THE SECRET OF INTIMACY: COMMITMENT

For many couples, the level of intimacy dwindles as the marriage goes on. I think this is unfortunate and unnecessary. Such lessening of intimacy will, however, certainly occur if you make the mistake of many couples, who allow the growing number of stressors in their lives to dictate where on the totem pole of priorities they position the important factor of attending to their marriage. As any happily married person knows, this is a mistake. As your years together advance, more and more important areas of responsibility get added to your list of priorities. The list never stops growing: children, mortgages, careers, grandchildren, health concerns, and so on.
If you attend to your marriage only when life allows you time to do so, you will spend less and less time doing so as life goes on. Intimate partners have the same lengthy lists of important areas of responsibility as bored partners, but they continue to place their marriage at or near the top of their list.
Both professionally and personally, I have found that we progress more healthily through life if our needs for intimacy are reasonably well met. We do better in life if we are living in an intimate marriage. Further, it appears that marriages work to the degree that they receive commitment from both parties. The problem that underlies many unsatisfying relationships is lack of commitment to the marriage. Marriage and family life work best if you clearly declare your loyalty to your mate above all other relationships or involvements in your life.
Yes, I mean that you must choose your partner over all else in your life if your marriage is to fulfill its potential. I believe that doing so does not take away from your healthy and loving participation in other meaningful aspects of life. Rather, living in a committed marriage energizes you to be an even more positive parent, friend, worker, relative, church member, recovering heart patient—whatever else is important in your life.
"What a lot of work! I'm not sure this marital intimacy business is worth it," you may say. This is a legitimate point. It is much easier to have a half-baked, lukewarm, functional, but not very intimate marriage than it is to create and maintain an intimate relationship. Indeed, in my opinion no intimate marriages are the statistical norm; most people settle for functionality and give up the hope and quest for intimacy in their relationships. The reason? Most people are too lazy to commit themselves to the work involved in maintaining intimacy as marriage progresses.
The question of whether the work involved in committing to marital intimacy is worth it to you is, perhaps, comparable to the question of whether the work involved in owning a house versus renting an apartment is worth the payoff. Owning your own home certainly does involve more work; you must compromise endlessly on decisions about spending your time and money on a house. However, the rewards of home owning do seem worth the extra efforts for most of us.
Marital intimacy, too, is certainly a matter of personal choice. However, be clear and honest with yourself about the available options in the quality of your marriage. In this age of "lite" everything— lite beer, lite ice cream, lite crackers—we somehow are getting lulled into pretending that there is an option to have a "lite intimate marriage." Where marriage is concerned, either you heavily commit yourselves and thereby generate intimacy, or you get lite marriage minus the intimacy. You choose. But remember: lite marriage tastes like spaghetti with no sauce, cereal with no milk, a bagel with no cream cheese.
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EPILEPSY AND PREGNANCY

Women with epilepsy are quite often concerned about getting pregnant. There appear to be five reasons for this concern. They wish to know:
if they are likely to hand their epilepsy on to their children;
whether their fits will get worse during pregnancy;
whether it is safe for the baby that the mother should take anticonvulsants drugs during pregnancy;
if there will be any problems in the newborn baby from these drugs;
if they can safely breast feed the baby.
With regard to handing on epilepsy to one’s children – as mentioned earlier, if one parent has epilepsy, the chances of one of the children having epilepsy are no greater than in the population at large. If both parents have epilepsy, it would appear that the risk of a child having epilepsy is about 10 per cent. So in fact the chance of a child inheriting epilepsy, particularly idiopathic epilepsy, is negligible.
As far as seizures during pregnancy are concerned, the situation is not as clear as it might be. There is evidence that for some women, seizure control may deteriorate, while for others there may in fact be no change or even an improvement. A patient told me recently that “she would like to remain pregnant forever” as she had not had a single fit during her pregnancy, compared with six fits in the preceding nine months!
As a general working rule, it is suggested that people who have more than one grand mal fit a month are those who are most likely to have a deterioration in seizure control during pregnancy. The deterioration, if it occurs, is most likely during the first three months of pregnancy. There are a number of theories why this may happen, but none has been proved. It may be of value to check the blood anticonvulsant levels during pregnancy, especially if there is a deterioration in seizure control. The blood levels may fall, necessitating an increase in dosage during the pregnancy.
The main concern for parents is whether the anticonvulsants can harm the unborn baby (foetus). It is known by most people with epilepsy that this is a potential hazard. The effects include physical abnormalities in the baby, a process known as teratogenesis. Abnormalities have been reported in the offspring of mothers on all the commonly used anticonvulsants with the exception of carbamazepine. This is particularly applicable to phenytoin, barbiturates and sodium valproate. Babies born to mothers who have been on carbamazepine have not been shown to have any physical abnormalities, but have a smaller head size than other babies. This has not been shown to be any handicap to the babies who have been followed up for five years.
The risk of abnormalities in the baby is difficult to assess, but it seems to be most common in mothers on polytherapy (receiving numerous drugs), especially if they are on three or more anticonvulsants. The risk in mothers on phenytoin, with or without other medications, appears to be about a 10% chance of the baby showing features of the ‘foetal hydantoin’ syndrome. This syndrome consists of cleft palate, abnormalities of the fingers, possible heart abnormalities and mild mental retardation. Thus, at present, if it is possible, it would seem wise to try to change patients over to carbamazepine before conception. This may not be possible in all patients and, of course, many women will first visit their doctor when already pregnant, at which time there is no purpose in making the change.
Anticonvulsants taken by the mother during pregnancy may have some effects on the baby immediately after birth, as they are transmitted to the baby across the placenta. These include the possibility of a mild bleeding tendency and some drowsiness. In mothers who have been taking barbiturates, the infant may occasionally show features of a withdrawal reaction with irritability, jitteriness and poor sucking. None of these features is [...]

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