach your total of l00 mcg.

Your partner should also find a good multivitamin and mineral supplement, such as Fertility Plus for Men – and then top up with the extras in the same way.

The benefits of many more nutrients in relation to fertility have yet to be discovered.

This is why it is so important to have a varied diet – in order to ensure that you get many different nutrients. The table below shows which foods are particularly rich in these essential vitamins and minerals. But in these days of refined foods, I believe it is important to take supplements to make up any shortfalls in your diet. None the less, as their name implies, food supplements are supplementary to your diet; they are not a substitute for good food. So, don’t assume that you can eat junk foods and take supplements and still be in the best of health.

There is a tendency for certain vitamins and minerals to be hyped in the press. So often, a certain nutrient or vitamin suddenly becomes the fashionable answer to virtually every problem on the planet. This is nonsense. In nature all nutrients work together and many are dependent on each other to function properly. So it is important when thinking about supplements – whatever your situation – to take a good multivitamin and mineral supplement as the basic foundation and then add in other individual nutrients on top.

Case History

Sarah was 34 when she came to see me for preconception care. She had been born with spina bifida and had been told that she had a one in seven chance of having a baby with it too. In this situation I needed to make sure she was taking 5mg of folic acid before conception rather than the standard 400 mcg. I sent her for an infection test which showed that she had a number of infections including Group  hemolytic streptococcus. She was treated for these and then given an intensive course of acidophilus to recolonise her gut. Her mineral levels showed deficiencies in selenium and zinc with high levels of lead. Her partner had extremely low levels of zinc and was also deficient in calcium and selenium. He was showing high levels of both aluminum and lead. They followed the Four-Month Plan in order to correct these deficiencies and I gave them both extra antioxidants to bring down the lead and aluminum over the four months. They now have a healthy baby girl.

Convincing Your Partner

Your partner may wonder if it is worth going to all this trouble of changing lifestyle habits, eliminating alcohol and taking supplements. But there is a real bonus for him because his general health will almost certainly improve. Many men report that they have more energy, fewer headaches, better digestion and feel more relaxed, and that other health problems that may have dogged them have cleared up. For instance, one man who consulted me with his wife when they had problems conceiving found that the changes I recommended to improve his fertility also cleared up a very upsetting skin complaint he suffered from called psoriasis. He said he had been to the best dermatologists and psoriasis experts and no-one had managed to achieve these results. It cleared up because the actual foundation of his health was improved by these simple and yet effective lifestyle and dietary changes.

Case History

Deirdre and her partner were both 31 when they came to see me because Deirdre’s irregular cycles, some as long as 41 days, were making it hard to conceive. Her Body Mass Index was also only 17 so I explained the link between being underweight and fertility and asked her to put on weight. She was also low in zinc and selenium. Deirdre’s partner had only a third of the required level of zinc and also low levels of selenium and magnesium. His first semen analysis showed a count of 25 million but 84 per cent of the sperm were abnormal, 75 per cent were not moving at all, and only 5 per cent were moving normally.

But within three months of going on the Preconception Plan, his sperm count had risen to 106 million and the quality of the sperm had improved dramatically, with 50 per cent of them moving normally. The couple then went on a maintenance programme of supplements and kept up the changes in diet and lifestyle and they conceived a month later and now have a healthy baby boy.

*53/73/5*

A condition in which the pancreas produces too much insulin (usually in response to a high sugar load in the diet) which in turn produces a host of mental, emotional and physical symptoms.

Hypoglycaemia is a normal phenomenon too. When our stomachs get very empty the level of glucose (sugar) in the blood falls and makes us feel hungry and faint. We remedy this by eating. The sort of hypoglycaemia we are looking at here is somewhat different.

All the cells of our bodies need glucose for energy but this is especially true of the brain. It cannot function normally for long without its supply of glucose. Some parts of the body store glucose but the brain needs a reliable ongoing supply. This is why any shortage of glucose in the brain’s blood supply can cause so many symptoms related to the brain. Nervousness, anxiety, irritability, depression (even suicidal feelings), forgetfulness, poor circulation, poor decision-making, nightmares, weepiness, and sensitivity to noise, are just some of the mental and emotional symptoms that have been reported in hypoglycaemia.

The physical symptoms of hypoglycaemia are just as real and just as disturbing as are the mental and psychological ones. Palpitation, weakness, dizziness, shaking and sweating, blurred vision and headaches are all common. Some people black out altogether if their blood sugar falls very low.

*175/72/5*

Do families with an eating-disordered member have more physical and psychiatric disease? Studies produce different – and conflicting – answers. There does appear to be a higher incidence of weight problems, especially among families with a bulimic child. And the rate of depression is higher, again particularly among bulimics, than in the population as a whole.

What about personality? Is there a “typical” eating disorder family? Are there certain traits that would lead a bystander to say, “If the Joneses aren’t careful, they’re going to turn their daughter into an anorexic one day”?

No, although a lot of studies claim to identify such traits. One researcher, Dr. Joel Yager of UCLA Medical School, took a close look at these studies. He found they contained more different “family portraits” than you’d find on the walls of a photographer’s waiting room.

One such study declared that an anorexic family was characterized by a fussy, nervous mother and a father who alternated between being quick-tempered and laid-back. No, said another, an anorexic’s mother is robust and nagging, her father passive. Wrong, said a third; fathers are domineering and aggressive. Close, another chimed in; fathers are domineering but ïîï aggressive. Or sometimes domineering or sometimes not. Depending on your source, mothers are either attached or ambivalent toward their daughters; they are too strict or too lenient. Fathers are lenient, kind, and affectionate. No, they are cool, antagonistic, and hostile.

Remember the blind men and the elephant?

As Dr. Yager concluded, “If common personality patterns are to be found in these families, they will have to be at more subtle levels.”

Does this mean that therapists must start from scratch every time a family walks into their office? Is there any pattern among eating-disordered families that provides some basis for therapy?

Yes – sort of. Recent research has found a number of different patterns among anorexic families, but certain anorexic families do fit to some extent the “model” of functioning I’ll describe in a minute. While these traits are by no means universal, they may provide a good place to begin working with an anorexic family.

Perhaps the most important trait is the lack of joint parental authority. The parents disagree about basic issues in child rearing. As a result, the child gets mixed signals; she doesn’t know what’s expected of her.

Another common theme is that the mother tends to be the center of the family. Fathers tend to be absent because of work, death, or divorce. The children understandably develop closer relationships with the mothers.

The stereotype of an anorexic family is that the members all think and act as one unit—they are, to use the technical term, highly cohesive. Conversely, bulimic families are often thought to be highly disorganized. The reality is much more complex. Some anorexic families are so chaotic they can’t plan a trip to the mall without arguing, while some bulimic families stick together like Velcro. Interestingly, as the patient gets older and is ready to leave home, some families grow more cohesive. It’s as if they realize that the illness has served as a stabilizing force, and they are reluctant to face the changes that will befall once the patient leaves.

Families can sometimes delude themselves that the eating disorder is the only problem they must confront. One father said, “If only Gwen weren’t starving herself, we’d be the all-American family.” Such families are sometimes in for a rude shock: When the eating disorder abates, they must confront the presence of other issues in their lives.

*97/35/5*

Since 1992, Linda Matulin has lost 400 pounds, a full two-thirds of her body weight. The 44-year-old Tucson resident attributes her success to discipline, determination, and one well-timed television show.

At her heaviest, Linda carried more than 600 pounds on her 5-foot-6-inch frame. “I don’t remember a time in my life when I wasn’t overweight,” she says. “But I really started to gain when I got a job working third shift. I don’t know why, but I ate all the time.”

Linda went on and off diets, never making much progress in her battle of the bulge. “Maybe that’s because I never tried really hard,” she says. “It may be difficult to believe, but I never saw myself as fat, even at 600 pounds. I lived a full life, doing everything I wanted—socializing with friends, going to concerts, traveling.”

Her mindset abrupdy changed on the day that she happened to catch a television interview with country singer Lorrie Morgan. “The interview had nothing to do with weight loss or fitness. Lorrie was talking about herself and her life—how she took control and made changes,” Linda recalls. “For me, something clicked. I became absolutely convinced that this time, I could really lose the weight.”

Despite her excitement, Linda said nothing to her family. “I knew that they meant well, but I didn’t want their advice,” she says. “The people closest to you tend to put a lot of pressure on you when you’re dieting.” She’d been through all that many times before, when she had tried different diets—and failed.

On her own, Linda began making dramatic lifestyle changes that supported her weight-loss goals. Most important, she stopped eating on autopilot, instead letting her body tell her when it needed food and how much. “It had always been telling me these things,” she says. “I just never took the time to listen.”

Having grown accustomed to eating as much as she wanted, whenever she wanted, Linda found the going to be tough at first. She had days when she devoured almost anything in sight. “But the more I focused on my body’s hunger signals, the less food—especially fatty food—appealed to me,” she says. And that’s when she started to lose weight.

Linda also looked for ways to be more active during the day. | She started with some gentle movements in her backyard swim- ST ming pool. After she dropped some pounds, she graduated to working out on a treadmill. “I’d do what I felt like doing on a par- § ticular day,” she says. “I didn’t have a set exercise plan, but I tried to move around a lot.”

Even as she lost weight, Linda continued to conceal her § trimmer physique under her newly baggy clothes. “I remained reluctant to tell my family what I was up to because I didn’t want them offering me advice,” she explains. When she finally broke down and bought some smaller-size attire, she wowed even those closest to her. “They were surprised, to say the least,” she says. “But they were really happy for me, too.”

Today, Linda is literally a shadow of her former self. In the years since she first began her weight-loss program, she has dropped to 200 pounds. She hopes to get down to 175 pounds, a goal that is certainly within her reach.

“Sometimes, I get a little frustrated because I’m not there yet,” she says. “But then I remind myself that I didn’t lose 400 pounds overnight. I’ll achieve my goal in good time.”

WINNING ACTION

Remember that you can do it. Linda’s story is an important inspiration for all of us. No matter how many pounds you want to lose, even if it’s 400, you can succeed. It may take some time—but remember, if Linda could do it, so can you.

*151\89\8*

Attitudes to physical beauty still seem harsher for women in their middle years than for men of the same age. We are so geared to youth, and youth is so tied up with femininity and sexuality, that once you reach menopause you may be viewed as ‘past it’.

The environmentalist and anti-nuclear campaigner Dr Helen Caldicott, whose marriage of twenty-six years broke up on the eve of her fiftieth birthday, says blinkered attitudes do not help. ‘In the eyes of some men, older women . . . have lost almost all value when they reach menopause because their hormones are no longer at the level they were before.’ Dr Caldicott has achieved a new beginning and a sense of liberation and independence since moving out of the family home, to settle first on the north-east coast of New South Wales and then in Gippsland, Victoria. ‘Doing it released me and made me understand the strength I had.’

Women actors complain that few challenging roles are available once they reach about forty-five. While men such as Sean Connery, Sam Neill and Robert Redford still play romantic leads into and beyond their fifties, women are rarely seen in such parts. Genevieve Picot, who played the role of the obsessive Celia in Proof and is deputy federal president of the Actors Equity section of the Media, Entertainment & Arts Alliance, says she is frustrated about being considered ‘old’ in the industry. ‘The irony and the disappointment for me is that as a performer I’m feeling much more confident and my skills are so much better than they were ten or fifteen years ago, yet I just don’t have the opportunity to use them very much.’

There are signs of change, however, the most obvious place being on television, where presenters and commentators are increasingly likely to include women over forty who do not necessarily look like stunners.

The highly regarded SBS newsreader Mary Kostakidis believes women themselves must make the first move. She refuses to dye her greying hair because she sees no point in camouflaging the maturity and complexity that come with midlife and beyond. ‘As a younger woman I was often attracted to older men because of these sorts of qualities. And now that I’ve arrived there myself, I’m not about to cover up the fact.’

She says that women presenters on Australian television are still largely ornamental. ‘It’s boring. We are an ageing population, and decision-makers who cannot accept this and act accordingly are behind the times. In many cultures older women assume positions of great status and respect. Australian women also have pride in their years. The time must come when they are no longer discarded for no other reason than their age. If not — if our institutions don’t reflect our values — our democracy is a farce.’

Women throughout Australia are, like Mary, Helen and Genevieve, asking questions, getting information, and deciding what is important for them at midlife and beyond.

*133\38\8*

Who would have believed, a generation ago, the current popularity of ‘alternative’ therapies and the challenge they have thrown down to orthodox medicine? There was little to indicate in the 1970s that the so-called fringe therapies like naturopathy, homeopathy, traditional Chinese medicine and herbal medicine would attract a vast pool of clients who alternated between orthodox and less conventional practitioners with breezy savoir-faire.

Equally unexpected were the greening of the Western diet and the enthusiastic adoption of power walking, jogging, aerobics and weight training by women of all ages. Many older women took to the challenge with gusto, viewing their increased involvement in physical activity as an antidote to the lack of strenuous exercise in their lives. When the 1991 Bulletin/Qantas Businesswoman of the Year, Sara Henderson, was writing her bestselling autobiography From Strength to

Strength and its sequel (still to be published at the time of writing), she felt the need to restructure her writing days to include short time-outs for exercise.

‘I’d played sport till I was forty-five, mainly tennis and squash. And there was a lot of physical activity at Bullo, down in the yards, working gates, building fences, lifting cases of beer in and out of the store. [Sara and her daughters own and run Bullo River, a remote Northern Territory cattle station.] To keep in nick when I’m writing twelve hours a day, I take a few minutes off every hour or so and do a couple of hundred skips. In the evenings I walk some kilometres along the airstrip with the dogs and, before going to bed, I do weights for my upper body for twenty minutes or so.’

Sara went through a fairly straightforward menopause when she was fifty. There were several months of irregular and heavy bleeding, followed by a return to normal periods, then irregularity again and so on, the whole process taking about three years and coinciding with the deaths of her husband, mother and son-in-law. Sara has not had HRT, says that people comment on how well she looks, and remarks on how well she feels. She enjoys a balanced diet mainly of fresh meat, vegetables and fish, does not smoke, and since the age of forty-five has drunk alcohol on special occasions only.

Whether women choose HRT or not, they should be aware of the range of lifestyle changes and alternative or complementary therapies capable of lessening menopausal symptoms and enhancing long-term health.

A common criticism of alternative therapies is the lack of solid scientific evidence about their effectiveness and safety, a problem compounded by the lack of quality control in the manufacture of some substances. As with HRT, uncertainties about effects should be considered carefully in assessing the benefits and risks.

*96\38\8*

‘The fact is that women are relatively protected, in terms of their cardiovascular status, by having oestrogens. It’s relative because it’s true as long as they have oestrogens. After the menopause, however, the incidence of heart disease rises rapidly, parallel to that in men; and as everybody knows, women live on average seven years longer. While men may have a head start, women have a higher chance of living widowed and with serious cardiovascular disease.’

Another unpalatable reality is that the causes and the most effective prevention *and treatment strategies for heart disease in women are still being learned, whereas they are well established for men with heart disease. This discrepancy relates to the male focus of much heart disease research, a fact that concerns health authorities in many countries. ‘Women die of heart disease almost as often as men do, but later in their lives,’ says Judith Dwyer, who chairs the Women’s Health Committee of Australia’s major health watchdog, the National Health and Medical Research Council. ‘It is surely inexcusable to base clinical advice on data that is good for the gander but may be worse than useless for the goose, even if that data is easier to gather.’

Judith Dwyer says the exclusion of women as participants in heart research is longstanding and ingrained in the system that governs trials of new pharmaceuticals. ‘Drug companies in Australia are almost required to use only healthy, young male volunteers when testing new formulations,’ she says. ‘It seems to me to be perfectly possible to develop methods of avoiding many of the perceived problems, such as the danger of liability in the case of pregnancy in women.’ In a bid to overcome the problem, a new approach has been devised to redress this kind of imbalance in Australian heart research.

*61\38\8*

It is a hormone that contributes to feelings of wellbeing and to the maintenance of a woman’s so-called ‘secondary sexual characteristics’ such as distribution of hair, type of voice, and libido. Although testosterone is usually thought of solely as a male sex hormone (also known as an androgen), this is incorrect. It is more accurately described as ‘the third female sex hormone’. Women are already producing testosterone during childhood and continue to do so for the rest of their lives.

TESTOSTERONE AS PART OF HRT If you have had your ovaries removed surgically, you may become aware of lethargy and loss of libido. The addition of testosterone to HRT, or perhaps testosterone on its own, may prove helpful in your case.

*27\38\8*